1. Proper Body Mechanics and Ergonomics
Posture
Proper body alignment helps avoid tired, achy muscles.
Standing
» Stand with your feet a comfortable distance apart, approximately shoulder width apart.
» Visualize that you have a string attached to the top of your head and someone is holding the string above your head so you can just stand on the ground.
» Slightly raise your shoulder until you feel tension, then let them relax so they are square.
» Your back should be straight, abdominal muscles tight, lower back flattened and knees relaxed.
» Avoid standing for long periods. When you do have to stand, frequently shift position or place on foot on a stool.
Sitting
» Choose a firm but comfortable chair with a straight back.
» Place lower back against back of chair.
» Elbows should always be supported.
» Knees should be slightly above hips. Roll a towel under your knees.
» Feet should be flat on the floor or stool.
» Head should be directly above shoulders.
» Avoid sitting forward or with back arched backward.
» Take frequent breaks to get up and walk around.
» Try not to sit for more than 10-15 minutes at a time.
Balance
» Establish you “center” by the following:
» Stand with your feet shoulder width apart.
» Gently rock forward until you begin to feel “heavier” or slightly off balance.
» Gently rock back until you begin to feel “heavier”.
» Then rock forward until you feel balanced.
Lifting
FMS patients should avoid lifting heavy objects. When you have to do any lifting:
» Plan your move and make sure there are no obstacles in your way.
» Directly face the object you are lifting to avoid twisting. Turn your whole body if you have to change directions.
» Stand in good alignment with your feet shoulder width apart.
» Pelvic Tuck: Contract your abdominal muscle and tuck your pelvis forward to help keep your back balanced when lifting. Bend at your knees so you use your largest and strongest muscle groups, which are located in your thighs and hips. Avoid bending from the waist, as that puts maximum strain on the small muscles of the lower back.
Lift and carry load with your shoulders back and your upper arms close to your trunk and your forearms at waist height. Use both hands and arms when lifting. Keep the object close to your body using your large shoulder and upper arm muscles. Avoid holding objects away from your body as that puts strain on the smaller muscles o your lower arms. Stress increases 7 to 10 times when your load is at arm’s length.
» Use the same techniques for setting the object down.
Footwear
» Help avoid tired achy feet by wearing proper footwear.
» Shoes should not change the shape of your feet and they should allow freedom to move your toes. They should have arch supports. Shoes should have low heels, which are a maximum of 5 cm in height, and provide a firm grip for the heel.
» Choose shoes made of natural materials that can breathe, e.g., leather and canvas.
» It is helpful to use shock-absorbing cushioned insoles.
When using a computer
[Adapted from information on ergonomics by the Canadian Centre for Occupational Health and Safety]
» Desk arrangement: Place working objects in easy range. Work objects should be able to be seen from a 10 – 30” angle below your line of sight.
» Chair arrangement: Use a swivel chair to avoid twisting your body. Adjust the seat to 25 – 35 cm below the work surface. The back of the chair should give good support and be contoured vertically and horizontally.
» Sitting: Sit up straight. Keep your hips, knees and ankle joints open slightly (90 – 120 degree angle).The upper body should be 0 – 30 degrees forward of an upright position. Keep your shoulders relaxed and upper arms vertical and close to your body. Keep your wrists in line with arms. Your elbows and forearms should be supported with your shoulders slightly elevated to reduce strain on your neck. Most FMS patients find it most comfortable to have the keybord slightly lower than the waist. Tuck the chin in to slightly lower line of sight. Avoid bending neck down. Change position frequently and get up and move around every 15 minutes.
» Eye discomfort: Place the monitor parallel to overhead lighting (not directly below). Adjust the brightness and contrast of the monitor so it is most comfortable. Have a good general lighting and diffuse overhead lighting. Make sure that any lamp focused on written documents is directed away from the monitor to avoid glare. Every few minutes take a few seconds to look away from the screen and focus on distant objects.
» Palming: Close your eyes and cup your hands over your eyes putting gentle pressure on the top of the cheek bones from te base of both palms. Hold for one minute. Blink several times. This helps reduce eye strain.
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Relaxation training techniques are many and varied in the nature of their content and impact upon physiology. They affect the body physiology in a general way, triggering a relaxation response by quieting the sympathetic nervous system, thus encouraging your breathing rate, heart rate, and blood pressure to decrease. They can affect the body in specific ways such as by increasing blood flow to different regions of the body. Relaxation techniques also assist in dealing with stress management and improving your overall sense of well-being. The following few examples represent guidelines only.
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Principles
» Healing environment: Set aside a time when you will not be disturbed. The room should be quiet, free from distractions, and be at a comfortable temperature. Sit in a comfortable position in a comfortable chair and relax. Breathe slowly.
» Focus: All relaxation techniques require you to focus on something such as a word, a picture in your mind, your breathing, or an action.
» Passive attitude: Ignore distractions. When other thoughts enter your mind, simply let them go. You can visualize the thought drifting off in a balloon, or on a bird flying across the sky.
» Practice is the key to success: The more you practice the more skilled and efficient you become and the greater benefits you will receive. Enjoy a deep sense of relaxation; minimize muscle tension, and reduce stress.
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Breathing Exercises
» Diaphragmatic breathing: This allows your lungs to expand and fill more fully. Close your eyes and put one hand on your chest and the other on your upper abdomen at the level of your belly button or stomach. Each time you inhale try to make your hand on your chest remain still and the hand on your abdomen rise. Try to feel your lower lungs filling up with air completely. When you exhale, your hand over your stomach should fall. Feel the air leave your lungs.
» Diaphragmatic breath-counting: While you are doing the same exercise as above, count “one” as you slowly inhale, “two” as you exhale, “three” as you inhale, “four” as you exhale, and so on. Cut off any thoughts that enter your mind.
» Complete breath: After completing diaphragmatic inhalation as in exercise above, fill the rest of the lungs with air to the top above the first rib, at the front, side and back. Then empty lungs completely from top to bottom. Do not hold the breath. Do two or three cycles.
» Pulse breathing: While you are taking your pulse, inhale and exhale to the same number of pulse beats. Begin with the number of pulse beats that you can do comfortable. Gradually increase the number of pulse beats per breath. Then gradually increase the length of exhalation compared to inhalation up to a maximum of 2:1 ratio.
» Spinal extension breathing: Sit with your legs crossed. Grasp your knees with your hands and keep your elbows straight. As you inhale, begin to extend your back (arching it backwards slightly). Keep your shoulder down and back. As you exhale, slowly return to starting position. Repeat five to ten times.
» Arms out-stretched: Stand with your feet shoulder width apart. Extend your arms to your sides at approximately shoulder height. Turn your left palm to face upward (to tighten the body and help stretch the muscles) and your right palm faces downward. Breathe deeply in and out through your nose ten times. Repeat with your right palm facing upward. Option: If your have difficulty standing or holding your arms up, do the exercise sitting on a couch and resting your arms on the back of the couch.
» Spinal stretch: Sit in an upright chair with your thighs parallel to the floor, your lower legs perpendicular to the floor, and your feet about shoulder width apart. Bend forward placing your elbows on the inside of your knees. Place your hands between your feet with the backs of your hands facing each other. Then place your fingers under your inner arches so that your palms are facing towards the outside of each foot and rest your thumb over the top of the foot. Let your spine fully stretch while in this position. Breathe slowly and fully for a maximum of five minutes. Do this in the morning. This will help stretch and loosen the spine, making it easier to stand up straight and walk.
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Visualization Techniques
If your mind races and you have difficulty falling asleep because you cannot control your thoughts, cognitive and visualization techniques can be helpful. A few examples:
» Photographs: Choose a photograph or a picture from a magazine that is serene and peaceful. Visualize yourself in the picture. If there are flowers, “smell” them or if there is a brook, “listen: to it. As you become more relaxed, feel your stresses float away to be replaced by feelings of peacefulness and happiness.
» Visualize a peaceful scene: This is basically the same as using a photograph but you use your imagination to visualize a peaceful scene such as mountains, streams, oceans, waterfalls, gardens and landscapes, sunrises, sunsets, snow scenes, a spring day, traveling into space, etc. Follow the same instructions as in the point above.
» Memory visualization: Choose a happy memory such as playing on the beach, a birday party, getting a pet, or doing something well, etc., and picture it in your mind’s eye. Let go of your stress and relive your joy.
» Guided imagery: There are numerous audio tapes of guided imagery.
» Rewriting a memory: Choose a troublesome memory and in your imagination “rewrite” the memory the way that you would have liked it to go.
» Cognitive thought processing: Whenever you feel yourself get upset visualize a red stop sign. This alerts you to stop! Take 10 deep diaphragmatic braths and relax. (You can’t concentrate on your diaphragmatic breathing and the stressor at the same time.)
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Autogenic Training
» Autogenic training, developed by Dr. J.H. Schultz, uses relaxation, autosuggestion and visualization techniques to normalize body processes. It is commonly used in Europe in conjunction with pharmaceutical treatments and surgical procedures.
» Technique: Relax while sitting or lying down with eyes closed. Adopt an attitude of passive concentration by imagining you are in mental contact with a certain part of your body. Visually or verbally keep repeating a given formula for one minute with a casual attitude toward the results of the exercise. Examples are:
» Body relaxation: Concentrate on your feet feeling heavy and think, “My feet are heavy, they are relaxed, I am at peace.” Repeat the same process for your other body parts, e.g., legs, hands, arms, pelvis, chest, neck, and head.
» Body warmth: Use the same method but think of the body parts being warm. This increases blood flow and relaxed blood vessels.
» Heartbeat: Become aware of your heartbeat, then come in “mental contact: with your heart and instruct it to be “calm and regular”. This strengthens the self-regulatory process of your heart.
» Breathing: This is the same as above, but you become aware of your breathing.
» Solar plexus: As above but think, “My solar plexus is warm, heat rays are warming the depth of my abdomen.”
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Progressive relaxation exercise:
Lie down or sit comfortable in a chair. Use diaphragmatic breathing. Begin at the top of your head. As you inhale, concentrate on and feel the tension in your forehead, as you exhale feel the tension drain away. E.g., while you breathe in mentally say, “forehead” and as you breathe out mentally say “relax” or some other key word. Mentally saying the instructions helps keep you focused. Inhale and feel the tension in your temples, and then as you exhale feel the tension drain away from your temples and instruct your temples to relax. Continue with this procedure progressively working down – cheeks and jaw, lips and tongue, neck and throat, shoulders, arms, hands, chest and upper back, stomach, pelvis, thighs, claves, and feet – until your whole body is relaxed. Repeat the exercise three times. A variation is to repeat the forehead relaxation three times, then the temples three times and so on. Repeat the exercise several times a day.
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