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Posted on 12-11-2015

5 Basic At-Home Exercises to Give You the Best Chance to Battle your Bad Posture

(Especially if you sit for a living)

Chances are that if you’ve seen your Doctor, Chiropractor, Physical Therapist, or even trusted massage therapist for issues such as neck pain, shoulder pain, mid-back pain, lower back pain, or even hip pain, you’ve been informed that you have poor posture. I can’t even count the numerous times that I, as a chiropractor, treating a patient with any of the above mentioned symptoms, have asked the question “What do you do for a living?” or “What position are you in most of the day?” and the answer turns out to be “I sit at desk most of the day” or “I’m usually working at my computer”.  Chances are your provider making an attempt to address your issues usually begins with an evaluation of your posture, and then determining that, barring any direct injury or trauma, the likely cause of your problems is usually your posture. Even though poor posture can be a benign, natural process that occurs over time during the aging process we are constantly putting our bodies through the stresses of everyday life, the fact is not everyone is affected in the same way. According to the American Journal of Pain Management “Posture effects and moderates every physiological function from breathing to hormonal production. Spinal pain, headache, mood, blood pressure, pulse, and lung capacity are among the functions most easily influenced by posture.” (1) The evidence points to the ideology that poor upper to middle back posture demonstrates to “a trend towards greater mortality” as discussed in a study by the Journal of the American Geriatrics Society. (2)

A fairly new term and maybe something that has also been mentioned by your chiropractor is the dreaded “text neck”. With the ever growing use of our cell phones, tablets, laptops and PC monitors, postural issues are continually on the rise and only going to get worse. Over the past seven years mobile device usage has grown from .3 hours a day to 2.8 hours a day for the average adult. Comparatively our computer use has remained about the same over the same time period at 2.4 hours per day. (3) A recent article by Kenneth Hansraj, MD, who is the chief of Spine Surgery at New York Spine Surgery and Rehabilitation describes that as the head tilts forward its weight effectively goes from 10 to 12 pounds in the neutral position to as much as 60 pounds at 60 degrees of flexion, which is the typical position that we have while using a mobile device. (4)

Over time this forward head position leads to ligamentous creep deformation having lasting neurophysiological effects. This was demonstrated with a feline study that found the creep deformation that occurred over the first 30 minutes did not recover with 10 minutes of rest and was present up to seven hours later. (5) This idea can be visualized if you think about applying a slow steady pull to play-doh or silly putty for any length of time, and noting that it is never able to rebound to the previous state once the force has been applied. Even though our ligaments have a little more rebound or elasticity than play-doh, the point can be made.

The even more alarming find coming from this research has to be that the primary risk factor was not the load itself but rather the duration of the load. The implication of this is concerning given we spend an average of 2.8 hours a day using our mobile device and 2.4 hours a day on our computers.

In addition to the ligamentous deformation, muscle adaptations occur resulting in the ‘Upper Cross Syndrome’ (UCS) as described by Janda. The UCS is characterized by tightness of the upper trapezius, levator scapula and pectoral muscles along with weakness of the deep cervical flexors (forward head motion) and middle to lower trapezius muscles.

As these postural changes occur with the neck and upper body, our lower body becomes increasingly susceptible to changes due to adaptations as well. These include weakened back muscles as evident in a study by Sanches-Zuriaga that found a decrease in low back muscle activation after soft tissue creep, suggesting that prolonged or repeated flexion could increase the risk of injury. (6) These findings support the fact that prolonged sitting should be interrupted with breaks in order to decrease this risk along with exercise intervention.

For the purpose of this article the focus will be on the Active Subsystem (spinal muscles) as described by Panjabi in his spinal stability system model. The following five exercises can be used for most people and require minimal time and no equipment. These exercises will not only help with preventing the above-described deformation and adaptation risks, but also encourage you to stand up regularly and perform mini exercise breaks throughout the day.

We will start with the forward head posture as described by Harman and colleagues who found that this position is associated with weakness of the deep cervical flexor and mid thoracic scapular retraction muscles. (7) Additionally, shortening of the opposing cervical extensors and pectoral muscles was also noted. A combination of strengthening exercises for the deep cervical flexors and scapular retraction muscles coupled with stretching of the cervical extensor and pectoral muscles was performed for 10 weeks. The findings of the study demonstrated that a short, home-based targeted exercise program can improve the postural alignment related to forward head posture.

As described earlier, prolonged sitting and its effect on posture is not limited to the upper body alone but also affects the lower body. Tightness of the hip flexors along with an inhibition of the extensor muscles can lead to an aberrant motor pattern known as “gluteal amnesia” according to McGill. (8) He recommends exercises to enhance gluteal muscle function to unload the back in additional to hip flexor mobility with specific psoas muscle targeting. (9)

Based on the above findings the following exercises are suggested given they are ‘low-barrier’ homework for clients that they can perform daily without any equipment (Thank you to www.webexercises.com for the images and a reference for this article):

Head Retraction

Head-retraction_2

Begin seated, or standing, looking forward with shoulders back with good neutral posture. Activate core muscles. Attempt to draw head directly backwards, giving yourself a double chin (eww, I know, but trust me it will help). Maintain level head position. Do not tilt head up or down. Hold for two seconds. Return to start position. Beginners should start with 3 sets of 10 repetitions.

Shoulder Retraction

Scap-retraction_1-
Begin standing in good posture. Shoulders should be back and head up. Bend elbows to 90 degrees and keep elbows near sides. While maintaining good posture, draw shoulders back squeezing shoulder blades together, while also drawing them downwards. A stretch may be felt in the chest and front of shoulder. Do not allow shoulders to raise upward. Hold for 5-10 seconds. Beginners should start with 3 sets of 5 repetitions.

 Doorway Chest Stretch

Chest-Stretch-1

Place forearm on wall, or doorway, with elbow bent at 90º. Elbows should be slightly below shoulder level. While maintaining forearm contact, lean body into doorway until gentle stretch is felt in the chest and shoulder, if needed step through the opening with the leg corresponding to the side you are stretching. Hold for 20-30 seconds. Beginners should start with 3 repetitions on each side.

Lower back and hip exercises

As described earlier, prolonged sitting and its effect on posture is not limited to the upper body alone but also affects the lower body. Tightness of the hip flexors along with an inhibition of the extensor muscles can lead to an aberrant motor pattern known as “gluteal amnesia” according to McGill. (8) He recommends exercises to enhance gluteal muscle function to unload the back in additional to hip flexor mobility with specific psoas muscle targeting. (9)

Here two very effective and easy to perform exercises that clients can do during short exercise breaks throughout the day:

Standing Hip Flexor Stretch
Hip-flexor_1

Begin standing in front of a chair about 18 inches away. Place one foot flat on the chair seat. Slowly allow hips to glide slightly forward until a gentle stretch is felt on the front of straight leg. Hold for 20-30 seconds. Beginners should aim for 3 sets each on each side.

Glute Hip Bridge

HP1214_2

Begin lying on floor, facing up. Bend knees so feet are firmly on floor and arms extended to sides. Activate core muscles. Lift hips off floor to attain a bridge position with knees, hips, and shoulders in alignment. Slowly return to start position. Repeat for prescribed repetitions and sets. Initially, you may develop some cramping in the back of the thigh. A simple hamstring stretch, before and after, may prevent this from occurring. Beginners should aim for 3 sets.

All of the above displayed exercises are easy to execute and include minimal risks if performed as prescribed. Most important here is the regular execution and mid- to long-term adherence to the program. A calendar or timer that reminds you to take breaks and perform the exercise while allowing you to check off performed sets and reps could be a nice motivation for you and helps to track your progress. Another tidbit I like to tell my patients is to put their phone on the other side of the room or desk and set it to alarm you every hour or two, so that you have to stand up to turn it off, breaking up the length of time spent sitting, in addition to preventing the dreaded “text neck”, at least from one of your devices. 

In addition to these at home exercises, you should talk with your chiropractor in regards to what else can be done to prevent these symptoms and decrease the effects of a poor posture. If you have been dealing with these or any other issues, please give the office a call and we'd be happy to evaluate your posture, or determine the cause of your symptoms and give you additional advice or treatment as needed determinant of our findings. 

Courtesy of Dr. Travis Ahrens, Chiropractic Physician @ West Loop Spine and Stability

References

(1) Lennon et al. (1994). Posture and Respiratory Modulation of Autonomic Function, Pain, and Health. American Journal of Pain Management. 4 (36-39).

(2) Kado et al. (2004). Hyper­kyphotic Posture Predicts Mortality in Older Community Dwelling Men and Women: A Prospective Study. Journal of the American Geriatrics Society. Volume 52 (10) 1662.

(3) Bosomworth, D. Mobile Marketing Statistics 2015. Retrieved from:

http://www.smartinsights.com/mobile-marketing/mobile-marketing-analytics/mobile-marketing-statistics/

(4) Hansraj, K. (2014). Assessment of Stresses in the Cervical Spine Caused by Posture and Position of the Head. Surg Technol Int. Nov; 25:277-9.

(5) Jam, B. (2005). The Neurophysiological Effects of the Creep Phenomenon and its Relation to Mechanical Low Back Pain.

(6) Sanchez-Zuriaga, D. (2010). Is Activation of the Back Muscles Impaired by Creep or Muscle Fatigue? Spine. Vol 35, (5) 517–525.

(7) Harman, K. (2005). Effectiveness of an Exercise Program to Improve Forward Head Posture in Normal Adults: A Randomized, Controlled 10-Week Trial. The Journal of Manual & Manipulative Therapy. Vol. 13 (3) 263-176.

(8) McGill, S. (2010). Core Training: Evidence Translating to Better Performance and Injury Prevention. Strength and Conditioning Journal. Vol. 32 (3) 33-46.

(9) Cruz, D. (n.d.). Circle of Docs- Chiropractic Social Network. Retrieved December 11, 2015, from http://circleofdocs.com/5-simple-exercises-to-combat-the-effects-of-bad-posture/

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