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
“I Am Living A Nightmare.”
That is a quote from of a patient of mine that developed shingles. Melanie is only 52 years old and worked in a dental office. She has two teenage children and an active social life. She snow skied in the winter and camped with her family in the summers. She attended the gym three days a week and was extremely fit. The pain and impairment of shingles took all of that away from her for the better part of a year. By the time the pain resolved, it left her debilitated and depressed. We are currently working on a rehab program, but full recovery will take months.
Please take the time to read Jane Brody’s article in the New York Times, *Why You Should Get the New Shingles Vaccine. Shingles is a devastatingly disabling disease that we can avoid with a pair of injections. The general public does not appreciate the severity of this now preventable disease. Ask anyone who has traveled through the shingles experience and they will tell you that they would do anything to avoid the nightmare.
Michael S. O’Hara, PT, OCS, CSCS
*New York Times, Jane Brody, Why You Should Get the New Shingles Vaccine. See the article here: https://www.nytimes.com/2018/04/09/well/why-you-should-get-the-new-shingles-vaccine.html
Modern medicine has lengthened our lives, but unfortunately, many older people physically deteriorate to a level that makes them vulnerable to minor health setbacks. Frailty is a syndrome marked by weakness, poor mobility, a slow gait, and excessive fatigue. Frail individuals are unable to adequately recover from physical activity or a challenge to their health. Minor illnesses send them to the hospital, nursing home, or assisted living center. Frail individuals are often unable to tolerate beneficial medical procedures and must live with pain and physical restrictions. Frailty is a problem that responds very well to treatment.
In the 65 year old plus population, frailty syndrome is common. Fifteen percent of the non-nursing home population is frail and forty five percent is pre-frail. Frail individuals are far more likely to fall. Forty percent of the frail and twenty two percent of the pre-frail individuals are hospitalized every year. Frailty is a marker for adverse health outcomes and a means of identifying opportunities for intervention in patient care.
Physical activity has been shown to be the best preventative and treatment for frailty. Patients bounce back from surgery much better if they under take a program of prehabilitation exercise prior to surgery. Research on rehabilitation has demonstrated the benefits of exercise to restore strength and mobility in the frail population. Take the time to read, One Last Question Before the Operation: Just How Frail Are You? by Paula Span in the October 27, 2017 issue of the New York Times. Read the article here: https://www.nytimes.com/2017/10/27/health/elderly-surgery-frailty.html
In the senior population, fitness activities must focus on training that maintains functional mobility and an independent lifestyle. You need to stand up and train to be a more graceful and competent walker. Practice drills that improve your capacity to transfer from the floor to standing. Always include balance and reaction exercises that keep you free from falls. Foremost are strengthening activities that maintain bone density and restore capacity to lift, carry, push, and pull.
Michael S. O’Hara, PT, OCS, CSCS
* New York Times, One Last Question Before the Operation: Just How Frail Are You? Paula Span, October 27, 2017