MISS.APARNA C LAKSHMY
SNEHODAYA COLLEGE OF NURSING
BODY MECHANICS is the utilization of correct
muscles to complete a task safely and
efficiently, without undue strain on any muscle or
It is the efficient use of body as a machine
and as a means for locomotion
Purposes of body mechanics:
To avoid stress and strain on the musculoskeletal system
It promotes proper physiological function of the body
It minimizes the expenditure of the energy
It helps in maintaining balance of the body without
To prevent kyphosis,lordosis,scoliosis and other
Principles of body mechanics
Maintain good posture in all activity by avoiding
twisting the body,turn your whole body,face the
area in which you are working.
It is easier to slide,pull,or roll an object than to lift
it.it helps to reduce the energy needed to raise
the weight .
Movements should be smooth and co-ordinated
rather than jerky to prevent injury.
Use strongest and longest muscles to perform tasks
which require physical effort.
Keep the object as close as possible to your body
when lifting,moving or carrying them.
Keep the work at a comfortable height to avoid
excessive bending at the waist.
Keep your body in good physical condition to
reduce the chance of injury.
Place the feet apart to provide a wide base of support
and better balance.
Get help if the object feels too heavy to lift.
Flex the joints(knees and hips) to come close to the
object instead of bending back.
Keep work close to the body
Use the weight of the body to pull or push an object
by keeping the body above the object.
General instructions in moving and
Plan the movement of the patient ahead of time
and be sure the path is clear.
Face the direction in which the movement will be
made, to avoid twisting of the vertebral column.
Place the feet comfortably apart to provide a
wide base of support.
Flex the knees and hip joints but keep the trunk
as vertical as possible.
Keep the patient as close to the body as
Avoiding jerking and twisting during the lift.
Heavy patients should be moved in bed by
sliding them rather than lifting them.
Assistance should be requested when lifting or
moving heavy patients.
The height of the bed should be adjusted to a
height that permits the nurse to keep her back
as erect as possible when moving the patient in
The patient is moved to the edge of the bed
before he is lifted from the bed.this helps the
nurse to keep her trunk more erect.
When moving a patient by more than one
person,each worker assumes the responsibility for
supporting one of the patient’s body sections.the
areas to be supported are,
1.head,shoulders and chest
3.thighs and ankles
In order to co-ordinate the movements of the
workers and to maintain the patient’s body in
correct alignment throughout,the leader gives the
signal by counting 1,2,3.etc.during each count a
particular procedure is carried out by the
Unless contraindicated,encourage the patient to
use his abilities as much as possible.
Observe the patient for symptoms of orthostatic
hypotension such as fainting,dizziness,sweating etc
Do not support the patient under his armpits,since
injury to major nerves and blood vessels may occur.
Always lock the wheels of bed and stretcher prior to
transferring a patient to increase marimum static
friction between the wheels and the floor.
Positions used for comfort
Supine position or horizontal recumbent or dorsal
or back lying.
Dorsal elevated or semirecumbent position
Lateral or side-lying position
Position used for physical examinations
Dorsal or horizontal recumbent
Dorsal recumbent position
Sim’s lateral or left lateral prone position.
Knee chest or genupectoral position
Dorsal or horizontal recumbent
used mostly for the head to foot examination.
Dorsal recumbent position
used for the vulval,vaginal and rectal
examinations and for the operative procedures
on the vulval area and for such procedures as
catheterisation of the bladder.
This is the normal standing position with both
feet on the floor.
Used for orthopaedic and neurological disorders.
Sim’s lateral or left lateral prone position
The patient lies on his left side.
One pillow placed under the head with the left
cheek resting on it.the left arm is drawn behind the
back and right arm may be in any position
comfortable for the patient.the right thigh is flexed
against the abdomen.
Used mainly for the vaginal and rectal examinations
The patient lies on his back with one pillow under the
The legs are well separated and the thighs are well
flexed on the abdomen and the legs on the thighs.
The patient’s buttocks are brought to the extreme edge
of the table and legs are supported on the stirrups.
Used for the gynaecological examinations and
treatments and during the surgical procedures involving
the genitourinary system.
Knee chest or genupectoral position
Mainly used for the examination of the rectum
Also as an exercise for the post partum
The patient lies on his back .the foot of the bed is
elevated at a 45 degree angle.
The body is on an inclined place and legs hang
downward over the end of the table.
This position is used during the examinations or
operations on the pelvic cavity into the upper
Also used to treat shock and decreased blood pressure.
Moving up in a bed
Turning a patient to lateral and prone position
Logrolling-(technique used to turn a patient whose
body must at all times be kept in straight alignment.)
Assisting patient to sitting position.
Transfering a patient from bed to chair.
Transfering a patient between a bed and
Factors affecting body alignment and
Growth and development.
In adolescence ,growth spurts may result in
awkwardness that can be manifested in posture.As
age advances,muscle tone and bone density
decrease,joints loose flexibility,reaction time slows
and bone mass decreases..
Eg:hip dysplasia,spina bifida,cerebral palsy .
Eg: muscular dystrophy,Parkinson’s disease,multiple
sclerosis are progressive that impairs the ability of
nervous system to control muscular movements
Chronic health problems:
These conditions often decrease mobility because such
disorders limit the oxygen and nutrients delivered to the
muscle contraction and movements.
Injury to joints,tendons,ligaments,muscles or bones affects
body alignment and mobility.
Affective disorders. Eg:depression and catatonic states result in limited
mobility,not because of physical impairment but due to lack of desire
Therapeutic modalities :
Eg :restrictive devices such as cast, splint may be used to immobilize
certain areas of body to promote healing.
Both under and over nutrition can influence body alignment and
mobility.poorly nourished people may have weakness and
fatigue.vitamin D deficiency causes bone deformity during
growth.inadequate calcium intake increases the risk of osteoporosis
Personal values and attitudes:
Choice of physical activity or type of exercises may
influence by values.
Range of motion exercises:
Range of motion exercises refers to activity aimed at improving
movement of a specific joint.
Active range of motion exercise(performed by the patient
Passive range of motion exercise(not performed by the patient
and the health care worker moves each joint through its range
Active assistive range of motion(the patient does the exercises
with some assistance from another person or equipment.
General rules for ROM
Use good body mechanics
Expose only the body part being exercised,
Explain to the patient what you are going to do and teach the
patient how to do .
Support the extremity being exercised.
Move each joint slowly,smoothly and gently
Return the joint to a neutral position after the movement.
Repeat each exercise 3-5times
Ideally these exercises should be done once per day.
Expect the patient’s heart rate and respiratory rate to increase
Joints are exercised sequentially,starting with the neck and
Don’t continue the exercise to the point that the patient develops
Some exercises may need to be delayed until the patient condition
Trunk –gliding joint:
Flexion:bend the trunk towards the toes
Extension: straighten the trunk from the flexed position
Hyperextension:bend the trunk backward
Lateral flexion:bend the trunk to the right and left
Rotation:turn the upper part of the body from side to
Hazards associated with immobility
Types of immobility
Social:withdrawal from normal patterns of social interaction.
Emotional :it can occur when stressors exceed the coping ability of an
Intellectual : It can occur in persons who lack the ability to acquire needed
Physical :can be caused by physical problems or by necessary therapeutic
Venous stasis:caused by prolonged inactivity that restricts or slows
Increased cardiac workload:due to increased viscosity from
dehydration and decreased venous return.
Thrombus and embolus :formation caused by slow flowing
blood,which may begin clotting within hours.
Hypostatic pneumonia :the depth and rate of respiration
and the movement of secretions in the respiratory tract is
decreased when a person is immobile.the pooling
secretions and congestions predispose to respiratory tract
Atelectasis :when areas of lung tissues are not used over a
period of time,collapse of lung tissue may occur
Muscle atrophy :disuse leads to decreased muscle
Contracture:decreased joint movement leads to
permanent shortening of muscle tissue,resistant to
Ankylosis:consolidation and immobility of a joint in a
particular position due to contracture.
Altered sensation caused by prolonged pressure.usually
pain is felt at first and the sensation is altered,and the
patient no longer senses the pain.
Peripheral nerve palsy.
Disturbance in appetite caused by the slowing of
Altered protein metabolism
Risk of skin breakdown which leads to necrosis and
ulceration of tissues,especially on bony areas
renal calculi caused by stagnation of urine in the renal
Urinary tract infections caused by urinary stasis that
favours the growth of bacteria
Decreased bladder muscle tone resulting in urinary
Decreased metabolic rate.
Altered exchange of nutrients and gases.
Increased risk of electrolyte imbalance.
Decrease in self concept and increase in sense of
Body image distortions
Increased risk of depression
Decreased social interaction.
Maintenance of normal body
alignment and mobility:
Body alignment refers to the arrangements of joints,tendons,ligaments
and muscles while in a standing,sitting or lying positions.
in a correctly aligned body,a line passes through specific points while in
a standing position.these points can be seen from the side and back
Side view,reference points are:top of ear,middle of shoulder,center of
hip,front of kneecap,front of ankle bone.
Back view,reference points are: center of head,midpoint of spine,middle of
buttocks, and the center point between heels.
Shoulder slightly abducted
Pull your abdomen in and up
Thighs extended and slightly abducted
Keep your back flat
Chest should be most forward apart
Elbows should be lightly flexed
Knees slightly flexed
Feet parallel about 3 inches apart
Chin tucked in
Abdomen flat and relaxed
Chest should most forward part
Elbows flexed can be supported.
Thighs flexed at right angles to the trunk.
Feet flexed at right angles to legs and supported on floor or foot rest
Get up,stretch and relax hourly when you have to sit for a long time.
place one foot in front of the other
Bend the knees as well as the hip
Squat while keeping the back straight to pick up an object from
WHILE WORKING IN STANDING POSITIONS:
Always face towards the work
Keep your feet apart 3 inches
Keep your back straight.
During lifting weights
Stand with both feet placed firmly on the floor and wide apart.
Stand close to the weight.
Use the stronger leg muscles for lifting
Bend knees and hip slightly,keep back straight
Lift straight upward,in one smooth motion
Hold the weight close to the body while lifting
Avoid twisting the trunk.
Stand high enough to avoid lifting above waist.
Better to push rather than lifting.
Place both feet on the floor.
Hold the object close to the body near the center of gravity.
Hold head erect and spine straight.
stand close to the object
Place yourself in proper body alignment
Tense muscle and prepare for movement
Hold the object close to the body near the centre of gravity
Lean towards the object
Push away from utilizing body weight to add force.
Lean away from the object to pull it towards you
To get an object above head level,
Stand directly in front of and close to the object
Avoid twisting or stretching
Use a stool or ladder for high objects
Maintain a good balance and a firm base of support.
Keep one foot forward
Keep the back straight
Reach with both hands
Before moving the object,be sure that it is not too large or too heavy
Exercises is a type of physical activity defined
as a planned ,structured and repetitive bodily
movement performed to improve health and
maintain fitness to achieve an optimal state of
Classified according to
Types of muscle contraction
the source of energy.
Isotonic exercise(Dynamic );
In this,muscle shortens to provide muscle contraction and
They are active ROM exercises
It increases muscle tone,mass,strength,and maintain joint
flexibility, and circulation
During isotonic exercise,both heart rate , cardiac output
There is muscle contraction without moving the joint.
Eg ;squeezing a towel or pillow bt knees
Cause mild increase in heart rate and cardiac output.but
no appreciable increase in blood flow to other parts
of the body.
Isokinetic (resistive exercise)
Involves muscle contraction or tension against resistance.
Special machines or devices provide resistance to the
These exercises are used in physical conditioning and are
often done to build up certain muscle groups.
Increase in bp and blood flow to muscle occurs with
It is the activity during which the amount of oxygen
taken into the body is greater than that used to
This exercises use large muscle group that move
It involves activity in which the muscles cannot
drawnout enough oxygen from the
bloodstream,and anaerobic pathways are used to
provide additional energy for a short time
Assessment relative to a client’s activity and exercise
should be routinely addressed and includes a nursing
history and a physical examination of body
alignment,gait,appearance and movement of
joints,capabilities,and limitations for movement,mass, and
strength,activity tolerance, problems related immobility, and
An activity and exercise history
Any change or difficulties with mobility.
Specific nature of the problem, its frequency, its cause, how the problem
affects daily life, client's coping mechanisms, etc.
Body alignment,gait,appearance,movement of
joint,capabilities and limitations for movement,muscle
mass and strength,activity tolerance,problems related to
Physical assessment of mobility status:
component Normal findings Significant alterations
General movements Voluntarily controlled,co-
Gait and posture Head erect,vertebrae
straight,knees and feet point
forward,arms at side with
elbows flexed.arms swing
freely in alteration with leg
gait,use of assistive devices.
Muscle mass,tone, and strength. Adequate muscle
accomplish movement and
Alignment: Independent maintence of correct
alignment.in the standing and sitting
position, a straight line can be drawn
from the ear through the shoulder and
Abnormal spinal curvature,inabitity to
maintain correct alignment
Joint structure and
Absence of joint deformities, full range of
Limitations in the normal range of
motion, increased joint motility,
swelling or tenderness in or around
cle atrophy, skin changes,
endurance Ability to turn in bed, maintain
correct alignment when sitting
and standing, ambulate and
perform self care activities.
Physiologic or psychological
inability to tolerate an increase
Significantly increased pulse,
Assessing problems of immobility
Measure arm and leg circumference, palpate
and observe body joints, take goniometric
measurements of joint ROM.
Decreased circumference due to decreased muscle
Stiffness or pain in joints
Decreased joint ROM,joint contracture
Observe chest movements, auscultate chest.
Asymmetric chest movements,dyspnea,diminished
breath sounds,crackles,wheezes,increased respiratory
Auscultate the heart, measure bp
,palpate peripheral pulses,
measure calf muscle circumference,
Observe calf muscles for redness,
Increased heart rate,orthostatic
edema,increased peripheral vein
Measure height and weight
Measure fluid intake and output.
Palpate urinary bladder
Observe stool,auscultate bowel sounds
Weight loss due to muscle atrophy and loss
subcutaneous fat.generalized edema due to
blood protein levels.
Dehydration,cloudy,dark urine,distended urinary
bladder due to urinary retention
Hard,dry,small stool.decreased bowel sounds
due to decreased intestinal motility
Break in skin integrity
developmental skills in children
decline in cognitive function, or
such as sleep and appetite
Impaired physical mobility
Decrease in muscle control
Decrease in muscle mass
Decrease in muscle strength
Activity intolerance related to
Bed rest,generalized weakness,immobility,sedentary lifestyle
Risk for activity intolerance related to
Circulatory problem,respiratory condition,history of previous
Impaired walking related to
Insufficient muscle strength,musculoskeletal impairment,neuromuscular
impaired standing related to
Injury to lower extremity,pain,neurological disorder
Impaired wheelchair mobility related to
Decrease in endurance,insufficient muscle strength.
Ineffective airway clearance,risk for infection,risk for injury,risk for
disturbed sleep pattern,
the goals established for clients will vary according to the
diagnosis and defining characteristics related to each individual.
Eg:the client will have,
Increased tolerance for physical activity
Improved capability to ambulate
Absence of injury from falling
Enhanced physical fitness
Improved social,emotional and intellectual well being.
Nursing strategies to maintain or promote body alignment and
Positioning clients appropriately,moving and turning clients in
Providing ROM exercises,
Ambulating clients with or without mechanical aids,
Strategies to prevent the complications of immobility
When ever positioning,moving and ambulating clients,nurses must use
proper body mechanics to avoid musculoskeletal strain and injury.
Home care management
Maintaining musculoskeletal function.
Teach the systematic performance of ROM Exercises.
Demonstrate the proper ways of exercises.
Offer an ambulation schedule.
Instruct the availability of assistive ambulatory devices, and
correct use of them.
Discuss pain control measures required before exercises.
Provide assistive devices for moving and transferring
Discuss safety measures to avoid falls.
Teach the use of proper body mechanics.
Teach ways to prevent postural hypotension
Managing energy to prevent fatigue:
Discuss ways to minimize fatigue such as performing
activities more slowly and shorter periods,using
assistance as required.
Teach ways to increase energy.
Provide information about available resources to help
with ADLs and home maintenance management.
Provide appropriate information about community
resources. Home care agencies, physical and
occupational therapy agencies etc.
Ambulation is the act of walking.
Prolonged bed rest can make the client feel weak and unsteady.
Nurse should encourage clients to perform ADLs,maintain good body
alignment,and carry out active ROM exercises to the maximum degree
possible yet within the limitations imposed by their illness and recovery
Clients who have been in bed for long periods often
need plan of muscle tone exercises to strengthen the
muscle used for walking before attempting to walk
Clients who have been immobilized for a few days
may require assistance.
Care of patients having restraints:
Restraint is defined as the intentional restriction of a person’s
voluntary movement or behaviours.
It should be selected to reduce client’s movement only as much as
Nurses should carefully explain type of restraint and reason for its
It should not interfere with treatment.
Bony prominences should be padded before applying it
It should be changed when they become soiled or damp.
It should be secured away from a client’s reach
It should be attached to bed frame not to side rails.
It should be removed a minimum of every 2 hours
Frequent circulation checks should be performed when
extremity are used.
Follow proper technique
Pad bony prominence
Maintain body alignment.
Rehabilitation of people with disabilities is a process aimed at
enabling them to reach and maintain their
physical,sensory,intellectual,psychological, and social functional
Using mechanical aids for walking
Canes are light weight, easily movable devices that are made of
wood or metal.
Types of canes
Single ended canes with half circle handle.
Single ended canes with straight handles
Canes with 3 or 4 prongs(qwad canes)
Instruct patient to stand with weight,evenly distributed between the
feet and the cane.
The cane is held on the patient’s stronger side.instruct patient to
position cane 6 inches(15 cm) anterior of the foot.
Move the affected leg forward to the cane while the weight is borne
by the cane and stronger leg.
Next move the unaffected leg forward ahead of the cane and weak
leg while the weight is borne by the cane and weak leg.
Repeat the steps.
A walker is a light weight metal frame with four legs.
patient’s requirements to use walker:
1.Partial strength in both hands and wrist
2..strong elbow extensors such as triceps brachi
3.Strong shoulder depressors such as the pectoralis minor
4.Ability to bear at least partial weight on both legs
Explain the method of using walker
Instruct patient to wear non-skid shoe or slipper
Instruct patient not to use walker on stairs
Have patient stand in center of walker and grasp handgrips on
Lift walker and move it 6-8 inches forward,making sure all 4 feet of
the walker stays on the floor.take a step forward with one
foot.then follow through with other leg.
If one leg is weaker than the other:
Move the walker and weak leg ahead together about 15 cm
while your weight is borne by the affected leg and both
The patient should be taught to examine the frame daily when
inspecting a walker.
Use caution when attempting to ambulate a patient who has
already been given an antihypertensive or analgesic medication
because the medication may cause dizziness or instability.
Caution should be used if the patient uses a walker on inclines
Care must be taken if the patient has IV line,urinary catheter etc.
Assisting with crutch walking:
Assisting patient to walk using crutches while providing
support and balance and as a convenient method of
getting from one place to another.
Types of crutches:
Lofstrand crutch(it has a handgrip and metal band that fits
around the patient’s forearm.
Platform crutch :it is used by the patients who are unable
to bear weight on their wrists.
Review patient’s chart:
Medical history,previous activity level,current activity level.
Assess patient’s physical readiness
Vital signs,orientation to time ,place and person
Assess patient for any visual,perceptual,or sensory
Place bed in low position and slowly assist patient to upright position.let
patient sit or stand for a few minutes until balance is gained.
Make sure it is of appropriate height.
There are 2 methods for measuring crutch length;
1.Client lies in a supine position and nurse measures from the anterior fold
of axilla to the heel of foot and adds 2.5 cm.
2.Position crutches with crutch tips at a point of 15 cm to side and 15
cm in front of patient’s feet and crutchpad 4-5 cm below axilla.crutch pads
should be 3-4 fingers width under axilla with crutch tips positioned 15 cm
lateral to patient’s heel
Assist patient in crutch walking by choosing appropriate gait.
1.four point gait:
This is the most stable of crutch gaits because it provides at least 3 points of
support at all times
Begin in tripod position: crutches are placed 6 inches in front and 6 inches to
side of each foot.
Move right crutch forward 10-15 cm.(4-6 in)
Move the left front foot forward,preferably to the level of left crutch.
Move the left crutch forward.
Move the right foot forward
Three point gait
The client must be able to bear the entire body weight on
affected leg.the nurse asks the client to,
1.move both crutches and the weaker leg forward.
2.Move the stronger leg forward.
Two point gait
It requires at least partial weight bearing on each
foot.it requires more balance.
Begin in tripod position
Move left crutch and right foot forward.
Move right crutch and left foot forward
Swing to gait
Used by patients whose lower extremities are paralysed or
wear weight supporting braces on their legs.
1.move both crutches forward.
Lift and swing leg to crutches, letting crutches support body
Repeat previous steps.
Swing -through gait;
Requires that patient have the ability to sustain partial
weight bearing on both feet.
Move both crutches forward
Lift and swing legs through and beyond crutches.
Assist patient in climbing stairs;
1.begin a tripod position
2.patient transfers body weight to crutches
3.patient advances unaffected leg to stair
4.then advance affected leg and crutches
Repeat sequence until patient reaches top of stairs.
Assist patient in descending stairs with crutches;
Begin in tripod position
Patient transfers body weight to unaffected leg
Move crutches to stairs and instruct patient to begin to transfer
weight to crutches and move affected leg forward.
Patient moves unaffected leg to stair and align with crutches.
Repeat sequence until stairs are descended.
Record in nurse’s progress notes-type of gait patient used,amount of
assistance required,distance walked,patient’s tolerance of activity.
Inspect rubber tips on bottom of ambulation device frequently
If wooden crutch is used,examine it for cracks
Remove obstacles from pathways
Avoid large crowds
Instruct patient to continue muscle strengthening exercise at
Teach patient with axillary crutches about the dangers of pressure
on the axillae.
Instruct patient to routinely inspect crutch tips.
Explain that crutch tips should remain dry
Equipment and assistive devices
Gait belt is a device used for transferring patients and
assisting with ambulation
The belt which often has handles is placed around the
patient’s waist and secured with velcrofasteners.
Lateral assist devices:
Lateral assist devices reduce patient’s surface friction during side to side
transfer.eg:roller boards,transfer boards,slideboards
Friction reducing sheet
Used under patients to prevent skin shearing when
moving patients in bed and when assisting with lateral
It reduce friction and force required to move patients.
mechanical lateral assist devices
It includes specialized stretches and eliminate the need to
the patient manually.
Chairs that can convert into stretchers are available.
These are useful with patients who have no weight bearing
capacity,cannot follow directions or cannot cooperate.
Powered stand assist and repositioning lifts
These devices can be used with patients who can bear weight
at least one leg, can follow directions and are co operative.
A simple sling is placed around the patient's back and under the
The patient rest his feet on the device’s foot rest and places his
hand on the handle
The device mechanically assist the patient to stand without any
assistance from the nurse
Powered full body lifts:
These devices are used with patients who cannot bear any weight
to move them out of bed, into and out of the chair and to a
commode or stretcher
A full body sling is placed under the patient’s body including the
head and torso, then the sling is attached to the lift. The device
slowly lift the patient.
Common devices to promote correct
A trapeze bar is a handgrip suspended from a frame near the
head of the bed.
The patient can grasp the bar with one or both hands and then
raise the trunk from the bed.
Sandbag-used to immobilize an extremity and support body
Trochanter rolls-used to support the hips and legs so that the
donot rotate outwards.
Handwrist splints or hand rolls-to keep the thumb in correct position
Suspension or heel guard boot:
These are made of a variety of substances.they
have a firm exterior and padding of foam to protect
the skin.they prevent foot drop and relieve pressure on
Abduction pillows:A triangular shaped foam pillow that
maintains hip abduction to prevent hip dislocation
following total hip replacement.
Antiembolism stocking are often used for patient’s at risk for
deep vein thrombosis, pulmonary embolism, and to help prevent
It increases the velocity of blood flow in the superficial and
veins and improve venous valve function in the legs, promoting
venous return to the heart
Pneumatic compression devices
They are composed of an air pump, connecting tubes, extremity sleeves.
They require a physician’s order and often prescribed for high risk surgical
patients, patients with decreased mobility, patient with chronic venous disease,
and patient at risk for deep vein disorder.
Pneumatic compression devices apply intermittent or sequential pressure to
the legs to enhance blood flow and venous return, stimulating the normal
muscle pumping action in the legs.