Preventing Gardener’s Trauma
After a long, snowy Michigan winter, the first warm and sunny day, we charge outside and clean up the yard. The months snow bound in the house have made the gardeners eager to start the spring clean up and prepare for the summer to come. Most of us will spend the winter in a fairly sedentary physical state and with no physical preparation to launch into hours of challenging outdoor work activity. Every year at our clinics, we treat patients with gardening and yard work induced injuries that could have been prevented with some modifications of activity and preventative exercise. These are my four hints to help safeguard my gardener friends from an unintended trip to the doctor’s office.
#1: Set a Time Limit.
Most of the patients we see with gardener trauma report that they worked “all afternoon” in the yard. It is not uncommon to hear patients report they were bending, pushing, or pulling for five or six hours. Use some caution and limit the duration of your weeding, raking, and shoveling. Set a time limit of two hours and then stop–the garden will be their tomorrow and you will be less likely to have to undergo a springtime MRI.
#2: Use Proper Ergonomics.
Many gardening tasks place your body in challenging positions. Ergonomic experts go to great lengths to eliminate forward trunk flexion and sustained knee flexion from industrial work settings. Pulling weeds and cleaning out flowerbeds combines both of these positions and can create mechanical back and knee pain. Avoid being in the “hands and knees” position for extended periods of time by changing positions frequently. Use knee pads to reduce compressive forces on the knee joints and purchase gardening tools with extended handles so that you need not bend as far or as often.
#3: Avoid Lifting Heavy Objects.
After a sedentary winter spent indoors watching television and knitting, the last thing you should attempt is to hoist the 40 lb. bag of fertilizer into the back of the wheelbarrow. Lifting injuries increase dramatically with loads greater than 25 pounds. Lifting any object from the floor to standing is risky, and carrying unstable loads that can shift around increases stress on the body. Divide heavy loads into smaller portions and avoid lifting directly off the floor. Get a bigger, stronger, and fitter neighbor or family member to help with heavy lifting tasks.
#4: Prepare For Battle.
Gardening and yard work are challenging tasks that should be met with a degree of preparation. If you want to work for five hours in the garden and remain pain free, you must train your body for that level of activity. I have selected three simple exercises you can do to get yourself ready for action in the yard. Simple modification of ergonomics, limitations on work duration, and preparatory exercise can prevent a summer of pain.
Getting Ready To Toil In The Soil.
These three exercises can help you avoid injury and make your spring gardening safer and more productive. Ideally you will perform these drills three times a week for two or three weeks before getting outside and working.
Hip Flexor Stretches
This stretch elongates the large muscle that runs across the front of the hip and attaches to the spine. This region tends to tighten with prolonged sitting and can restrict hip and spinal motion. Place one knee up on a cushioned chair and the other foot slightly forward on the floor. Keep the spine tall and bend the front knee to stretch the hip flexor muscles. Hold for five to ten seconds and repeat five times. Perform the stretch on the other side.
Four Point Fold Ups
If you are going to spend time on all fours, it is a good idea to train your body for this task. Assume a four-point position, knees under the hips and hands under the shoulders. Keep the hands stationary and drop the hips back toward the heels. Go back to the point you feel a stretch and hold–do not stretch into pain. You may feel this in your hips, shoulders, lower back, or upper back. Hold for five to ten seconds and repeat five times.
Gardening and yard work involves a lot of squatting. Being able to safely squat allows you to lift with better body mechanics. Simple bodyweight squats will strengthen the legs and trunk in preparation for these tasks. Place your feet at least shoulder width apart. Check the foot width with a full length mirror– most people squat with the feet too close together. Keep the heels flat on the floor and squat down by pushing the hips back. Work on maintaining balance and control during the motion. Practicing this movement pattern will also improve your flexibility. Perform a series of ten repetitions and then rest and perform another set of ten.
Michael O’Hara, PT, OCS, CSCS
Three Gifts I Would Give And Three I Would Take Away
Santa Gives You Gluteal Activation
You need a responsive and strong set of butt muscles to function at optimal levels. Many gym goers have gluteal muscles that are neurologically disconnected. The term physical therapists and strength coaches use is “gluteal amnesia.” Our sedentary lifestyle involves very little of the glute recruiting sprinting, deep squatting, and climbing that activates the butt muscles. We mistreat our gluteal muscles with hours of compressive sitting and little in the way of full range hip movement. Most fitness clients are in need of some intensive gluteal training. The hip lift is a simple exercise activity that produces a superior response. See the attached video for a demonstration.
Scrooge the Lumbar Spine Flexion
Drop the sit ups, stop doing crunches, ditch the glute ham developer sit ups, and forgo the toes to bar competitions. Father time, gravity, and the stress of prolonged sitting are already bending our lumbar spines forward all day long. The last thing you need to do is accelerate degenerative breakdown of the lumbar segments with more repetitions of spine flexion. Please forget about isolating abdominal muscles. Instead learn how to control the team of muscles that hold the lumbar spine stable. It is a neural event that is worthy of all your efforts.
Santa Gives You Medicine Ball Throws
Life is an up tempo game. What you do in the gym is reflected in how well you can move during activities of daily living. If you continually exercise at slow tempos you will get better at moving slowly. The capacity to decelerate a fall requires fast reactions. Gracefully traveling up the stairs and getting out of the car are only improved with exercise that enhances power and speed of movement. Medicine ball throws are the easiest way to improve power. Medicine ball throws can be scaled to all fitness levels and are safe as long as you use a properly sized and weighted ball. The large, soft Dynamax balls are a good choice for beginners. They rebound well off of the block walls in the gym and are easy to catch. Do not overload your medicine ball throws, a two to eight pound ball is best for most gym goers. Get with one of the trainers for instruction on adding medicine ball throws to your training program.
Scrooge Sitting Down in the Gym
Movement happens in an upright, standing position. “Seated exercise” is an oxymoron. If you want to improve how your body functions, you must stand up and defy gravity. Every athletic endeavor is performed in a standing position. Seated exercise reinforces poor postural habits and diminishes your capacity to move. I call it the “illusion of exercise” and it will always be highly visible in commercial gyms because it is easy to sell.
Santa Gives You Four-Point Training
Crawling is the neurological training tool an infant uses to develop the capacity to stand and walk. It is the pathway to better motor control and less pain. Nearly every physical therapy patient and most fitness clients benefit from a healthy dose of four-point position exercise. In your fitness program, reinforce the patterns of spinal stability and reboot the postural reflexes with some horse stance horizontal, crawling, and Jacobs Ladder training. Four-point training can be scaled to any fitness level. Watch the attached video for some examples.
Scrooge Elliptical Training
I know you love the elliptical. It is the no impact, cardio darling of the gym but it should be used as a fitness dessert and not a main course. Elliptical training has multiple drawbacks. Ergonomically, it is a one size for everyone apparatus that does not work well for taller or shorter people. When you walk or run, you improve the important skill of stabilizing your body over one leg. An elliptical keeps both feet stapled to the machine and deadens any neural enhancement of balance or single leg stability. Hip extension keeps our back healthy and our body athletic. Maintaining or improving hip extension should be part of every training session. There is no hip extension produced when you train on an elliptical. Many people maintain a flexed spine when they use an elliptical. Sitting produces the flexed forward spine we all need to work against in our fitness programs. The repetitive use of the shoulder girdle is a frequent generator of referrals to physical therapy for head and neck pain. Metabolic adaptation to elliptical training happens fairly quickly. In January, a 30 minute session burns 330 calories, but by June, your body becomes more efficient and that same routine creates only a 240 calorie deficit. The low impact, reduced weight bearing nature of an elliptical makes it a poor choice in your fight against osteoporosis.
I am happy when people are more active. Patients and fitness clients love the elliptical and they believe it helps. Use that belief to keep you motivated and training. I just want everyone to manage the drawbacks of this type of training. Injured people always say “Why didn’t someone tell me?” Before you jump on the elliptical, take ten minutes and improve your core stability and hip function with some four-point exercises and hip lifts. Learn how to throw a medicine ball and stay standing through the rest of your training program. Next Christmas you will thank me.
Merry Christmas and a Humbug to you.
See video of Mike in the gym demonstrating these exercises here: https://youtu.be/H0my94BPHNQ
Michael S. O’Hara, PT, OCS, CSCS