The way my physical therapy practice is set up allows everyday people to get care faster. Often times, I find that the more effort it takes to get medical care, the less likely we are to seek it. Getting the proper help can feel as though it just isn’t worth jumping through the hoops…until things get much worse. Luckily for my patients, they can come directly to me, rather than waiting for things to get that bad.
This vastly improves the potential of a full recovery. As many things go in the medical world, the longer one waits to receive treatment, often the longer and more difficult it may become to completely resolve the issue. This has long been the case with low back pain, and is now thought to apply to many other common ailments, everything from arthritic pain to poor balance.
A strong minority of my patients and clients come to me, not with sports injuries nor with chronic illness. They come to me with complaints that are easily related to poor habits established during a long tenure in a desk job : aka, prolonged sitting. In this post I’ll talk about the 5 most common problems I see and ways to avoid and/or fix them.
Problem #1: Hip Tightness Leading to Low Back Pain and Sciatica
All of those hours seated in a chair can slowly take away from your hip mobility. Whereas normal walking requires about 15-30 degree of hip extension (that’s when your knee ends up behind your body), a limitation in this area often results in prolonged overarching the lower back to compensate.
Patients I see with this problem often complain of pain in the front of the hip with walking, and more often low back pain or sciatica with prolonged standing or walking. The runners may also complain of chronic Achilles’ tendonitis or plantar fasciitis.
To help keep your hips flexible, try a half kneeling lunge stretch a few times each week. Be sure to avoid arching your back while doing this stretch, lest those back problems get worse. Over time, you’ll realize how much easier it is to walk without distorting your back posture, and likely taking some larger steps with ease.
Problem #2: Rounded Shoulders Leading to Rotator Cuff Problems
Sitting with the shoulders rounded for prolonged periods creates a two-fold problem. First, it creates tightness in the pecs or chest muscles, and then it overstretches and weakens the muscles that are in charge of pulling the shoulder blades back. This position draws the shoulder blades apart and elevates them slightly.
If you think of the arm and hand as a tree, then you should consider the shoulder blade to be the roots of the tree. When the shoulder blades are stuck in this position, they can no longer adequately remain in the normal position for overhead tasks, and eventually, these patients begin to have shoulder pain, often rotator cuff problems.
To prevent or address this, try to avoid prolonged posturing with your shoulders rounded. If you find you sit this way often, practice both stretching your pecs regularly and strengthening the muscles that put your shoulder blades the in the right position. Healthy shoulder function starts with the shoulder blade itself.
Problem #3: Forward Head Posture Leading to Chronic Headaches
This is a favorite posturing of college students, coffee shop bloggers, and people like me who often can’t read the computer screen. That lurching of the head forward to see better, exponentially increases the demand on the muscles that are responsible for keeping your head from rolling off your body. This is another one that is common among the cyclists of the world, most notably the road cyclists.
Over time, this creates a long list of changes to the spine and soft tissue surrounding the neck. The most common problem I see relates back to a shortening of a muscle group called the suboccipitals. These tiny muscles connect the very top of your neck to the back of your skull and are famous for causing headaches when they become tight or aggravated.
To address this habit, perform a quick self-assessment to first see if they are already adaptively shortened. Additionally, make simple ergonomic changes that will keep you from falling into this bad habit in the first place: wear your glasses, elevate your computer screen, and take regular breaks from the computer to look up and look around.
Problem #4: A Slouched Back that Leads to Neck and Arm Pain
I imagine this posture settles in during the teenage years. Teenagers grow so fast, their muscles sometimes have trouble keeping up, and when prolonged sitting is added to the equation, it simply becomes easier to slouch forward. For someone like me who measures in at 6’2”, I can totally relate to this one. This also tends to be a big one for the cyclists out there.
The problem with the slouched back is this: no matter how much you hunch over, your gaze is likely still affixed straight ahead. This means that the more you curve your mid back, the greater you must curve your neck in the opposite direction to compensate. This often parks the neck at the end of its range of motion for prolonged periods causing neck to middle back pain, and in worst cases, nerve pain in the shoulder, forearm and even the hand.
If you find yourself in this posture regularly, don’t stress too much. Try to get some good quality time bending your back in the opposite direction throughout the day to alleviate some of the stress. Think about some downward dog, cobra pose, or gently bend over the back of the chair. If you have the mobility, but simply can’t hold the posture, I see some back strengthening in your future.
Problem #5: Core weakness that leads to exaggerateD sitting postures
Somewhere between core weakness and poor mobility in the lower back, I find my patients will fall into two categories. The first group are those who regularly perform a ‘sacral sitting’ posture when your butt is on the edge of the chair and you lean back almost to the point of reclining. The latter group, I find sit for prolonged periods with the lower back arched excessively, often excessively erect or upright.
The sacral sitters tend to have little core activation while sitting, and often suffer more pain related to walking and/or running due to poor stability of the pelvis. The second group tends to over-arch as a means of relying on bony anatomy for postural support, rather than using their muscles. This tends to result in centralized and sharp low back pain.
Similar to the aforementioned neck, the best functional posture for the low back is in a neutral anatomical position. The spine is made up of a very flexible system of interconnected joints, however, it functions best, and requires less compression when it is neutrally postured.
To address this, I often teach my patients what neutral posture actually feels like. I have them start by excessively arching their lower back while sitting, followed by excessively rounding it. After repeating this several times, I tell them to stop somewhere halfway. It’s that simple. If you can’t hold your back in this position for long, you likely would benefit from some core endurance training.
Don't Delay the Care You Need
As mentioned above, these are all fairly common postures to be seen in any random room of seated persons. It may be confusing, but none of these are inherently "bad." The key idea to hold on to is that the body is designed for movement, but not so much prolonged postures of any kind.
Not everyone with these postural tendencies will complain of pain, but eventually, these prolonged habits often lead pain or dysfunction that interferes with life. If you sit 8 hours each day for your paycheck, start considering some of these points.
An ounce of prevention is worth a pound of cure. If you are already experiencing pain, seek medical care immediately. Certain things resolve on their own, but many continue to worsen over time and become more difficult to resolve. I can often get patients scheduled within two days which is a good option when most other places have a 2-4 week wait. My practice also does not require a referral from a physician, which saves my patients that added expense.
Until next time, don't stop moving!