PROPER POSTURES

TherapyProtocols

PROPERPOSTURES
Sagar Naik, PT, Dr. Saravanan, Dr. Prerana, Dr. Bhargav Desai

SITTING

NEVERALLOWSLOUCHPOSTUREWHILESITTING

ENCOURAGETOUSELUMBARROLLTOMAINTAINLUMBARLORDOSIS

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ADVICEFIRMSTRAIGHTBACKCHAIRS

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AVOIDBACKLESSCHAIR(REQUIREDTHENUSENADACHAIR)

ENCOURAGE FREQUENT MOVEMENT BREAKS. INSTRUCT PATIENT TO AVOID SITTING LONGER THAN 20 MINUTES AT A TIME FOR THE FIRST 2 WEEKS AND THEN GRADUALLY INCREASE DEPENDING ON TOLERANCE TO PAIN ALLOW PATIENT TO RETURN TO DRIVING FOR SHORT PERIODS AFTER ABOUT 1 TO 2 WEEKS. REMIND THE PATIENT THAT SAFETY IS A PRIORITY FROMTHEMNOTACONVENIENCE.

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1) ADVICE PATIENTS TO LIMIT STANDING AT THE KITCHEN SINK OR BATHROOM COUNTERTOSHORTPERIODS. 2) AVOIDBENDINGATTHEWAIST. 3) ENCOURAGE PATIENT TO MAINTAIN LUMBAR LORDOSIS DURING STANDING ANDWALKINGWHILEPERFORMINGABDOMINALBRACE.

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STANDING&WALKING

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TherapyProtocols

SLEEPING

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LYINGONSOFTMATRESSESORSOFAS

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BODYMECHANICS
TRANSFERS

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1) TEACHPATIENTTOMOVECORRECTLYFROMSUPINETOSITTING

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2) TEACH PATIENT TO MOVE CORRECTLY FROM STANDING TO LYING ON THE FLOOR

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3) TEACHPATIENTTOMOVECORRECTLYFROMSITTINGTOSTANDING

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4) ROLLING IN BED AS A UNIT AND RISING FROM BED SHOULD BE PERFORMED CORRECTLY. 5) ALL TWISTING MOVEMENTS SHOULD BE AVOIDED. INSTRUCT TO MOVE THEIR FEETTOTURNINSTEAD.

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DRESSING
1) INSTRUCT THE PATIENT IN THE CORRECT WAY TO PUT ON PANTS, SOCKS, AND SHOESINTHESUPINEPOSITION. 2) SLIPONSHOESARETHEEASIESTTOHANDLEINTHEFIRST2WEEKS. 3) TYING SHOES CAN LATER BE PERFORMED SAFELY BY PUTTING THE FOOT ON A STOOLORCHAIR.

1) SHOWERINGCANBEGINAFTERTHESECONDWEEK. 2) PATIENT CAN SHOWER LEGS IN STANDING POSITION, WITH FOOT ON THE TUB ORSHOWERSEAT,AVOIDINGLUMBARFLEXION.

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HYGIENE

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LIFTING
1) AVOIDALLLIFTINGINPHASEI. 2) SWOOP LIFTING IS USUALLY A SAFE AND WELLTOLERATED TECHNIQUE FOR LIFTINGINPHASEII. It is performed by making a long stride forward to the kneeling position (lunge) andthenreachingtoliftalightobject.

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BENDING
1) AVOIDALLBENDINGMOVEMENTSATWAIST. 2) LUMBARFLEXIONWITHLOADINGISTHEMOSTHAZARDOUSMOVEMENTINTHE FIRST2PHASES. 3) OCCASIONALLYLIMITEDBENDINGISNECESSARY. Patientcansafelybendbysimultaneouslyflexingatthekneesandhips(HINGEAT THEHIPS)whilemaintaininganeutralspineandanabdominalbrace.

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KINESTHETICPROPRIOCEPTIVECOORDINATION
1) Patients with low back pain may possess poor kinestheticproprioceptive coordination. 2) Thiscanbeimprovedbyusinglumbartape. 3) Therapist places the patient on all fours and asks to maintain neutral spine position. 4) Then therapist places a 12 to 18 cm long tape on the paraspinals parallel to the spine,avoidingincisionsite. 5) Then patient is asked to make small movements into flexion and extension, alwaysreturningtoneutral. 6) Additional feedback from tape puling or wrinkling will assist the patient in learningspinalproprioception. 7) Various postures can be tried, including kneeling, sidelying, sitting, standing, withsmallmotionsofthelumbarspine. 8) Patientcanprogresstofunctionalmovementslikewalking,transfers.

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