Introduction

Body mechanics is a term used to describe the ways we move as we go about

our daily lives. It includes how we hold our bodies when we sit, stand, lift,
carry, bend, and sleep. Poor body mechanics are often the cause of back
problems. When we don't move correctly and safely, the spine is subjected to
abnormal stresses that over time can lead to degeneration of spinal structures
like discs and joints, injury, and unnecessary wear and tear. That is why it is
so important to learn the principals of proper body mechanics [1].

• Good body mechanics means using the body’s strength to the best
mechanical advantage to do a task efficiently and without injury.
• A task does not have to be “heavy” or seem difficult to put us at risk
for injury; many injuries occur because of the wear and tear of poor
body mechanics on our bodies over time [2].
• Proper body mechanics are vitally important for keeping your spine
healthy, it's easy to incorporate these principals into daily life.
Posture

Good body mechanics are based on good posture [read link].

Good posture means the spine is in a "neutral" position - not too rounded
forward and not arched back too far.

“Neutral” Postures

• Avoid “awkward” postures that cause injuries,

• Try to keep the body close to “neutral” or normal position while
working and in daily tasks.ie a straight spine with centre of gravity
being within persons base of support.
• We move in and out of “neutral” posture all the time! (ie: walking,
reaching, etc.) The idea is to be as close to neutral as
• possible and do not use heavy forces (ie: pushing, pulling, lifting)
when outside of our base of support [2].
Sitting

Whether sitting at a desk or at home watching television, good body

mechanics are still important to keep in mind. For deskwork, consider
investing in an ergonomically enhanced chair.

Good sitting:

• Place your buttocks at the back of the seat while maintaining a small
space between the back of your knees and the seat of the chair.
• Place your feet flat on the floor with your knees bent at a 90° angle.
• Pull your shoulders back and lift your chest.
• Lift your chin until it is level and relax your jaw and mouth.
 • If your chair has armrests, make sure they are positioned to support
the weight of your arms. Not too high to make you hunch or too low
to make you reach. Footrests can also be a helpful way to maintain
good posture while sitting. Make sure the footrest is positioned so
that your knees are bent comfortably and are level with your hips.
• Make sure you have enough support for your lower back. Look for a
chair that has adjustable lumbar support. If that is not possible,
increase back support by using a lumbar roll or even a rolled up
towel or cushion placed behind lower back. [1]

Working with Wheelchair/seated clients Clients

In General:

• Plan first and set-up equipment properly.

• Clear area of obstacles.
• Transfer or lift a client over the shortest possible distances.
• Communicate with client and other staff.
• Allow the client to assist as much as they are able to.
• Use general body mechanics principles.
• Always ask for assistance if you are not sure.
• NEVER lift or carry a client alone manually (must be lifted by at
least two staff or by mechanical lift if alone) [2]

Injury Prevention Tips

• Design work/tasks that facilitate variety.
• During all loading tasks, avoid a fully flexed spine and rotate the trunk using
the hips.
• During lifting, choose a posture to minimize the reaction torque on the low
back (stoop, squat, etc), but keep the external load close to the body.
• Consider the transmissible vector: direct external forces through the low
back when pulling on a door handle, vacuuming, etc.
• Use techniques that minimize the actual weight of the load being handled.
• Allow time for the disc nucleus to “equilibrate,” ligaments to regain stiffness,
and stress on the annulus to equalize after prolonged flexion, and do not
immediately perform strenuous exertions.
• Avoid lifting or spine bending shortly after rising from bed
• Pre stress and stabilize the back even during light tasks.
• Avoid twisting and simultaneous generation of high twisting torques.
• Use momentum when lifting awkward placed light loads.
• Avoid prolonged sitting
• Consider the best rest break strategies based on your job demands.
• Practice joint-conserving kinematic movement patterns.
• Maintain reasonable level of fitness.

Physiotherapy
Educate clients on proper body mechanics (table R, benefits of good posture)

• Muscle strains, especially those of the back, are a frequent reason of

people coming to our clinic. Many people strain their backs because
they carry and move objects incorrectly. It is vital to have correct
technique when lifting which we can demonstrate to you.
• Poor posture often leads to complaints of back, neck and shoulder
pain, because it throws the muscles out of alignment. Poor posture
may also alter gait which can lead to back and knee pain. By
correcting posture, we can help clients avoid all these injuries.
• Assess posture and then prescribe effective exercises or suggest ways
clients can improve posture at work/sport/ADL by assessing the
ergonomics of their work station.
• Mobilise stiff joints and stretch and massage tight muscles to
improve your posture.
• Teach good lifting techniques and strengthen appropriate muscles.
• Ensure core muscles are strong and used correctly.

Knee Assessment and Hip Mechanics

An online course by Lee Herrington
Learn more on this topic
Related articles
Injury Prevention and Body Mechanics - PhysiopediaIntroduction Body
mechanics is a term used to describe the ways we move as we go about our daily lives. It
includes how we hold our bodies when we sit, stand, lift, carry, bend, and sleep. Poor
body mechanics are often the cause of back problems. When we don't move correctly
and safely, the spine is subjected to abnormal stresses that over time can lead to
degeneration of spinal structures like discs and joints, injury, and unnecessary wear and
tear. That is why it is so important to learn the principals of proper body mechanics[1].
Good body mechanics means using the body’s strength to the best mechanical
advantage to do a task efficiently and without injury. A task does not have to be “heavy”
or seem difficult to put us at risk for injury; many injuries occur because of the wear
and tear of poor body mechanics on our bodies over time[2]. Proper body mechanics
are vitally important for keeping your spine healthy, it's easy to incorporate these
principals into daily life. Posture Good body mechanics are based on good posture [read
link]. Good posture means the spine is in a "neutral" position - not too rounded forward
and not arched back too far. “Neutral” Postures Avoid “awkward” postures that cause
injuries, Try to keep the body close to “neutral” or normal position while working and in
daily tasks.ie a straight spine with centre of gravity being within persons base of
support. We move in and out of “neutral” posture all the time! (ie: walking, reaching,
etc.) The idea is to be as close to neutral as possible and do not use heavy forces (ie:
pushing, pulling, lifting) when outside of our base of support[2]. Sitting Whether sitting
at a desk or at home watching television, good body mechanics are still important to
keep in mind. For deskwork, consider investing in an ergonomically enhanced chair.
Good sitting: Place your buttocks at the back of the seat while maintaining a small space
between the back of your knees and the seat of the chair. Place your feet flat on the floor
with your knees bent at a 90° angle. Pull your shoulders back and lift your chest. Lift
your chin until it is level and relax your jaw and mouth. If your chair has armrests,
make sure they are positioned to support the weight of your arms. Not too high to make
you hunch or too low to make you reach. Footrests can also be a helpful way to maintain
good posture while sitting. Make sure the footrest is positioned so that your knees are
bent comfortably and are level with your hips. Make sure you have enough support for
your lower back. Look for a chair that has adjustable lumbar support. If that is not
possible, increase back support by using a lumbar roll or even a rolled up towel or
cushion placed behind lower back.[1] Working with Wheelchair/seated clients Clients
In General: Plan first and set-up equipment properly. Clear area of obstacles. Transfer
or lift a client over the shortest possible distances. Communicate with client and other
staff. Allow the client to assist as much as they are able to. Use general body mechanics
principles. Always ask for assistance if you are not sure. NEVER lift or carry a client
alone manually (must be lifted by at least two staff or by mechanical lift if alone)[2]
Injury Prevention Tips Error creating thumbnail: Unable to save thumbnail to
destination • Design work/tasks that facilitate variety. • During all loading tasks, avoid
a fully flexed spine and rotate the trunk using the hips. • During lifting, choose a
posture to minimize the reaction torque on the low back (stoop, squat, etc), but keep
the external load close to the body. • Consider the transmissible vector: direct external
forces through the low back when pulling on a door handle, vacuuming, etc. • Use
techniques that minimize the actual weight of the load being handled. • Allow time for
the disc nucleus to “equilibrate,” ligaments to regain stiffness, and stress on the annulus
to equalize after prolonged flexion, and do not immediately perform strenuous
exertions. • Avoid lifting or spine bending shortly after rising from bed • Pre stress and
stabilize the back even during light tasks. • Avoid twisting and simultaneous generation
of high twisting torques. • Use momentum when lifting awkward placed light loads. •
Avoid prolonged sitting • Consider the best rest break strategies based on your job
demands. • Practice joint-conserving kinematic movement patterns. • Maintain
reasonable level of fitness. Physiotherapy Educate clients on proper body mechanics
(table R, benefits of good posture) Muscle strains, especially those of the back, are a
frequent reason of people coming to our clinic. Many people strain their backs because
they carry and move objects incorrectly. It is vital to have correct technique when lifting
which we can demonstrate to you. Poor posture often leads to complaints of back, neck
and shoulder pain, because it throws the muscles out of alignment. Poor posture may
also alter gait which can lead to back and knee pain. By correcting posture, we can help
clients avoid all these injuries. Assess posture and then prescribe effective exercises or
suggest ways clients can improve posture at work/sport/ADL by assessing the
ergonomics of their work station. Mobilise stiff joints and stretch and massage tight
muscles to improve your posture. Teach good lifting techniques and strengthen
appropriate muscles. Ensure core muscles are strong and used correctly.Work-Related
Musculoskeletal Injuries and Prevention - Physiopedia Introduction Work-
related musculoskeletal injuries (WRMI), also known as work-related musculoskeletal
disorders (WMSD), are any range of inflammatory disorders resulting from injury
sustained while completing work duties[1]. WMSDs are: 1) the result of regular
exposure to work activities that contribute significantly to the development or
exacerbation of painful symptoms; (2) conditions that are worsened or that persist due
to work conditions[2]. Such can be the result of repetitive and frequent work activities
resulting in overuse and strain to nerves, ligaments, muscles, tendons, joints, and
spinal discs[3]. These disorders are also commonly referred to as repetitive strain
injuries, cumulative trauma disorders, and overuse syndrome, among others. Due to the
emphasis on upper extremity use in occupational tasks, the vast majority of WRMIs
impact the hands, wrists, elbows, shoulders and neck; however, conditions involving
the lower extremities and feet, as well as spine and back are common[3].WMSDs do not
include conditions caused by slips, trips, falls, or related injuries, whether or not
sustained in the workplace[2]. WMSDs can be broadly broken down into three
categories: (1) Muscle injury, (2) Tendon injury, and (3) Nerve injury. Common types of
WMSDs include carpal tunnel syndrome (CTS), tendonitis, thoracic outlet syndrome
(TOS), and back pain[3]. [4] Prevalence[edit | edit source] Key Facts[edit | edit source]
Low back pain is considered the leading cause of physical disability according to the
2012 Global Burden of Disease Study, and some estimates conclude that "37 percent of
all back pain worldwide" is a consequence of workplace hazards[5]. Europe (EU-
28)[edit | edit source] Based on a 2019 European Agency for Safety and Health at Work
(EU-OSHA) report, approximately three out of every five workers in the EU-28 report
MSDs (most common types are backache and upper extremity muscle pain)[6]. 60% of
EU workers report MSDs as their most serious work-related health problem. One out of
every five workers in the EU-28 coped with a chronic neck or back disorder in the last
year[6]. Australia[edit | edit source] In 2011, MSDs accounted for 12 percent of
Australia's total burden of disease and injury, and 23 percent of the non-fatal burden;
and in 2014-15, MSDs affected 6.9 million people in Australia[5]. The total cost from
2012-2013 totalled to over $24 billion The Australian Work Health & Safety Strategy
2012-2022 considers MWSDs as one of the top six priority disorders[5]. U.S.[edit | edit
source] The economic cost of WMSDs is between $45 and $54 billion yearly, based on a
2001 Institute of Medicine Report[2]. In 2001, MSDs accounted for about 70 million
physician office visits and 130 million total health care encounters in the U.S.; MSDs on
average resulted in 8 days away from work. Based on 2006, 2009, and 2014 National
Health Interview Surveys, 11.2 million workers reports WMSDs, at a 30-day prevalence
of 8.23%; construction workers represented the highest prevalence[7]. Percentage of
workers reporting exposure to various physical risk factors at work at least a quarter of
the time, EU-28, 2005, 2010, 2015 (EU-OSHA 2019) [6] Who’s at risk for developing
WMSD?[edit | edit source] General Risk Factors[edit | edit source] Work posture
(especially awkward or improper posture)[3] Heavy physical work Lifting Repetitive,
labor-intensive work Vibration (via hand tools) Temperature extremes (low
temperature) Individual risk factors including smoking, high BMI, and presence of co-
morbidities[8] Organizational Risk Factors[edit | edit source] Lack of influence or
control over one's job Being subjected to verbal abuse, or sexual harassment, at work
Risk Factors Specific to the Healthcare Setting[edit | edit source] Lifting patients or
equipment Transferring patients Responding to unexpected movement Manual therapy
Failure to take rest breaks Inadequate staffing Inadequate training on injury prevention
Psychosocial Risk Factors [9][10][edit | edit source] Low work content Low social
support High perceived work load Time pressure Low job control Perceived stress High
psychological stresses Providing domestic work Unsatisfactory leisure activities
External Risk Factors[edit | edit source] Low Back [9][10][11] [12][edit | edit source]
Small workspace High productivity demands Understaffing Pt’s size, condition, shape,
assisting during gait, confused/agitated Providing manual resistance Unadjustable
beds/mats/chairs/commodes Repetitive bending, twisting, lifting Cumulative loads to
the spine throughout the day, week, years Although peak forces may be mild, repetitive
cumulative loads increase risk of damaging low back tissue thus resulting in injury
Neck/Upper Back/Shoulder [9][10] [13][edit | edit source] Type A personality
Scheduling Rest breaks Work-load OverTime High work-load Repetitiveness (Female)
Manual techniques High mental load Hectic work enviornment Exhaustion at end of
day Unsatisfactory leisure time Female and Males - Neck Males - Shoulder Blue collar
work (Male) Hand and Wrist [14][edit | edit source] High volume of manual therapy
Static positioning of a joint - decreased blood flow to area Sustained duration pressure
through a joint Small, unsupported joints High work load Scheduling/decreased rest
breaks Internal Risk Factors[edit | edit source] Low Back[9][10][11][12][edit | edit
source] Female Ht and wt less than male counterparts Pregnancy, increased stresses on
body and increased ligamentous laxity Psychosocial Health Stress Lack of experience
Uncomfortable requesting assistance Postural Stresses Standing, walking, stooping
Neck/Upper Back/Shoulder[9][10][edit | edit source] Poor posture "rounded
shoulders" - increased anterior muscle girth Volume of pressing is greater than pulling -
i.e. weaker posterior musculature Lack of stability through trunk and hips Age Smoking
Mental stress Previous injury Unhealthy BMI Wrist and Hand[15][edit | edit source]
MCP is more commonly injured in younger therapists CMC is more commonly injured
in older therapists Increased CMC joint laxity Decreased tip pinch strength Decreased
Body Mass Index (BMI) Biomechanical Forces Present in High Risk Activities[edit | edit
source] Consequences of Injuries [9][16][edit | edit source] Personal [edit | edit
source] Depression Anger Early signs of aging due to stress Potential negative effects on
family or relationship Work-Related[edit | edit source] Leave work Absentee Worker’s
Compensation Lost productivity Retraining of staff Economical Costs[edit | edit source]
The direct costs of an injury are the easiest to see and understand. These costs include
emergency room and doctor visits, medical bills, medicines, and rehabilitation. Indirect
costs of an injury are often overlooked. These costs can amount up to 4 times the direct
cost of the injury. Indirect costs include administrative time dealing with the injury
and medical care, raises in insurance costs, replacing the hours lost of the injured
employee with hiring another employee, loss of reputation and confidence in employees
and clients, unwanted media attention, and more. The total costs of an injury are
suprising. Beyond the direct costs, the indirect costs greatly increase the overall
costs. This is the true amount that the injury will cost in terms of money. Prevention of
Injuries[edit | edit source] Risk Assessment [9][edit | edit source] Employer’s
responsibility Eliminate or minimize work hazards encourage open discussion among
employees regarding injury and prevention To include (but not limited to): Minimal
lifting approach Knowledge/training on proper use of equipment Adequate staffing Re-
evaluating content and frequency of training courses Especially w/ younger/newly
hired PT’s Training programs have little effect without aggressive ergonomic evaluation
PT available for staff Training [11][14][edit | edit source] "...bodymechanics and back-
care training are valid elements of injury prevention programs, but only when combined
with an ergonomic approach..." -Owen and Garg "To help prevent shoulder injuries,
employers should conduct a worksite evaluation, consider feasible control measures
and train employees"[17] "Integrating your entire body, using your body's weight,
proper joint alignment, and a variety of movements will help develop dynamic body
mechanics ensuring the successful use of your hands." - Barbara Frye Custom Training
[16][edit | edit source] Bio-mechanic and ergonomical training, lifting and manual
handling with hand/body as main tool, safe use of equipment, effects sustained
postures, caseload variation, work organization, working with other professionals
Include Cognitive Behavioral Theory Activity Pacing Scheduling activities Attention
Diversion Distracting patient Cognitive Restructuring Identify and restructure
dysfunctional thoughts and emotions Goal Setting Patient-centered Graded Exposure
Gradual systematic progression Maintenance Strategies Plan to manage flare-ups
Problem-solving Strategies Define problem and how you are going to solve the problem
Prompted “micro” breaks Leads to increased work productivity However ... risk
reducing behaviors without immediate benefit are often NOT perceived as beneficial
Body Mechanics[18] [11][12] [12][edit | edit source] Spinal Compression is a result of
trunk extensor activation along with ligaments and discs trying to support the force
from Lumbar spine up. According to NIOSH (National Institute for Occupational Safety
and Health) spinal compression >3400N puts a person at risk of low back injury; with a
maximum permissable limit of 6400N. When comparing 3 different (unspecified) lifting
techniques, Gagnon et al. estimated compressive forces to be 5744-7951N at the L5/S1
disc space. This estimate exceeds the limit of risk but also exceeds the permissable limit
defined by NIOSH. Analysis & Evidence shows: "Free Style" vs "Squat Lift" Free
style lift revealed participants pulled load toward body while a squat lift requires
vertical lifting Free Style lifting limiting muscle is hip extensor strengh Lifting
Vertical limiting muscle is knee extensor strength Free style lifting (“perceived as
most suitable by subject”) vs. Squat lift Able to lift more weight (~16% greater load)
and repetitively Transfers load from the UE and torso to the LE (which have greater
strength) Greater load = greater lift angle The greater the angle leads to less
muscle energy expenditure Lifting at an angle / "free style" results in: Decreased
compressive forces at elbow, shoulder, L5/S1 disc space (~11%), and hip Pt reported
comfort and feeling of security during transfer Increased compressive forces at knees
and ankles Lifting Techniques[edit | edit source] Keep objects in your “green” zone
"Green" zone = elbows at your side Reaching at arm’s length increases load on low back
x 10 Bend w/ legs NOT (only) hips Bending at "hips only" results in substantial increase
of spinal loading; demanding the lumbar muscles and ligaments to support the trunk
which is usually ~ 1/2 total body weight[11] Keep normal curves Cervical, Thoracic,
Lumbar, and Sacral No holding breath Legs and abdomen Know limits MAINTAIN
NEUTRAL SPINE Keep normal curves Cervical, Thoracic, Lumbar, and Sacral Keep
head up Wide BOS Scissor position (in tight spaces) Keep load close Contract
Abdominals Bend knees and hips Move Trunk (hips up) as a whole body unit --> Move
feet (do NOT twist) Equipment [17][11] Non-Compliance with assistive devices is
generally due to shortage of staff to assist, increased time (of pt care) and accessibility
of equipment, apprehension of younger PT's to contradict “typical” protocol of more
experienced PTs and ward culture Compliance is greater with heavy patients, and when
there is a perceived risk of injury Compliance increases when staff properly trained
on equipment May reduce peak forces however what is the effect on cumulative forces?
Bending to retrieve equipment, pt transfers and set-up of equipment Many times results
in greater forward flexed times and greater cumulative spinal forces than manual
transfer Hand and Wrist Saving techniques [14][edit | edit source] Good example of
reinforcing one hand with the other and using the knuckles instead of the finger tips
ALWAYS keep joints that you are not using relaxed Use elbow for sustained, static
pressure Use the forearm for effleurage, increasing circulation to the area Knuckles can
be used for light to medium weigth bearing Keep joints in line with one another Keep
wrist in neutral Two hands are always better than one Reinforce joint in with opposite
hand Use entire body in movements Prevention/Intervention Strategies [9][10][edit |
edit source] Reporting Injuries Makes the problem less invisibile --> increase workplace
safety Implementing mandatory “micro” rest breaks throughout the day
Managing/Coping with stress Footwear Use your entire body when possible, especially
large muscles that are meant to take the load Exercise Increase core/trunk strength
Flexibility Endurance Mid and Lower Trap, Rotator Cuff Warming up prior Stairs,
walking ~5 min Stretching/Going through the motions before a transfer/lift/manual
therapy Maintain Healthy Weight/Lifestyle Posture Checks throughout day Sitting,
standing, pt care Ask for help Work as a team (Co-treats) Use your whole body when
performing manual therapy instead of just your upper extremities Use of Assistive
Devices (including but not limited to)[16]: Battery operated lifts (hoyer lifts) Gait belts
Draw sheets and friction reducing sheets Exercise to Maintain Healthy
Shoulders[17][10][edit | edit source] Key to prevention of shoulder injury is
strengthening core rotator cuff musculature Apply heat to shoulder muscles before
exercise Keep arm below shoulder height while doing arm stretches Gradually increase
shoulder movements while warming up i.e. - big circles, across body movements,
shoulder blade rolls etc. While sitting or standing, keep arm vertical and close to body
Pendulum stretching exercises relieve pressure on the rotator cuff Perform muscle
strengthening exercises Exercise Selections for Prevention of Shoulder Injury Shoulder
Injury Prevention Video ClipRunning Mechanics for Clinicians -
Physiopedia Overview of Running Injuries Lower extremity running-related injuries
range from 19.4 to 79.3 percent[1]. The most common injuries are:[2][3] Patellofemoral
pain Medial tibial stress syndrome (shin splints) Achilles tendinopathy Iliotibial band
syndrome Plantar fasciitis Stress fractures of the metatarsals and tibia Hamstrings and
calf problems were reported by male marathon runners, while hip pain problems were
common among women[4]. Most of these injuries have a high recurrence rate. A study
from 2018 by Poppel and colleagues found that previous injuries, training volume and
age are important risk factors for running related injuries.[5] Sanfilippo and colleagues
also note that previous injury was the most relevant risk factor for running-related
injuries.[6] A 2015 systematic review[7] of 15 studies identified different risk factors for
women and men: Women Men contributing factors to tissue stress Age History of
previous injury History of previous sports activity Running experience for 2 years
running on a concrete surface History of previous injury Participating in a marathon
Average weekly running distance (20–29 miles) weekly running distance (30–39 miles)
wearing running shoes for 4 to 6 months Stress Frequency Model[edit | edit source]
Running injuries are caused by multiple, related factors. A simple injury causation
model using the stress frequency curve can help us to develop an idea about the
contributing factors and how to address them in the management plan. A tissue is
influenced by the applied stress and the frequency of application. If the stress and its
frequency are below the injury threshold, the tissue will function normally within its
capacity. However, if either or both of these factors exceeded the injury threshold, the
tissue is more likely to be injured. This explains why some runners may not experience
injury for a long time and develop one as soon as they increase their frequency of
training such as training for a marathon. Considering stress and frequency is important
to understand individual tissue's capacity. Running mechanics influence the stress
applied to the body, magnitude, type (bending, shear or tension) and the speed of
application on each foot contact. Assessing running mechanics leads us to think about
the stressed structure and explains the presented symptoms. For example; landing on
toes -forefoot strike- results in greater stress on Achillies tendon and the calf muscle
forces[8]. Assessing the frequency of running and training volume to understand the
effect of the accumulated tissue stress. If falling below the tissue's threshold the
likelihood of developing injury will be low and vice versa. A subjective examination can
help us to understand the frequency, so ask your client about their weekly training and
what is their standard training like? How much running they do? What was the
frequency of applied stress before the injury occured? The next thing is to identify the
injury threshold which refers to the interaction between the tissue capacity to tolerate
the stress the tissue capacity to tolerate the frequency of the applied stress. Tissue
capacity refers to the functional capabilities of a specific tissue to cope with stress type
and frequency. A muscle capable of producing high peak force may be able to tolerate
high level of stress on individual foot contact. On the contrary, if the muscle's capability
is low, applying stress with high frequency the muscle may not be able to cope well
leading to injuries. To translate this into practical application, when assessing a runner
we should think of adjusting the mechanical pattern or push up the tissue's endurance
to tolerate the applied load. Lowering the applied stress by reducing the amount of
running can be a method of off-loading the injured tissue while building up the tissue
resilience to cope with the functional aspiration. Clinical Running Assessment Set-
Ups[edit | edit source] Many of the common running-related biomechanical patterns
can be identified by 2D analysis using inexpensive tools[9] such as a mobile phone or
tablet camera. Standardizing the method of assessment is important for accuracy of
identifying the patterns and to make sure your findings are not due to viewing angles.
Settings: Tools/equipment: High speed camera or mobile phone/tablet camera and a
tripod. Distance: 1.5-2 meters from the treadmill Height:0.8-1 meter-pelvic height
Views: side (saggital) and rear (frontal) Timing: initial contact and mid-stance
Joints/regions: thorax, pelvis. hips, knees and ankles. Follow a structured process of
assessment by looking at one joint/region at a time. To end up with a structured
problem list, slow down the speed of the camera to allow you to go backward and
forward and take still pictures to draw lines and identify areas of stress. [10] Common
Mechanical Patterns[edit | edit source] Bramah et al found that similar mechanical
patterns were associated with multiple injuries[11]. Looking from the saggital plan, we
can identify the following patterns: Foot Inclination Angle at Initial Contact: by
drawing lines to compare the angle between the sole of the shoes and the treadmill. A
great angle indicates greater foot inclination. It can potentially be caused by rear foot
strike if the runner's toes are too high compared to the heel or a forefoot strike when
the inclincation is mainly due to a high angle at the heel. Neither strikes are considered
to be superior to the other. Landing with high inclination will limit the ability to engage
in dorsiflexion which serves as shock absorption. A high inclined foot will take longer
time to get the foot flat on the floor to start the shock absorption mechanics resulting in
high impact vertical loading[9]. Fig 3 in the study by Souza RB shows how to identify
foot inclination. Conversely, landing with forefoot strike (on tip-toes) allows less time
to engage in dorsiflexion utilizing the calf complex and possibly stressing the achilles
tendon. Refer to this link to see the difference between different foot strike patterns. In
the management plan, a relatively low inclination angle where foot is low to the ground
regardless of the type of strike (heel or toe) minimizes the stress on achillies for forefoot
runners or engage dorsiflexion for heelstrike runners. Knee flexion angle at mid stance:
compare a straight line drawn through femur to the floor to a line from the lateral
condyle of femur to lateral malleolus (Figure). A greater angle indicates more knee
flexion. Injured runners tend to land with more knee extension at initial contact[11]
This influences tissue stress and the ability to absorb shocks. During running, the knee
and ankle function as suspensions. Landing with the knee in flexion and foot flat
engages the suspension spring from the moment the foot touches the ground[9]. On the
other hand, runners with extended knee and high inclined foot at initial contact are less
likely to engage the shock absorption mechanism within knee and ankle resulting in
higher shocks. This places greater eccentric demands on the quadriceps and is linked to
the development of PFPS[12]. The body can respond by compensating on different
levels leading to further complications. From a management perspective, this can e
addressed by gait re-education to alter the mechanical pattern and/or eccentric training
of quadriceps to meet the shock absorption demands. Frontal plane: Trunk side
flexion : the angle between a vertical line drawn through the central line (starting mid-
way between Posterior superior iliac spines PSISs upwards through the trunk) and a
vertical line starting between PSIS to C7. A greater angle indicates greater side flexion.
There is no evidence suggesting an associated pathology with increased trunk side
flexion, however, it may indicates compensation from a dysfunction in a distal joint. As
the trunk shifts greatly side to side it shifts the body's centre of mass COM. This could
result in excessive pelvis drop opposite to the weight bearing leg. To address this
pattern we need to think of possible causes for trunk shifting as compensation to off-
load hip muscles by shifting COM away. Contralateral pelvic drop away from weigh-
bearing leg (hip dip): an angle between a horizontal line between PSISs and another
horizontal line across the body. Refer to (Figure3) in this study. Healthy runners show
some degree of pelvic drop, ranging from 3-4 degrees but it's usually controlled. Injured
runners demonstrate contralateral pelvic drop compared to healthy runners which refer
to a link between this pattern and multiple injuries. Different compensations can be
expected to keep the body's balance as the COM is shifting away from such as increased
hip adduction resulting in different presentations such as ITB, patellar maltracking
and/or PFPS[11]. Hip adduction angle: the angle between a horizontal line across the
PSISs and another starting at the PSIS on the weight-bearing leg down the central point
of the tibiofemoral joint. A greater angle indicates great hip adduction. Losing the gap
between the knees indicates greater hip adduction. As a response, the femur will rotate
medially underneath the patella which, in response, will rotate laterally elevating the
stress in patellofrmoral compartment. A runner may develop ITB syndrome as a result
of increased hip adduction[13]. Other possible compensations are; rearfoot eversion
stressing the medial compartment of Achillies tendon, increased tibial adduction
influencing the bending forces on tibia[14]. [15] Key Points[edit | edit source] A
stressing mechanical pattern associated with increased training volume (frequency)
contribute to the possibility of injury When assessing running mechanics, follow a
structred method to identify abnormalities Always look for obvious patterns. If a
mechanical abnormality is not obvious then it's unlikely to contribute to the presented
pathology Adjust training frequency initially to off-load the stressed tissue while
addressing mechanics or building up tissue resilience. Addressing mechanical patterns
by gait re-training will help lower the applied stress and can possibly allow runners to
recover from injuries and progress beyond their pre-injury potentials If addressing
mechanical problems wasn't enough to address the pathology, consider building up
tissue tolerance to increase its ability to cope with the mechanics. Rowing Injuries
Project - PhysiopediaInjuries in High School Rowing Athletes: Welcome! Thank you
for visiting our Physio-pedia page. We are a group of graduate students in the Doctor of
Physical Therapy Program from Bellarmine University in Louisville, Kentucky. We
have been looking at and performing research related to injuries in rowing. The
literature is showing that rowers often experience overuse injuries due to the mechanics
of the rowing stroke along with its repetitive motion.[1] And while there are several
prevalence studies for elite adult rowers, there have been few studies assessing the
prevalence of injuries in high school rowers. We recently conducted a pilot study with
the Louisville Rowing Club's high school team (detailed information on this study can
be found below) in which we surveyed them on injury prevalence and implemented an
exercise program with emphasis on strengthening the core to prevent low back pain.
While we obtained some information from this study, we would like to collect more
information on injury prevalence in the high school population in order to fill the gap in
the literature. In order to attain this information we respectfully ask for your
participation in a survey. In the section below, there are links to two different
surveys. If you are a rowing coach, please follow the link for the coaches and complete
the survey. If you are an athlete, please follow the link for the athletes and complete the
survey. Please rest assured that no personal information will be released by
participating in this survey. Survey Links:[edit | edit source] Survey for
Coaches: 'https://www.surveymonkey.com/s/3JCCV6S Survey for
Athletes: https://www.surveymonkey.com/s/3DR2MZY Prevention of Low Back Pain in
High School Rowing Athletes: a pilot study[edit | edit source] Background Rowers often
experience overuse injuries due to the mechanics of the rowing stroke along with its
repetitive motion.1 Among these overuse injuries, the most common occur in the low
back, forearm/wrist, and knee.2,3 Evidence has shown that low back pain made up the
majority of injuries experienced in junior elite rowers, however there have been
minimal studies assessing prevention strategies of this injury in the high school
population.2-4 Rowers with less experience are more likely to acquire traumatic
injuries.4 During the catch phase of the stroke there are increased rotational and tensile
stresses on the low back resulting in increased risk for injury.1 Injury also occurs due to
erector spinae fatigue and increased lumbar flexion throughout the rowing stroke.2
Research has shown that circuit training may be an effective exercise regimen for
rowers because it simulates the repetitive overload of the rowing stroke, therefore
training endurance to prevent low back injury.1 A 12 week study by Chtara
demonstrated that a low frequency resistance type circuit training program resulted in
significant improvements in muscular strength, explosive strength and power, and
strength endurance.5 Rowers rely heavily on both aerobic and anaerobic systems to
train power and endurance, therefore circuit training is an adequate method to address
these demands. Additionally, it is important for rowers to have a strong core and
adequate trunk stabilization to prevent injury. Research supports that retraining the
local muscle groups or core musculature is important for trunk stabilization and
prevention of low back pain.6 The purpose of this study is to design and implement a
specific prevention program for low back pain in high school rowing athletes. This
prevention program will utilize circuit training concepts to include trunk stabilization
for specific core muscles. Additionally, this proposed study may provide insight on the
prevalence of low back pain and other chronic injuries in the high school rowing
population. This information could help to fill a gap in the literature. Methods
Participants The participants in this study are a convenience sampling of 24 high school
rowers, 13 females and 11 males that are members of the Louisville Rowing Club.
Rowers ranged in experience from 2 months to 3 years. Ages ranged from 14 to 18 years
old. Survey A survey to collect data on demographics, rowing experience, and injury
history was completed by rowers before initiation of the prevention program. A
modified survey to assess the progress of the program will be given at 6 weeks and at
the cessation of the program. Examples of the survey are included in this packet.
Protocol Generally, rowing requires the use of major muscle groups beginning with the
legs then to the back and finishing with the arms. When muscle imbalances or fatigue
occur, athletes are more prone to acute and chronic injuries. Research has shown a
correlation between core stability, trunk endurance and the reduction of low back pain
symptoms.6 Among rowers, management of low back injuries has been suggested to
include stretching of the hip extensors, core stability and strengthening, proper pelvic
alignment, endurance training of lumbar erector spinae muscles, and neutral postural
alignment.2 It is from these concepts that we designed a training program that
incorporates dynamic exercises not only addressing the strengthening of the major
muscle groups used in rowing, but includes specific activities suggested to prevent low
back pain. The training program will be performed once a week for 30 to 40 minute
sessions in addition to the team practice schedule, which is held every weekday. The
program is broken up into three phases in order to correlate with the physiological
responses to long term training. These three phases are known as the anatomical
adaption phase, the strength phase, and the maintenance phase.1 The anatomical
adaption phase will emphasize low resistance and high volume, so less sets and high
repetitions. The strength phase involves a transition to more sets and lower repetitions.
This follows the idea that in this phase of strength training, weight is increased, thus
repetitions decrease. However, in this protocol, instead of increasing the weight, the
difficulty of the exercise is progressed to require more strength and control. The
maintenance phase will focus on preserving gains resulting from the strength phase.
Exercises in the three phases can be broken up into categories of stabilization, upper
extremity, lower extremity, combination, and flexibility exercises. The majority of the
exercise activities that make up these categories address muscles that either attach to
the spine or contribute to posture and core stability. These interventions were compiled
into an exercise bank to be used as a reference in organizing circuit training outlines.
Each circuit includes an even distribution of exercises from each category and each
circuit is repeated three times within a training session. The phases are made up of
three circuits, which are rotated in the weekly session. Researchers were present for the
first phase (weeks 1-6). The second and third phase of the program will ideally be
distributed and implemented by the coaching staff. Results/Outcomes Results from
pre-program survey (week 1): Eighteen of the twenty four rowers reported experiencing
low back pain during their rowing career. Nineteen of the rowers had been rowing for a
year or less. Six people reported an injury other than low back pain that was related to
rowing. Four of those individuals reported knee pain, one reported elbow pain, and one
reported hip flexor injury. Of the individuals who reported low back pain, greater than
50% of them rowed on both port and starboard side. Twenty two of the twenty three,
who reported low back pain, stated their pain was a 5 or less on the visual analog scale.
Approximately 80% of the rowers participated in training/practice for 5-8 hours per
week. A summary of the survey responses are attached at the end of this
document. Survey results after phase 1 or program (week 6): Only 14 of the 24 who
filled out the initial survey, also filled out the follow up survey. Of those 14 individuals,
100% answered yes to the following questions: 1. Do you feel like you have a better
understanding of the importance of core stabilization in the prevention of low back
pain? 2. Do you feel like you gained a better understanding of proper body mechanics
needed during exercises used in this circuit training program? 3. Have you noticed any
improvements since the start of the exercise program? Four of the 14 individuals
reported that they are currently experiencing low back pain. All pain that was reported
fell below 3 out of 10 on the visual analog scale. Discussion The major finding of this
pilot study was that 75% of the rowers reported experiencing low back as a result of
rowing. This finding supports our primary hypothesis that low back pain has a high
prevalence in high school rowing athletes. Another interesting finding was that majority
of the rowers who reported low back pain had been rowing for less than one year. This
may suggest that low back pain is common in both experienced and inexperienced
rowers. These inexperienced rowers may sustain low back pain secondary to lack of
body awareness and proper form during exercise. Researchers observed poor body
mechanics and lack of appropriate strength and endurance during the circuit exercises.
Specifically, researchers noted increased difficulty with exercises such as dead lift with
dumbbells, prone and lateral planks, squats, push-ups, V sit-up, and supermans.
Increased difficulty with these exercises demonstrates that these rowers lack adequate
core and lumbar stabilization. According to our research, we know that core and lumbar
stabilization are essential to prevention of low back pain. We can infer that if these poor
body mechanics are used during the circuit, that they will also be adopted when rowing.
The combination of these poor mechanics and inadequate core and lumbar stabilization
may explain the increased incidence of low back pain among high school rowers.
Although positive results were seen from the exercise program, our results are not
conclusive due to the limitations of the study. Limitations The circuit could only be
implemented one time per week with coaching staff at the Louisville Rowing Club.
Better results might have been seen if the program would have been implemented two
times per week as planned. Also, only one phase of the program was able to be
supervised by the researchers. Since the second and third phase will not be supervised
by the researchers, there is no guarantee that the program will be continued according
to protocol, which will decrease validity of the study. Another limitation of the study
was the survey. They survey was too open ended which lead to increased variability of
responses and lack of quantitative measurements. There were also no objective
measurements that were taken other than the survey that was created by the
researchers. In addition, there were 34 rowers who participated in the circuit, but only
24 returned the initial survey and 14 returned the follow up survey. Conclusion In
future studies it would be more beneficial for the program to be implemented two times
per week to maximize results. There is a need for higher quality research in this
population. The researchers hope for this community partnership is that it will continue
to be implemented in the following months by coaching staff. The researchers also
educated the rowers on better body mechanics and awareness to help decrease injury
occurrence. Ideally, this knowledge will benefit them in their future rowing careers. Our
community partnership has helped us to realize that there is a lack of research on
rowing injuries in high school athletes. The goal of the Capstone will be to obtain
information regarding the prevalence of injuries on a larger scale in high school rowing
athletes.Thoracic Manual Techniques and Exercises - Physiopedia Introduction
Physiotherapists often address movement disorders of the thoracic region that respond
well to manual techniques and/or exercise prescription to address joint restrictions or
muscle weakness. This page outlines some of the Manual Techniques and Exercises for
the Thoracic Spine. Range of motion (ROM) in the thoracic region is necessary for a
number of daily activities and sporting tasks such as golf, throwing sports, tennis, and
rowing. Dysfunction of the thoracic spine can also play a role in breathing difficulties
and may be linked to postural issues in the later stages of life. Additionally getting more
ROM through the thoracic spine has impact on areas upstream and downstream the
body. Restrictions in motion have the potential to impact performance and may
manifest as local or distant musculoskeletal pathology. Movement of the thoracic spine
is coupled with movement of the adjoining ribs. Thoracic extension involves concurrent
posterior rotation (external torsion) and depression of the posterior ribs with elevation
of the anterior ribs. Bending to the side is a combination of spinal segments side
bending, ribs on the same come together while ribs on the opposite side separate.
Inability to move well in all directions predisposes people to injury and pain.[1] Motion
restrictions may be due to contractile or non-contractile structures, and interventions
to address each specific tissue restriction can vary depending on the source of the
involved tissue. Contractile restrictions - eg.muscle tightness, trigger points, may be
addressed via muscle stretching or manual interventions such as soft-tissue
mobilization or sustained pressure. Non-contractile restrictions - eg hypermobile, or
hypomobile joints Joint hypermobility is usually addressed with therapeutic exercise to
improve neuromuscular control Joint hypomobility may be addressed with manual
interventions including joint mobilization and manipulation. Hypomobility of vertebral
and costovertebral joints in the thoracic spine may prevent the patient from attaining
full motion of the thorax. Most interventions to address thoracic spine mobility are
dependent on the clinician providing the intervention. The ability for the patient to
incorporate self-mobilizations of the thoracic spine into therapeutic exercise programs
may help maximize intervention outcomes.[2] Range of Options - Manual Therapy
Thoracic Spine As therapists we are trained in a multitude of techniques - chooseing the
appropriate ones are usually to do with your expertise and choice. The following have
great site links for detailed information. Traction Massage Trigger Point Therapy Active
Release Techniques: A practitioner determines where adhesions are through touch, the
practitioner then couples a patient's active movement with his/her touch. [3] Assisted
Active Range of Motion (AAROM) Passive Range of Motion
Thermotherapy/Cryotherapy Stretches (muscle, neural tissue, joints, fascia) Instrument
Assisted Soft Tissue Mobilization Joint Manipulation: A passive, high velocity, low
amplitude thrust applied to a joint complex within its anatomical limit* with the intent
to restore optimal motion, function, and/ or to reduce pain.[4] Joint Mobilisation: A
manual therapy technique comprising a continuum of skilled passive movements to the
joint complex that are applied at varying speeds and amplitudes, that may include a
small-amplitude/ high velocity therapeutic movement (manipulation) with the intent to
restore optimal motion, function, and/ or to reduce pain.[4] Mobilisations Joint
mobilisations have been defined by Maitland as an externally imposed, small amplitude
passive motion that is intended to produce gliding or traction at a joint[5]. They are
often used in Physiotherapy management in order to produce mechanical and
neurophysiological effects[5]. These videos demonstrate 3 common mobilisation styles.
This first 2 minute video shows a good upper thoracic function mobilisation for
extension, and extension combined with rotation. [6] This 4 minute video is a
demonstration of a reverse NAG for thoracic spine using the Mulligan concept (MWM).
[7] This video is of mid thoracic Maitland PA mobilisation (5 minutes). [8]
Manipulation There is no much research literature on the safety of joint manipulation
when applied to the thoracic spine. Thrust joint manipulation should never be
performed when contraindications or precautions are present.[9] Exercises Exercises
are beneficial in situations of hypomobility to increase movement and hypermobility
and postural issues to increase strength. They are an essential part of physiotherapy
The first video (6 minutes) gives a good range of exercises for hypomobile joints [10]
The next video is of exercises for eg Scheuermann's Kyphosis Exercises - home exercise
program A good way to help clients to combat a painful/stiff upper back is to make an
appropriate home exercise program (HEP) ie the right stretching and strengthening
routine. Be sure to read this link to help get better adherence to a HEP Error creating
thumbnail: Unable to save thumbnail to destination Stretching and Strengthening of
the thoracic extensor muscles can be achieved by following exercises: Cow -Cat stretch
To perform: Begin in quadruped (hands and knees) with knees under hips and hands
under shoulders. Inhale as you move your sit bones up towards the ceiling, arching the
back and pressing the chest towards the floor as you lift the head up. Relaxing the
shoulder blades behind you. From there, inhale as you move from this “cow” position to
an angry “cat” position, rounding out your back and pushing shoulder blades away from
you as your spine forms a “C” curve in the opposite direction. Go through this cycle 10
times. Open Book This stretch is a great way to improve rotation in the thoracic spine.
Begin by lying on your left side with knees bent and arms straight out in front of you,
palms touching. Gently lift your right hand straight up off of the left hand, opening up
the arm like it’s a book or door while following the top hand with your head and eyes
until your right hand is on the other side of your body, palm up, with your head and
eyes turned towards the right. Hold this stretch for a few breaths before returning to the
starting position with palms facing each other. Repeat up to 10 times on each side.
Thoracic extension over Foam Roller If using a foam roller, place the foam roller
perpendicular to torso. Sit in front of the foam roller, and gently hammock the head
with your hands, interlocking the fingers and supporting the weight of your head
without pulling it. Lean backwards so that your upper back is reaching backwards over
the foam roller. Gently allow your shoulders to reach towards the floor while the foam
roller supports your upper back. Carefully lift the hips to roll up and down the muscles
of the upper back or move the foam roller up and inch after each stretch, leaning
backwards over the roller until a gentle stretch is felt. Repeat several times, without
forcing your body into discomfort. This stretch can be very intense, so start with small
movement and don’t spend more than a couple minutes in this position. Doorway
Stretch (Pec stretch) Use the walls of a standard doorway to stretch out the pecs. Bring
each forearm up against one side of the doorway. Gently lean forward through the
doorway keeping the arms on one side to stretch out the chest. Hold for 30 seconds.[11]
Occiput to wall [4] Stretching the Extensor Muscles and strengthening the Anterior
Neck Flexors: The patient stands with his back against the wall and retracts the chin.
There will be an upper cervical spine flexion and lower cervical spine extension. Hold
this position for 15 seconds. [4] Education - Postural training and Body mechanics The
complications of poor posture include back pain, spinal dysfunction, joint degeneration
and rounded shoulders. Suggestions to improve posture include regular exercise and
stretching, ergonomic furniture and paying attention to the way the body feels. It is is
important that the patient understands his problem and the cause of his problem.
Postural education and training is an important aspect of treatment. Postural
awareness training steps: Explaining the patient what the problematic posture is
Demonstrating correct posture, explaining every motion that should be made: Belly
button in & down (soft contraction) Knees slightly bent Shoulders back ie scapular
retraction, it can help to do external rotation in the shoulder to accompany this motion
Chest up Chin slightly tucked in Have the patient try this him/herself, the first time still
going over every cue. Once the patient has practiced the posture a sufficient amount of
times to immediately be able to resume good posture on command, taping and random
reminders (timer) can be used to ensure the posture is kept during the day. The training
of all the postural muscles is important to assure the stability of the spine. Training of
the postural muscles can be achieved by eg.balance training a balance exercise example,
Single leg stance - With this exercise it is important to give the following instructions:
The upper back and abdominal muscles should be working at all times as well as the
pelvic floor. Roll shoulder blades backwards, “Lengthen” your neck, Don’t raise your leg
to high (+- 10cm of the floor) see also: Thoracic Hyperkyphosis, Sway Back Posture,
Posture; Forward Head Posture. Concluding Remarks Because pain in the thoracic
region is often caused by muscle tension and poor posture, initial treatment efforts
focus on relieving the tension with Physical therapy - using some of the techniques
given above eg. home exercises that stretch and strengthen the back, shoulder and
stomach muscles, massage, postural education, joint mobilisations, heat and/or ice
therapy etc. 2. Over-the-counter medications such as acetaminophen or ibuprofen. The
majority of clients usually will improve with these measures

References
1. ↑ Jump up to:1.0 1.1 Colorado spine inst. Body Mechanics Available
from:https://www.coloradospineinstitute.com/education/wellne
ss/body-mechanics/ (last accessed 25.5.2020)
2. ↑ Jump up to:2.0 2.1 2.2 Ongwanada Body Mechanics and Injury
Prevention Available from:https://www.ongwanada.com/wp-
content/uploads/2019/10/Body-Mechanics-and-Injury-
Prevention.pdf (last accessed 25.5.2020)