More than 65 million people — almost 30% of the population of the United States — are actively involved in providing 20 or more hours of care each week for a chronically ill, disabled or aged family member or friend. As our population continues to age, this number is expected to grow rapidly.
The role of a caregiver is multifaceted and often involves tasks and skills beyond the education or comfort level of most providers. Caregivers may be asked to manage money, pay bills, shop, clean, maintain and repair a home, dispense and inject medications, clean wounds, change dressings, manage a catheter, provide bed baths, assist in position changes, transfer a patient from a bed to a chair, aid in ambulation and stair climbing, provide bathroom assistance for toileting and showering, and many other responsibilities.
Consequently, a caregiver is often at risk for mental, spiritual and physical fatigue or breakdown. It’s no surprise that depression, illness and injury often plague caregivers — who, eventually, may be in need of a caregiver.
One of the most common injuries suffered by a caregiver is back pain. Lower back pain (LBP) is one of the most common physical problems. Over 90% of all Americans will suffer from it at least once in their lives. It is generally agreed that prevention is the best treatment for LBP. Here are some tips on how to achieve that:
Maintain health and fitness level
As little as 10 extra pounds puts great stress on your lower back. It also makes it more difficult to maintain good posture. Eat well and exercise regularly.
Aerobic exercise
Aerobic exercise will help prevent weight gain and stiffness for a healthier lower back. It will also help with the stress and depression associated with providing care for a loved one. Perform mild aerobic exercise, such as walking, three to five times per week for 30-45 minutes. You can also use an elliptical or bike at home while your loved one is resting. Get outdoors and take multiple short walks; walk around the block a few times per day.
Core exercises
Core stabilization exercises designed to strengthen the abdominal and lower back muscles will help prevent injury. Some examples of core exercises are:
• Pelvic tilt: Lie on your back and perform a pelvic tilt as you flatten your lower back into the floor.
• Pelvic tilt and heel slide: Lying on your back, hold a pelvic tilt as you slide one heel up and down, and repeat with the other heel.
• Core on ball: Perform arm exercises such as biceps and triceps curls with light weight while sitting on a therapeutic ball. Simultaneously try to hold an isometric contraction of your abdominal and lower back muscles.
Do not smoke
Smoking affects natural healing because it constricts the small blood vessels. Smokers have a much higher incidence of LBP and failure from lower back surgery.
Practice good posture and body mechanics
Good posture is critical for a healthy back. When sitting, standing or walking, maintain a slight arch in your lower back, keep shoulders back, and your head over your shoulders. When seated, use a towel roll or small pillow in the small of the back.
Caregivers spend much of the day with their spine bent over a bed or chair feeding, bathing and lifting a loved one. Postural exercises are designed to stretch your back in the opposite direction of this forward flexed position. Examples include:
• Chin tucks: Tuck your chin back to bring your head over your shoulders.
• Shoulder blade pinch: Pinch your shoulder blades together.
• Standing arch: While standing, put your hands behind your back and extend your lower back 10-20 degrees.
Perform these slowly, hold for three to five seconds and repeat six times each, six times per day.
Ergonomics
• When sitting, use an ergonomic workstation and chair with a lumbar support and adjustable heights. Get close to your desk, keyboard and monitor.
• If you drive long distances, use a lumbar support to keep an arch; sit close to your steering wheel to prevent bending forward.
• Get an adjustable bed and raise it to a comfortable height when feeding, dressing or bathing your loved one.
• Think twice when lifting. First, bend your knees and arch your back. Then brace your abdominal muscles. Bend your spine forward as little as possible to lift the patient.
Moving from lying to sitting in bed
Bend your knees; maintain an arch in your back with head up, and bend over as little as possible. Bend the knees of your loved one; roll their trunk toward you to get their legs over the edge of the bed as you pivot their weight on their butt to get them sitting upright.
From sitting in bed to sitting in a chair
Bend your knees, maintain an arch in your back with head up, and bend over as little as possible. Place your hands around the waist or on a transfer belt. Use your legs, turn with your feet and do not twist the spine. Block the feet and knees of your loved one with your feet and knees, and use them to pivot and transfer from the bed to the chair. Be sure the chair is alongside the bed, and the arm of the chair is removed if possible before the lift.
Transferring
• Use a transfer belt around the waist of the patient. Grip the transfer belt instead of the patient or clothing, during the lift or when ambulating.
• Lower back lifting belt: If you have a back problem, consider using a lifting belt or back brace to protect your back when lifting the patient. Immediately after the lift, stand up straight and stretch your lower back into extension.
Transfer belts and lower back lifting belts can be found online or at your local pharmacy.
• Lift chair: For patients who require maximum or moderate assistance and when only one caregiver is available to lift or transfer, an electric lift chair should be considered.
Paul J. Mackarey, P.T., D.H.Sc., is a doctor in health sciences specializing in orthopedic and sports physical therapy. He is in private practice in Scranton and Clarks Summit and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. Email: mackareypt@gmail.com.
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