Doctors of chiropractic have long emphasized the
importance of posture and other lifestyle factors in the body’s ability to
function optimally. In a broad sense, good posture can be considered an ongoing
battle against bad habits. “The body endures hundreds of insults each day,”
says Scott W. Donkin, DC, DACBOH, “but we have the choice of controlling how
they affect us. Once destructive habits are identified, people can change,
prevent and relieve both present and future physical problems. The quality of
our later years can be enhanced and many physical problems prevented if we
understand and deal early on with the underlying issues. Dr. Donkin is the
author of Sitting on the Job.
most don’t know is that the following should be a lifetime regimen for
everyone and not just when the back hurts. ACA Council on Chiropractic
Orthopedics vise president Gary L. Carver, DC, DABCO, says that when they first
get up in the morning, “People should use their hands and arms for support to
get into a seated position. Next, they should swing their legs to the floor and
stand up-using the hinge of the hips, rather than the back.”
once the body is upright, is it up right? In other words, are the muscles,
joints and skeleton in a balanced posture? Too often, the answer is “no.”
“As long as our body is performing, we take it for granted. We don’t
concentrate on what we need to do to maintain good posture habits,” says Leo
Bronston, DC, DABCO, DACAN, CCSP and secretary of the ACA Council on
Chiropractic Orthopedics. “Generally, we tend to hunch forward when we should
be rolling our shoulders back and opening up the chest wall. That is something
we need to practice-activating the proper postural muscles. We see many patients
who simply don’t know how to achieve a more balanced trunk and neutral spine.
Just as we learned to eat with a fork and that became automatic, we can train
our muscles for good posture and balance, whether we’re standing, rising from
a seated position, or getting out of bed.”
causes of poor posture are numerous, including subluxations, loss of
proprioception, weak muscles, poor eyesight, weight problems and injuries. In
addition, the added weight and pressure of pregnancy can alter the body’s
posture. Psychological factors, such as self-esteem and depression, can
contribute to poor posture, as well. Once established, poor posture begins a
chain reaction throughout the body. For example, it can cause stress on joints,
which, especially if the muscles are weak, can cause wear and permanent damage.
Eventually, damage to surrounding tissues can lead to more progressive damage
beyond the musculoskeletal system to the respiratory, circulatory and digestive
systems. Poor posture can also result from or cause fatigue, which has a
debilitating domino effect of its own.
is one of the most common symptoms of poor posture,” Dr. Donkin explains.”
To hold the body in a fixed and awkward position consumes a lot of energy and
when people slump forward in their cars or in front of their computers they
becomes shallow breathers. The body was designed to breathe most efficiently in
a good postural position, as when we push in our lower back so that our
shoulders align themselves over our hips. In that position, we not only breathe
in more air, but we breathe more easily. Seated tasks, which are often visually
and mentally demanding, consume a lot of oxygen, so if we’re not getting air
in and out at a good rate, then we have an oxygen deficit, which can take the
edge off our awareness. Also, when we breathe shallowly, the stroke volume of
the heart tends to decrease and overall circulation diminishes. Of course, this
is not life threatening, but it does affect awareness and concentration and the
body becomes more fatigued because it is not getting what it needs.”
Time Management is Key
Bronston points out that many patients begin the day by lifting children,
carrying heavy briefcases and laptops and driving to work. All of these
activities harbor potential for injury. The basic rules of lifting and carrying
are well known: when lifting, bend the knees, not the back and let the leg and
stomach muscles do the work. When carrying, keep objects close to the body. If
carrying on one side of the body, as in the case of purses and packs, switch
sides from time to time to achieve a balance. In addition, injuries while
lifting or bending can happen more easily when we are in a hurry, which is one
reason Dr. Bronston recommends time management.
are all so busy. Children are going to any number of events after school and
families seem to be torn in all directions. Without adequate planning, the day
becomes more stressful, which can lead to health problems in some
individuals,” he says. “Families need to slow down. When lifting children
and strapping them into car seats, for example, take the time to put them into
the seat. Certainly parents will have to struggle with small children who
aren’t being cooperative, so they really need to concentrate on using their
muscles and trying not to twist the trunk. They need to focus on what they’re
doing and try to maintain good posture to recruit the right muscles. Small
babies are easier, you can place a baby in a car seat outside of the car, which
eliminates all the twisting and reaching.”
in the car, parents need to adjust the seat so they can sit firmly against the
seat back without having to lean forward or stretch. Buckle the seat belt and
shoulder harness and adjust the headrest so that it supports the center of the
back of the head and keeps the back of the head close to the restraint to help
prevent whiplash in case of an accident. Keep both hands on the steering wheel,
have the knees slightly higher than the pelvis and pay attention, says Dr.
Bronston. “Don’t eat pizza or talk on your cell phone while driving. It’s
too distracting. Again, it goes back to time management,” Dr. Bronston adds.
“As busy as we are, we feel we have to eat or discuss something on the phone
while we are driving. And depending on what we are talking about on the phone,
that may raise our stress level. This is certainly not healthy, and it’s an
endangerment to others.”
Child-Sized Furniture a Must
Bronston says that schools are doing better at providing equipment scaled to
smaller bodies. “Schools have made significant accommodations for children,”
he says. “But in our own households, I don’t believe many of us make those
same accommodations. This can be stressful for kids. Furniture, such as chairs
and tables, can be too high for them and children can fall. It’s best to have
a smaller table for them to do their work at, rather than force them to use a
standard table and chair. If their feet cannot touch the floor, you can always
put a stepstool under their feet while they are sitting. Kids have traditionally
sat on books, but books can fall over and cause injury.” Another point to keep
in mind is that books are uncomfortable for children or anyone to sit on.
Bronston noticed how teachers were constantly bending over to address children
at school. “To be honest, I don’t know why teachers don’t have bad
backs,” he adds. “I get down on my knees to talk to the kids. Don’t bend
over at the waist. Get down at their level and make eye contact.”
In the Office
those working in an office setting, counteract the stress and strain of sitting
at a desk by taking breaks and alternating tasks that use different muscle
groups. Anyone who stares at a computer screen much of the day needs to blink
frequently and take time to let the eyes rest-glare and constant focus can cause
fatigue and strain. A host of ergonomically correct furniture and
equipment-desks, chairs, mouse-keyboard combinations, non-glare monitor screens,
polarized lighting to reduce strain and laptop platforms-are now available to
help ease the stresses at work. Roger Russell, MS, DC, FACO finds the new
wireless keyboards a boon to improved posture. “You can work with the keyboard
in your lap,” he says, which is a more natural position than working at a
desk.” Dr. Russell is president of the ACA Council on Chiropractic Orthopedics
and also holds a Master’s degree in biomechanical trauma.
workstation should be set up so that everything is handy- phone, mouse,
reference materials, reports- to minimize awkward stretching and reaching. When
talking on the telephone, use a headset if possible or a speakerphone. If those
are not available, hold the receiver in the hand. Never cradle it between head
monitor needs to be at eye level at a height that allows good neck posture.
Forearms, wrists and hands should be in a straight line. The elbow angle should
be at about 90 to 100 degrees and the keyboard should be as close to the lap as
possible. Position the mouse next to the keyboard. When using the keyboard,
strike the keys lightly.
should be adjustable to fit their occupants’ unique bodies and allow them to
sit comfortably with the back straight. Thighs should be parallel to the floor,
feet flat on the floor, and the back well supported. Slumping can cause
long-term problems. Dr. Donkin says armrests work only when they are the right
height and width apart for the person. If they are too low, for example, and a
person wants to rest his elbows on them, he’ll have to bend his whole body to
the side or crouch his body forward in order to reach them. Generally, if a
computer keyboard and monitor are positioned properly, armrests are not
Russell also cautions against turning the head to one side while working, as
typists often do. “We give our clients a list of head and neck range-of-motion
exercises they can do every two hours or so,” he says. “These breaks allow
them to stop, stretch the arms, stand up, walk around for a few minutes and get
the blood flowing.”
rising from the desk, use the legs more than the trunk. “Don’t stand up from
a seated position using your back muscles, but hinge at the hips,” Dr.
Bronston says. “Use your arms for support and put your weight on your feet.
Then, hinge forward at your hips, as though you were going to do a
Many times patients are so concerned about
their work tasks that they forget about posture. To counteract this, Dr. carver
uses psychology. “We get them to be detectives. They watch other office
workers to see if they’re doing things that might be harmful. Then we get the
patients to analyze themselves. We hear some interesting responses from that
process. Patients’ posture starts to improve and the next thing you know,
they’re passing the information along to their fellow workers, who also start
to improve. That’s nice to see, because a large percentage of people lose work
every year due to back-related conditions.”
job requires a lot of standing, Dr. Russell recommends a non-fatigue padding for
floors to reduce stress. While standing, people should keep the spine straight,
bend the knees slightly, change feet frequently and if possible, use a footstool
to help distribute weight by resting one foot on the stool.
Travel Posture Tips
travel is a minefield of potential health hazards. For starters, heavy
suitcases, laptops and briefcases can cause serious strain and discomfort.
“travelers should invest in a wheeled suitcase that has a sturdy handle,”
advises Dr. Bronston. “And don’t always carry it on one side-take frequent
breaks and transfer the weight to the other side. Don’t wait until you are
don’t try to carry too much. Even wheeled suitcases can cause problems to the
neck, shoulders and lower back when pulled from behind. “When you’re
dragging a suitcase, briefcase and laptop behind you and you’re weaving
through a large crowd of people, it’s very strenuous,” Dr. Carver adds.
“And I often see people reaching back behind them to get a briefcase or laptop
out of the back seat. It’s much better to get out, open the back door and
seats are notoriously uncomfortable and again the one-size-fits-all attitude
lies at the root of the problem. In a recent study Dr. Donkin conducted, 100
women were surveyed. Most were dissatisfied with the seats.
you are not the right dimensions for your seat, you’re out of luck. There is
no adjustability,” he says. “for people who are taller, the headrest tilts
their heads forward. If the forward curve of the backrest doesn’t match your
back, you tend to slump. That, plus the relatively long period of time you are
in the seat, makes it very strenuous.
Donkin has also researched hotel beds and pillows and gives them low marks for
excessive softness. He says many pillows, especially for sleeping on the back,
are too thick.
Don’t Tough It Out
Construction and other manual labor occupations
put different stresses and strains on the body. Problems are exacerbated by a
pervasive “tough-guy” attitude that leads to trouble when, for example, a
worker decides to carry a load in one trip when he should do it in two or three.
The same attitude can cause problems when a laborer won’t ask for help when
lifting heavy objects. To get off the right start, manual laborers should start
with warm-up exercises similar to those performed before sports activity, though
Dr. Russell finds this is a difficult group to convince because many of them
believe that work gets them into good shape.
have blanketed misconception that when they do heavy manual labor, they are
essentially working out. I always tell them, “You’re not working your body
out. You’re repetitively stressing your body.” They need exercises to keep
their stomach, trunk and back muscles strong. Even if they are lifting
correctly, they should be doing supplemental exercises and stretches to lessen
the chance of suffering an injury.
problems arise in factory and assembly-line settings where, with feet planted
firmly in one position, workers are twisting and turning their shoulders and
hips, which can lead to repetitive-motion injuries. “We have a rule: Your nose
and your toes should face your work,” Dr. Carver adds. “It takes just half a
second to turn those feet and get yourself lined up correctly. Something that
simple can really make a difference in activities and help eliminate fatigue and
posture is but one component in a healthy lifestyle. Exercising, getting a good
night’s sleep, drinking plenty of water and eating a nutritious diet augmented
by nutritional supplements contribute not only to health but to the ability to
heal after injury.
with a healthy lifestyle heal so much faster than sedentary, obese
individuals,” Dr. Russell says. “Also, other factors, such as high blood
pressure, tobacco, recreational drugs and excessive alcohol, all contribute to
Bronston stresses the importance of nutritional supplements, especially calcium
and vitamins, for maintaining healthy frame and posture. “Most people don’t
realize that bone strength is only built through the first two to three decades
of their lives and it decreases after that,” he explains. “There are studies
that show that the healthier you can build that frame early on, the longer
you’ll retain it. You will lose some, but you’ll have reserves and a healthy
lifestyle can help retain bone density longer.”
is essential, not only for its cardiovascular benefits but also to develop and
maintain flexibility. “You can avoid a lot of injuries if you’re
flexible,” says Dr. Russell, who has a black belt in kenpo karate.
“Most injuries result from tight contracted muscles. I like to get
everybody on a good stretching regimen that can take as little as 10 to 15
minutes after work.”
Stretch and Strengthen
Dr. Russell gives out exercise handouts, based
on the regions where strengthening and stretching are needed. He has developed
handouts for approximately 30 conditions, each featuring a brief explanation in
layman’s terms, exercises, supplements that may help and other helpful
side of the exercise sheet has stretching exercises. The other has strengthening
exercises,” he says. “I like
patients to do the stretching daily and the strengthening three times a week.
People really appreciate the stretching and strengthening program because they
understand that if they will continue it, they will help themselves get over
this injury and help prevent subsequent injuries. I’m very conservative and I
try to get people out from under my care as quickly as possible. These handouts
are something they can look at even when they’re not in the office, and they
serve as a reminder of what they need to be doing on their own.”
Sanna, DC, president of Breakthrough coaching, believes doctors can develop
techniques to help patients make important lifestyle changes.
of chiropractic provide the feedback loop of accountability, he explains.
“Human beings seem to hate change. We can’t create long-term changes in our
patients’ structure and biomechanics if they continually undo all of the good
that we have done in the office. It is human nature to return to familiar habits
in the home environment, even though those habits may be the cause of the
problem to begin with. If a patient can adopt a new behavior for 30 days, the
likelihood of that behavior becoming a habit increases exponentially. Patients
who remain under care past four weeks of care-past 30 days-are very likely to
complete the entire program recommended to them. Doctors should seek to
reinforce their biomechanic and ergonomic instructions frequently during that
period. This means telling patients that they will be checking on them.
Audiovisual aids, such as illustrated handouts, videos and one-on-one
instruction, should also play a dominant role during this period.
patients know that the odds favor their condition returning unless they comply
with the doctor’s instructions during the initial phases of care also
increases compliance. No one wants to waste his other time, energy and finances
correcting a problem that will only be solved temporarily. Share with your
patients your desire for the most cost-effective and permanent solution to their
problems-creating a lifetime habit of excellent spinal health.”
is bad for posture if it is too soft and/or does not fit. Dr. Donkin researched
recliners for Smart Money magazine and found that while they are comfortable,
most are not supportive. “They encourage a forward slumping position and a
backward curvature of the lumbar spine,” he says. “Find a chair that
supports good body position and is comfortable. Cushions on couches are often
soft. We need to change the density of the foam and use pillows or add-on
devices to complement the natural curve of the lower back.” What about those
cheap molded chairs? “Melt them!” he says. “There’s no give in plastic.
They’re very uncomfortable. There’s no good interface between the chair and
activities, such as housework, lawn work, and gardening, can also cause
problems. A few tips from the doctors include:
some warm-up exercises before beginning.
lock the legs
the waist as a hinge joint and get the whole body working together. Never
bend from the waist.
reaching or get onto your hands and knees so that the reach is supported.
sure tools, such as mops, brooms, shovels and hoes have sufficiently long
handles (use handle extenders if necessary). When using tools, stand
straight with the legs offering support.
moving to the side, step in that direction rather than twisting the body.
house and garden work in smaller sessions, rather than all-day marathons.
self-propelled vacuum cleaners and lawn mowers.
Russell also advises his patients to take care of the often-overlooked
hamstrings. They tend to shorten without exercise and there are no everyday
activities that strengthen them. “If the quads are toned and the hamstrings
are not, the hamstrings will pull. It’s the same with the rotator cuff in the
shoulder. When people lift weights, they do bench presses to get their chests
big, but they neglect the rotator cuff and end up with insufficiency problems.
If you look at them, you’ll notice that their shoulders are often hunched
forward and their hands are more in a coronal plane. Normally, the hand should
just be at the side with the palm at sagittal plane.”
Donkin believes a patient who pays attention to proper posture and lifestyle can
be saved from the debilitating “dowager’s hump” that is often erroneously
attributed to “natural aging.” “That’s how we’re accustomed to seeing
people age, but it is more a product of habit than destiny,” he says. “I’m
continually amazed at the work of engineering and the art of movement that the
human body is able to accomplish. The body has an inherent mechanism-the
principle of balance-that workers with gravity rather than having gravity work
against it. For example, the spine has seven cervical vertebrae and five lumbar
vertebrae with a lorthotic curve, for a total of 12. And there are 12 thoracic
vertebrae that have a kythotic curve. That’s a balanced position that is
relatively effortless. If, however, you break that balance, then a set of
dynamics takes place that requires energy to maintain. If we look at how much of
our day is spent in an out-of-balance position - standing, sitting, and sleeping
– we will find that as little as one percent of our day is in a truly balanced
position. That’s why what we typically call natural aging seems inevitable.
But it is not. If we can keep our eye on how it is that the body moves and works
naturally in accordance with the laws of nature and the way it was engineered,
we will have the keys to healthy longevity. As doctors of chiropractic, we face
a rather daunting task, but also a huge opportunity. If we can help people
understand the true mechanisms of how the body is built to perpetuate itself,
and that it can have a long and very healthy life, then we can add a new
dimension to our practice.”