Why posture is important for back, shoulder, chest and neck pain at He's Fit

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Why posture is important for back, shoulder, chest and neck pain

Posted October 4, 2007 at 02:00 PM by Julie R. Keen

Section: His Fitness, Injuries & Rehab

bad skeleton What constitutes good posture? What are some of the common deviations in the spine and the body, and what contributes to them? What can you do to prevent these deviations? It’s all about gravity … well, fighting it really. Proper posture is maintaining good alignment of all your bones, upright against gravity. Your mother nagged you about it growing up, and it turns out, she was right about this too.

The spine has many functions. It protects our spinal cord and nerve roots. It is an attachment point for many muscles in the pelvic and shoulder girdles, so it provides a stable base upon which the arms and legs can move. It gives us great mobility as Homo Sapiens. It also provides structure for and protects our internal organs along with the ribcage.

When the spine is not aligned properly, many things can happen, from aches and pains from abnormal strain on the ligaments, nerves, and muscles of the spine, to shoulder and hip dysfunction and even decreased respiratory capacity. Trust me, Quasimodo had more problems than just worrying about Esmeralda.

Good posture is generally described as having all the vertebrae in the spine stacked in such a way that a plumb line would bisect the ear, shoulder, hip, and ankle in a view from the side. There is a slight arch in the neck and lower back, and a slight curve in the mid-back. Looking from the front or back, bony landmarks are symmetrical and level.

Since most of us sit at our workspaces—in front of a computer, at meetings, during our commute—this is where we get into the most trouble, and it carries through to other movements and positions in our lives. If you have postural problems, sitting is likely where you break down and it just carries over to standing and other positions. So this is where we will focus our discussion.

good skeleton Proper sitting posture involves sitting directly on the ischial tuberosities (sits-bones) deep in your buttocks, with the tailbone lifted off the seat, and the rest of your spine lined up as described above. Unfortunately, most people cannot sustain proper unsupported sitting posture for more than a few minutes. Instead, we lose the battle to gravity and we slump, letting our tailbones contact the seat, our lower backs round, and our heads jut forward.

Starting at the top, one of the most common deviations we see is a forward head. The average human head weighs approximately 10 pounds. Imagine balancing a 10-pound weight on a stick the diameter of the cardboard tube at the center of the roll of paper towels. Is it really any wonder that we see a lot of forward head? That is a lot of weight for the small postural muscles in your neck to hold up, especially if the bony framework is not doing the majority of the work.

The shearing force that occurs with forward head puts abnormal stress on the joints, ligaments, muscles, and sensitive nerve structures in the cervical spine. It can lead to headaches, neck pain, TMJ dysfunction, cervical disk injury, fatigue, and degenerative arthritis.

Next down the kinetic chain comes the thoracic spine. This area of your spine is important because this is where the ribcage attaches. It is vital for the thoracic spine to be mobile, yet be in good alignment for the health of your internal organs. Try this if you don’t believe me: sit up nice and tall and take a deep breath or two. Notice the ease with which you inhale, and the depth of the inhalation. Now slouch as much as you can. Take another deep breath or two and compare. It should be pretty obvious now.

In a slouched posture, the thoracic spine increases the forward bend (called kyphosis) and the sternum (to which the ribcage attaches in the front) collapses inward. This puts pressure on all of your internal organs. It also puts pressure on the joints between the ribs and sternum, called the costochondral joints, and can cause a painful inflammation of the area called costochondritis (NB: This is not the only cause of costochondritis.)

The loss of mobility that occurs in the thoracic spine with an increased kyphosis can also lead to problems with the shoulder. Here’s another test. Sit nice and tall as before, and raise your arms up overhead. Notice the ease of movement and the range of motion. Now slouch as before. Raise them again and compare.

When someone has shoulder problems, we always look at the thoracic spine as a potential contributor. In an excessively kyphotic spine, the shoulder blades are pulled forward (protracted) and tilted so that the inferior angle is pulled away from the ribcage. This leads to poor mechanics in the shoulder complex and over time can lead to impingement and rotator cuff problems.

In the lumber spine, which is the next region down the chain, the reaction to poor posture is most commonly a decrease in the natural arch. By flattening out this arch, the pressure on the lumber disks increases and can lead to disk bulges and eventually herniation. It also changes the mechanics of the muscles that attach there like the gluteal muscles, often inhibiting their contractions, which leads to other compensations and problems.

Wow. Almost makes you want to quit your desk job, doesn’t it?! Well, never fear, there are some simple steps you can take to minimize these abnormal stresses. And if you are so slouched you are often mistaken for Quasimodo, there is help for you too.

First, SIT UP STRAIGHT!
Seriously, if you sit for a living, make sure your chair and workstation are ergonomically appropriate. Your feet should rest on the floor. When you sit up tall and wiggle all the way to the back of the seat, your lower back should feel supported, but your knees should still have clearance to bend (in other words, you don’t look like Edith Ann). The chair should hit you just below the shoulder blades AT LEAST (it’s okay for it to be taller). Ergonomics is a whole other long topic … if you aren’t sure if your set up is good, or you have pain after working several hours, talk to your supervisor. Your company should be able to get an ergonomic assessment for you since it is an OSHA regulation.

Second, perform these stretches daily while at work. If you sit for a living, perform them hourly at a minimum.

•Scapular Circles: sit up tall and roll your shoulders up and back. Repeat 10-20 times.
•Shoulder Blade Retractions: sit up tall and pinch your shoulder blades down and back together. Picture sliding them into your back pockets. Your spine should be tall during this exercise, but should not move at all. Hold for 10 seconds and repeat 10 times.
•Doorway Chest Stretch: in a narrow doorway, place your forearms on the doorjambs and lean forward into the open doorway until you feel a good stretch in your chest. Hold for 30 seconds and repeat three times, changing the position of your arms each time.
•Chin Tuck/Head Nod: sit up tall, and reach the crown of your head up toward the ceiling as much as possible using easy effort. You will feel the back of your neck stretch a bit and your chin will drop towards your chest. Do not use too much effort. If you have a significant forward head, this exercise will take some time to get good at. But use low, easy effort. Hold position for 30 or more seconds. Perform every 10 minutes while sitting. chin tuck
•Posture Check: every 20 minutes, recheck your posture. Roll your pelvis forward from the bottom, and stretch the crown of your head toward the ceiling.

Add these stretches to your workout routine in your warm-up or do them in the evening before going to bed.

•Press Ups: lie flat on your stomach with your hands under your shoulders. Use your arms to push your upper body up while leaving your hips on the floor. Don’t force the movement, and keep your lower back and buttocks relaxed. Hold for 5 seconds, and then relax to the floor. Repeat for 2 sets of 10 repetitions.
•Thoracic Extensions: lie on your back with a foam roller or rolled up towel across your back (perpendicular to your spine). Cross your arms over your chest, and let your back relax over the foam roller.
•Hamstring Stretch: there are many variations to this. I like the one where you lie flat on your back and grasp your hands behind your knee. Then extend your foot toward the ceiling. Hold for 30 or more seconds, repeating twice on each leg.
•Hip Flexor Stretch: kneel on one knee with the other foot in front (like the bottom of a lunge position). Keep your trunk upright and your abdominals braced as your shift your weight forward until you feel a good stretch in the front of your hip/pelvis. Hold for 30 or more seconds and repeat twice on each leg.

If your problems are long-standing and you have poor body awareness, you would benefit from an assessment from a qualified individual, either a physical therapist or personal trainer (especially one who specializes in corrective exercise).

Julie R. Keen, PT, NSCA-CPT is a physical therapist and personal trainer. For more information about Julie, please visit her website http://www.keenfitness.com.

Research sources and for more information: [pictures 1 & 2]; [picture3]; [picture4]