Making Exercise Healthy Medicine
Stop Pain from Long Sitting - Back, Neck, Leg, and Hip
Desk, Computers, Chairs, Trains, Planes, Cars, Buses, Internet, TV, etc.
Bookspan, MEd, PhD, FAWM
Director, Neck and Back Pain Sports Medicine
Director, AFEM - Academy of Functional Exercise Medicine
training and pain prevention methods developed by Dr. Bookspan
are used by top spine centers in the United States and abroad.
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Hello, You're on Dr. Bookspan's no-ad, no hype web site dedicated to getting you back to your life - healthy, mobile, happy. There are hundreds of free articles here for you. This article shows you how to fix bad sitting ergonomics.
Sitting around has never been healthy. Sedentary life harms physical capacity and overall health. Being less sedentary is key to good health and happiness in general. For the sitting you do, this article shows how to stop main unhealthful sitting mechanics that cause back, leg, arm, hip, and neck pain.
Most lists of instructions for sitting tell you to sit in exact ways at exact angles or use devices and special chairs. These rules are uncomfortable and not necessary. Instead, this article shows you concepts of how and why strain and injury may occur when sitting so that you can sit in healthy ways that are comfortable and easy. Then you no longer will get the pain and your neck, shoulder, and back can heal. Also remember to get up and get outdoors in fresh air and a healthy amount of daylight exposure every day. You can sit healthfully on a bucket and badly in a thousand dollar ergonomic chair.
No health insurance is needed to fix pain from these methods. Much of costs, time, and worry spent on many current medical treatments and surgeries are unnecessary, and often unhealthful. It's not health care if it's not healthy. Not all exercise is medicine. Not all medicine is healthy. We change that. I have developed information through years of research in the lab, and put it here on my web site to benefit the world - evidence-based primary source sports medicine. Get better and the world will be better. See the books on the BOOKS page. More about me in Adventures. Now go get better:
Short History of My Work To Develop These Methods (skip
this to go straight to fix pain)
I have seen fitness and rehab myths and fads come and go, but these methods remain effective over time. More about me in Adventures. Limited Classes and appointments to train directly with me, and workshop certification by me through AFEM for top students. To keep this quick and easy, much is shortened. Get the books for reference while you keep getting better:
Now, go fix your pain
Answers In A Nutshell
- You do not need special chairs or expensive ergonomic foot rests or a ball or rocking device, or any of the range of strange positioning devices claiming to relieve pain or to "make you sit in healthful ways." You can sit badly on any of them or well on a bucket - with a little info and practice given in this article.
- You do not need to give up working at a computer or desk, or avoid car trips. With a little common sense and information, you can sit and move in healthy comfortable ways - yourself. This is different from doing sets and reps of exercises, or devices to "hold" you correctly (when they really don't), then going back to injurious daily habits.
- You do not need to sit in specific rigid angles of the hip or legs or arms; in fact, that often causes more pain. Instead, by leaning concepts of healthful movement, you can apply them in all the various situations you will need.
- Painful muscles, discs, or joints are not the cause of the problem - they are the RESULT of what you are doing to hurt your body - things you can fix yourself. Even when inflammation or immune response are identified, they are results, not causes. This article will show you how to understand and fix causes instead of using drugs and surgery or bracing and devices for the results.
- A large number of common medicines and prescription drugs can cause much body pain. This may be mistaken for pain from sitting. Unneeded treatments, surgeries, and pain products are used next to relieve this pain - often causing more pain and reduction in physical ability. Easy changes can stop the need for harmful medicines.
- Not all pain is from the results that show on an x-ray or other test or scan. You are not doomed by scan results.
- Anyone who sits immobile for hours can hurt or feel stiff, that is not a mystery. Anyone sitting badly, squashing one area, can have numbness there that is not from disc or nerve problem, even if you have been told that your x-ray shows a disc bulging. Many people have bulging discs with no symptoms and their pain is from normal bad slouching and no surgery or treatments or repeated adjustments are needed, just better sitting and more getting up. Bad sitting is no mystery.
- This is not alternative medicine. This is standard of care, common sense sports medicine techniques, applied to real life - where you actually need it.
- This article explains the above. Make sure you understand the concepts (many highlighted in green).
We have found certain people like this information so much that they copied entire sections and illustrations to their own web sites without credit or link to this site, sole author, Dr. Bookspan. You may ask to share this info with full credit to Dr. Bookspan, but don't steal. See copyright reprint info at page end. We have begun embedding copyright info into graphics.
Why Does Slouching Hurt?
Sitting with a rounded back does several things to cause injury and pain.
It does not matter if you sit at a desk, at a computer, to play music, to knit, on an assembly line, for hobbies, for long travel, on an exercise ball or ergonomic chair, or any other sitting. It can hurt from simple bad body mechanics, no matter what object you sit upon. No expensive chairs or devices can make you sit right, but you can easily do that yourself, even on a bucket.
Rounding your spine forward (slouching) when sitting holds the back muscles in a longer than normal position is a main way to make them ache. It can also weaken them.
Sitting with your spine too rounded, or bent forward all day, even leaning forward chronically with a straight back, can slowly degenerate the discs, the little cushions between the back bones (vertebrae), and push discs outward. This is how discs bulge, also called herniated or slipped. Holding your neck tilted forward for much of the time, or angled back with the chin jutting forward and or upward, also mechanically harm soft tissue, discs, and the spine joints in the neck. A disc can bulge outward enough to press on nearby nerves, sending pain down your leg. Pain down the back of the leg is called sciatica. Pain can also go down the front of your leg when other nerves are pressed, and down your arm from neck and shoulder bad positioning.
Even without disc involvement, soft tissue pain from slouching can be uncomfortable and frightening, often mistaken for diseases, and given unnecessary drugs and treatments. These are all easy to prevent.
Pain when sitting badly at the computer - "Cyber-myalgia"
Years of rounding and sagging under your body weight pushes on soft tissue and and can eventually wear on the discs, pushing them outward (herniate). Look at the discs drawn in showing how tilting helps push them outward. More in the DISC article.
Check If You Round Your Back When Sitting
Do you round your back all day to work, to drive, then the same to "relax." Too much. No wonder your neck or back hurts.
Many seats have a round (concave) back. Do you allow your back to round to fit the round chair back?
Check if you not only round into the chair back, but hunch forward even more, or put a pillow behind your head, pushing the head further.
Do you sit away from the back of the chair, and create a "hammock" of your spine?. Body weight pushes outward on your low back muscles and discs.
Also Check If You Overarch (or Tighten) The Other Way When Sitting
Photo shows tight, rigid, too much inward curve of the lower spine - a common way to get a tight, sore back and neck.
Holding an overarched lower spine (overdoing the inward lumbar curve) and yanking the chin inward (double chin posture) can hurt, tighten, or strain as much as slouching. The above photo shows rigid strained forced posture. Instead try the above solutions to relax with healthful positioning while sitting.
Simple Pain Prevention
Instead of sitting forward in your chair, move your hip all the way to the back of the chair. Lean slightly back in comfort. If the chair back is rounded, put a small soft cushion in the space between your low back and the chair, to preserve healthy normal back posture instead of assuming the curved posture of the chair.
Relax back over the small roll to keep the normal small inward curve, instead of rounding your back outward to fit a concave chair.
Don't exaggerate the inward lumbar curve, and don't strain to hold it, or you will cause pain from that.
Making a Lumbar Roll
To feel the right size for a lumbar roll, sit back in a chair and nestle your forearm behind you in the lumbar space between your lower back and the chair. Lightly lean your upper back against the chair so that the low back does not press your arm, but rests lightly. It should feel comfortable. It it's not comfortable, it's wrong. Your forearm is usually about the size to look for in a lumbar roll.
There are commercially available rolls. Some are expensive and cumbersome, and many are uncomfortable. You do not need to purchase anything. Many soft household items can work for a lumbar roll. Try a small folded towel, shirt, or gloves. Fold your jacket or part of it, just enough to be the size you want. If it is too large, it will not be comfortable. Use a small inflatable pillow, available at dollar stores or camping supplies. You can cut a roll of soft foam lengthwise to make two lumbar rolls:
If a foam lumbar roll is too big, cut it lengthwise to make two - one for home and one for the car.
Put the cut side to the seat and the rounded side facing your lower back.
Using the Lumbar Roll - Lean Back, Not Forward
Don't use a lumbar roll that feels too large. It will be uncomfortable. If you feel like it is sticking you in the back, check to make sure you aren't rounding against it, or that it isn't too large, or extending too high or low on your back. If it is not comfortable, it is not right or helpful. Change it:
Lean your upper back against the chair instead of pressing your lower back against the roll. Don't force into unnaturally straight or arched posture. Keep head upright, not tilted forward or back, or craned and bent back at the neck
Do you round your back against the lumbar roll? That is uncomfortable and just as useless as rounding without one.
Long Sitting When Driving
- Use a lumbar roll, described above, if needed.
- Sit with your hip at the back of the seat, not the middle.
- Move your seat in so that you do not round forward or downward to reach the desk or steering wheel. Tilt the seat slightly backward. Sit up and lean your upper back back against the seat, instead pressing the lower back and reaching and rounding. A bonus to moving the car seat forward, is that by sitting back instead of reaching forward, your chest and face are farther from the airbag, said to be safer.
Long Sitting at Your Desk
- Use a lumbar roll, described above, if needed.
- Sit with your hip all the way against the back of the chair.
- Move the seat in and sit closer to the desk so you can sit up instead of hunching forward.
- Put the monitor up on a book, block, or shelf. Use an external keyboard for laptops.
Even without a seat back, you can sit comfortably. Move your seat in. Put the monitor up on a block or shelf. Keep the keyboard up on the desk, not under it on a keyboard tray. Don't overdo the inward curve of the lower back. Depending on your height, lower your seat as needed so you don't reach down for the desk.
Don't Be Fooled by News Articles Saying "Don't Sit Straight" - (that's not what they meant)
News articles came out that misinterpreted a study that said "Don't sit up straight." They never mean that you should slouch or that rounding your back and neck was better than keeping the spine straighter. They found that leaning back (with good positioning) is less work on the back than sitting upright vertically. When they said "Don't sit straight" they meant "Don't sit vertically". Not that you shouldn't sit with spine straighter rather than rounded.
A certain amount of "work" (exercise) is fine for the back. Don't be afraid of sitting vertically either. Your own muscles need exercise and can hold you to sit upright without pain or damaging yourself.
For long desk sitting, it is often more comfortable to lean back against your chair, but not to round and slouch to do it.
Long Sitting for Buses and Flights
Commercial airline, bus and train seats are often rounded, encouraging prolonged, enforced rounding.
- Often two pillows are needed, one in the natural curve of your low back, and the second above that one for your upper back, in the space still left by the rounded seat. Adjust as needed, use your brain to make it right, comfortable, and healthier. Sit upright and lean back to rest the back of your head against the head rest.
- Depending on the shape of the chair, you will need to move the lumbar roll higher o lower. What is important is to understand why you are using it (to make the chair back shape healthy for you) and to pad it accordingly.
For the very rounded (concave) seats common in flights and buses,
two pillows may bee needed to allow you to sit comfortably straight, not rounded forward to fit the chair.
- Flights sometimes have a video message encouraging in-seat stretching. Often the advice is forward bending. That is the last thing you need after sitting bent forward for so long. Instead, stretch your back and shoulders backward, not forward. Pull your chin in while leaning back. Breathe. Smile.
Sitting to Relax
Use the principles above to easily and inexpensively fix your existing chairs and sofas.
A nice stretch you can use for editing papers, or relaxing briefly.
Sitting On The Floor and in Exercise and Yoga Classes
More to come here about sitting on the floor, and squatting to rest and work. Check back!
Until then - food for thought - people sit in terrible posture on yoga mats waiting for class to begin (and often during class) that they actually think will magically, automatically *give* them good posture. They know sitting for long periods at a desk is terrible for your health, but sit painfully for long still periods on a mat and call it "meditation" and people will pay money for that. Not healthy, obviously. There are standing, walking, even running meditations. In a gym, people wear expensive workout clothes and go to classes or machines and SIT DOWN! Even lie down. In a gym! Elders who need standing and balance all the more are shunted to chair yoga and exercise. Get up.
Sitting In Strollers for Parent and Baby So-called "Fitness" Classes
More to come here - there is much to be said about sedentary children. Check back!
Until then, it is not fitness, or physical or mental health, for parents and their able-bodied baby or child to strap the child into what is essentially a wheelchair (stroller) while you lift little artificial hand weights next to them. It is travesty to think that lifting a baby causes back pain but lifting a magic little weight will fix it. Sitting, whether parent or child, in any class calling itself fitness is counter to fitness. Please get up and use your own muscles to support your body weight. Lift the babies for your weight lifting. Lift older children too. Get children out of stroller "wheelchairs" for these classes, and as often as you can in daily life, before you teach their bodies (and minds) to sit instead of move, dragging down their health and motor skills to increasing lows. Use my books to learn healthy lifting and carrying to increase strength and decrease back pain using good mechanics. Start with this summary article on Healthy Lifting.
Ergonomic Chairs, Kneeling Chairs, Sitting Devices, and Exercise Balls Do Not Make You Sit Well
Somehow, people love to believe that sitting on an exercise ball or kneeling chair or other engineered or fad device will automatically make you sit straighter or better. Of course not. You can slouch just the same on almost any surface. No rocker device, no special sitting strap, or the new fad of clothing with straps to claiming to hold you in proper position will actually give you healthy positioning. Some do nothing, others put you in worse positions or make you think you are sitting right when you are not. Sitting without slouched, strained, or over-stylized rigidly "correct" posture is up to you.
Sitting slouched on an exercise ball.
A ball does not make you sit well or use core muscles.
A ball does not make you sit upright or prevent unhealthful, uncomfortable sitting position. You can sit upright or not. It is not the ball, but you, that determines what you do with your own body.
This photo shows slouching on a ball, and not being able to sit close enough,
rounding even more to reach the surface.
Use common sense and your own muscles for simple, comfortable, healthful sitting habits.
Ball and bad and good chair sitting photos taken for me expressly by Healthine.com staff.
Please do not try these bad postures at home. Healthline staff are trained professionals.
Standing to Work
Obviously, standing is generally more exercise than sitting. Standing to work is often touted as the new cure for "sitting disease" which is not an actual, literal "disease" but the same harm of sedentary life. I hope that standing to work does not merely perpetuate the same problem people do sitting - slouching, craning, and doing everything except what is healthy and sensible, mindlessly calling it a fitness activity or thinking they have some strange new disease when they hurt from slouching when standing.
Upper back pain from standing is usually from rounding forward too much. My web page on neck and upper back pain explains. Sometimes people lean the upper body backwards, causing lower back pain, as explained below. When they round or crane the neck forward to balance or compensate, their neck and top of the shoulder may hurt.
Lower back pain from long standing is usually typical of a certain kind of slouching - increasing the inward curve of the lower back, called hyperlordosis. My web page about fixing back pain from long standing explains that strengthening abs does not fix this, but how you use them to position your spine.
Don't Forget To Get Up
No matter how well you sit, it's still a lot of bending at the hip and time spent off your feet. It's sedentary. You lose physical capacity ( mental too). Muscles at the front of the hip eventually shortens. Short, tight hip muscles add their own posture and pain problems. Your hip needs standing weight for strong bones. Your legs need use. Long sitting, even pain free, isn't healthy.Your body and mind and spirit need movement. This isn't strange new age stuff, but long-known. Studies of space flight where people don't have benefit of the pull of gravity experience devastating losses of bone, muscle, and cardiovascular status. Sitting all day and doing a few exercises won't undo the large damage.
Stand more. Even for my wheelchair patients, I recommend pulling to a stand for time every day. It is that important.
Get up. Move. Assess your day. It is a startling realization to count the numbers of people who go to gyms and sit to lift weights and "exercise.". Elders are told to sit for exercises somehow thinking it is safer or preferable. Yoga enthusiasts sit for an hour actually believe it makes them stronger. If you want to exercise get out of your chair. Even sitting on a ball isn't exercise, it's sitting (for gosh sakes). My book Health & Fitness - How to be Healthy Happy and Fit For The Rest of Your Life" is a fun compendium of hundreds of ways to have healthier movement all day, along with healthy everything else. See it on my BOOKS page. Thanks for checking it out.
Stand up and straighten out. If your pelvis tilts forward (belt line down in front) straighten it to neutral spine - away from the bent "behind-stuck-out" position - see the free abs article and the back pain article for details of how.
Movement is key to your health. If you sit all day for work it is no mystery that you hurt. Learn basic healthy movement skills to use to fix a lot of pain with my Bookspan Basics functional fitness page and Fitness as a Lifestyle which will show you how to use healthy movement for your everyday body mechanics even in the office.
Another nice stretch to straighten out after house chores or exercise is to lie face down and prop up on elbows. Don't pinch or crane your back or neck, just gently stretch the entire spine and hip the other way. Remember that is more time off your feet and to use it to feel how to straighten then apply it to when you stand.
Don't forget to get out of your chair, stand and get weight on your legs, and "unround" your entire spine
When you look upward, straighten from the upper back. Don't pinch or bend back your neck or lower back.
No Strange Rules
It is not true that you must sit at 90 degree angles (or any specific angles) or hold your thighs parallel to the floor, or other strange, strict rules about positioning your arms or legs.
Don't worry about exact angles. Get the concepts, then you can keep healthy posture while you go about your life. Don't sit frozen in place. Movement is important for joint health. Joints don't have much blood flow. Joints get nutrition in and waste out by physical movement. Move freely in your chair instead of sitting still for hours at a time.
Sit in healthy position whether the chair has straight back, a round back or no back. When you use a lumbar roll or any towel or jacket for the same purpose, understand what it should accomplish. Then you will be able to think where it should go and how large it needs to be to accomplish that.
You are the one to determine your positioning, not the chair. Keep it simple. Sit well without rounding your back forward or overdoing the inward curve of the lower back, not jutting your chin, not hanging your neck forward, not lifting the chin, not straining rigid "straight" posture. You will be able to get up after long sitting with straight happy position and no pain.
How Long Does It Take To Stop Lower Back Pain With Good Sitting?
If you hurt when sitting, you should feel the pain and pressure stop the moment you change your sitting to healthier ways.
If you're not feeling better right away (that means as soon as you try it), check what you are doing compared to what is presented above. Are you still rounding your back anywhere, or leaning forward? Are you craning your neck? Are you using an expensive (but wrong) ergonomic keyboard tray. Are you sitting forward of the seat back and letting your back "hammock?" Is your chair made to round you? Don't let it - use the techniques above? Are you tightening or clenching any muscles? Remember - fixing pain is not "doing" a bunch of exercises or stretches, then going back to sitting badly. That is defeating the purpose.
Make sure there is not something else contributing to your pain - many common prescription drugs and supplements that are not needed in the first place, a bad chair, an expensive ergonomic chair that is not really so ergonomic, or that you sit in wrong. It is is almost always quick and easy to start getting your life back and start feeling better right now. Don't wait.
In 2009, I ran the contest "What Does It Take To Sit Upright?" We had great results and winners. I will post them below when I have a moment, check back here.
Here were the examples:
Bad sitting Photo 1 at left- Note the neck pinched back, upper back rounded forward, and hip tilted back (see the stripes?)
What does it take to change to photo 2 at right? Easy, relaxed upright.Not stiff or exaggerating inward lower back curve.
Photo 1 by djwhelan http://farm1.static.flickr.com/227/499227037_7a913abfee.jpg
Photo 2 by magnusdigity http://flickr.com/photos/magnusdigity/157752211/
Here was the contest:
Conventional beliefs about posture include that you must do certain exercises or stretches or strengthening to change your posture. Is that true? Look the photos above and answer the simple questions below:
- What muscle strengthening or stretch is required to change from first (unhealthy rounded) to second (upright) sitting?
- Name the muscle(s) and action needed - don't just name a muscle, say which way it needs to pull.
- Explain why the same people (with the same tightness or weakness) who sit with the lower spine rounded forward (flexion) often stand with the lower back overly curved inward (hyperlordosis) - just the opposite.
Disregard the leg position in the two photos - the question is not how to move the leg, those were just the two photos I could find. Focus on describing how to change yourself to upright sitting without moving the leg (why? if you need to move the leg, then you are too tight for basic health. This question is how to restore that basic).
Use your brain. Partial credit applies. I will put the answers, explanations, and winners below. Check back here.
Hint for success:
Sit and try it yourself, don't go only to anatomy books.
The contest ran on my FItness Fixer column. The company removed the winning photos when the column ended and the comments section where readers left their answers. I will put them up here. Until then, here were the articles:
Fast Fitness - Contest: What Does It Take To Sit Upright?
Contest To Sit Up Straight - A Hint
Contest Winners - How Sit Up Straight
How To Remember Healthier Sitting:
- Please do not e-mail saying, "I read the article, now please tell me how to sit right" or "I am doing the exercises 10 times and still sit rounded, now please write me a personal article on how to stop my pain" or "It hurts to sit at the computer to read your book on fixing pain." Here is the answer now: If you stop hurting yourself with bad sitting, then the pain can stop. This free article tells how. More free articles on my Sports Medicine Office page. The books tell more.
- Watch how other people sit - it helps remind you why it is not a mystery when people hurt.
- Notice injurious positioning and movement habits, especially those featured in fitness and health magazines.
- Notice your own sitting habits.
- Don't waste money on expensive ergonomic chairs or sitting devices, rockers, straps, etc. Inmost cases, you can can sit well on a bucket. Fix your own chair or change it simply using simple principles above.
- Please don't combine other people's injurious stretches and exercises or ineffective sitting rules, then come back to me and say my work isn't fixing that.
- Get out of your chair often, straighten out, get outside for fun and real life.Try it now.
- Send me photos and your success story showing the principles in action. Prizes for best candid.
You Don't Have To Live With Pain
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