Think of the three “S”s—Sitting, Standing and Sleeping—when making postural adjustments.
The word posture tends to evoke the image of a schoolgirl standing perfectly erect with a book on her head. More accurately, static posture refers to the way in which a person holds his or her body or assumes certain positions, such as sitting, standing or sleeping. The cumulative effect of the time spent in certain positions can lead to prolonged static-posture damage to both the musculoskeletal and myofascial systems of the body. Therefore, this effect must be addressed in conjunction with an exercise program to ensure that clients remain pain free and fully functional.
The human body is designed to be upright and weight bearing on two feet, with the hips extended under the spine to support the torso and head. This bipedal position has enabled us to move around for thousands of years and accomplish the various tasks needed for survival. Unfortunately for our body, the Industrial Revolution paved the way for standardization and automation of many tasks. The technological advancements of computers over the past 50 years have taken things further and launched us into a brand-new era that diminishes the need for coordinated multiplanar movements in our daily lives. Instead of standing erect and walking upright, people are spending more and more of their time in seated positions. Extended seated postures have a detrimental effect on vari-ous soft-tissue structures and muscles throughout the body.
From a musculoskeletal perspective, prolonged periods of sitting over many years are not good for the body. When a person is seated, the lumbopelvic hip girdle, thoracic spine, shoulder girdle, legs and feet are no longer required to engage in some of their major functions. The hips and spine no longer have to extend, and the feet no longer have to accept the weight of the body.
Instead, the hips remain in flexion, and the chair supports the body’s weight. As a result, the glutes no longer have to work to extend the hips, which soon become dysfunctional (Golding & Golding 2003). Furthermore, the hip flexors and abdominals become chronically shortened and compressed in this bent-hip and rounded-spine position that results from sitting (Wilson 2002). Therefore, when a person is required to stand after a prolonged period of sitting, other muscles that are not designed for the job initiate the movement. This can lead to overuse of certain tissues, potentially causing back, hip, knee and foot pain.
Several upper-body problems can also develop as a result of chronic sitting. When a person is seated in front of a computer or in the driver’s seat of a car, the arms and hands are placed in front of the torso. This forward position of the arms and hands causes the shoulders to round forward and the spine to flex, creating numerous restrictions in the fasciae and muscles of the torso (Freivalds 2004). Additionally, this forward position of the arms and shoulders means that the neck and head must adjust (by tilting the head upward) to keep the eyes aligned with the horizon or object (e.g., the computer screen, television or road). This adjustment of the head position creates an excessive arching of the neck, which over time can lead to imbalances, pain and dysfunction in these areas.
Prolonged sitting postures make it very difficult upon standing to erect the spine and extend the hips. Additionally, since the feet do not have to bear the weight of the body or deal with ground reaction forces when seated, their system of arches becomes weak. Thus, when we must stand, our feet are less able to accept our body weight, and the arches collapse (i.e., overpronation occurs).
When the feet are no longer capable of handling the body’s weight, a person may develop the habit of shifting from side to side in an effort to redistribute the weight and alleviate the discomfort. This continual shifting can cause problematic changes in all the structures of the body.
Footwear is another important factor that can contribute to the development of painful and dysfunctional standing positions. High-heeled shoes tip the body’s center of gravity forward. Hence, when you place your feet into shoes that are not parallel to the floor, the entire body has to shift in order to avoid toppling forward. The knees, for example, may have to remain slightly bent, which can eventually lead to knee pain. The raised-heel position will also raise the back of the pelvis, which can result in excessive arching of the lower back. Consequently, people who stand or walk around in high-heeled shoes for extended periods of time will often experience lower-back pain.
Chronic muscular imbalances and restrictions created by prolonged seated and standing postures can make it very uncomfortable when it comes to sleeping, particularly for those who lie on their backs. People with an excessive arch in the lower back often have very tight hip flexors (McGill 2002). Therefore, sleeping on the back with legs straight can pull the lumbar spine forward toward the legs. This will make the arch in the lower back even greater, which may cause pain. For this reason, people with such imbalances will likely prefer sleeping on their sides.
However, sleeping this way for prolonged periods can create problems as well. When a person is sleeping on the side, the arms usually drop across the front of the torso as the upper back and shoulders round. Over time, this sleeping position can lead to myofascial restrictions across the chest, front of the shoulders, and abdominals. Upon rising, this type of sleeper may experience pain in the shoulders, neck and/or upper back.
There are also many people who like to sleep on the stomach. Sleeping on the stomach can arch the lower back excessively and twist the neck. If you have clients who prefer to sleep face down, it is extremely important to encourage them to change this habit.
Many soft-tissue changes can occur from standing, sitting and sleeping in chronically misaligned postures. The impact of these prolonged static positions can be far-reaching and will have a direct effect on the success of your clients’ exercise programs. As such, it is important to incorporate corrective exercises and suggest non-exercise-related solutions to minimize the corporeal stress.