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It is common knowledge that it is better to bend with the knees when lifting. However, many times moms are bending over a car seat, crib, or are in a situation where it just isn't practical to bend with the knees to lift. In addition, lifting feels like more effort if you have to fully bend down with the legs and lift the body each time as well. Consequently, there is a great deal of bending at the waist and lifting with the low back. This movement puts significant stress on the lumbar muscles, and is a common contributor to low-back pain. The average multitasking mom also winds up engaging in a lot of quirky maneuvers in an attempt to hold her child and get other things done at the same time. The result is awkward positioning involving side bending and rotation in the lumbar region, which is a notoriously challenging position that can lead to lumbartissue overload. In many cases, a seemingly small and insignificant movement can cause serious pain simply because it's the last straw of biomechanical overload for the body. Carrying the infant in a car seat creates another physical demand on the already fatigued mom. The seat is usually carried on one side instead of with both arms, which Deep paraspinal muscles 3 104 Quadratus lumborum Deep paraspinal muscles and the quadratus lumborum take heavy loads from postural strain. 3D anatomy images. Copyright of Primal Pictures Ltd. www.primalpictures.com. massage & bodywork may/june 2013 means the opposite-side lumbar muscles are taking the primary responsibility for offsetting that load. The car seat's shape puts the baby's weight farther away from the mother's center of gravity as well. As with forward-head posture, the farther the load is from the central axis, the greater the load the muscles must offset. A weight that doesn't seem very heavy can seriously overwhelm soft-tissue structures simply by being lifted farther away from the body's center of gravity (Image 2, page 103). Muscles such as the quadratus lumborum, multifidus, and erector spinae group carry a primary burden for lifting power in the lumbar region. These compromised positions put these muscles at a mechanical disadvantage, leading to chronic tightness from overload, and sometimes cause strain. Bringing the baby's weight in close to the body, as is done when wearing a front baby carrier, alters and reduces the load on these muscles. Carrying a car seat also puts excess stress on the tissues in the shoulders and upper extremities. These stresses are magnified when the seat is not lifted close to the body, and can overwhelm muscles that are not that strong, but that still play a major liftingaction role in the upper extremity, specifically the rotator-cuff muscles. For example, lifting objects away from the body's center of gravity can put a much greater load on the supraspinatus muscle, a moderately small rotator-cuff muscle that maintains stability during shoulder movements. There is a poor blood supply to the supraspinatus tendon, and the musculotendinous junction is a common site of strain injury as a result. Overloading the muscletendon structures can lead to chronic problems like tendinosis, but could also be a primary cause of rotator-cuff strain. Treatment approaches should be highly specific. A relatively superficial massage may feel good but not get at the real root of the dysfunction in the deep paraspinal muscles (Image 3). The quadratus lumborum is another deep, low-back muscle that requires highly specific treatment. However, make sure general and more superficial techniques are performed first to make the deep work more effective. The shoulder and upperextremity regions should also be treated with this same protocol of general and superficial work first, followed by deep, specific work on those muscles most exposed to overuse, such as the deltoids, rhomboids, supraspinatus, and upper trapezius. Remember that the new mom's joints in the lumbopelvic region may still be more mobile than normal. Advise the client to move slowly after the massage and encourage her to be particularly cautious in how she moves for the remainder of the day as the body readjusts to a different level of muscle tonus. Off-Balance Lumbopelvic Stress Watch any mother carrying an infant and it is easy to identify one of the chief biomechanical challenges that leads to lumbopelvic pain in mothers. Holding a child in one arm and hiking the hip on that same side causes a lateral tilt of the pelvis to the opposite side. For example, if the child is held on the right hip, that would