Moving Without Pain

Imagine that 500 cars of the exact same make and model were assembled at the same factory by the same workers. If each of the cars was sold to a different person, would all of the cars break down at the same time? Of course not! How fast or how far a person drives is unique to that individual and to the specific day, so the wear and tear of the vehicle will be determined by how it is driven. Our bodies are our vehicles in life and how we move them will affect when the Service Light (or pain) will come on.

When humans are born, our bodies do not come with a User Manual. Fortunately, the field of biomechanics, which looks at the effects of movement and forces on the body, can help us understand how to use our physical bodies more efficiently.

I have been fortunate enough to work with and learn from a great number of injured people from various occupational backgrounds. After seeing how different people position themselves and move during home and work activities, I have gained a deep appreciation for the effect of postures and movements on pain. From these experiences, I have formulated a few principles of movement that will help you to perform more of your daily activities with less pain.

 

Principle #1 - Maximize your Base of Support

Figure 3 - Standing on the right (or left) hip can alleviate pressure on the back for low back pain sufferers.

Figure 2 - By widening your feet, your base can accommodate more weight in front of you. Pregnant women may benefit from this way of standing.

Figure 1 - Lean directly on countertops instead of just standing close to them. When you offload your weight onto things in your environment, you won't have to work as hard against gravity since your surroundings are doing the job for you.

The structural frame of a human body, the skeleton, is simply a bag of bones. Without any muscles, this bag of bones would fall to the ground due to the force of gravity. People in pain often have weaker
muscles that cannot adequately support their mass against gravity (eg. when sitting, standing, walking, etc.), so the muscles go into spasm…resulting in more pain.

Your base of support refers to what is beneath you that connects you to the ground. Just as a house requires a broad and deep foundation to be steady, you need to have a stable base. The best way to do this is to lean against walls, countertops and furniture (Figure 1).

If there is nothing in the immediate space that you can lean on, then stagger your feet (Figure 2) or shift your weight onto the parts of your lower extremities that can tolerate more weight (Figure 3).

 

Principle #2 - Keep your arms as close to your body as possible

Figure 5 - Proper carrying technique

Figure 4 - The muscles in the back must tighten-up (green arrow) in proportion to the torque caused by the weight of your arm (orange arrow).

When you reach out with your hand, your arm creates a force (called a torque) on your body. The amount of torque depends on both the weight you are holding and the distance your arm is away from the body. According to the third law of Classical (Newtonian) Mechanics, every action has an opposite and equal reaction; therefore, to counterbalance the torque made by your arm, the muscles in the back of your body must tighten up in proportion to that torque (Figure 4).

In common English, this translates to: If you reach out with your arms, you will increase the tension (and pain) in the neck and back. You don’t have to be holding anything to generate a torque since your arm itself has a weight. This is why trying to grab a cup of coffee or reaching to use a keyboard can cause neck and back pain. So step close to an object instead of reaching for it and rest objects against your body or leg instead of holding it away from you when carrying an item (Figure 5).

 

Principle #3 - Anchor yourself

Figure 7 - Although there are not a lot of unexpected forces during dish washing, you can still decrease the forces going through your arm, shoulder, neck and lower back by resting a pot or your arm against the side of the sink.

Figure 6 - Putting your knee or foot onto a surface and then putting your forearm onto your leg is a great way to anchor your body against unexpected forces when performing tasks.

A common cause of injury and pain is unexpected forces on the body. A parent with chronic low back pain can attest to this every time they are interacting with their infant and the infant leans back all of a sudden. To avoid this, secure yourself and objects against something stable whenever possible so that unpredictable events do not cause excessive forces on your body (Figures 6 and 7).

 

 

 

 

 

 

 

Principle #4 - Rethink angles

Figure 10 - Toothbrush is held in a typical way with the palm and bristles facing the same direction to brush the right side of the mouth. The arm is resting by the side.

Figure 9 - Toothbrush is held like a pen in the right hand to brush the left side of the mouth so that the arm can rest by the side.

Figure 8 - Arm is held away from the body.

How do you brush your teeth? Typically, people demonstrate what's shown in Figure 8.

This is not a good position since the elbow is away from the body and the arm is moving. Since every action has an equal reaction, the muscles in your neck, shoulder and back must all activate to counterbalance the forces produced by your arm. So the mundane task of brushing your teeth may actually be perpetuating your pain. By changing the way you hold the toothbrush (Figures 9 and 10), you can minimize the overall forces on your body.

Figure 11 - The more the knee is bent when climbing up or down stairs, the more force goes through the knee - resulting in more pain.

How do you climb stairs? Commonly, people face the way they are walking. But in this situation, the forces on your knees can be quite high (Figure 11). Thus, this movement can be nearly impossible for people with degenerative changes in the knees.

If you change your angle toward the stairs and take one step at a time instead of alternating steps, you will not have to bend your knees as much, resulting in decreased forces and decreased pain (Video 1).

In general, if you feel increased pain during a task, try changing how you hold an object or angle your body differently.

Video 1 - The body facing the stairs at 45 degrees and the right knee is relatively straight. A rocking motion is used to get the body on top of the right foot then the left foot comes up to the same step rather than going to the next step.

Principle #5 - Use momentum instead of strength

According to the first law of Classical Mechanics, in order to change the movement of an object, you must give it a force. Consider the acts of vacuuming or ironing clothes in which you must constantly change the direction of movement of these objects. People tend to have their feet planted while moving these objects with their arms (Video 2). That's a lot of force that the arms have to generate over time! Additionally, the neck and back muscles will tighten in order to counterbalance all of those arm forces.

A strategy to minimize the muscular forces on the body is to create a momentum using the legs and letting the arms piggy back on that momentum to move the vacuum or iron (Video 3).

Video 3 - The legs are producing all the movement. The arm stays relaxed by the side.

Now consider the act of getting up from a chair (Video 4).

The energy required for this movement can be reduced by using the head and upper body to create a momentum to allow the body to "fall upward" instead (Video 5).

Video 4 - Most people will get up by using their legs or arms to move the entire weight of their body vertically out of the chair.

Video 5 - The arm is anchored against the leg then the head and shoulders fall forward.

Principle #6 - Always keep a neutral spine

Figure 13 - Here, the shoulders are behind the hips. When the shoulders and hips are not aligned, the spine is twisted - which can cause pain.

Figure 12 - The back is bent, increasing the forces (and pain) on the spine. Some people bend with their knees instead. This puts a lot of force on the knees instead and can be difficult for people with knee pain.

Excessive bending (Figure 12) and twisting (Figure 13) of the body can cause tremendous stresses on the joints, discs and nerves in the spine resulting in debilitating pain. Therefore, it is important to avoid bending and twisting of the spine whenever possible.

Figure 16 - By pivoting with the right foot, the trunk moves as a single unit so the shoulders and hips are aligned. This can be used when turning to put dishes on a drying rack when washing dishes.

Figure 15 - By sitting back on the hips, the back and knees have less force going through them. This technique can be used for heavier objects. Note that the left arm is anchored against the left thigh for support.

Figure 14 - By bringing one leg back, the spine straightens out. This technique can be used to pick up light objects (eg. less than 5 kg).

In order to keep a straight spine when bending forward, use your hips instead of your spine (Figures 14 and 15).

In order to keep a straight spine when turning your body, pivot your feet instead of twisting your spine. (Figure 16).

It should be pointed out that "straight" does not necessarily mean "vertical."  Many people believe that Figure 17 is the ideal posture for sitting.

However, the science shows that this vertical posture puts more loads onto the spine than standing (Figure 18)...and none of my patients have ever found this position to be comfortable.

Figures 19 and 20 demonstrate more relaxed sitting postures for people.

Figure 20 - Again, the spine is still straight.

Figure 19 - The spine is still straight even though it is reclined. A pillow or towel can be placed behind the low back to support it during long periods of sitting (eg. long car rides).

Figure 18 - Sitting upright puts 1.4 times more pressure through the spine than standing. Bending in sitting is worse. As a person reclines, the amount of the pressure on the spine decreases.

Figure 17 - Typical sitting position

There are countless ways in which a person can position and move their bodies so I cannot possibly discuss all scenarios here.  The purpose of this blog is simply to bring your attention to the connection between movement and pain and to give you some ideas about alternative ways of moving.  You don't have to always adhere to these principles since sometimes it is not practical to follow a principle...but knowing about these principles will give you choices that you may not have had before...and these choices will give you more power over your pain.

Some of these strategies may not come naturally, so it will take some time to adjust.  Be patient with yourself when trying to implement them.

Dr. Trung Ngo founded Novah Healthcare in 2017, an interdisciplinary clinic that specializes in the conservative management of acute and chronic pain. His Novah clinic will continue the work he did from 2011 to 2016 at Mount Sinai Hospital, where he led an interdisciplinary team in assessing and treating complex, chronic, non-cancer pain. His Mount Sinai team helped patients decrease their pain, improve their daily and vocational functioning and reduce or eliminate their intake of pain medications (including opioids). Dr. Ngo graduated from the Canadian Memorial Chiropractic College and subsequently pursued a residency program at Hamilton General Hospital in which he furthered his training in orthopaedics and pain management.

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