Helping another person to move carries significant risk of injury for both the lifter and the individual being moved. Improper technique is a leading cause of musculoskeletal injuries, particularly to the back, among caregivers and family members who provide assistance. The primary goal of any transfer or lift is to ensure the safety and dignity of the person receiving help while protecting the lifter from strain. Understanding the biomechanics of movement and preparing for the task allows caregivers to reduce the likelihood of accidents and physical damage. Preparation and clear communication form the foundation for all safe patient handling practices.
Fundamental Principles of Safe Lifting
Before attempting any transfer, the situation must be assessed to determine the person’s ability to assist and to clear the path of movement. A wide, stable stance should be maintained, with the feet spread shoulder-width apart to create a broad base of support for the lifter’s body weight. The most protective posture involves keeping the back straight and bending at the knees and hips, allowing the strong leg muscles to perform the actual lifting work.
The person being moved must be kept as close as possible to the lifter’s body, near the lifter’s center of gravity, to minimize strain and leverage forces on the spine. Any lifting action should be a smooth, steady upward movement, avoiding sudden jerking motions that can easily lead to muscle tears or loss of balance. The lifter must never twist their torso while bearing a load, as this motion is a common cause of disc injury; instead, the lifter should move their feet to change direction. Communication with the person being lifted is essential, ensuring they understand the plan and can synchronize their movements with a clear “one, two, three” count.
Controlled Transfers (Bed to Chair or Chair to Chair)
Controlled transfers involve moving an individual who can bear at least some weight for a brief period between two surfaces of similar height. Preparation begins by positioning the receiving surface, like a wheelchair, as close to the bed as possible, often at a slight angle, and ensuring all wheels are securely locked. The person should be helped to the edge of the bed so their feet are flat on the floor, and they should be wearing non-slip, supportive footwear.
A gait belt, placed low and snug around the person’s waist, provides the caregiver with a secure point of control and leverage without grasping clothing or limbs. The lifter should stand in front of the person, placing one of their own feet between the person’s feet to block them from sliding forward. With a firm grip on the gait belt, the lifter encourages the person to lean forward, shifting their weight over their feet, and then uses a pivoting motion toward the target chair. The transfer is completed by slowly guiding the person downward, bending at the knees and keeping the back straight, until they are safely seated.
Lifting Someone Who Has Fallen
Lifting someone from the floor requires a careful sequence of steps to prevent further harm. The first step involves assessing the person for pain or injury. If there is any indication of a head injury, fracture, or severe pain, they should not be moved, and professional medical help must be called immediately. If the person appears uninjured, the lifter should gently guide them to roll onto their side, and then assist them into a hands-and-knees kneeling position.
A sturdy, non-rolling piece of furniture should be placed directly in front of the person to serve as an intermediate support surface. The person is encouraged to place their hands firmly on the seat of the chair and use their arms to help push their upper body up. The lifter can then assist the person in moving one leg forward into a half-kneeling position, which provides much greater stability. From this staggered position, the person uses their arms and legs to push up to a standing height, or they can be guided to pivot and sit down on the chair behind them.
When to Use Mechanical Aids
Manual lifting of an adult should be avoided whenever possible, as even with correct body mechanics, it can cause cumulative micro-injuries to the spine. The recommended maximum weight limit for a single caregiver to lift manually is widely cited at 35 pounds. This limitation means that any person who is fully dependent, or whose weight exceeds this amount when divided among caregivers, should be moved using assistive technology.
Full-body lifts, often called Hoyer lifts, use a sling to safely transfer non-weight-bearing individuals between surfaces. Stand-assist lifts are designed for individuals who have some leg strength but require help getting from a seated to a standing position. Simple tools like slide sheets or friction-reducing devices are used to reposition someone in bed or perform lateral transfers, significantly reducing the force needed to push or pull a person.