We have an ill-formed idea that leisure time is a modern invention—that we spend too much time crammed in office chairs and lounging on couches, and that’s why everybody has back pain or knows someone who complains about it. Eighty percent of Americans, in fact, will deal with back pain at some point in their lives, says Carisa Harris-Adamson, an ergonomist at the University of California, San Francisco.
People call blue-collar work “backbreaking labor” all the time, but back pain is as much of a white-collar, developed-country problem. People in hunter-gatherer societies and those who work physically demanding jobs in developing countries sit as much as most office workers do, but they don’t have back pain. And it’s because they sit differently.
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“In pre-industrialized societies, people were not sitting in one specific position for eight hours a day,” says Charla Fischer, an orthopedic surgeon at the NYU Langone Spine Center. In agrarian societies, she explains, every stage of labor involved a shift in posture: Imagine a person picking vegetables, putting them in a basket, and then taking the basket somewhere else to dump and sort the veggies. The stress load, likewise, was frequently redistributed to different back muscles. Contrast that with an office worker who sits in a computer chair with their legs out in front of them all day, she says, and it’s no wonder their muscles cramp, spasm, and get stiff from being in one position for too long.
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Most people with back problems slouch. We spend our days bent over when we sit, looking into computer screens that are too low, not eye-level, and we don’t stand often enough to give our back muscles a break, Fischer says. The rare times we do rise, we tend to stand with shoulders rounded and rolled forward. So we remember to “sit up straight” and “stand up straight,” as our parents and teachers would chant. Only you can’t sit or stand with a perfectly straight spine because the spine should curve naturally, Harris-Adamson says. Good posture doesn’t radically reconfigure alignment of the spine so much as it makes minor but important adjustments, Fischer adds.
To set your posture while sitting, shift your weight onto your pelvic bones, Harris-Adamson says, rather than on the end of your spine—which is too rearward. Once your weight is on your pelvis, squeeze your shoulder blades together to open up your chest, and make sure your head is balanced over your neck, but only if the chair supports that posture. Leaning against a properly adjusted back support will reduce intradiscal back pressure and muscle fatigue, she says. There’ll be a bit more curve in your lower back. It may feel weird and initially unnatural, but most people get used to it over time. Keep your feet on the floor, Harris-Adamson says—dangling your feet makes the back work a lot harder to keep itself in proper alignment.
It’s not just how you sit, either—it’s how long. “We recently did a systematic review and meta-analysis of sit-stand desks, and certainly prolonged sitting seems to be associated with increased low-back pain,” Harris-Adamson says. “So does prolonged standing.” She laughs at the seemingly contradictory advice, but it’s not that one is better than the other; it’s that people who move around more tend to have less discomfort in their backs, she says.
In other words, standing more isn’t necessarily the answer—people don’t tend to do that right either, she says. When standing, it helps to imagine a string attached to the top of your head, pulling you upwards. Keep your shoulders back and relaxed, suck in your abdomen, place your feet hip-width apart, and relax your knees. Fischer adds that you should lean back into your heels rather than place your weight in the balls of your feet. Good posture is enabled by a strong core of abdominal muscles, back muscles, and shoulder muscles. “When those muscles are stronger, then having better posture is much more comfortable,” she says, adding that she likes planks for working her core and allowing for a more comfortable standing alignment.
Fischer recommends a timer on your phone set to go off every hour. Discomfort is normal at first, but pain is a signal to stop. “If that posture isn’t comfortable for you, then don’t do it,” Harris-Adamson says. After all, the whole point of improving posture is to feel more comfortable in the long run. Constantly reassessing and readjusting your posture may seem like a nuisance, but eventually you’ll default to good alignment subconsciously.
If you have been sitting or standing with bad posture for a long time and suddenly correct it, however, you may feel fatigued and uncomfortable because your muscles aren’t used to holding you in that position, Harris-Adamson says. Likewise, perfect posture is often unrealistic at first, but if you remember frequently to reset your posture, sitting correctly will eventually become second-nature, she says.
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