Prevent Back and Neck Pain When Sitting

Stop Back and Neck Pain from Long Sitting-
Desk, Computers, Trains, Planes, Cars, Buses, Internet Cafe, and TV

© Jolie Bookspan, MEd, PhD, FAWM
Director, Neck and Back Pain Sports Medicine
and the Academy of Functional Exercise Medicine

The training and pain prevention methods developed by Dr. Bookspan
are used by top spine centers in the United States and abroad

With good sitting, you can sit long periods without pain. Most lists of instructions for sitting without hurting your back tell you to sit in exact ways at exact angles. This is uncomfortable and not necessary. Instead, this article shows the concepts of how and why strain and injury 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. Not all exercise is medicine. Not all medicine is healthy. We change that.

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Why Does Slouching Hurt?
Sitting with a rounded back does several things to cause injury and pain. Rounding forward (slouching) when sitting holds the muscles in a longer than normal position, which weakens them. It also slowly degenerates your discs, the little cushions between your back bones (vertebrae), and pushes the discs outward to the back. This is how discs herniate, also called a slipped disc. A slipped disc can bulge outward enough to press on nearby nerves, sending pain down your leg. This is called sciatica. This is easy to prevent.

Rounding your back pressures discs and soft tissue in your neck, your upper back, and lower back. Over years the discs can be pushed outward (herniate), especially the neck and the lowest one that takes the most weight when you sit and bend badly. That hurts. (The lowest disc and back bones are shown in the drawing.)

When Do You Round Your Back?
Check to see if you round your back when sitting.

Do you round your back all day at work, then round to "relax." No wonder your neck or back hurts.

A problem is that many kinds of seats have a round (concave) back. It's common to sit in these round chairs and allow your back to round to fit the round chair back.

Check to see if you not only round into the chair back, but hunch forward of the chair or put a pillow behind your head, which pushes the head further forward.

Another common way to hurt your back sitting is to sit away from the back of the chair, and create a "hammock" out of your spine, sagging between the buttock and the upper back. Your body weight presses down on your low back discs.

Simple Pain Prevention
Instead of sitting forward in your chair, move your hip all the way to the back of the chair, and lean slightly back in comfort. If the chair back is rounded, put a small 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.

Preserve the normal small inward curve instead of rounding to fit the chair.

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 natural lumbar space between your low back and the chair. Lightly press your upper back against the chair so that the low back does not press your arm, but rests lightly. It should feel comfortable. 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, 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 foam lengthwise to make two lumbar rolls:

If a foam lumbar roll is too big, cut it lengthwise, then you will have 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 fell 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: Lift your upper back against the chair instead of pressing against the roll. Don't force into unnaturally straight or arched posture. Keep head up, not tilted or craned forward.

A common mistake is to 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 without strain. 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. Depending on your height, you can lower your seat a bit so you don't have to reach down for the desk.

Long Sitting for Buses and Flights
Commercial airline, bus and train seats are often rounded, encouraging prolonged, enforced rounding.
- Use two pillows, 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. Sit upright and lean back to rest the back of your head against the head rest.

For the very rounded seats common in flights and buses, use two pillows 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

Don't Forget To Get Up
No matter how well you sit, it's still a lot of bending at the hip. Muscles at the front of the hip will eventually shorten from this. Short, tight hip muscles add their own posture and achy hip and back pain problems. Stand up and straighten out. Tip your hip under you to straighten it from the bent "behind-stuck-out" position - see the free abs article and the back pain article for how.

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.

Don't forget to get out of your chair and stretch the other way

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. You are the one to determine your positioning,not the chair. Keep it simple. Sit preserving the small inward curve of your back and you will prevent injury and 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. It is is almost always quick and easy to start getting your life back and start feeling better right now. Don't wait.

What To Do Next
- 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. The books tell more.
- Watch how other people sit - it helps remind you why it is not a mystery when people hurt.
- Use principles learned to identify and eliminate the cause of your own pain - Notice injurious postures, especially those featured in fitness and health magazines
- Notice your own sitting habits.
- Get out of your chair every now and then, straighten out and keep better habits.
- Send me photos and your success story showing the principles in action. Prizes for best candid.

You Don't Have To Live With Pain

What To Do Next-
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