Table of Contents
- 1. Use an External Device to Maintain Your Lumbar Curve
- 2. Use a Variety of Sitting Postures
- 3. Take Short Breaks Throughout the Day
- 4. Exercise During Your Lunch Break
- 5. Get Used to Finding and Maintaining Neutral Spine Positions
- 6. Don’t Lift or Bend Immediately Following Sitting
- 7. Remove the Wallet from Your Back Pocket
Low back pain will affect nearly everyone throughout their lifetime and is one of the most common reasons that people visit their doctor. Sitting, especially prolonged sitting, is frequently cited as a predisposing factor for low back pain. It is also an aggravating factor and is one reason why the condition is recurrent in many people.
Over the past few years, the phrase “sitting is the new smoking” has become popular, and while I wouldn’t go that far, it is harder on our bodies that many of us think. This is especially true because, in the effort of trying to make chairs more comfortable, most seats allow us to slouch.
When you take into account the fact that the average American sits for more than six hours per day, and this number has risen over the past ten years, it is no surprise that the rate of low back pain is so high. While the majority of Americans work at a job that requires them to sit for hours each day, research has demonstrated that sitting doesn’t have to hurt.
According to the article, “Seeking the Optimal Posture of the Seated Lumbar Spine,” a sitting posture that maintains the normal lordotic curve of the lumbar spine, especially when regularly interrupted with movement, is the optimal strategy for spinal health.
Lordosis is the inward curve of the lumbar spine, and while the optimal amount of lordosis varies between individuals, maintaining the proper curve while sitting has been shown to reduce disc pressure and ligament tension in the low back.
By using this information, there are several modifications you can make to your work station and daily routine that can help reduce stress on your low back during prolonged sitting.
1. Use an External Device to Maintain Your Lumbar Curve
As stated earlier, it is important that your work chair maintains your lordotic curve. While many chairs have a lumbar reinforcement built into them, these are generally too broad and don’t provide adequate support. An external device, called a lumbar roll, tends to work the best.
By moving your hips to the back of the chair and placing the roll just above your belt line, at the level of the lower lumbar spine, your lordotic curve can be preserved while sitting.
A variety of lumbar roll options can be found on the internet, for example, the classic McKenzie Lumbar Roll, and they should have the same size and feel like a roll of paper towels. It should be noted that lumbar rolls aren’t for everyone, and at the very least, an upright sitting posture should be adopted to minimize the deleterious effects of slouching.
In addition to its benefits on the low back, maintaining lumbar lordosis also corrects the posture of the mid back and neck. If you are more comfortable sitting in the front of your chair, however, a lumbar roll would be of no benefit.
In this circumstance, you would want to sit on a fairly dense wedge that is a little higher in the back than the front. This support could be in the form of a pillow or a rolled-up towel, anything that tilts your pelvis forward to help maintain your lumbar lordosis. While sitting on this wedge, your knees will be slightly lower than your hips.
2. Use a Variety of Sitting Postures
As it pertains to sitting posture, it is important to change positions every 10 minutes during the workday. The goal of this fairly frequent postural change is to avoid the phenomenon of creep, which is defined as the continuous displacement of collagen fibers (e.g., in spinal ligaments) in response to sustained load, for example, during prolonged sitting.
Under most circumstances, collagen fibers gradually resume their original shape and length (termed hysteresis) when the individual moves out of the posture. Hysteresis, however, occurs more slowly than creep, and tissue laxity can remain for a substantial period of time.
The phenomenon of creep causes a progressive reduction in the tissue strength and may eventually result in injury. This is why changing positions is very important for the prevention of injury. An easily adjustable ergonomic chair that allows for freedom of movement is the chair of choice for prolonged sitting.
The chair should be adjusted so that your knees are bent to 90 degrees, and your torso is upright. Consistent with the point of changing positions, it is important to remove the lumbar roll or sitting wedge for short periods of time in order to promote postural variety.
Letting your low back slouch briefly throughout the day isn’t a big problem; however, you don’t want this to be your consistent posture for long periods of time.
3. Take Short Breaks Throughout the Day
In addition to modifying your sitting posture, it is vital to take short breaks and get out of the chair. This break should consist of an activity that opposes the stresses imposed on the body when we sit, again minimizing the effects of creep.
This break could be as simple as standing upright for 30 seconds or taking a quick walk, which counteracts the forces on the spine, knees, and hips encountered during sitting. Other movements, such as gentle neck and shoulder stretches, as well as taking a few deep breaths, can be performed during these interruptions from sitting.
Brugger’s Relief Position
A great exercise to perform during breaks is called Brugger’s Relief Position, named after the Swiss neurologist Dr. Alois Brugger. This should take about 20 seconds, and the steps to the exercise are as follows:
- Sit at the edge of your chair, with your knees and feet a little wider than your hips, and your toes pointing slightly outward.
- Sit in an upright posture. Slightly roll your pelvis forward, elevate your chest and slightly tuck your chin.
- With your arms at your side and your hands open, rotate your arms so that your thumbs point outward.
- Pull your shoulder blades back and down.
- Take 3-4 deep breaths in and out.
4. Exercise During Your Lunch Break
Another great way to counteract the stress on the back due to prolonged sitting is by performing a mid-day exercise routine. This could include something as simple as going for a walk or run during your lunch break.
In addition to the numerous physical and mental health benefits of exercise, from a biomechanical perspective, any upright activity can serve to offset the flexed posture that sitting promotes. In addition, research has shown that general exercise is beneficial for the rehabilitation of chronic low back pain.
This was demonstrated in the article, “A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain.”
5. Get Used to Finding and Maintaining Neutral Spine Positions
Because we sit so much as a society, we have become accustomed to a flexed lifestyle. As a result, our awareness of a neutral spine position is often lost. In order to promote back health when sitting, we need to be able to easily find and maintain the position of spinal neutral.
Strengthening exercises alone cannot improve your posture; it needs to be practiced so that it becomes habitual. There are a couple of drills that are important to perform frequently in order to encourage proper spinal posture.
The first drill is called the Slouch-Overcorrect exercise. This helps you to become aware of the extremes of seated spinal posture and to learn what is the correct sitting position.
- Begin by sitting at the edge of a chair and allow your entire spine to slouch.
- Move into an extreme upright posture by increasing the inward curve of your lower back and bring your head and shoulders back.
- Relax back into the fully slouched position and then repeat the movement into an extreme upright posture.
- Perform this sequence for a total of ten repetitions.
- After completing the tenth rep, hold the overcorrected posture for a couple of seconds and then relax about 10% off of the extreme upright posture. This is the correct unsupported sitting position and should feel like the posture maintained by a lumbar roll.
- Hold this new posture for up to one minute.
- Perform this exercise a few times per day so that the position becomes habitual.
The Hip Hinge
The second drill is called the hip hinge. This is important in order to learn to dissociate spine movement from hip movement, which is crucial in sparing the back from excessive stresses. You will need a wooden dowel, a broomstick, or a PVC pipe, which will provide feedback to maintain neutral spine posture.
- Begin by standing with your feet shoulder-width apart.
- Position the dowel behind your back, oriented vertically along your spine so that it contacts your head, mid-back, and the back of your pelvis. Grasp the dowel with both hands, one behind your neck and the other behind your lower back.
- The hip joints are the primary movers, not the back, so in order to maintain spinal neutral, you want to keep the points of contact of the dowel adhered to your body throughout the movement.
- The hips initiate the movement, and you do this by moving your ‘seat’ backward. Your torso will tilt forward, however, the dowel reinforcement will discourage spinal bending.
- Keep moving your hips back as far as you can, which will cause a slight knee bend, until you can’t maintain the dowel contact. At this point, you should feel a stretch in your hamstrings.
- Repeat this exercise 10 times, moving to the point just before you lose dowel contact.
- As this pattern becomes habitual, you will find yourself bending (e.g. to pick something up), as well as moving from sitting to standing by using the hip hinge pattern.
6. Don’t Lift or Bend Immediately Following Sitting
It is also very important to avoid bending or lifting immediately following a period of sitting, or to avoid sitting immediately following a period of bending or lifting.
In addition to creep, prolonged flexion during sitting can predispose the spinal intervertebral discs to damage. Therefore, it would be unwise to stand and lift the jug for the water cooler or reach down to access the bottom drawer of the file cabinet immediately after sitting.
If you have been sitting, it is best to stand up and walk for a short period of time before lifting.
It has been shown that following prolonged flexion, 50% of the joint stiffness of the spine returns after two minutes of standing. Therefore, assuming an upright position for a few minutes before lifting can greatly decrease the chance of injury.
It is equally important to do the same before you sit, after a period of lifting or bending. In addition, as shown in the article “How to take care of your back,” using the aforementioned hip hinge pattern and keeping the object you are lifting close to your body is crucial in protecting your low back when lifting.
7. Remove the Wallet from Your Back Pocket
One last piece of advice is to remove the wallet from your back pocket while sitting. According to the article entitled, “The Effect of Wallet Thickness on Spine Posture, Seat Interface Pressure, and Perceived Discomfort During Sitting,” sitting on a wallet can cause postural deviations from the neutral spine position.
While sitting on a wallet is more apt to cause buttock pain due to pressure on the hip joint and gluteal muscles, these spinal postural deviations, especially when maintained for prolonged periods, can result in overloading of certain spinal tissues and result in low back pain.
A small billfold that can allow you to store your cash, credit cards, and driver’s license is a more biomechanically advantageous option and can easily be carried in your front pocket.
Prolonged sitting has been shown to be problematic for many tissues of the low back. However, the tips listed above can make a big difference in preventing the onset of low back pain as well as promoting recovery if you have the condition.
According to Hippocrates, “Healing is a matter of time, but it is also a matter of opportunity.” Correct sitting mechanics and postural variety that reduces the accumulation of stress on various spinal tissues provide the best environment.
As stated earlier, if you work at a desk job, your back doesn’t have to hurt. The combination of promoting proper spinal posture and interrupting sitting with movement can go a long way in keeping your back healthy.
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