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What Doctors Don't Tell You

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May 2018 (Vol. 3 Issue 3)

Bad back from sitting? Try these myofascial support techniques

About the author: 
Charlotte Watts

Bad back from sitting? Try these myofascial support techniques image

It's what we do more than anything else, but here's how dynamic sitting can minimize the damage of staying seated, says Charlotte Watts

Since the phrase 'sitting is the new smoking' hit the headlines last year, many people have begun to associate long-term sitting with structural issues and pain, and there's a burgeoning discussion about exactly how much of a risk factor sitting may be for chronic inflammatory and metabolic conditions, often referred to as 'diseases of civilization.' Adults now spend, on average, more than half of their waking hours in a sitting position.1

To investigate the question of whether sitting causes diabetes, researchers from University College London and the University of Sydney in Australia followed 4,811 British public servants with an average age of 44 for 13 years. None of them had diabetes at the start, but 402 people developed the condition during the study period.2

They discovered that the length of time a person spent sitting overall, or specifically sitting in front of the TV, was associated with the development of diabetes. But this association weakened when they also factored in the participants' body mass index—in other words, being overweight combined with sitting was more closely connected with diabetes than sitting alone.

Interestingly, this and other studies have found that sitting for work is not linked to the same health risks. This may be because higher-status jobs involve more sitting, and higher socioeconomic position is associated with a lower risk of chronic disease.

On the other hand, sitting and watching TV is most consistently linked with such long-term health risks; those who watch more TV hours are more likely to be of lower socioeconomic status, unemployed, have mental health issues, eat unhealthy foods and be exposed to unhealthy food advertising.

Overall though, whether the sitting happens at work or home, the most pertinent association with health risk is not the amount of sitting per se, but how active a person is when they're not sitting. People who sit for long hours at work but who also engage in high physical activity do not appear to be at increased risk of diabetes.

A large review that combined data from over one million participants found that 60-75 minutes of daily physical activity canceled out the harmful effects of sitting on life expectancy.3

Perhaps the most obvious connection between sitting and health issues is in the case of back, neck and shoulder pain. There is a large body of research linking sitting to increased pressure on the discs, stiffness of the lumbar spine, reduced lower back muscle strength and a lowering of metabolic rate, leading to excessive body weight. One study investigating the correlation between time spent sitting and the incidence of back pain in 201 people found a significant association between sitting time and high-intensity lower back pain.4

Primary curves

Sitting for long periods is simply not what we humans were designed to do. As bipedal animals standing upright on two legs, we rely on calibrated curves to continually negotiate the downward pull of gravity.

We are a collection of curves and spirals; we are most stable and our structure most congruent when our spine can retain its natural 'S' shape. We have evolved many secondary spinal curves to stand upright; the curves that move inward (anterior), rather than out; the lower back and neck (lumbar and cervical spine) as well as the backs of the knees and the arches of the feet.

Our primary curves tend to rely on bone support, while the secondary curves have myofascial (muscle and connective tissue) support. We can see this most obviously at the tailbone—the bony site of the sacral primary curve, the shape of the ribs at the level of the thoracic spine, and the back of the skull.

In 'ideal' standing posture, these three curves rise above the primary curve of the back of the heel suspending the weight of the head above the similar weight of the pelvis. If one secondary curve is affected by shifts in the primary curves (or another reason), it ripples out to all the myofascial support.

We are not designed to sit up on chairs, or, for that matter, to slump on the sofa where there is little resistance to rise up from, and we sink down into compression with no balancing support.

Healthy and unhealthy sitting

When sitting, ideally we sit up from the 'heels' of the spine as we would rise up from those in the feet when standing. A heel is a rounded bone we can rock on, and for optimal upward expression of the spinal curves, we need to sit just to the front of the sitting bones, as we do the heels of the feet.

When we slump back, as in the image on page 40, we are actually sitting onto our tailbone and dragging it under, encouraging habitual lumbar flexion or flattening of the lower back when we stand.

The sacrum needs a 30-degree angle for its supportive keystone design in the lower back primary curve. If flat (vertical), the top of the femur gets moved back as the pelvis shunts forward (see the image on page 40). This upsets our most efficient alignment up from gravity: ears above shoulders, above hips, above the head of the thigh bone (greater trochanter), above the ankle.

One advantage of this S-shape spine design is to help support our pelvic and digestive organs, which, unlike our four-legged friends, are stacked vertically for us. A healthy lower back curve means that these viscera are happily weighted against the lower back, rather than directed straight down (see image on page 40) toward the pelvic floor, which must then contract and tense to support them and can weaken in the process. This also sends ripples of stress through the pelvic and digestive organs, creating fascial tightness, reproductive and digestive conditions, as well as many lower back issues.

The hip joints and the sitting bones are directly underneath the sacroiliac (SI) joint (see below), where the sacrum (the base of the spine; see right) fuses with the pelvis. This is the root of lower back issues for many; collapsing backward into the pelvis strains this connection and can cause inflammation and instability there. Especially if we tend to sit cross-legged in the same direction habitually, off-center tendencies of the pelvis can create micro-tears in the joint ligaments of vertebrae in the sacrum.

These can also become overstretched from injury, surgery, accidents, pregnancy or emotional holding in protective patterns; sitting for long periods will exacerbate all
of this.

Dynamic sitting

Sitting is often viewed as inert and relaxing, but although it may be for the legs, it is as dynamic as standing for the spine and torso. As it is rare for a human with natural movement to actually stand for any period of time equally on both legs, to sit equally on both sitting bones without moving is tiring, hence we can tend to collapse into our lower back after a while.

We do need to pay attention to sitting posture and lift up through the front spine, but getting up and moving around is more helpful on many levels—moving and hydrating tissues, supporting circulation and raising metabolism, to name just a few.

It is not unusual for the majority of a modern day to be spent hunched over a keyboard (see below). If this is not counteracted with conscious, supported upright posture (see below), it can quickly descend into a hunch that can contribute to a collapsed standing posture, where we lift up from the ground 'up the back and down the front' rather than the more open, grounding and supportive 'up the front and down the back.'

We can see from the images below that the head can be progressively pushed forward from the spine, which places strain on the neck, partly from the forward angle and partly because the head becomes 'heavier' to hold up as it moves further away from the center of gravity.

The pelvis will shift forward or back to counter this weight, adding to lower back issues.

Seated yoga

A seated yoga practice on a chair can help inform how we bring awareness to sitting and also create the movement in the spine and pelvis that can become limited from chair-sitting (see below).

1) First, sitting toward the front of the seat with heels under the knees and feet grounded will help you to sit up from the sitting bones. Here, posture is naturally aligned with ears above shoulders, shoulders above hips; with natural curves in place. Finding this lift from uplift through the back of the skull—as if itwere 'floating' above the tailbone—is the optimum upright seated position, where you retain space at the base of the skull. In this position, the brainstem also stays awake, whereas when you collapse down you can become more mentally 'dull'—the reprimand to 'sit up straight' at school had some validity to keep up concentration!

2) Creating space between the discs of the spine will allow you to twist without compression. Regularly turning around the axis of the spine helps to counter the tension in torso fascia that contributes to back pain and digestive issues. Taking one hand to the back of the chair seat and the other to the outside of the opposite front thigh provides some purchase to open the collarbones and drop the shoulders.

3) Pelvic tilts in this position help remind you where the lower back can ideally sit. Inhaling, arch the back to open the front body and chest.

4) Exhaling, curl in to open the back and consciously move into the pattern of 'collapse' to free that tension. Move between the two pelvic positions to create awareness of your sitting bones on the chair and where the lower back curve lies.

5) You can rest and relieve spinal tension in a chair version of 'child pose.' Bring your head down between your legs or, if any dizziness or unease comes from this position, just bring your elbows to your thighs. Breathe fully here to allow the nervous system to calm.

Meditation posture

When taking these habits into meditation positions (and for the majority of natural hip rotation), most people collapse into their pelvis sitting directly on the ground with full uplift (see below), where they may also lift the chin and compress the base of the skull—a major source of neck and shoulder pain—due to both the habit of looking up at a screen and also to feel the illusion of 'sitting up.' When you're working, moving the eyes, not the head, to look down and/or forward can help to avoid this.

One or two yoga blocks or folded blankets under the sitting bones allow upward engagement—the feeling of lifting the abdominal contents out of the pelvis with natural lengthening between the ribs and the pelvis. This may be cross-legged if knees and hips allow, or many are more comfortable with legs bent back or even on a dedicated meditation stool to raise the hips higher (see below).

All of these positions nurture the natural S-shape spine that creates the expanded inner landscape that meditation invites.

Because collapsed posture can become a set state, especially for those sitting for hours on chairs, when we create more length in the front this way and begin contracting overstretched muscles in the back body that have been habitually over-stretched, this can feel challenging at the beginning and even sore after practicing. People even feel quite tired from sitting up onto a block as the muscles are not used to holding this configuration.

This is also worth remembering when we are creating a new pattern for habitual sitting, at work or on the sofa; new conscious body patterns can go through growing pains as we reconfigure, but your body will thank you, and you will be more able to listen and respond to the cues that you need to get up and move around.


Does your dog have hip pain? image

Does your dog have hip pain?

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Enzyme blends: ending pain, healing your gut, and even fighting cancer!

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