There are many ways people can improve their posture and some are as simple as taking a break from work, putting a device down, and stretching. There are also specific exercises that strengthen muscles needed to support good posture.
What advice do you have for people who are setting up a workstation at home so they can maintain good posture while sitting and working?
Dr. Luke Stringer: Great question, Liz, and it couldn’t be more prevalent during this pandemic, right? A lot of our patients are used to going to the office and the office is designed for people to be there, to sit, stand, and essentially work in a controlled environment. What people are not used to doing is essentially sitting at home at their kitchen table or at their breakfast bar for 10, 12 hours a day, five days a week. So, workstation and work ergonomics are really, really important.
So essentially if we’re sitting, there’s a couple of key points that we need to adhere to. But we also have to break up the amount of sitting we do because fortunately we’re bipedal, right? We’re upright. We’re designed to move. Sitting is essentially something that we’re not accustomed to. And when we sit for extended periods of time, over time, unfortunately it breaks us down, hence the term, sitting is the new smoking.
So, if we are sitting at home, it’s really important to kind of get in an environment or create an ergonomic environment that creates good posture. So, for example, feet should be flat on the floor. Your chair shouldn’t be too low or too high so you’re not putting too much pressure on the hamstrings or too much pressure on your hip flexors so try and have a 90-degree bend in your knee. Make sure your knees aren’t above your hips or your knees aren’t below your hips. It’s going to create a lot of stress and tension on the lower extremities. Make sure your pelvis and your lumbar spine is pushed right up to the back of your seat. If you don’t have an office chair at home and you’re sitting on a bar stool or a dining room chair, again they’re not built ergonomically for sitting for extended periods of time, grab a kitchen towel, a small hand towel, roll it up, put it right in the middle of your lumbar spine to help keep your lower back in good alignment.
And as we work up, shoulder blades should be touching the back of the chair. And then importantly, when we look out to our laptop, we should make sure our chin is four fingers off of our chest because when we’re in flexion, i.e. we’re bringing our head forwards and we hold it there over time that’s how we lose that cervical curve. That curve of life. And if you listen to our previous podcast, that’s going to create all the symptoms in your neck, neck pain, headaches, upper back pain. So, make sure your fingers are four inches off your chest. Your monitor needs to be around two feet away from you, 5 to 10 degrees in the monitor pointing away. And then shoulders needs to be nice and relaxed, shoulder blades nice and tucked in and tight at the back, 90-degree bend in your elbow, no flexion extension so no bend in the wrist.
So that’s how we should sit, but just sitting for 8 to 10 hours in that position is going to create a lot of stress. So, what we need to try and do is build in a couple of things, try and challenge yourself to stand up and work in a sound standing environment. But at least the last 20, 30 minutes of the hour. A good algorithm is sit for 20 to 30, stand for 30 to 40, and you should be up down, up, down, up, down all day. And then obviously we should be moving at some point throughout the day, regardless if we’re in the office or sitting at home, you need to be moving for at least 20 minutes a day, by doing that, you can decrease your chance of cardiovascular disease by up to 40%.
And also building in some postural breaks. We teach all of our patients here to strengthen those neck flexors at the front of your neck. That’ll keep that curve in, really working on those muscles that sit behind your shoulder blades that keep your shoulders back. And then really working on your pelvic floor, your core to make sure your hips are nice and stable so your lower back doesn’t do too much work.
How can people improve their posture while standing or walking?
You can do many postural exercises while standing. And essentially, the majority of our work with our patients is done while they’re standing. Now walking specifically, unless you’re working on a specific gait issue, pelvic pain, lower back pain, pain that refers into the extremities, then obviously you’ll have to go through an exam and figure out what’s essentially not functioning correctly and address that through rehab.
So, the postural exercises are going to be better than stationary. I’ve focused more on standing, but you can do things such as chin tucks. We call them the clicking, clucking chicken because they’re really important on activating those neck flexors that keep those neck flexors nice and strong. When we sit over time our head shifts forward and those neck flexors become really redundant. And then we do things where we just work on our shoulder blades, our scapulas retraction. So essentially our shoulder blades will be nice and flush to our rib cages where they should be.
Unfortunately, as we sit the muscles that keep our shoulder blades nice and tight to our rib cage switch off. So that’s how our shoulders start rounding, our heads start shifting forwards. So, there’s many exercises you can do just sitting down or standing up. We call them the wall angel and an exercise we call the Bruegger’s. Essentially, we’re just activating those postural muscles that sit between your shoulder blades. You should be doing that every day. You should be spending at least five to 10 minutes, at least once to twice a day, taking time to take postural breaks.
And then by doing that, you can keep those muscles nice and active. You can do sitting down, you can do standing up. Again, we educate all our patients to make sure they’re taking postural breaks throughout the day to make sure we don’t kind of build up those compensatory poor postural issues.
You did touch on this, but can you explain how people can improve their posture while using handheld devices?
Dr. Luke Stringer: Absolutely. So, this is an issue that we’re dealing a lot of, and unfortunately, we’ve seen a lot of it in our kids too, but screen time should be limited period for everybody, right? However, if you’re a parent and your kids are on the screen, you’ve just got to limit them. I’m not going to tell you how to parent, but you want to limit their screen time. But importantly, you want to watch how they are kind of using their device, their iPhone or their iPad or whatever it may be.
There’s nothing worse when I go out shopping with my wife, for example, go to the grocery store and we see a dozen kids with their chins down on their chest, just staring at their phone. It couldn’t be any worse for their spinal health. And for us as chiropractors, we all know that all these sensory disorders that are going through the roof, ADD, ADHD, there’s definitely a correlation between poor posture and poor spinal health.
So, I’d start with limiting their screen time, but you’re right. We touched on it a little earlier in the podcast. It’s just, how are you using the device, right? So, when you’re using any form of that device, a monitor on your computer screen, your laptop, your iPhone, your iPad, a good thing you need to focus on is keeping your chin four fingers off of your chest. So, it’s simple. If you’re on your iPhone, your iPad or on your computer, if you can take your four fingers, pinky finger through to the index finger and you can slide it comfortably under your chin, great. However, if you’re not able to slide those fingers under your chin, you’re in too much flexion. Your head’s coming forwards too much.
Our heads weigh 12 to 15 pounds, plus every inch we go forwards, that’s another 12 to 15 pounds of pressure on the spine and the soft tissue. So, over time that’s how we lose that poor posture. So, I would start with limiting your screen time. I would start with taking breaks. Break it up minimum last five minutes of the hour, every hour you are working, just get up and move around and obviously just make sure you’re in good posture. And that kind of four finger rule is something that we preach in the office and it goes a really long way.
What exercises should people be doing to help improve their posture?
Dr. Luke Stringer: Obviously it’s case dependent, right? And we can have poor posture in our neck and our upper back, or we can our poor posture in our lower back and our pelvis, right? So essentially, we’re in poor posture in our neck and our upper back, it’s called upper cross syndrome. Upper cross syndrome means all the big movers in the body, our traps, our shoulders, our chest, they essentially start to dominate and take over because they’re the big muscles, while the intrinsic muscles that we’ve discussed on this podcast that sit deep in front of the neck flexors, that sit deep between our shoulder blades, through inactivity, through being sedentary and not moving, these muscles get weaker and essentially switch off. So over time, it’s just these compounding issues. The big muscles work harder. They try and stabilize as well as they try and move and that creates massive amounts of issues, stress, and tension in our neck and our shoulders.
So again, exercises that we should be doing, unfortunately I can’t show you because we can’t show the listeners at home because they’re listening, not watching, but we’ve got to essentially focus on things going backwards. So, anything that involves the muscles in the back of our body. So, for example, drawing your chin towards your neck, it’s going to activate those neck flexors. We call those the clucking chicken. You should be doing those periodically throughout. Exercises that involve bringing your shoulders back and down and then moving your shoulders North to South is going to activate those muscles between your shoulder blades. And we want to make sure that we’re avoiding those muscles that kind of do all the work.
And then in your lower back, poor posture is called lower cross syndrome. So, we get really dominant in those hip flexors at the front of our hips. Why? Because we sit in that flexed position so that tissue shortens and then the muscles in your lower back start to work really hard. Why? When we don’t move our pelvic floor, our core is never activated. That creates stability in our pelvis and our lower back. So, when we’re not moving that pelvic floor switches off. So, when we go to move, the lower back does all the work. So, what do we need to do? We need to be moving while we sit. A couple of things we prescribe for our patients here is a wobble disk. Simple little inflatable disk that you put on your chair. So, when you’re sitting, it creates instability and that essentially activates the pelvic floor. Some of our patients go an extra mile and they use a blowup exercise ball, and they sit on that. So, they’re constantly moving and recruiting those little muscles and stabilizers.
Obviously, we should be doing good work outside of when we’re sitting. So, stretching the hip flexors, stretching the glutes and making sure we’re doing exercises that address the muscles that are used to be stabilizers and don’t get used. So, some pelvic floor work, some basic diaphragmatic breathing, some core bracing. Exercises such the planks are great exercise, and then also make sure we are activating the hamstrings and the glutes. So, things essentially like a glute bridge or a single leg glute bridge to make sure those muscles are nice and active.
What are some posture mistakes people make and how can they be corrected?
Dr. Luke Stringer: Posture mistakes can be across the board, right? A mistake might be made from how your workstation is set up when we’re sitting or how we’re standing at our stand-up desk. So, let’s start there. You’ve got to control the environment, right? So, make sure if you’re at home, you can jump on our website, we’ve got a kind of downloadable how to guide where there are diagrams and information on how to set up a workstation whether you’re sitting or you’re standing.
Then also you want to make sure you do the right exercises. And again, on that downloadable how to guide it discusses all the muscles we’ve spent a lot of detail in discussing. The neck flexors, the muscles that sit between the shoulder blades, our pelvic floor. A lot of times what people do is when they exercise, they really want to work out and work out hard, which is great. And we should be doing that, but it usually involves the big muscles. So, for example, lots of pushups is more chest than shoulder. Lots of pressing is more chest than shoulder. So, you want to be making sure you’re doing plenty of opposite of what’s in front of us. So, lots of pulling exercises, for example, and then make sure we’re doing lots of exercises that are going to activate the pelvic floor, the glutes and the hamstrings instead of everything being in front of us.
So, I think not necessarily mistakes per se, but just the environment that we put ourselves in over time can break us down. And then the way we address that environment is we just compound the issue. We do a lot of things that are in front of us instead of lots of things that are behind us in terms of using the muscles that keep us upright and stabilized through movement.
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