The nature of care-giving can place great physical stress on you as the caregiver. Practicing proper body mechanics will decrease the stress and strain and help to safely manage the mobility of the care-receiver. The primary rule is to maintain the normal lumbar curve at all times. By following this one simple rule, injury to the lower back can be avoided. This means that you may need to get in different positions or use different transfer techniques, based on your own body type/size and that of the care-receiver. The following lifting principles will help keep the normal lumbar curve.

Principles of Safe Lifting

1. Maintain a sturdy or broad base of support. A stable position is necessary when assisting the care-receiver with moving. A wide base of support is stable—spread the feet at or greater than shoulder-width apart—but keep in mind that having the feet in a scissor position, with one foot forward and one foot backward, also offers a wide base of support. The physical space available will dictate which position to use when assisting with moving. For an example, when assisting someone with a car transfer, there may not be enough room to spread the feet shoulder-width apart; therefore, the scissor position may be the better option.

2. Keep the load close. This applies to lifting objects as well as to assisting a care-receiver with a transfer. For example, when lifting a chair, if the chair back is close to the body, it feels much lighter than if the chair is lifted with the arms extended, with the chair away from the body. Most likely, with the latter technique a strain will be felt in the low back. The farther away the object (or care-receiver) being lifted, the greater the lever arm, which makes the care-receiver or object feel heavier. It is much easier to lift and much easier to keep that normal lumbar curve when the load is closer. 

3. Bend with knees, not with the back. The take-home message here is that bending forward with a rounded low back (lumbar spine) loses the normal lumbar curve and causes stress to your low back. The larger, stronger leg muscles are more equipped to do the lifting than the low-back muscles. Remember to tighten up the stomach and bend down with your legs.

4. Push instead of pull, whenever possible. When pulling a load, it is much harder to keep the normal lumbar curve (neutral spine), so whenever possible, push rather than pull. For example, in assisting a care-receiver up from a low chair, it is better to stand on the side of the care-receiver and push him forward so that his center of gravity is over his feet—so that he can use his legs to transfer to standing—rather than standing in front of him and pulling forward where you are performing more work and potentially placing more strain on your lower back.

This article was adapted from The Pocket Physical Therapist: A Caregiver’s Complete Guide for Mobility and Independence in the Home due out in August of 2010 from Langdon Street Press. For more information: www.ohanapacificrehab.com.

Whether you are a new family caregiver or have been taking care of your family member with Parkinson’s disease for a long time, it is easy to get lost in the day-to-day challenges. Most caregivers feel stress at some point, while many feel stress all the time. Some stress is natural; it is the body’s reaction to a real or perceived threat. When the threat is over, your heart rate and blood pressure return to normal. However, when it comes to caregiving the stress is almost constant and your body never has a chance to recover. That is why it is important to deal with it as it is happening. But how?

“Take care of yourself” is the most common advice you will get from professionals and friends. And it’s good advice. It’s just hard to get a good night’s sleep, eat healthy foods, exercise, and go to the doctor regularly when caregiving seems to take every minute of every day.

As a former caregiver, I’ve been given all kinds of advice. But I’ve learned that there is no one answer that works for every caregiver. What I have found valuable, in terms of advice, is to try focusing on the one area that makes you feel most at risk. For example, if you have a chronic health problem, seeing a doctor regularly and following his or her recommendations is the most important step you can take. If you are generally healthy, but feeling seriously depressed or anxious, consult a doctor or therapist. Depression is treatable, but only if you acknowledge that your mood is affecting your life and probably your caregiving as well.

In addition to focusing on taking care of your most immediate needs, there are many other steps you can take as a caregiver to care for yourself. In fact, I believe the most important step is the very first one you take, whatever it is. After you take the first step the second step will be easier. The following are a few self-care tips to help you in your daily life as a caregiver:

• Take stock of your strengths and acknowledge your limits. Recognizing what you are doing well can help you deal with the aspects of caregiving you find most troubling.
• Analyze the sources of your stress. Is it the deteriorating health of your family member, financial issues, isolation, family conflict, competing family or work responsibilities, or lack of time for yourself? Just dealing with health care and insurance bureaucracies can be a major source of stress. What exactly is the problem?
• Take a problem-solving approach to each source of stress. What can be done to ease that particular strain?
• Enlist others in the solution. Depending on the problem, seek the support of another family member, a trusted friend, social worker, physician, nurse, therapist, home care aide, financial adviser, lawyer, or religious leader. Some solutions will be temporary or incomplete; accept that and move forward.
• Follow a diet and exercise program that is realistic and satisfying.
• Learn some breathing techniques to use when you feel tired or overwhelmed. “Take a deep breath” is always good advice for a reason; it gets oxygen to your brain.
• Try to find an outlet for your own interests, creativity, and individuality. You had a life before caregiving; what were the things you liked to do? Try to find a way to do them again, even in a limited way. What were the things you always wanted to do? Try to find a way to start. There will be a life after caregiving, and these activities will help you then as well as now.
• Develop your spiritual side, whether that is through prayer, meditation, nature, art, literature, music or whatever takes your thoughts to a different plane.

I know how hard it is to put such plans into action. But I also know from experience that every small step makes a difference.

Carol Levine is director of the Families and Health Care Project at the United Hospital Fund in New York City and the Next Step in Care campaign. She directs the Fund’s Next Step in Care campaign, which has created a website – www.nextstepincare.org – with guides for family caregivers to help them through transitions in care settings – hospital to home, for example. One of the newest guides, “The First Step in Care: Becoming a Family Caregiver,” offers practical advice to both new and experienced caregivers about adjusting to the role and responsibilities.