A complaint that is often heard by manual handling instructors, from delegates, is that "I can’t bend my knees, so I can’t use the techniques you are suggesting" – an issue recently highlighted on the manual handling instructor forum.
I suggested on the forum that the response depends upon whether the trainee is just being awkward or whether they have genuine reasons why they cannot bend their hips, knees &/or ankles.
With both groups, it is probably worth stressing that good technique would have bending down into a semi squat position – only as a last resort. We should start at the top of the control hierarchy and try to eliminate, automate, use manual handling aids and then rearrange the tasks – e.g. raise the working height.
If bending down cannot be avoided, I would use various arguments with non-genuine knee sufferers – as we cover on the 2 day City & Guilds Manual Handling Train the Trainer course:
- Show them the surface area of the discs compared to a knee – which is better to spread load over!
- Emphasise that if they are bending the back, they are relying on their back support muscles to do the work. Use the exercises we show on the course to emphasise this point
- If they are bending the knees / hips, then the backside and thigh muscles are being used. Which do they think are biggest / best for this purpose?
- The knee joints are designed for pivoting and have a much greater range of movement than the discs in the spine.
Often their reluctance is not due to physical issues, but just down to inertia – dislike of change. This is logical enough as the chances are that they have tried to avoid bending hips and knees for the past few decades – so it will take perseverance and time to secure any lasting changes.
For people with genuine physical problems which prevent them using good technique – there is even more of a duty on us to do all we can to avoid putting them at risk by working our way back up the control hierarchy.
Sports therapist John Jackson is a regular contributor to the Forum as well as one of the trainers on the City & Guilds course. John advocates the benefits of keeping our knees working through as great a range as possible for as long as possible. As with any other MSD (musculo skeletal disorder) if you ‘don’t use it you lose it’. The current advice for arthritis is to move the joint as often as possible. When we walk normally we only utilise a small portion of the articular surface of the femur (thigh bone) and the tibia (shin). the area we don’t use tends to roughen up if it’s not used, so the less we use the joint the more it stiffens up.
As John mentions, visit any Yoga class and you’ll see some very flexible older people who have worked hard to acheive their flexibility and the dividends are enormous. For anyone with knee pain whose movement is restricted, he would advise a visit to the GP and request an orthopedic consult to see how much of a problem exists. In most cases patients will see considerable improvement with regular articulation of the joint.