Posture and back pain

[nasde]

Hi all

Wanted to ask for some opinions and info re: posture and back pain. I am currently working with a lot of work related cervical and thoracic pain in a predominantly office environment and are constantly being asked about posture.

1) what is good posture? is it "sitting tall" for a majority of the day? do you think it prevents back pain?

2) is there any evidence for the efficacy of posture training on back pain? couldn't find anything much on pedro.

From what i know - the current theory of sitting posture is to have an upright/neutral position of back, chin tucked in shoulders straight etc. Still so many patients come through to the clinic saying that there shoulders ache, they have a stiff neck, upper limb disorder etc.

So my question is: is it more important to regularly stretching and move about than to sit upright in a rigid "good posture"?

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[alophysio]

Hi!

For what it is worth, i believe that a lot of people have a poor understanding of what good posture is.

A lot of people tend to think that it is sitting up straight and then complain that this is unsustainable. That is because most people lose their L/S lordosis and T/S kyphosis.

For me, firstly, good posture involves maintaining "neutral" spine with all the curves in place.

Secondly, a lot of people (like myself) have tight hamstrings which means that when sitting, they posteriorly tilt their pelvis and so their whole sitting base is wrong.

Thirdly, most people think you have to "pull" your shoulders back but this usually results in T/S extension and pain.

Peter O'Sullivan has done work on chronic low back pain and the mal-adapations that are seen.

Dianne Lee has written about neutral spine in "The Pelvic Girdle" and "The Thorax" and has good practical progressions of exercises for posture.

Basically, you need a good wide base (wider ischial tuberosities) , L/S lordosis, T/S kyphosis and a gentle C/S lordosis. Shoulders should be relaxed - they may need stretching of the anterior structures but that is a different problem.

Most people describe the position above as "poor" posture but if you take a photo of what they consider "good" posture to be and then comapre it to the "correct" posture, you will find little difference, it just feels like a lot of difference.

The best way I have found to teach them if they have the correct posture is to get them to sit up in what they would consider good posture. Then ask them to rotate or LF their head (or whatever movement they feel restriction in, Rot is usually best). Then correct the posture (relax tummy for L/S lordosis, let chest sink slightly to increase T/S kyphosis) then ask them to rotate their head again - they should feel a lot less tension and increased ROM.

And that is only for "Flat back" / "active extension" posture problems!!!

You can have people who have too much lordosis or too much kyphosis etc. Just get them back to neutral.

Posture should only require "adequate" muscle activation, not maximal or absent muscle activation. They should feel relaxed (maybe different or uncomfortable) and they should feel less tension and effort to hold up "good" posture.

I hope this helps!

[somasimple]

Hi,

1/ the good posture is the one that doesn't create pain.
2/ not really. but flexed postures aggravate problems.

There is no good posture for sitting since man is made for moving, not immobility.
Thus the best posture is the one that uses the less energy and creates no problem. No rule.

Just move.

[Physiobase]

I would like to offer comment that the important thing is spinal mobility, in all directions, and then stability and endurance (strength) thoughout that range of that mobility.

The concept (verbalisation) of sitting tall can lead to increased tension in the shoulders, whereas the maintenance of the correct pelvis position will help establish the right thoracolumbar curve and therefore balance the head and shoulders on the trunk. This of course all relies on having the mobility and strength to achieve an optimal balance of all the spinal curves.

I tend to look at spinal mobility first and only advise the individual to correct within their limitations. If they lack spinal extension (mobility), expecially in the thoracolumbar junction then I work to achieve more movement and awareness of that area of the body. As they become more mobile then their ideal sitting posture should continue to change (usually a lengthening of the spine and a return to a more s-shaped spine rather than acute angles at lumbosacral, cervicothoracic and upper cervical junctions. Hope this makes sense? 8o

[nasde]

Thanks all for your insights so far

All the information so far sounds like what I've had a hunch about so far, but been unable to find any written backup to. Will have to try my best to convince the management at my company to spend more on physiotherapy education and less on chairs (they just spent many millions on chair upgrades)

And alophysio - am currently reading thru Diane Lee's "Pelvic Girdle" and finding it extremely dry and slow going but am persisting ...

[alophysio]

Yes it is dry in the first few chapters.

I forced myself thru it and it was slow going.

But once i hit the examination and treatment sections, things got a lot more interesting and practical.

Just jump ahead to the treatment section about setting a wider base to sit on for starters then work your way backwards thru the book to get the rationale behind the treatment - it makes reading a bit more interesting!

Also, it helps if you are into that sort of stuff - i am schizophrenic in that way - sometimes i love the detail, other times i abhor it!

[aroun2000]

HI

go to

www.spine.com
and view the manual of ergonomics

u can get correct idea.
regards

[katie80]

Is there anywhere that i can find a posture analysis guide. A tennis coach is wanting to know about posture and muscle imbalance in elite tennis players and asked me to go through a posture analysis. Just wondering if there is something that could help guide him for when he is looking at posture on his own?

[Praneeks]

[QUOTE=nasde;1317]
Hi
Theoritically speaking, human skeletal system can maintain upright posture without external support or muscle action. This is possible only if componets of human skeletal system are arranged in one particular alignment. This alignment can be referred to as IDEAL POSTURE, In practical however this posture is constantly subjected to external forces either voluntarily when we change the posture or involuntarily which is referred to as swaying. In both situations muscle forces & ligamentous restraints come into force to maintain desired posture or for culmination of smooth transition to new posture.
Hence postural muscles & ligaments are put under undue strain if the body segments are not in ideal alignment. in other words the position in which there is least strain on the surrounding ligaments, where muscles controlling the body segement are at mechanical advantage & have to exert minimally to maintain the posture.
Maintainence of good posture is significantly geopardised if there is stiffness in the body segment, if there is tightness hampering correct posture or the muscles controlling are weak.

[Dr.Mansi]

hi friends..
I m a physio...but at the same time, I m patient. I have dull thoraco-lumber pain. Almost 2 wks over......but pain is still there. I think its due to my low level of activity......as I m at home since last 3 months.....
For the pain I can say that.. if some one tries to massage my back...I feel lighter n much reduction in pain. But it comes back within 15 mins........
I usually sense it when I m free..means its not so severe that creates problem in my working......
I jus wanna knw..... what might b other causes of these type of pain. n if u knw some gud n new exercises let me knw.

your help is much appreciated.

Mansi