The spine is a beautifully engineered structure, and we know posture is good if someone can effortlessly maintain normal position and movement for extended periods of time. Maintaining normal posture is a function of the ligaments that support the spine and legs and also of normal tension in muscles. When any component of the balanced spine is moved off center, this effortless state is altered (fig 11.1).
Every day, your spine enables you to accomplish a number of tasks without pain. Think of it. Your spine supports your body when you lift a large object, and it stays straight when you make it sit in a car on a drive from Washington, D.C., to Boston, with only one stop for gasoline. If your spine is positioned correctly while you accomplish these tasks, you will suffer no ill effects. However, if a heavy load is off center, which twists your back, or if the car seat offers no support, you will probably develop back pain.
When lifting any object, your feet and your back should be going in the same direction. You should face the object, bend your hips and knees, and lift with your legs, not your back. The object should be kept as close to your body as possible. If you can, it is better to lift the object from a height as opposed to lifting it from the ground.
If you must lift heavy objects frequently, consider using an abdominal corset to increase intra-abdominal pressure to support your spine. These corsets are not magic—they don’t work if they aren’t closed around your body. At one of the local hospitals, I noted that many of the hospital employees leave the corsets open. A recent study showed that most people who are given instructions about using abdominal corsets still use them incorrectly. However, the corsets may be helpful, even if left open, if it makes you remember to lift with your legs, not your back.
Standing in one position for a length of time can lead to fatigued muscles in your lower back. You may have experienced this feeling at a party where no chairs are available, or in a museum with no place to sit down. The upright posture increases the curve in the lumbar spine and stretches the muscle (psoas) in the front of the spine that travels to the hip. Lift one leg to rest on a stool. Transfer weight from foot to foot, or flatten your back with a pelvic tilt (see chapter 8). These positions take pressure off the psoas muscles and the curve of your back. Do these with any activity that requires prolonged standing, such as ironing, giving a lecture, or painting a wall.
A good sitting posture requires that the height of the seat allows your feet to be flat on the floor, with your knees at slightly above 90 degrees. The back of the chair should support the lumbar curve. Chairs used in offices have an adjustable back and wheels, and the tension and position of the back support should be adjustable along with the height of the seat.
If you are experiencing back pain, the best chair for you has a firm upholstered seat, with a firm straight back and armrests. Wait to use the soft, sofa-type chair when your back pain has totally resolved. In a soft chair, your back is constantly making adjustments to support your spine, and these tiny adjustments can cause fatigue or increase pain because your back is working very hard. When you sit in a chair with firm support, the muscles can relax because the chair supports them.
Many of us get into trouble when we stretch. You’re the last one on the plane, so you have to stretch to squeeze your carry-on bag into the overhead bin between suitcases that seem to weigh a ton. Or you have to stretch across the bed to tuck a sheet under the corner. Maybe a bag of groceries has shifted to the farthest recesses of your car trunk. In these situations, you may stretch to reach, only to recognize that you are about a foot too short for the task! About five seconds later, the muscles in your low back and side have realized this fact, too, and now they are in spasm.
The simple answer to overstretching is to get closer to the object you want to move. If it is above your head, get a step stool. (If it’s in an overhead airline bin, ask for help.) If you must reach the other corner of the bed, put one knee on the mattress and move closer to the corner. Instead of bending over to vacuum, kneel down on your knee to keep your back straight, depending on the type of vacuum you have, of course. Place packages in the front of the trunk, or on the backseat of the car.
Avoid Back Fatigue
Never stay in one position for an extended period of time. Whether you’re standing or sitting, change the position and move around at least once an hour, more frequently if your back quickly fatigues. Constant contraction of muscles makes them fatigue, and once that happens, they start to ache. Aching muscles are weaker muscles, and once their functioning is compromised, you are at greater risk for injury.
It’s easy to forget simple prevention tips. For example, you may sit like a prisoner on an airplane. But take a stroll to the lavatory even if you don’t need it. If you sit at a computer, remind yourself to get up to get your muscles moving. If you spend hours on the phone for your job, get a headset if possible, which allows you to get up and walk around. All these activities improve the function of your lumbar spine, and it will thank you by aching less.