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DO NOT SIT WITH SHRUGGED SHOULDERS

Make sure your work station does not force you to sit with shrugged shoulders (SEE ABOVE). If you use a keyboard, it should not be elevated so that your shoulders are in a perpetually shrugged position. Likewise, do not use an elevated desk or rest your elbows on the desk or arms of the chair, as this forces shrugged shoulders. The desk height cannot typically be altered, which is why it is important to use an ergonomic chair that can be raised and lowered accordingly.      

          POSITION YOUR COMPUTER MONITOR CORRECTLY

  Hopefully, you don’t sit at a computer for longer than 50 minutes. However, if you do, make sure the computer monitor is positioned appropriately to prevent any back problems. Be certain the monitor is positioned so that there is no glare on the screen. Second, place the monitor so that your head is not too far forward or backward, and you don’t have to squint while looking at the screen. Please see the above picture for proper seated posture, while working at a computer.

ROCK BACKWARD AND FORWARD WHILE STANDING  

              FIGURE 1- FORWARD                 FIGURE 1A - BACKWARD

Evidence shows that you can develop chronic low back pain from excessive standing. This chronic low back pain seems to result from a lack of movement, specifically forward and backward, while standing. As a result, I suggest rocking backward and forward on the balls and heels of your feet. Please refer to FIGURES 1 and 1A. Rocking backward and forward is not something you do constantly. I recommend every five minutes you rock backward and forward for about 60 seconds. Again, there is no rule set in stone as to the frequency with which you should rock forward and backward, as it is based on your feeling. 

DON'T STAND TOO LONG

As mentioned, I don’t believe excessive standing is as much of a problem as excessive sitting. However, standing can lead to chronic low back pain. To combat the potential effects of standing too long, I recommend taking a break from standing after every 20-30 minutes. Excessive standing is typically considered 50 minutes or longer, but I recommend 20-30 minutes because of spinal memory (see February 7th blog post). If your job or lifestyle requires prolonged standing, bring a stool to your workstation. I suggest sitting for a minute or two every 20-30 minutes. Combining a rest break after 50 minutes, and sitting every 20-30 minutes is a great way to avoid the effects of excessive standing. 

Another suggestion is to switch your weight-bearing foot. Every 10-15 minutes, switch your weight to your right foot. Stand with your weight on the right foot for one minute. Then, switch the weight to your left foot for one minute. Next, stand normally with the weight equally distributed on both feet. In another 10-15 minutes, switch weight-bearing feet again and repeat the process. A different way to accomplish this same concept is with a small step stool. Place the non weight-bearing foot on the small step stool and alternate feet as previously described.  There is no set rule to how frequently you should switch weight-bearing feet. Do what makes you feel best.     

STAND UP CORRECTLY FROM SITTING

                         Figure 1                                         Figure 2

Standing up correctly from the seated position is one of the most important things I tell patients they can do to spare their backs. It is also one of the easiest. Most people use their low backs to assist them in getting up from the seated position. This is wrong! Think about how many times you get up from sitting. Every time you use your low back to stand, you are flexing your spine and placing unnecessary stress onto it. Here is the easy solution:  before you get up from sitting, scoot all the way to the edge of your seated surface, keep your back straight, and get up using your legs, as in FIGURE 2. This may feel strange at first, but should become second nature after a few days. One tip to get started:  use your arms to assist your legs in the process (FIGURE 2). Place your hands into fists and use them to push up off the seated surface, while using your legs. Do not place your fists on your legs. Again, at no time will you flex the low back or use it to assist you in the standing process.

            Be sure to not bend your spine—keeping it neutral, as you sit down, too. Simply reverse this standing process, and use the same technique to sit down properly. 

 STRETCH EVERY 20-30 MINUTES

                       FIGURE 1 – REACH                     FIGURE 1A – SQUEEZE

Stretching every 20-30 minutes combats the effects of excessive sitting. It helps avoid the physiological effects of excessive sitting and the associated spinal memory. To perform the appropriate stretch, stand up and reach toward the ceiling (FIGURE 1). Inhale through your nose and exhale through your mouth. During exhalation, stretch higher toward the ceiling.  Next, with your palms pointed up, bring your arms down to the side of your body. Then, pretend you are holding a pencil between your shoulder blades and squeeze them together to prevent the pencil from falling. Inhale through your nose and exhale through your mouth. During this exhalation, hold the contraction of your shoulder blades together for 10 seconds (FIGURE 1A).  Relax. You have successfully completed the basic stretch needed to combat the effects of prolonged sitting. The entire stretch break will not take more than 30 seconds, yet its benefit will last exponentially longer. Repeat this stretch every 20-30 minutes, or as needed. 

 DON’T SIT TOO LONG

Working conditions in the United States demand less physically of its workers now, than were required of its workers in the past. Most jobs now involve sitting rather than laborious tasks such as lifting, pulling, pushing, etc., yet disability claims for back pain have been increasing. This increase occurs because sitting can be more harmful to your body than physically demanding tasks. There is a definitive correlation between excessive sitting and low back disorders, such as disc herniations, also known as bulging discs. The solution is to avoid sitting for prolonged periods of time. A worker who sits longer than 50 minutes should stand up, take a walk, or stretch, though I recommend he shouldn’t sit longer than 20-30 minutes due to the effects of something called spinal memory, which I will discuss at a later time.     

            This information is particularly useful to any athlete, such as a baseball or basketball player, who sits for 20 minutes or longer before performing. Because sitting places your back in a stressful position, athletes are at a higher risk for injury if they immediately perform their athletic tasks after sitting for 20-30 minutes or longer. If an athlete must sit for an extended period of time before playing, he/she must remember to sit with proper posture, take stretch breaks, or use a lumbar support of some kind.

USE AN ERGONOMIC CHAIR

                                    FIGURE 1 – BASIC ERGONOMIC CHAIR

The most ideal seated position is one that changes. An ergonomic chair allows you to adopt different seated positions more easily than regular chairs. Be sure the ergonomic chair allows seat adjustments forward, backward, and side-to-side. It needs to have an adjustable seat height and wheels. If it has arms (which is not necessary), be sure the arms are height adjustable. Do not place your shoulders in a shrugged position. It is equally important that the chair allows for a slight recline. In fact, 95-105 degrees is the ideal seat back position, not 90 degrees. The ergonomic chair in FIGURE 1 is a basic ergonomic chair. I featured this chair to show that it is not necessary to spend a fortune on an ergonomic chair to reap its benefits. 

Last month's blog discussed the importance of using a lumbar support. You may use a lumbar support in combination with an ergonomic chair. However, not all ergonomic chairs will require the use of a lumbar support.

   USE A LUMBAR SUPPORT

                 CHAIR                                   CAR

My previous blog discussed how to sit properly. You should know by now that sitting is harmful, but sometimes necessary. When sitting, it's important to sit with proper posture. But when that is not feasible, the next best option is to use a lumbar support. Most seated surfaces are designed for comfort, but fail to provide proper support for the back. This lack of support can cause disc herniations, also known as bulging discs. It is this repetitive misuse that leads to 85% of low back injuries. To prevent injury from sitting improperly, use a lumbar support. Lumbar supports are inexpensive and may be transferred to different seated areas (see images above). Most cars are equipped with an inherent lumbar support. However, I believe an accessory lumbar support is more efficient. Make sure you are using it correctly. If used correctly, your low back will not have a “C-shaped” hump while you use the support, and you won’t slouch. The lumbar support should not come up higher than the bottom of your shoulder blade. 

You may visit our "Products" section to find the exact lumbar support that I recommend. 

How to Sit Properly

FIGURE 1

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.