General Back Education for the Certified Physical Fitness Instructor Thursday, May 27, 1999 8:30 9:00

0 A.M. 9:00 0: ! A.M. 0: ! 0:30 A.M. 0:30 *:00 *:00 :00 ..M. :00/ *:30 ..M. *:30 *:5! ..M. *:5! 3:5! ..M. 3:5! 5:00 ..M. Friday, May 2 , 1999 8: ! 9:00 A.M. 9:00 0: ! A.M. 0: ! 0:30 A.M. 0:30 *:00 *:00 :00 ..M. :00 *:00 ..M. *:00 *:30 ..M. *:30 *:5! ..M. *:5! 3:30 ..M. 3:30 5:00 ..M. Assessing ,trengt(6 Fle2ibilit"6 )alance and $ange of Motion of t(e Lo0er 12tremit" and )ac% in t(e #At $is% Indi&idual'. .("sical :raining for t(e #At $is% Indi&idual'. )rea% Instruction in .ro-er Manual Materials ;andling. Lunc( Instruction in .ro-er Manual Materials ;andling. Incor-orating t(e #<ogniti&e )e(a&ioral .rogram for .atients 0it( <(ronic )ac% Disorders'. )rea% Incor-orating t(e #<ogniti&e )e(a&ioral .rogram for .atients 0it( <(ronic )ac% Disorders'. $e&ie06 =uestions6 and :raining 8ra-/u-. Introduction to Motion Diagnostic Laboratories Functional Lift Assessment. Identif"ing #At $is% Indi&iduals' using t(e Functional Lift Assessment. )rea% Anatom" and +inesiolog" of t(e ,-ine Lunc( Anatom" and +inesiolog" of t(e ,-ine and Lo0er 12tremities 3 In4uries of t(e ,-ine. )rea% Assessing ,trengt(6 Fle2ibilit"6 )alance and $ange of Motion of t(e Lo0er 12tremit" and )ac% in t(e At $is% Indi&idual. Da" 7ne 8ra-/9-

Introduction to Motion Diagnostic Laboratories Functional Lift Assessment. :(e FLA ob4ecti&el" measures and documents a recruits lifting mec(anics for t(e -ur-ose of identif"ing recruits #at ris%' of in4uring t(eir lo0 bac%. E!"lanation of #ata Ta$les 1% &'M a. b. c. *. >ormal $7M ,ub4ect $7M ? of >ormal

#yna(ic Tor)ue @force 2 distanceA a. >ormal Ma2imum b. c. d. ,ub4ect Ma2imum ? of >ormal Boint .ercent <a-able @B.<A ? of t(e adult -o-ulation t(at 0ould (a&e t(e static isometric strengt( to -erform t(e tas%.

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+,-.1 Ma!i(u( #yna(ic Tor)ue and Force /alues a. :orCue :orCue D force 2 distance from a2is of rotation b. <om-ression Loading mode in 0(ic( eCual and o--osite loads are a--lied to0ard t(e surface of t(e structure6 resulting in s(ortening and 0idening. ,(ear loading mode in 0(ic( a load is a--lied -arallel to t(e surface of t(e structure.

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1ori2ontal #istance Fro( +oad a. >ormal Ma2imum b. c. ,ub4ect Ma2imum ? of >ormal

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3nee 4ersus 1i" Coordination a. >ormal ,lo-e b. c. d. e. ,ub4ect ,lo-e ? >ormal #+nee &s. ;i- Angle' Era-( #;i- and +nee Angle' Era-(

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Calculation of the 6I'.1 +iftin7 E)uation a. $ecommended 8eig(t Limit @$8LA b. Lifting Inde2 @LIA

7%

.tick Fi7ures 6I'.1 +iftin7 E)uation - 1991

A committee of e2-erts: . re&ie0ed current literature on lifting *. recommended criteria for defining lifting ca-acit" 3. re&ised t(e 98 lifting eCuation :(ree criteria: . biomec(anical com-ressi&e and s(ear forces and torCue on s-ine @L!/, A *. -("siological energ" e2-enditure to limit loads for re-etiti&e lifting 3. -s"c(o-("sical defining 0or%ers strengt( and ca-acit" to -erform manual lifting at different freCuencies for different durations :(e eCuation 0as designed to assist in t(e identification of ergonomic solutions for reducing t(e -("sical stresses associated 0it( manual lifting b" identif"ing t(e features of t(e lifting tas% t(at contribute t(e most to t(e (aFard for lo0 bac% in4uries. Lifting eCuation for calculating t(e &eco((ended 8ei7ht +i(it 9&8+:: &8+ ; +C ! 1M ! /M ! #M ! <M ! FM ! CM Multi"lier Load <onstant ;oriFontal Gertical Distance As"mmetric FreCuenc" <ou-ling +iftin7 Inde! 9+I: LI D Load 8eig(t 3 $ecommended 8eig(t Limit +I ; + > &8+ Load 8eig(t @LA D 0eig(t of ob4ect lifted @lbs. or %gA. $8L for a tas% re-resents a load &alue t(at nearl" all (ealt(" 0or%ers could -erform o&er a substantial -eriod of time @e.g.6 u- to 8 (oursA 0it(out an increased ris% of de&elo-ing lifting/ related L). <$$re4iation L< ;M GM DM AM FM <M Metric *3 %g *!3; @.003HG/I!HA 0.8* @5.!3DA @.003* J AA :able ! :able I =%.% ! lbs. 03; @.00I!HG/30HA 0.8* @ .83DA @.003* J AA :able ! :able I

:(e Lifting Inde2 is a ratio or com-arison bet0een t(e actual 0eig(t lifted @LA and t(e recommended 0eig(t limit @$8LA. It is a relati4e inde! of "hysical stress% :(eoreticall"6 t(e magnitude of t(e LI ma" be used as a gauge to estimate t(e -ercentage of t(e 0or%force t(at is li%el" to be at ris% for de&elo-ing lifting/related L).. Identif"ing (aFardous lifting 4obs3tas%s using t(e Lifting Inde2: It is li%el" t(at lifting tas%s 0it( a LI K -ose an increase ris% for lifting/related L). for some fraction of t(e 0or%force. :(erefore6 t(e LI ma" be used to identif" -otentiall" (aFardous lifting 4obs or com-are t(e relati&e se&erit" of t0o 4obs for t(e -ur-ose of e&aluating and redesigning t(em. :(e 99 committee belie&ed t(at t(e combination of using a multi-licati&e model and t(e -ractice of using t(e most conser&ati&e criterion or data &alues 0(en faced 0it( uncertaint" ser&ed to -ro&ide a final lifting eCuation 0(ic( is more li%el" to -rotect (ealt(" 0or%ers for a 0ider &ariet" of lifting tas%s t(an met(ods 0(ic( rel" on a single tas% factor @e.g.6 0eig(tA or single criterion @e.g.6 intradiscal -ressureA. $eferences: 8aters :$6 .utF/Anderson G6 Earg A6 Fine LB 9936 $e&ised >I7,; eCuation for t(e design and e&aluation of manual lifting tas%s. 1rgonomics6 3L:I6 I59/IIL. 8aters :$6 .utF/Anderson G6 Earg A 9956 A--lication Manual for t(e $e&ised >I7,; Lifting 1Cuation. 9.,. De-artment of ;ealt( and ;uman ,er&ices. 8or% .ractices Euide for Manual Lifting6 936 American Industrial ;"giene Association. Identif"ing #At $is% Indi&iduals' using t(e Functional Lift Assessment 1% &an7e of Motion 1i" 3nee D"namic :orCue ;i +nee Boint .ercent <a-able @-s"c(o-("sicalA ;i +nee 99? for males 3 I!? for females L!/, Ma2imum :orCue and Force Galues :orCue Co("ression ? .hear ? 1ori2ontal #istance for( +oad 3nee 4ersus 1i" Coordination >I7,; Lifting 1Cuation $8L

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LI Anatom" of t(e ,-ine

33 &ertebra 03 *3 IG dis%s I cer&ical * t(oracic ! lumbar ! sacral @fusedA 5 cocc"geal

,-inal >er&es from t(e ,-inal <ord <er&ical / emerge from abo&e t(e corres-onding &ertebrae 1.g. s-inal ner&e <5 is bet0een t(e 3rd and 5t( cer&ical &ertebrae :(oracic and Lumbar / emerge from belo0 t(e corres-onding &ertebrae. 1.g. s-inal ner&e L5 is bet0een 5t( and !t( lumbar &ertebrae.

,tructure of a :"-ical Gertebrae: Gertebral bod" anterior Gertebral arc( -osterior * trans&erse -rocesses @di&ides arc( into anterior3-osterior -ortionsA anterior -ortion "edicle -osterior -ortion la(inae s-inous -rocess 5 articular -rocesses * su-erior articular facets * inferior articular facets "ar 9inter-:articularis -osterior -ortion of laminae bet0een su-erior M inferior -rocesses <artilagenous end -lates Lie on t(e &erterbral bod"

Inter&ertebral Dis% ,tructure of IG Dis%s <nnulus fi$rosus 7uter -ortion of dis% Annular fibers @tree/li%eA <om-osed of collagen6 fibrocartilage6 ;*0 6ucleus Pul"osus Inner -ortion of dis% )all/li%e <om-osed of ;*0 and collagen

Facet @oints @N"ga-o-("seal or A-o-("seal BointsA Articulations bet0een t(e su-erior and inferior facets3articular -rocesses +i7a(ents and @oint Ca"sules Anterior longitudinal ligament A2is to sacrum .osterior longitudinal ligament A2is to sacrum Ligamentum fla&um A2is to sacrum .osterior surface of &ertebral canal connecting ad4acent lamina ,u-ras-inous :(oracic and lumbar s-ines Ligamentum nuc(ae <ontinuation of su-ras-inous ligament in cer&ical s-ine Inters-inous .rimaril" lumbar Intertrans&erse .rimaril" lumbar Facet Boint <a-sule 1nca-sulate t(e facet 4oints

Functional Anatom" of t(e ,-ine Functions of the ."ine :(e s-ine is needed for bot( stabilit" and mobilit"OO . *. 3. 5. )ase of su--ort for (ead M internal organs )ase of attac(ment for muscles6 ligaments6 and bones of t(e e2tremities @a2ial &s. a--endicular s%eletonA6 rib cage6 and -el&is .rotect ,< :ransfer loads bet0een (ead and nec% and -el&is

Cur4es of the ."ine .rimar" cur&es @con&e2 %"-(otic t(roug(out lifeA . :(oracic *. ,acral ,econdar" cur&es @initiall" con&e2 conca&e lordoticA J . <er&ical *. Lumbar

J de&elo- as an accommodation to t(e u-rig(t -osture c3s cur&e de&elo-s as c(ild begins to (old (ead u l3s cur&e de&elo-s as c(ild begins to stand and 0al% cur&es cease de&elo-ing bet0een * and I Function of cur&es: . Attenuate Eround $eaction Forces @E$FA @oints of the ."ine . *. cartilagenous 4oints bet0een &ertebral bodies and IG dis% s"no&ial 4oints called F"ga-o-("seal3a-o-("seal3facet 4oints bet0een articular -rocesses

Inter&ertebral Dis%s in lengt(6 0idt(6 and t(ic%ness from c3s to l3s distribute loads and restrains motion

>ucleus .ul-osus <om-osed of 0ater and collagen Acts ("drostaticall" uniform -ressure to store energ" and distribute loads Dis% is ("dro-(ilic @-roteogl"cansA (o0e&er age and degeneration reduce t(is resists tensile forces and com-ressi&e forces @:"-e II collagenA Dr" dis% is inelastic abilit" to store energ" and distribute loads.

Motion .e7(ent Functional =nit of the ."ine * ad4acent &ertebra and t(e inter-osing &ertebral dis% 7rientation of t(e facet 4oints determines t(e direction of mo&ement in t(e motion segments C1-C2 (oriFontal3trans&erse -lane .ermits mostl" rotation C*-C7 5!0 angle to t(e trans&erse -lane Fle2ion3e2tension6 lateral bending6 and rotation Thoracic L00 to trans&erse lateral fle2ion6 rotation6 and some fle2ion3e2tension lateral fle2ion limited b" ribs +u($ar 900 to trans&erse fle2ion3e2tension6 lateral bending6 al(ost no rotation

Passi4e restraints 9li7a(ents: of the s"ine Anterior longitudinal ligament Limits e2tension reinforces anterior dis% .osterior longitudinal ligament Limits fle2ion reinforces -osterior dis% Ligamentum fla&um Limits fle2ion @es-. in L3,A (ig(est elastin content allo0ing it to contract during e2tension and elongate during fle2ion @al0a"s under tension e&en in neutralA ,u-ras-inous Limits fle2ion Gulnerable to ("-erfle2ion in4ur" Ligamentum nuc(ae Limits fle2ion Gulnerable to ("-erfle2ion in4ur" Inters-inous Limits fle2ion Gulnerable to ("-erfle2ion in4ur" Intertrans&erse Limits fle2ion Facet Boint <a-sule Limits fle2ion Gulnerable to ("-erfle2ion in4ur"

Musculature of the ."ine Fle2ors 12tensors 1rector s-inae @sacros-inalisA . ,-inalis @medialA attac( to s-inous -rocesses ca-itis6 cer&icis6 t(oracis $ectus Abdominis Internal 7bliCues 12ternal 7bliCues Ilio-soas fle2 t(e trun% but e2tend t(e lumbar s-ine

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Longissimus @middleA ca-itis6 cer&icis6 t(oracis Iliocostalis @lateralA sli-s to angle of rib cer&icis6 t(oracis6 lumborum

3.

$otators and Lateral Fle2ors Anterior Musculature $otation <ontralateral e2ternal obliCues I-silateral internal obliCues Lateral )ending I-silateral obliCues

.osterior Musculature $otation to same side 1rector s-inae =uadratus lumborum $otation to o--osite side :rans&eros-inalis Lateral bending to same side =uadratus lumborum ilio-soas

:rans&ersos-inalis dee-est la"er . res-onsible for finer mo&ements of t(e s-ine assist in e2tension6 rotation6 and lateral bending ,emis-inalis @s-an about ! inters-acesA ca-itis6 cer&icis6 t(oracis Multifidus @s-an about 3 inters-acesA ,acrum a2is s-ine $otatores @s-an about /* inters-acesA 8ell/de&elo-ed in t(oracic region

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Ty"es of forces incurred in the s"ine 1% a!ial co("ression t(ru long a2is of s-ine to t(e IG dis%s *0: gra&it" muscular contraction ligament restriction ligamentum fla&um

resisted $y I/ disks and 4erte$ral $odies facet Aoints also assist in resistin7 co("ression Ereatest in e2tension 30? of total load Also (ig( during cou-led fle2ion and rotation

2%

Bendin7 <ombination of com-ression and tension Fle2ion com-ression of anterior structures and tension in -osterior structures :ensile forces resisted b" ALL6 .LL6 etc. Torsion *0 a2ial rotation 0(ic( often occurs 0it( cou-led motions resisted b" outer la"ers &ertebral bod"6 IG dis%6 orientation of facets .hear Mo&ement in t(e same -lane as t(e IG dis% and &ertebral bod" $esisted b" facet 4oints3&ertebral arc(es and IG dis%s34oints ,-ond"lol"sis and s-ond"lolit(esis

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$estriction of $7M at one motion segment results in increased $7M at ad4acent segments. Loading of s-ine in &arious -ositions see >ac(emsonss 0or% Forces on t(e ,-ine during lifting: Forces on t(e lumbar s-ine during lifting are (ig(l" de-endent on t(e distance t(e ob4ect is from t(e bod". .roduces a s(ear and com-ression com-onent. 8(at forces are acting on t(e s-ine 0(en lifting an ob4ectP . 0eig(t of load *. 0eig(t of u--er bod" 3. forces -roduced b" musculature / erector s-inae 7t(er contributing factorsP Intra/abdominal -ressure Force -roduce b" abominal musculature In 7eneral, the (usculature creates lar7e co("ressi4e loads on the s"ine% 8(ic( lifting -osition3tec(niCue 0ill create a greater load3com-ressi&e forces on t(e lo0er bac%P ,traig(t bac% or rounded bac% $ounded bac% 8;QP .arado2ical Forces are actuall" -roduced b" ligaments @resisting fle2ionA muscle in a lengt(ened30ea%ened -osition

Ligamentum fla&um (ig(est elastin content allo0ing it to contract during e2tension and elongate during fle2ion @al0a"s under tension e&en in neutralA :o -rotect ligaments / 0ant muscles to contract

IM.:. static anal"ses tend to underestimate t(e forces -laced on 4oints3s-ine. ,tatics do >7: consider t(e &elocit"3acceleration in&ol&ed in lifting (ig( accelerations during lifting d"namic forces

Forces on L3, generated during abdominal strengt(ening: Ereatest forces found during full sit/u- as o--osed to curl/u-3crunc( or re&erse curl3crunc( :"-es of In4uries in t(e s-ine . *. 3. Muscular ,trains3-ulls Ligamentous ,-rains Facet In4uries Im-ingement ligament and ca-sule ,ublu2ation Loc%ing ,-rains ca-sule3ligamentous ;"-ermobilit" and ("-omobilit" ;erniated Inter&ertebral Dis%s Art(ritis @7A &s. $AA Fractures :raumatic <ongenital defects <auses of In4uries . 12cessi&e com-ressi&e forces inter&ertebral dis% &ertebral bod" 12cessi&e s(ear forces ligamentous facet IG dis% 12cessi&e tensile force s-rains strains 7&ere2ertion in4uries

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strains

<umulati&e trauma in4uries @re-etiti&e liftingA <:Is3$,Is microtraumatic tissue brea%do0n .rolonged static -ostures3-oor -osture @sitting and standingA IG dis%

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.re&ention of ,-inal In4uries . *. 3. Learning -ro-er tec(niCues for manual (andling of materials. Maintaining and im-ro&ing fle2ibilit" and strengt( in t(e lo0er e2tremities and trun%. A&oidance of -rolonged static -ostures. Assessment b" t(e <ertified .("sical Fitness Instructor @<.FIA Motion Diagnostic Laboratories Functional Lift Assessment 0ill be used initiall" to ob4ecti&el" identif" and document recruits at ris% for lo0 bac% in4uries. :(e <.FI 0ill t(en -erform a -("sical assessment of t(e #at ris%' recruit to identif" s-ecific -("sical deficiencies t(at ma" e2ist. If no -("sical deficiencies are identified6 it is most li%el" t(at t(is #at ris%' recruit does not understand t(e general -rinci-als of manual materials (andling or t(e recruit (as motor -lanning and3or control -roblems. :"-ical causes of im-ro-er manual materials (andling: . *. 3. 5. !. L. I. .oor understanding of manual materials (andling. Muscular 0ea%ness6 imbalance6 or as"mmetr". Muscular infle2ibilit". $estricted 4oint range of motion. Boint -ain secondar" to 4oint -at(olog". .oor d"namic balance @standingA. .oor motor -lanning and3or control s%ills.

Eeneral Areas of Assessment: . *. 3. 5. !. L. I. $ecognition of a -oor understanding of -ro-er manual material (andling Lo0er e2tremit" and trun% strengt( Lo0er e2tremit" and trun% fle2ibilit"3muscle lengt( Boint range of motion $ecognition of 4oint -at(olog" D"namic standing balance $ecognition of -oor motor control3-lanning

Assessment 9nderstanding .ro-er Manual Materials ;andling :o a&oid -erforming an" unnecessar" -("sical testing6 it is ad&ised t(at t(e <.FI determine t(e #at ris%' recruits understanding of -ro-er manual materials (andling. Qou can do t(is b" re&ie0ing 0it( t(e recruit t(e basics of -ro-er manual materials (andling:

:en $ules of Lifting: . Assess t(e en&ironment and tas% *. De&elo- a strateg" to -erform t(e tas% in t(e s-ecific en&ironment 3. 9se a 0ide6 stable base of su--ort @feet a--ro2imatel" s(oulder/0idt( a-artA 5. )end3fle2 at t(e (i-s6 %nees6 and an%les @dorsifle2A to meet an ob4ect on t(e floor !. +ee- t(e ob4ect as close to "our bod" as -ossible t(roug(out t(e lift L. Maintain a neutral s-ine @a&oid e2cessi&e lordorsis or %"-(osis in t(e lumbar s-ineA I. Maintain a &ertical torso -osition t(roug(out t(e lift 8. Initiate t(e lift from t(e floor u-0ards @distal to -ro2imalA 9. Mo&e in a slo0 and controlled manner3a&oid Cuic%6 abru-t mo&ements 0. A&oid t0isting motions of t(e trun% and lo0er e2tremities M7G1 Q79$ F11:O >7:1,: . .rior to instructing t(e recruit in t(e basics of -ro-er lifting6 (a&e (im3(er -erform some brief functional acti&ities @e.g. sCuat or lungeA to determine if an" gross deficiencies. A gross deficienc" 0ould 0arrant immediate -("sical assessment as o--osed to furt(er instruction.

,trengt( Met(ods of assessing strengt(: . Functional strengt( *. Isolated muscle strengt( Manual Muscle :esting @MM:A Iso%inetic3Isotonic :esting Functional ,trengt( Full ,Cuat Lunge Isolated Muscle ,trengt( .rimar" Eastrocnemius3,oleus =uadrice-s ;i- 12tensors @Elute Ma2A :run% 12tensors :run% Fle2ors

,econdar" ;amstrings ;i- Fle2ors 9--er e2tremities if -erforming u--er bod" lift

,trengt( As"mmetr" ,trengt( Imbalance

Fle2ibilit" and muscle lengt( Met(ods of assessing fle2ibilit":

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Functional fle2ibilit" Isolated muscle fle2ibilit" Functional Fle2ibilit" Full ,Cuat Lunge Isolated Muscle fle2ibilit" .rimar" Gastrocne(ius>.oleus B heels on the 7round =uadrice-s ;i- 12tensors @Elute Ma2A

,econdar" :run% 12tensors :run% Fle2ors ;amstrings ;i- Fle2ors ;i- Adductors 9--er e2tremities if -erforming u--er bod" lift

Boint $ange of Motion3Boint .at(olog" . *. Functional Isolated Functional 0eig(t bearing ma" elicit 4oint -ain sCuat lunge Isolated .rimar" An%les +nees ;i-s

,econdar" :run% 9--er e2tremities

J If a <.FI feels t(at an recruit (as some t"-e of 4oint -at(olog"6 su-eriors s(ould be notified so -ro-er action can be ta%en @referral to a -("sicianA. D"namic )alance ,Cuat Lunge

=uiet standing e"es o-en &s. e"es closed :andem standing e"es o-en &s. e"es closed ,ingle leg standing

$ecognition of -oor motor control3-lanning If an #at ris%' recruit continues to lift incorrectl" after recei&ing re-eated instruction and (as no -("sical deficiencies t(en it is &er" -ossible t(at t(e recruit (as a motor control and3or -lanning -roblem. :(is occurs &er" rarel"6 but if it does occur6 su-eriors s(ould be notified and -ro-er -lans of action s(ould be ta%en @referral to a -("sician6 .:6 7:A.

Place(ent of recruits into a""ro"riate 7rou"s De-ending on t(e outcome of t(e instructors assessment6 #at ris%' recruits are directed into one of t0o grou-s: . $ecruits t(at lift im-ro-erl" and (a&e no underl"ing -("sical deficiencies are -laced into an #instruction onl"' grou-. :(ese recruits attend educational sessions designed to instruct t(em on t(e basics of s-ine -reser&ation and -ro-er manual materials (andling. $ecruits 0(o lifted im-ro-erl" as a result of some underl"ing -("sical deficienc" are -laced in t(e #instruction and -("sical training' grou-. :(ese recruits recei&e indi&idualiFed -("sical training designed to address t(e recruits s-ecific -("sical deficienc". In addition6 t(ese recruits s(ould be reCuired to attend t(e educational sessions.

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It is recommended t(at e&en t(ose recruits 0(o -erformed 0ell on t(e FLA s(ould attend t(e educational sessions to strengt(en t(eir %no0ledge of s-ine -reser&ation and -ro-er manual materials (andling. <ogniti&e )e(a&ioral .rogram for Lo0 )ac% .reser&ation In addition to t(e grou- 0or% described abo&e6 it is (ig(l" recommended t(at all recruits6 regardless of t(eir -erformance on t(e FLA6 -artici-ate in t(e <ogniti&e )e(a&ioral .rogram for Lo0 )ac% .reser&ation. :(is -rogram is designed to increase t(e recruits a0areness of s-ine -reser&ation and manual material (andling. It is a si2/0ee% be(a&ior modification -rogram 0(ere eac( recruit self/monitors (is or (er lifting (abits t(roug(out eac( da". $ecruits are gi&en 0ee%l" assignments 0(ereb" t(e" document t(e number and t"-es of lifts -erformed eac( da". :(is includes not onl" lifts -erformed at 0or% but also t(ose -erformed at (ome since man" recruits in4ure t(emsel&es at (ome. Follo0/u- meetings are t(en sc(eduled bet0een t(e recruits and t(e instructors to discuss t(e recruits lifting (abits. $ecruits are educated on a number of tec(niCues to ma%e t(em more a0are of t(e effects of manual materials (andling on t(e lo0 bac%. #escri"tion of Grou"s I. #Instruction 7nl"' $ecruits recommended for t(e #Instruction 7nl"' grou- 0ill recei&e t0o one/(our sessions of inter&ention t(at 0ill focus on education and instruction in s-ine -reser&ation and manual materials (andling. :(is instruction s(ould ta%e -lace in grou-s of eig(t to ten recruits.

.ession 'ne B General Education Eeneral instruction in anatom" and functional anatom" of t(e s-ine. Discuss t(e t"-es of in4uries t(at occur in t(e s-ine. 8(at are t(e causes of t(ese in4uries in t(e s-ineP 12cessi&e forces 7&ere2ertion <:Ds3$,Is .rolonged static -ostures ;o0 can "ou -re&ent t(ese in4uriesP Learning -ro-er tec(niCues for manual materials (andling. Maintaining and im-ro&ing fle2ibilit" and strengt( in lo0er e2tremities and t(e trun%. A&oidance of -rolonged static -ostures.

.ession tCo B Instruction ,ession t0o reCuires more acti&e -artici-ation from eac( recruit. :(is is a lab session t(at 0ill reCuire t(e recruits to -erform lifts6 -us(es6 -ulls6 etc. in grou-s of t0o or t(ree. 9se of abdominals to ac(ie&e neutral or braced s-ine. $e&ie0 of t(e basics of -ro-er manual materials (andling: :en $ules of Lifting: . *. 3. 5. !. L. I. 8. 9. 0. Assess t(e en&ironment and tas% De&elo- a strateg" to -erform t(e tas% in t(e s-ecific en&ironment 9se a 0ide6 stable base of su--ort @feet a--ro2imatel" s(oulder/0idt( a-artA )end3fle2 at t(e (i-s6 %nees6 and an%les @dorsifle2A to meet an ob4ect on t(e floor +ee- t(e ob4ect as close to "our bod" as -ossible t(roug(out t(e lift Maintain a neutral s-ine @a&oid e2cessi&e lordorsis or %"-(osis in t(e lumbar s-ineA Maintain a &ertical torso -osition t(roug(out t(e lift Initiate t(e lift from t(e floor u-0ards @distal to -ro2imalA Mo&e in a slo0 and controlled manner3a&oid Cuic%6 abru-t mo&ements A&oid t0isting motions of t(e trun% and lo0er e2tremities M7G1 Q79$ F11:O

Lab ,essions Lifts ;ig( far lift ;ig( near lift Floor lift Arm lift .us(es .us( out .us( do0n .us( u-

.ulls .ull in .ull do0n .ull uLifts6 -us(es6 and -ulls6 in&ol&ing multi-le recruits .racticing actual lifts6 -us(es6 -ulls t"-icall" -erformed b" state troo-ers 1.g. remo&ing and returning lig(ts to t(e to- of a -atrol car

II. #Instruction and .("sical :raining' :(e recruits designated to t(is grou- recei&e t(e instruction and education described in t(e #Instruction 7nl"' section6 as 0ell as indi&idualiFed -("sical training -rogram t(at can be -erformed in a grou- or indi&iduall". It is im-erati&e t(at t(e recruits in t(is grou- com-lete t(e -("sical training -rior to beginning t(e instruction and education. 8it(out t(e -("sical ca-acities6 t(e recruit 0ill be unable to -ro-erl" -erform manual material (andling. :(e duration of t(is -("sical training 0ill last from a--ro2imatel" * to * 0ee%s. It is t(e res-onsibilit" of eac( recruit in t(e grou- to notif" an instructor 0(en (e or s(e feels t(e -("sical deficiencies are corrected. At t(is -oint -("sical com-etenc" s(ould be demonstrated to t(e instructor so t(e recruit can begin t(e education and instruction. If a recruit does not demonstrate com-etenc" after * 0ee%s6 an e2ecuti&e decision s(ould be made regarding t(e future of t(is recruit. )ased on t(e instructors -("sical assessment of t(e recruit6 t(e instructor s(ould de&elo- and indi&idualiFed -("sical training -rogram for t(e recruit. :(e -rogress of t(e recruit s(ould be follo0ed on a 0ee%l" basis and t(e -rogram u-dated 0(en a--ro-riate. :(e instructors s(ould (a&e formal indi&idual and3or grou- meetings 0it( t(e recruits. :(e recruits are reCuired to 0or% inde-endentl" as 0ell.

:(e -("sical training s(ould focus on t(e follo0ing areas de-ending on t(e s-ecific needs of eac( recruit: Im-ro&ing muscle strengt( Im-ro&ing 4oint range of motion Im-ro&ing fle2ibilit" Im-ro&ing d"namic standing3sCuatting balance Im-ro&ing t(e understanding of -ro-er manual materials (andling

FolloC-u" .essions :o0ard t(e end of t(e academ" training6 eac( recruit s(ould be reCuired to attend one or more sessions 0(ere t(e instructors test eac( recruits abilit" to -erform a &ariet" of manual materials (andling tas%s reCuired of a troo-er. It is at t(is time t(at -ro-er materials (andling -rinci-les can be re&ie0ed and reinforced. :(ese sessions s(ould be interacti&e for t(e recruits and t(e instructors. Specific Physical Training Muscle ,trengt(

<oncentric6 1ccentric6 Isometric Isolated &ersus functional strengt( Lo0er 12tremities Eastroc3soleus =uadrice-s ;i- e2tensors ;i- abductors :run% Fle2ors 12tensors $otators 9--er e2tremities 0(en a--ro-riate

Fle2ibilit" and Muscle Lengt( Eastroc3,oleus =uadrice-s $ectus Femoris ;amstrings ;i- 12tensors :run% e2tensors 9--er e2tremities 0(en a--ro-riate

)alance Acti&ities :andem 0al%ing ,ingle leg stance Gisual distraction tec(niCues