Blog posts tagged with 'homewood'

How to Sit Properly- Thursday, October 15, 2015

How to Sit Properly


The perfect seated position is one that changes. There is no ideal seated position, because it is the act of sitting that is inherently bad. However, let’s say you are required to sit for an hour without moving, while working at a computer. In this situation, there is a way to sit that will do the least amount of harm. To clarify, this advice applies to the person who is not able to stand up and stretch for a rest break OR use an ergonomic chair. In this instance, the perfect seated position involves having perfect posture (FIGURE 1). Note the head is balanced in neutral position, meaning it’s not too far forward or backward. Neutral position involves a slight chin tuck—almost as if you are on the verge of a double-chin, but not as extreme. The back is erect with the shoulders pulled back, hips are moved backward at 90 degrees (avoiding the “C-shaped” hump in the low back), feet are flat on the floor, shoulders are not shrugged, elbows are at 90 degrees and wrists are not bent. If you are not working at a computer, you need not worry about your elbows and wrists. However, don’t shrug your shoulders. Note there is a lumbar support to induce extension into the low back and prevent slouching.

            A person, who cannot change positions or take a stretch break while sitting, may sit on a “vestibular disc.” A vestibular disc as an inflatable, 1-2 inch thick cushion that health care practitioners typically use to restore balance. These special “cushions” force you to keep a dynamic seated position. I’ve witnessed numerous patients in clinic improve their back pain and discomfort after sitting on vestibular discs. Because I’ve personally seen their benefit, I’m comfortable recommending them for you. I suggest sitting on one (with the smooth surface facing up) for 20-30 minutes out of an hour for the first week or two of use. If you don’t experience discomfort after 20-30 minutes out of the hour, try sitting on the disc for the entire hour. I don’t recommend sitting on an exercise ball, as research does exist stating the disadvantages of using an exercise ball DO NOT exceed the advantages.

STEP FORWARD TO REACH- Thursday, August 13, 2015


                   GOOD FORM                                    BAD FORM

An alternative to flexing/bending your back to reach for an object is to step forward. Keep your spine neutral as you step forward to reach for an object to prevent the use of your spine and protect your back. Notice the difference between the two photos. With good form, the back is neutral (straight), whereas bad form demonstrates a flexed back with that nasty “C-shape” that you want to avoid. Cycles of bending forward and coming up, or extending, cause back injuries. Stepping forward to reach is an alternative to flexion and extension of the spine.  



The muscles, discs, and ligaments of the spine adapt to sustained positions. For example, after 20 minutes of sitting, the soft tissues of your body retain the flexed (bent), seated position. So, if you were to flex your spine, which is the incorrect way to bend after sitting for 20 minutes, you would put your spine at risk for injury. This concept is called “spinal memory.” Similarly to lying down for 2-3 hours, I do not recommend improperly flexing (bending) your spine for 30 minutes after you’ve sat for at least 20 minutes. Give the spine time to “forget” the previously adapted position. If you must bend your back within that 30 minute time period, squat or use a hip rotation. 



The spine consists of discs in between each vertebra, which allow for movement and cushion. These discs are primarily made of fluid, which is lost during the day and reabsorbed while you sleep, in a process known as disc imbibition. In fact, we lose up to 19 mm of height each day from the loss of disc fluid! After lying down for 2-3 hours, the discs reabsorb their lost fluid and are at full size. When they are full size, the potential stresses placed on the discs are increased by 300%. As a result, it is imperative not to flex/bend your spine for one hour after you have rested for at least 2-3 hours. If you must bend during this time, try squatting, stepping forward, or rotating at yoru hips. Avoiding flexion of the spine after 2-3 hours of lying down is a great way to protect your back. Please understand, that I’m not saying you can’t bend during these aforementioned times, I’m saying it is especially important that you bend the CORRECT way.


 AVOID REPEATED FLEXION/EXTENSION                                          

Repeatedly bending forward and subsequently straightening your spine is known as flexion and extension. Cyclic full spine flexion and extension may cause stress fractures in the spine and displaced vertebra, also known as a spondylo. The discs between your vertebrae are vulnerable to this repetition as well and can become injured. A patient of mine worked in a deli at a grocery store. Her job required repeatedly bending down to remove products from the refrigerated display, which caused her spinal discomfort. We discussed ways to alter her work environment so she did not exacerbate her condition and she improved. Had she known what to avoid, she never would have had the issue in the first place. One alternative to repeatedly bending down and coming back up is stepping forward to reach for the item, instead of bending down if possible.



1.     “I’m too young, and in too good of shape, to get back pain.” Each time I speak to people about back pain, I get the same reaction. People aged 45 and older pay attention to what I say. The people aged 44 and younger couldn’t care less. Why? Because most people believe back pain only affects the elderly or out-of-shape population. This belief cannot be further from the truth. Low back pain is the number one reason people aged 45 and younger seek health care services. The spine is the most frequently injured part of the body in most workman’s comp cases. The discs in between each vertebra, that cushion your spine and provide movement, can start to degenerate before you hit puberty.

Now, close your eyes and think of ten people. It doesn’t matter their age, race, gender, whether they’re in shape, or out of shape, rich or poor. Eight of these ten people will experience back pain at some point in their lives. Pay attention, because it doesn’t matter your age or whether you’re in good shape. You are at risk for back pain.

2.      “My back pain will just go away on its own.” Patients entering my clinic frequently come in with the mindset that something very serious is happening to them because they’ve had lingering back pain that won’t go away. Why? Because the majority of people believe their back pain will go away on its own. And, if it doesn’t, it must not be back pain. It must be something more serious. Right? Wrong. Low back pain is typically not self-limiting--it won’t just stop on its own. In fact, almost 50% of people that have back pain will still have pain after one year. And if you’ve already had back pain, you have a 40% chance of getting back pain again within the same year. On a side note, 90% of back pain is usually just a simple backache. Less than two percent of back pain is from a serious spinal problem. Get your back pain fixed. It’s probably not going away.

3.      “I know what caused my back pain.” Patients ask me all the time, “What did I do to cause my back pain?” And I’ll say, “Probably what you’re doing now.” Of course, the patient will look at me confused because he/she is just sitting. So why do I say this? Because the majority of back pain (approximately 86%) is caused by repetitive misuse, or doing things the wrong way for a long time. It’s likely your back pain was caused by you performing the same tasks the wrong way for a long time. Think of the spine as a long row of dominoes. Each time you perform a task the wrong way, you knock down one of those dominoes until they all fall down. When this last domino falls, your back “goes out.” It didn’t “go out” because you bent down to put on your shoes last night. Your back went out because you’ve bent down to put on your shoes the wrong way for five years. Your back “went out” because you’ve sat for eight consecutive hours at your job every day. Your back “went out” because you’ve picked up children improperly at a day care every day. Get the point? It’s imperative that you learn the proper way to perform daily tasks and activities so you don’t play dominoes with your spine.