It just takes one little wrong move, like leaning over to tie a loved one’s shoelace, for something to pop in the lower back and put you out of commission. For the caregiver of a person with ALS, this kind of injury can be disastrous.
"Loads of people have had to give up caregiving due to injury," says Brenda Shaeffer, a physical therapist at the MDA/ALS Center at Johns Hopkins University in Baltimore. "Then they have to find someone else to provide care, or in some cases find a nursing home."
Good body mechanics (like lifting with the legs, not the back) and assists (like a Hoyer lift or another person) significantly reduce the risk of injury and always should be used. But unless you’re also taking care of your body, a back, neck or shoulder injury may be just one wrong move away.
Muscles need flexibility and strength to resist injury — and stretching and strengthening exercises are the way to achieve those goals.
Wait! Don’t run away at the mention of exercise! We’re not talking about an hour-long trip to the gym, but exercises that fit neatly into odd moments of the day, like when you’re watching TV or sitting at a traffic light.
And the beauty is, "whatever you can do will help," says Jean Hill, a physical therapist with the Kessenich Family MDA/ALS Center at the University of Miami. "A little bit here and there all adds up."
Most adults have bad body habits, like poor posture or only moving in a few routine patterns. Childhood falls have caused many adult bodies to become slightly asymmetrical, making one side tighter than the other.
The result of these habits is that muscles only stretch within a limited range of motion that works OK for everyday life, but doesn’t stand up to stress.
"Injuries occur when you put your body into positions it’s not used to," explains Lee Burkett, professor in the Department of Exercise and Wellness at Arizona State University in Tempe. "When your muscles are supple, you can put your body into more positions than you could before."
Beyond flexibility, leg and hip strength is vitally important for lifting, and strong abdominal and buttocks muscles stabilize the lower back region.
There are dozens of opportunities during the day to fit in quick, gentle exercise.
You can perform the exercises listed below while you’re: on hold on the telephone, using the bathroom, filling the coffee pot, working at the computer, sitting in a waiting room, standing in line, cooking … basically anytime you have a spare 30 seconds. If you pair an activity with an exercise — for example, always doing partial squats while waiting for your toast to pop or hamstring stretches during TV commercials — you’ll improve without even realizing it.
If you already have painful back, neck or shoulder muscles, check with your doctor before undertaking any of the exercises below.
Stretch like a cat
Stretch to the edge of comfort but not beyond, or you may trigger a stretch reflex that actually contracts the muscle and defeats your efforts. Pain isn’t the point, nor is distance. Luxuriate in a stretch, the way a cat does.
Hold stretches about 15 to 30 seconds, repeating two or three times. Never bounce to get a greater stretch.
• Lower Back Stretch: Tight hamstring muscles can cause back pain, says John Klune, physical therapist at the MDA/ALS Center at the University of Arizona Health Sciences Center in Tucson.
Stretch your hamstrings by sitting in a chair with your feet up on a footrest or coffee table. Keeping your knees straight, lean forward until you feel an easy, not painful, stretch.
• Shoulder Stretch: Scratch your back. First point your elbow in the air and scratch the top of your spine. Next, curl each arm around the front of your neck and scratch over your opposite shoulder. Finally, hold your elbow down by your side and twist your hand back up between your shoulder blades.
• Chest Stretch: Place your hands at shoulder height on either side of a doorjamb, then step into the doorway so your arms slightly wing out behind you. Feel the stretch through the middle of your chest.
• Neck Stretch: Lower your ear to your shoulder on either side.
The rule of thumb for strengthening without weights is to tighten your muscles to their maximum, hold for a count of 10, relax for a count of 10 and do 10 repetitions. Be sure you’re stable, either by taking a wide stance or by holding on to a secure object.
• Legs and Hips: Whenever possible, climb stairs instead of using an elevator. In addition, try partial squats. Hold on to a stable object like a countertop. Keep your back straight and slowly lower as if you’re about to sit down. Go down as far as comfortable, then back up.
For greater effect, use only one leg at time. You also can work on leg strength each time you get up from a desk or table, by rising from the chair using only one leg. Hold on to the table for stability but don’t pull yourself up. Alternate legs for an equal workout.
• Lower Back: Here’s an exercise nobody will even know you’re doing. Whenever you think of it, squeeze your buttocks or your abdominal muscles as tight as you can and hold. "You can’t overdo it," says Klune.
A recent San Diego State University study of abdominal exercises found that they should be done frequently rather than for intense periods. Five minutes a day can make a difference if done regularly.
• Shoulders and Arms: Take a weight like a shoe or soup can and lift it straight up in front and to the side, from your waist all the way over your head.
Hold arms straight out to the sides at shoulder height, then bring one arm across in front of your chest, keeping the elbow straight. Go just to the point where your arm starts to bend, then back.
Force your shoulder blades together in the back, then relax, then push them together again. Do shoulder shrugs that bring your shoulders up toward your ears, as if you’re saying, "I don’t know."
• Neck: Place your palm in the middle of your forehead and gently press, resisting the push by holding your head still. Repeat on each side and the back of your head.
These are just a few of the many exercises that will help keep your muscles supple and strong. For more information, Betsy Curless, physical therapist at the MDA clinic at the Via Christi Medical Center in Wichita, Kan., recommends these books: Treat Your Own Back and Treat Your Own Neck, both by Robin McKenzie (Spinal Publications LTD, 1989).