The perfect position is the position that reduces, abolishes, or prevents symptoms. And if a lumbar roll doesn’t reduce, abolish, or prevent symptoms, then it is not indicated. A roll may make symptoms worse initially, but, as therapy progresses, it becomes helpful. Or it may only be tolerated for 20 mins but eventually is useful for long stretches. Its use should always be assessed, not recommended without reasoning.
When it comes to prevention, often that looks like a person who doesn’t have symptoms in sitting but has trouble rising, especially with straightening his low back. Or it may look like a person who has no pain all day sitting at work but then pain in the evenings at the gym. If using a lumbar roll all day prevents pain later at the gym, then it is indicated.
Lumbar rolls can be extremely effective as can any decent lumbar support built into a chair. The point is usually to reduce prolonged spinal flexion or enhance extension. Lumbar rolls can be easily added, adjusted, and removed. They can come in the form of a rolled up sweatshirt, household pillow, or something purchased. I’ve had patients support their low backs with water bottles and purses. I myself used my wallet while driving once. Their low cost and ease of use make them potent tools for helping those with musculoskeletal complaints. -- Laura
For the Lower Body, The Most Significant Aspect of Sitting All Day is Lumbar Flexion, Not Hip Flexion
I know this because I test it versus make assumptions. The hips and lumbar spine are physically close to each other, but tests can easily differentiate the two. We can move the lumbar spine without moving the hip and vice versa.
As I’ve written before, I strongly disagree with the popular idea that prolonged sitting (which puts the hips in flexion) leads to tight hip flexors which leads to pain in the hip flexors. That theory falls apart on so many levels. For starters, since when do tissues (especially “tight” tissues) hurt when put on slack? What is actually happening in the majority of patients who experience anterior pelvic and hip pain in sitting (the “hip flexor area”) is they are experiencing referred pain from the lumbar spine, which is also almost always in flexion when seated. In a smaller number of cases, the pain is referred from the hip joint(s).
If you have pain, you can’t just assume it’s from the muscle in that area. Often it’s coming from somewhere else, which I usually address with specific movement. You’ll get better faster - and stay better longer - if you treat the actual problem. -- Laura
I do not preach sitting 100% upright 100% of the time, but I believe that the majority of sitting time should be in the upright position. A chair like this in which the back slopes backward makes it difficult to attain upright posture since there is no upper mid back support in the upright position. Without that support or tactile feedback you are (much) less likely to sit upright - nothing is cueing, reminding, or helping you to do so. (It’s not as though we commonly lean back and therefore need this slope anyhow.)
A good work chair does not have to be expensive. In general, I prefer a straight back that comes up to the shoulder blades, a comfortable bottom portion, depth that fits your femur, arm rests that allow you to navigate your desk, and a lumbar roll that can be added and removed. --Laura
Regularly sitting for prolonged periods, especially slouched, can lead to orthopedic problems. But the problems arise almost always from joints, not muscles. I continually hear people (health professionals, notably) declare that sitting’s “shortened” position of the hip flexors can cause painful, tight hip flexors. Granted this doesn’t affect all sitters (nothing does), but if large amounts of time in shortened states can lead to painfully tight muscles, then where is the observable pattern? Why aren’t more biceps affected secondary to prolonged elbow bending? Where’s the complaint of painful anterior neck muscles as our heads are so often forward?
Though I make my case verbally, people won’t budge. It’s likely the only way to prove my point would be to demonstrate an evaluation and treatment of someone with this given “diagnosis.” In the absence of that, I put forth that, one, we have ways of clinically determining if this is occurring, which, importantly, involves ruling out joints and nerves. Two, if we consider joint mechanics, deranged upper-mid lumbar segments and hip joints can send referred/radicular pain to the hip flexor area. Deranged elbows usually refer pain to the medial, lateral, or posterior elbow. And neck derangements typically send pain posteriorly and laterally – rarely anteriorly. The deranged joint pattern is observable. --Laura
I recommend checking the spine first in nearly all patients, but if your symptoms are not improving (even symptoms like sinus congestion!) with whatever treatment, repeated movements are worth a try. The McKenzie method typically uses repeated movements to address patients' symptoms as movement is frequently the best medicine - and carries little to no risk as we use the least force necessary. While my role is to investigate exactly how you need to move, it's true that most therapeutic movements are those opposite our normal joint position. In this patient's case, that means neck retraction (moving the neck back). --Laura
Learn more about Robin McKenzie and the method he developed for treating patients. Dr. Yoav Suprun, DPT, Dip. MDT talks to Robin regarding posture, MRI use, exercise versus passive care, and more. Enjoy! --Laura
Your car seat alignment is very important for your health! For starters, we tend to spend a decent amount of time in our vehicles. Additionally, the time spent in your car seat is spent in one position. You're typically not moving around by crossing your legs, shifting your weight, etc. - because you can't. So if you're going to be stuck in one position, it better be the best possible position for your spine and body as a whole.
Three things are crucial: (1) Ensure the headrest is not pushing your neck/head forward. I turned mine around. It took time getting used to being in a NEUTRAL position, but now it feels natural (as it should!). (2) Get your bum level with your knees. No sinking into the seat! If you can't adjust your seat, sit on towels or purchase something. I use a wedge I got from my local Relax The Back store to lift up my hips. (3) Get adequate lumbar support. You might have an inflatable support in your car, but even that might not be enough. I use a firm McKenzie lumbar roll. -- Laura
Just as important as the mechanical therapy I provide to patients to eliminate their symptoms is the education I provide regarding how to keep their spines healthy in the future. A terrific analogy I've learned from mentors enlists teeth brushing. Just as we recognize the significance of keeping our teeth healthy via flossing, brushing, and dietary habits, we should acknowledge that devoting a few minutes a day to our spines is a worthy endeavor. My goal with patients in this educational arena has two facets.
The first is simply teaching people to be aware of the movements and positions our spines adopt on a daily basis. Unlike our peripheral joints which tend to get a fair amount of both bending and straightening throughout the day, when we look at spines, the majority of people in the US spend their days in an imbalance in favor of forward bending (flexion). (The upper neck, however, is often hanging out more in a backward bent (extension) posture. Why? Because our lower necks are stuck forward, and we need to see ahead!) To be sure, certain manual jobs, or desk jobs in which the computer monitor absolutely has to be to your side, create movement imbalances in other directions. Likewise for someone who takes hundreds of right-handed baseball or golf swings per day or throws overhead regularly. Once this observational ability sets in - which undoubtedly takes time - the plan of attack is straightforward: reduce the imbalance. This is akin to reducing your teeth's exposure to deleterious foods and drinks.
The second piece to keeping our spines healthy, and preventing re-injury, is intentional movement. As I tell my patients, just as you brush your teeth twice a day, give your spine some good, healthy movement twice a day. In the most common scenario, this translates to bending backwards - all the way backwards - about ten times twice a day. Sometimes it is rotation or even bending forward. My patients leave my care knowing what their specific movement is.
Like most people, over my lifetime, my spine scale was heavily tipped in favor of forward bending. Sitting slouched at desks over books, slumping "comfortably" into couches and chairs, and later bending over patients added up to a lot of spine flexion. Did I ever bend all the way backward? Maybe a handful of times. It's no wonder I injured myself. Once I learned to look at how we position ourselves, however, I adopted several changes to narrow the gap between the amount of my spine's flexion and extension. Firstly, I almost always sit with a lumbar roll which places my lower spine (except L5-S1, which remains in 60% flexion in sitting) in extension, or at least neutral. If I don't have something to support me, I sit up straight, slouching only occasionally. Secondly, I spend more time lying on my stomach propped up on elbows while reading, watching television, or using electronic devices. Thirdly, given the choice, I often choose to stand instead of sit; for example, I will stand when using my computer on my high counter or when out at places like bars or concerts.
As far as the second component - deliberate movements - I have two go-tos. A few times a month, I'll notice I need to rotate my spine to one side so I'll do that. Most days, though, I move my neck, mid back, and low back into extension a few times. This tallies up to roughly 5 minutes per day, which is a more than reasonable price to pay to keep what I call the "body's fuse box" working correctly. -Laura
I approach fixing a patient's injury in three ways:
1. Find a specific movement to correct the injury.
2. Address and correct everyday habits (especially posture) which contribute to the injury.
3. Place the patient's activities which prevent the injury from healing on hold temporarily.
This video (about 2 minutes) is a nice example of how to correct everyday habits, including posture. Making these simple adjustments can make a world of difference to our bodies. (I'd prefer better posture on the bicycle, however. Or forgoing the biking for walking or jogging.) -- Laura
I can't emphasize the importance of correct posture enough. This example (image) has become the norm. And people often slouch for 8 or more hours per day - at work, in the car, on the sofa, and on the bed on their tablet or phone! It's important because of its effect over time. If your spine is nearly always bent forward (as it is with poor posture), something called creep occurs. Ligaments, tendons, etc. in the back of your spine get overstretched and things in the front get compressed. Basically, your spine gets out of whack! This in turn creates a vulnerability to injury. So it's no surprise when during a normal run, or when sneezing, or while picking up your newspaper your spine moves enough out of whack to become painful. Reaching for that cup of coffee wasn't a silly thing to do; you just didn't have a healthy, mobile spine to handle it! And the blame for that is usually years upon years of creep due to poor posture.
Find more information about the world of diagnosing and treating orthopedics here!