This list is not all-inclusive, but makes up about 90% of all the injuries we see in the office. It covers the common effects of each, and solutions to avoid them.
Honorable Mention: Falling off ladders - by far the worst in terms of seriousness of injuries, and mostly preventable by staying off the top two steps, having a spotter hold the ladder to help with stabilization, ensuring the feet of the ladder are securely planted on a level firm surface, making sure the ladder itself is fully open, and not believing that little voice inside your head telling you that the top steps are really just fine. Over the age of 50, most people have the capacity for great strength and stamina, however reaction time begins to worsen. On a ladder, that slight extra delay in response if beginning to fall can mean the difference between catching oneself or falling to the ground. So far during my years in practice, we have lost three patients who died of head injuries from falling off a ladder doing simple things like stringing Christmas lights or taking out and putting away boxes in the attic or ceiling storage. PLEASE be careful.
10. Sitting on the floor to wrap presents or sort papers - At Holiday time, we call this Wrapping Back, and in April, we call it Tax Back. The usual injury is to the sacroiliac joint of the pelvis, but can also result in disc bulge or herniation. The only solution to avoiding this problem is getting the work up off the floor and onto a desk or table where it really belongs.
9. Weeding and gardening - Prolonged bending, twisting, and pulling motions are the top reason for causing sacroiliac joint injuries. The cantilevered weight of the body leaning forward, the uneven load on the lower back caused by the twisting of the shoulders to get one arm and hand to the ground, complicated by pulling up and back overstrains the muscles and ligaments and can not only injure the joint, but tear local muscles and ligaments. The best solution to avoid these common injuries is to kneel on a knee pad, and use one arm to do the work while the other arm supports your upper body weight.
8. Vacuuming and sweeping - Classic case of what we refer to as the “BLT”. Bend, Lift, Twist. Like with gardening, this is the recipe for injury to the lower back. The combination of all three motions at the same time is the cause of the injury, and with sweeping and vacuuming all three are constantly involved. Eliminating one of the three dramatically reduces the chance of injury. Avoiding twisting of the shoulders and upper body in those activities will help a lot. For vacuuming imagine you are a fencer, and have your legs create the forward and backwards motions rather than thrusting with the arm and shoulder. With sweeping, use only your arms to make the motion rather than by twisting the shoulders and upper body.
7. Reaching overhead to clean, change light bulbs, and get or put things away on high shelves - When the head and neck are extended and the arms raised up, there can be some significant compression of the nerves in the upper neck. Aside from pinching one, it is also the most vulnerable position for adversely affecting the alignment of the upper neck. One additional risk is causing a stroke via damage to the arteries in the neck. Ideally, you should not work with the hands higher than the level of the top of your forehead. If reaching high up is unavoidable, position your body to be pointing straight at the object and use two hands to create a symmetrical strain on the neck and shoulders. (Or call a handyman?)
6. Tripping - Entirely avoidable by just being aware of where you are and where you are going. Usually this isn’t a problem, but when carrying something in front of your body, you are not able to see what is in front of you. Scouting out your path before starting to walk will alleviate that risk. The injuries we see from tripping range from fractures, to torn ligaments and herniated discs in the back or neck. Also, don’t forget to use adequate lighting!
5. Moving boxes, furniture, potted plants - This action places you into the “BLT” position. Usually people bend over, lift the object, and then twist to set it down in the new location. The proper way is to bend over, lift the object mainly using the legs, stand fully upright, turn using your feet until you are facing where you plan on placing the item. Then lower it down using the legs and stand back straight up. As with vacuuming and gardening, we see herniated discs, torn and strained muscles and ligaments, and damage to the sacroiliac joints.
4. Making the bed - Leaning out over the bed (bending), lifting the covers (lifting), and then pulling them up (twisting), is yet another classic “BLT” error. Here the injuries are usually confined to torn and strained muscles and ligaments, and sometimes injury to the sacroiliac joint. To avoid this, don’t make the bed until you have been up and moving around for a bit, for example after breakfast, so that your body is warmed up somewhat. Also, use one hand to support your upper body weight while the other manipulates the covers.
3. Walking the dog - great for exercise, but terrible when Fido sees a rabbit or another dog off to the side, and then lunges towards it while you are looking in the other direction at some nice flowers. The jerk can injure the shoulder muscles and tendons, and often pulls the person off balance resulting in a fall onto pavement or concrete. Fractures, strains/sprains, and a host of injuries can result. The solution is a well-trained dog that won’t lunge. Short of that, mindfulness is necessary to be able to see what is about to happen and not be taken off guard.
2. Lifting the kids/grandkids - For everyone, but over the age of 70 the problem is almost universal. The action of lifting a baby creates the “BLT” movement again, and the repeated movements for all the naps, changes, and other needs breaks down the tissues in the lower back resulting in sprains/strains and sacroiliac joint injury. The problem isn’t the baby, but the reconditioning that has occurred from not using the body for that function for 30-40 years. The ideal solution is to always have a regular exercise program so the muscles are prepared for that lifting, but to also eliminate one of the three components of the “BLT” so that you are only bending and lifting, but not twisting in the process.
The Number 1 home injury: Sleeping! For a much more thorough discussion of sleeping positions, beds, and pillows, see my earlier post on the subject. Whenever the weather changes from warm to cool nights or vice versa, we see a procession of acute painful necks. Stomach sleeping is simply bad for the neck, lower back, and causes facial wrinkles. If a side or back sleeper, an appropriate pillow is needed that keeps the head in the same position relative to the body that it occupies when upright. In line with the spine, not tilted forwards or backwards. The arms should not be under the pillow. That usually indicates for a side sleeper a pillow that is too thin.
So, what to do if you have been injured? There are several criteria you can follow that are generally pretty good predictors of whether you need treatment for the injury or can just allow time to heal it on its own.
If any of the following occur, you should come into the office if: you experience sudden severe pain that prevents or makes standing upright very difficult; pain shooting into an arm or leg; pain that worsens with coughing or sneezing; pain that lasts to any degree into the 4th day after the injury. Any of these symptoms indicate the injury is more serious than a simple pulled muscle or spasm.
Ice any injury initially for the first day or two. See this post for details on how long, etc. Heat might feel good, but can cause significant swelling to occur, creating much more pain and a much longer recovery.
Avoid prolonged bed rest. Studies repeatedly show bed rest over three days significantly worsens the long term outcomes and weakens the muscles making the back even more susceptible to repeat injuries. Instead, walk around slowly and when tired sit on the front edge of a firm chair. Avoid deep soft couches or chairs that allow the back to slump. That may feel good while sitting there, but when you try to rise from that position, the added swelling will make the action difficult/impossible and significantly worsen pain.
