------------------------------------------------------------ POSTURE, FATIGUE AND SPINAL CURVATURE ------------------------------------------------------------ This chapter includes general posture information as well as a "secret" to greater comfort for computer users who suffer from back pain. I have put this little secret towards the end of this chapter since you need to absorb ALL of it rather than seeking only a "quick fix" for your back pain. Improper curvature of the spine and poor posture are the largest sources of most back pain. In fact if you wanted to read only two chapters of this tutorial to achieve fast relief from back pain, this chapter and the chapters on exercises would probably provide the most immediate relief. Posture governs the relation of the body's structures whether we are standing, sitting or prone. Obviously the shape of the spine is related to the muscle groups and is of critical concern. Things are not necessarily what they appear to be when you examine the topic of proper posture. For example, when a person stands we often think of the old advice to "put your shoulders back and stand tall." Good advice? Not really. When you force your shoulders back, the stomach usually moves forward to counterbalance the effort. This results in excessive curvature of the frequently painful lower lumbar area. Not a terribly good idea for optimum spinal curvature and back support. When a person is in an erect standing position a more ideal posture would display reasonably slight bending of the primary and secondary curves of the back. Good posture would provide a mild lumbar (lower back) curve, abdomen and buttocks not prominent or protruding, and head carried erect with shoulders not sagging or rounded. Obviously weight and height would adjust this picture which is for the most part an ideal. A person with reasonably good posture is also less likely to suffer sudden or chronic trauma when lifting, sitting or driving a car. Good posture tends to distribute sudden or chronic load on the back EVENLY rather than CONCENTRATING damaging forces in one region of the back which leads to eventual injury. An ignored principle of physics... When you apply a force to a curved surface, the greatest force buildup or stress is exerted on the CONCAVE or inner curve of the surface. Thus the inner curves of a poorly positioned spine suffer the greatest wear and risk for injury. The spine has cleverly evolved with specialized primary and secondary curves to counterbalance most of the forces of our erect existence; however, excessive curvature and poor posture contribute to wear and tear due to this imbalance. If you sit or walk with slouchy shoulders, rounded back or flabby abdominal and buttock muscles you WILL sooner or later experience back pain. Posture extends to other activities such as sitting and sleeping. This requires muscle tone and for some folks a conscious decision to lose weight and do some exercises. No amount of surgery, pain medications or good intent can have as much benefit as these simple changes in posture mixed with a dash of simple spinal exercises. Just what is good erect posture? While standing or walking this involves lifting your head up and tucking the chin slightly which flattens the upper cervical curve mildly. The crucial lower back (lumbar) curve where most back pain occurs needs special attention. Usually this means tilting the pelvis forward slightly as you walk or stand by contracting the powerful muscles of the buttocks. Relax your buttocks too much and the pelvis tilts rearward and the lumbar curve increases rapidly. Some involvement by the abdominal muscles may be needed to help the buttocks achieve the proper tilt of the pelvis. Simply taking a walk for 15 to 20 minutes twice a day may painlessly increase the strength of the buttocks muscles. A conscious effort to try the specific back-strengthening exercises described elsewhere will accelerate the process. Head forward and high, pelvis tilted forward and buttocks tucked in. Things may be a little stiff at first, but the relief in pain should be worth it. Try it right now: stand, tilt your head forward and tilt your pelvis forward by tensing your buttocks. Hold the position for a good 30 seconds and you should begin to feel a little tingling, almost pleasant feeling as your spinal muscles "stretch and wake up." Now slouch back into the old bad position and notice the difference. Try to memorize the sensation of how it FEELS and repeat this "reminder" when you are standing at the supermarket checkout or waiting for an elevator, after a while it will become your normal correct posture. Practice and good muscle tone goes a long way to relieve back pain. The idea is to slightly flatten excessive lumbar (lower back) and cervical (neck area) spinal curvature. Back pains from all other causes such as trauma, pregnancy, disc injury and other causes are frequently traced to poor posture and spinal curvature which weakened the structure of the back and led to the related problem. In the study of back pain, posture really is the starting point. Here's a simple test to check your posture. Stand with your back against a wall and your feet about 10 to 12 inches apart. Bend your knees slightly and lean forward just a bit so that only your buttocks touch the wall. Now slowly tilt backwards so that vertebra by vertebra you flatten each inch of your back against the wall. As you start to press your middle back against the wall you will notice that the lower lumbar section tends to lift or pull away from the wall. Temporarily try to hold the lower lumbar section against the wall as you continue to press the remainder of your spine against the wall as well. Keep your knees slightly bent during this time. Finally straighten your knees and keep your back flat. Finally walk away from the wall slowly while you maintain this position for a few moments. Study the sensation. This posture is probably too exaggerated for most people to hold for very long, but it will give you an idea of the "feeling" of a more erect posture. A little exercise and conscious effort to maintain a more straightened, less slouchy posture goes a long way to relieve pain. What about sitting? Good posture suggests sitting in a relatively firm chair with your back snug against the back rest and both feet flat on the floor or slightly elevated. If you have a tendency to lean, it is better to lean slightly forwards rather than backwards since the latter increases the lumbar lordosis or swayback curvature which is so damaging and painful. The excessive curvature of the lower lumbar area or "swayback" inwards towards the stomach of is probably the most common damaging posture misalignment. Swayback sufferers tend to be unusually susceptible to lumbar (lower back) pain. Remember that the spine is a vertical stack of bony vertebrae each cushioned by a shock absorbing disc. When a swayback condition persists, the rear or back edge of each vertebra is forced closer together and, over time, nerves which lie in that region can be painfully compressed and add to muscle spasm. A painful "locking" or "catch" in the lower back may develop, commonly referred to as lumbago. Shooting pains can sometimes radiate downwards into the legs (sciatica) as the pain intensifies and the compressed nerves react. Swayback or excessive lumbar lordosis is a condition which obviously should not be allowed to persist for these reasons. It can usually be corrected by conscious attention to posture, and mild exercises to strengthen weakened muscles. When driving, sit close to the wheel so that your legs do not stretch out. Another trick which relieves back pain on long drives is to occasionally lift your left foot and rest it on the edge of the door-jam next to the driver's door. This slightly raises your left knee and surprisingly adds comfort. While you drive occasionally tense your buttock muscles and try to reduce the swayback curve of the lower back if it is sagging due to fatigue. Sleeping posture is also important. Unless specifically recommended by a doctor, NEVER sleep on your stomach. This exaggerates the lumbar curve of the lower back and is the worst sleeping position. A relatively firm mattress is recommended for most people. Waterbeds and overly soft mattresses usually are generally not good for the curvature of the spine. Especially if you suffer from back pain in the first place. The best sleeping posture is to lie on your side with both knees slightly pulled upwards and tucked together. A small pillow or towel between the knees can lesson the bony contact between each knee joint. If you must sleep on your back, a slight elevation of the knees is the preferred position and some people place one or two small pillows underneath both knees to elevate them properly and thus flatten the lower lumbar curvature. During the night you will move and toss a bit, but if you train your body to sleep either on your side or back (or a little of both), gradually this will be the position you will adopt and your back will be more comfortable in the morning. Speaking of awakening in the morning, another trick which is useful for some people is to try to do the back exercises we will present in a later chapter upon arising from bed and perhaps soon after a "warm up" shower. This is because in the morning the spine is at its greatest anatomical length and is most supple and flexible at this time of the day. Also, the spine is usually not fatigued and tense from standing or sitting all day. Try this wakeup idea and see if it reduces back pain for you. It may take one or two weeks to adopt to these "new" postures and exercise suggestions; but they are medically sound and your only recourse is more pain and intervention by a physician or surgeon. Back to standing posture. Most folks notice that after standing for extended periods of time gradually a lower (lumbar) backache appears and to a small extent an upper backache. This is almost ALWAYS caused by the gradual unconscious relaxing of the muscles of the buttocks and abdomen. You sag and slouch into a "more comfortable" position only to find it less comfortable in the end. A simple trick to avoid this if you must stand for long periods of time is to place a small stool or footrest in front of you and alternately put one foot or the other on the footrest as time passes. This small trick takes a little strain off the lower back and keeps the lumbar curve somewhat straight and thus prevents fatigue. Bars and taverns usually have footrests in front of bar stools because it is more comfortable on your lower back so you will usually stay longer and perhaps buy a few extra drinks. No kidding! Here is my "secret" to back comfort for those of you who spend a lot of time with computers. Computer users will do just about anything to alleviate back pain. It is our most constant complaint. Here is my unorthodox method to reduce backache: I frequently spend 8 to 10 hours daily working with computers. Obviously, I am a good candidate for backaches. First, I sit for perhaps half an hour in a good quality chair with my feet just slightly elevated, torso slightly leaning forward. After half an hour I move both my monitor and keyboard to an elevated platform (old piano bench placed on the desk) which sits to one side of my desk. I then stand with both feet on a shock absorbing pad and alternately move either my left or right foot onto a small footrest as I stand and type. Periodically (every ten minutes or so) I consciously tense my buttock and abdominal muscles to keep the lumbar curve comfortable and tilt the pelvis forward into correct position. The footrest and shock absorbing footpad go a long way to alleviating back pain and lately I spend about 40% of my time standing and typing and the remainder seated. I have found that these adaptations to life with the computer produce better attention, more work and are comfortable at the end of the day. Computing while standing has become a fairly comfortable regimen. It also has the advantage of allowing me two positions (seated and standing) from which to work rather than one. I usually find the standing position workable at the beginning of the day and gradually move into a seated position as the day progresses and fatigue sets in. But I still try to alternate between the two positions regardless of the time of day. Try these ideas yourself, but allow a week or two of "practice" to achieve pain reduction results. There are no fast cures for heavy computer users and office workers. Lifting and proper posture is a neglected topic. Most folks generally recall something about "lifting with your back straight." But there is a lot more to it than that. Generally locking your knees straight and bending from the waist to pick up anything is an invitation to to increase stress as the critical lower lumbo-sacral joint. The heavier the object, the greater the chance of stressing a muscle or joint either temporarily or permanently. To lift something heavy, squat to the floor, both feet about a foot apart and "hug" the object close to your body. One way to visualize this is to pretend you are hugging a small child who wants attention but does not want to be picked up - the child wants you to SQUAT and come down to its level. Keeping the object "hugged" close to the body minimizes the leverage applied on the lower back. Lift STRAIGHT up with the powerful leg muscles and NOT the back muscles. This is one procedure you should practice a few times when you can concentrate on the fundamentals and not when you have to lift a heavy truck tire in the pouring rain some dark evening. You have to discipline yourself to lifting properly since all of us unconsciously lift the wrong way (bending at the waist) because it is quick and easy. And dangerous. A few words about posture and women. Although a woman's pelvis is slightly wider than a man's, the principles are the same when is comes to a discussion about posture. During pregnancy, as we will discuss in a later chapter, the tendency of the lower back to bend into a "swayback" position with an exaggerated lumbo- saccral curve can be pronounced. Additional lower back exercises may be prescribed by a physician to bring the spine back to its normal curvature after the woman has given birth. Another sensitive area of discussion concerning posture concerns the formative teenage years during which some young women can develop psychological sensitivity and embarrassment about developing breasts to the point that a pronounced "slumping or hunching" of the shoulders takes place. This psychological reaction produces poor posture (shoulders slumped forward) to "hide" developing breasts and may unconsciously continue into adulthood. This posture adjustment can produce back fatigue and severe pain and should also be corrected by consultation of a woman or teenager with her physician. In most cases simple back exercises and posture adjustments are sufficient as corrections. Severe back pain has also been reported in medical literature as occasionally related to breast implants and their effect on posture. In these reported cases, women who have poorly conditioned muscles of the back, abdomen or buttocks suddenly suffer extreme backaches with the additional weight or size of enlarged breasts. The reaction is not metabolic or based on the immune system, but is simply mechanical fatigue of the back and lower lumbar region due to the additional breast weight. In most cases a proper exercise regimen will correct the back pain. This is obviously a sensitive topic but might be considered by some women and discussed with a physician. Curiously, shorter people tend to have the best posture and, on average, a lower frequency of back pain. Perhaps this is due to decreased weight loads placed upon the back which is inherently an unstable structure. This may also be due to the psychological tendency to "stand tall" as a mild psychological compensation for short stature. Tall people typically suffer greater chance of backaches. Additional posture-related diseases have also been reported in the medical literature. Poor posture can affect the primary dorsal curve of the upper back and the higher cervical curve of the neck region. This usually develops from the same poor habits of standing or walking with stomach protruding, chest in and buttocks muscles out of tone. If the primary dorsal curve in the upper back begins to curve strongly for these reasons it can negatively affect the cervical curve and lower lumbar curve as well. Excessive dorsal kyphosis describes this condition. Also associated with this defect in the dorsal curve is a condition known as Scheuermann's disease which, although rare, is noted most frequently in teenage males. It is not entirely clear if this disease is caused by poor posture, genetic defects, diet or if in fact the disease causes the poor posture. Another relatively rare disorder is scoliosis which does not affect the front to back curvature of the spine but the side to side or lateral curvature. This condition is found most frequently among teenage girls, as reported within medical literature. When seen from the front or back, the spine of scoliosis sufferers bends in an S shaped curve which may vary from mild to extreme. The cause of the disease is not entirely understood. Back braces and physical therapy are frequently prescribed. Surgical correction is also attempted in some cases and bone to bone vertebral fusion is the usual procedure. Historically, polio also caused some forms of scoliosis. If scoliosis is allowed to run its course in advanced cases, impairment of pulmonary (breathing) and cardiac (heart) functions take place as the chest cavity assumes a characteristic sunken shape and compresses internal organs. Good posture begins in two primary areas: the pelvis (controlled by buttock and abdominal muscles) and head (neck and shoulder muscles.) Align those two and the rest of the spinal structure usually falls into line. The lower lumbar region of the back usually causes the most pain, so it is the area to work on. This means exercise and conscious effort to strengthen these areas plus conscious posture changes. This tutorial is merely a starting point! For further information on back care and back pain, be sure to register this software ($25.00) which brings by prompt postal delivery a printed, illustrated guide to back pain written by a physician plus two software disks. From the main menu select "Print Registration Form." Or from the DOS prompt type the command ORDER. Mail to Seattle Scientific Photography (Dept. BRN), PO Box 1506, Mercer Island, WA 98040. If you cannot print the order form, send $25.00 to the above address and a short letter requesting these materials. End of chapter.