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November 2018 (Vol. 3 Issue 9)

The end of back pain

About the author: 
Montana, Bowman, Baniel Montana, Bowman, Baniel Montana, Bowman, Baniel

The end of back pain image

In this special issue of WDDTY, we offer a trio of articles to help you tackle back pain that results from our modern lifestyles. Biomechanist Katy Bowman offers the best positions for working at a desk, NeuroMovement® specialist Anat Baniel provides three exercises to combat sitting and our reporter Cate Montana investigates three new therapies that get to the root of the problem: faulty posture.

Standing pretty

Now that sitting has been recognized as the latest health hazard, we’re all told to stand at our desks, but biomechanist Katy Bowman has another answer.

Chances are you’ve read a headline that screams something like ‘Sitting is the New Smoking!’ These headlines imply that sitting, like smoking, is statistically associated with numerous health issues, including death from cardiovascular disease and cancer, and that it will take some time before we all wise up and quit.

In light of sitting research and sit-less campaigns, health-minded individuals have been super-motivated to get out of their chairs and onto physio balls, standing workstations and treadmill desks. The options to sit less are endless, so the notion that standing in one place is the solution to sitting so much reminds me of the joke about all accidents happening 15 miles from your home. “I read that all accidents happen within 15 miles of one’s house, so I moved.” Or “I read that sitting kills, so now I’m afraid to stop standing.”

But sitting itself isn’t really the problem; it’s the repetitive use of a single position that makes us literally become ill in a litany of ways. Your muscles will adapt to repetitive positioning by changing their cellular makeup which, in turn, leads to a reduced joint range of motion. This muscle-and-joint ‘stiffness’ can lead to rigidity of the arterial walls within these muscles. The good news is that, because we’ve all been sitting (static) the same way for decades, changing our position (standing more) can improve our health, as can moving intermittently throughout the day.

As a biomechanist, I help people understand that the stance of the body on a gross level (posture) affects the shape of its cells. In other words, the way you’ve been sitting has changed the tiny parts that make up your structure, like the shape and density of your bones, the length of your muscles and tendons, and the resting tension in your connective tissues. This adaptation on a deeper, cellular level to sitting means that reaping the benefits of not sitting so much requires more than just swapping one static position for another—it requires an entire overhaul of the way you think about and move your body.

Indeed, the ‘all you need to do is start standing’ advice made me realize that a more thorough explanation is needed.

In many cases, the physical effects of sitting are just as much created by repetitive geometry (always sitting in the same way) as they are by the metabolic changes that come from being sedentary. So sitting differently can improve your health in the same way that standing can on a cellular level.

But ‘standing’ is not the simple, turnkey solution we think it is. Every way of standing is not equal; some ways will create more positive adaptations.

Heralding standing still as the solution to sitting still perpetuates the problematic belief that we can indulge in a vast amount of stillness—whether sitting or standing—and still have the level of health necessary for a thriving quality of life.

Effects on your arteries

Arteries are arranged specifically to maximize pressure gradients and to keep blood flowing smoothly, but this all changes with posture. Prolonged alterations in arterial geometry can change the way blood flows, creating scenarios where the loads on the vessel wall induce cellular changes that cause them to shift from atheroprotective (protective against plaque formation) to atherogenic (promoting plaque formation).

In fact, the amount of sitting typically required for office work is associated with increased coronary artery calcification, an early marker of heart-disease risk. One study analyzing heart scans and accelerometer data (how much people move) from more than 2,000 adults found that every hour of sedentary time on average was associated with a 14 per cent increase in coronary artery calcification. The association between calcification and sitting was independent of exercise and other traditional heart-disease risk factors.1

For decades, researchers have been trying to figure out the best way to organize the body for optimal performance at the office. The underlying flaw in much of the research—or at least in its presentation—is that it fails to highlight the use of a single position as the problem. Our quest to find an optimal position for stillness will always be frustrated by the problems inherent with a lack of movement.

Fortunately, given our new understanding of the importance of all-day movement as opposed to exercise buried in a mostly sedentary day, a new trend in health research is to look at the physiological and biomechanical effects of sitting behaviours.

This is why the sedentary desk—whether a sitting or standing one—is a problem. If we keep trying to solve the ‘what’s the best way to sit at my computer’ problem, we’ll miss the answer: ‘as little as possible’.

But you still need to work, to sit at your computer and commute with regularity—which can be included in figuring out how to use greater ranges of motion to prevent our muscles and other body tissues from atrophying due to movement deficits.

There are evidence-based ways to sit and stand better, but the conditions that make them better are limited. Which is why, in addition to making postural adjustments to introduce new body loads to work different muscles, you also need to move more throughout the day.

The newest research shows you can be active (completing your daily gym workout or logging ‘ran 10 miles today’ on your marathon-training programme) and still be sedentary (commuting every day to your desk job and consuming extensive digital entertainment during your leisure hours).

The perfect workstation

The key to finding health through an alternative workstation is to make sure your setup is as fluid as possible. The more time you spend at a ‘fixed’ station—even a super-fancy one with a five-star rating—the closer you’ll be to sitting all day. Standing is great after a decade of sitting, but with no refreshment of your mechanosensors (tiny sensors in your cells; see box, right), your body will simply begin a new set of adaptations to your new static position. And adaptations do not necessarily equal improvements.

So, if you sit cross-legged in your chair as you’re reading this, you’ll be doing your body better because you’re loading different parts. Try one ankle over your opposite knee. After a few minutes, switch to the other. The combinations at a workstation are endless.

Standing workstation kits

The standing workstation is a rather basic concept—move your keyboard and screen to a higher platform that doesn’t require you to sit in a chair. You can do this quickly and inexpensively with stuff you probably already have.

Prefab stand-up kits are stable and safe for office use, which can make transitioning at work easier if you need approval from your supervisor or human resources department. The only drawback, if you can call it that, is that a fixed setup might limit your options when your body needs to sit down.

Most upper-body parts are desperately underloaded and underutilized in comparison to the legs. The shoulder’s range of motion is mind-blowingly underused, and a bonus of the latest separated keyboards is that, if you want, you can work with your hands a greater distance apart than with the typical placement found in the usual keyboards. When you move your hands apart, the bones in your shoulder joint have to change position, which is a good thing for the muscles, blood vessels and nerves there. Issues like shoulder impingement syndrome (bursitis, bicep tendon tears) and thoracic outlet syndrome are brought about by insane amounts of stillness surrounding even more insane frequencies of tiny movements (like clicking your computer mouse).

Treadmill desks

There are indisputable benefits with treadmill desks; they allow you to keep moving in a way that’s great for your mind, metabolism and circulatory system. In one study, 18 subjects were given a text and emails to read while they either sat (control group) or walked at a treadmill desk. Ten minutes later, everyone was given a quiz on what they had read; those who were walking answered correctly a greater percentage of the time.3

Nevertheless, there are still many yet-to-be measured potential drawbacks that, over time, might have profound effects on your physiology and health.

To move through this world, you can either push backward, using muscle force to move forward (think of a paddle pushing against the water to move a canoe forward), or lean and fall forward, letting gravity do the work as your weight pulls you toward the ground in front of you.

Our natural, reflex-driven gait involves a big posterior push-off. This is a complex muscle-driven event that uses the lateral hip muscles, glutes and hamstrings. Walking or running in this manner keeps your torso upright and spine stable, loads the pelvis and hipbones optimally (strengthening them where they should be strengthened), and keeps frequent loads on your knees and hips at a level they can handle.

But this posterior push-off (rowing action) of the leg requires that the ground be stable. The belt on a treadmill is not fixed, but already moving in the direction you’d want your leg to be going, which means you need an entirely different way of walking to deal with a treadmill. When you’re on a treadmill, your body, instead of firing muscles to push back, is forced to catch up to the moving belt—which means you have to actively lift your legs up in front of you. While the walk may look the same, the pattern of muscle activation involved in walking on a treadmill is entirely different from what’s involved in walking on land.

The gait we are forced to use while walking on a treadmill is a recipe for future injury, the ingredient list being one part repetitive hip flexion (a movement pattern for which people visit a physical therapist to learn how to undo, in the event of particular injuries and disorders) and one part repetitive and excessive blows to the leg-stuffs (foot, knee and hip tissues) that are used to catch and cushion millions of tiny falls.

By using a treadmill, not only are you missing out on the many benefits of a natural gait (like strong glutes, which help support your pelvic floor), but you’re actually creating tiny negative outcomes that, over the long term, could add up to overworked knees, hips and lower back tissues, to name just a few.

If you’re currently experiencing musculoskeletal issues of the hips, lower
back, pelvic floor or knee joint, then logging millions of hip-flexing steps could exacerbate these issues. Instead, build small actual walks across the earth into your workday—walk for three minutes every half-hour of your eight-hour workday, and you’ll be moving for an extra 48 minutes each day.

Adjustable workstations

The best workstation is one that gives you endless options. It’s more helpful to think of every workstation as an adjustable one, as simply changing the way you sit can change your health for the better.

Whether you’re at a standing desk or in one of the hundreds of queues you’ll stand in this year, you can practise standing in a way that uses more muscles actively.

The changes that allow you to stand without muscle force can damage your connective tissues, and the parts that would otherwise be supporting the body will then gradually lose their functionality. For instance, thrusting your pelvis forward when you stand, which forces tension in the quadriceps (the ‘four-headed’ group of muscles at the front of the thigh) and the psoas (the long muscle running between the spine from just below the rib cage to the top of the thigh—on both sides of your body—while attaching to all your lumbar vertebrae and spinal discs along the way) to hold you up, also takes the job of standing upright away from the butt and core muscles.

Also, if you stand in one place for long periods—six to eight hours a day—those passive positions can do long-term damage to structures that don’t adapt well. All that rib-thrusting can overstretch the ligaments between vertebrae, and all that quad tension can weaken structures in your knees.

How your cells sense their environment

Cells in your body have parts with the specific function of sensing their mechanical environment (how the cells are positioned in response to forces created by movement and position). In a process called mechanotransduction, cell-shape distortions are turned into chemical signals that create adaptations in cells and tissues. Think of mechanosensors as fluid-filled balloons, then imagine squeezing the sides together, making the ends bulge out. Distortion of the mechanosensor (the cell’s structural change and resultant movement of fluid in it) is mechanical input—information that the cell can use to adapt.

The way we adapt depends on how we—our cells, really—are deformed. But it’s not only such cell deformation that signals a particular behaviour; the frequency of cell stimulation is just as—if not more—important than the ‘load’ (the cell deforming squeeze) itself.

It’s not only your trousers that stretch when you sit; the cells in your bottom deform as the weight of your pelvis presses into the mass that you sit on—like a ball of clay spreading out in all directions—so creating a particular signal within those cells (mechanotransduction). Research shows that sustained deformation of a fat cell can cause the cell to produce more lipids (fat) at a faster rate. What does this mean for you? It means get up and move!2

8 steps to better standing

The following is an eight-step checklist to help you stand better—meaning this arrangement uses greater muscle force to keep you in place, while decreasing the loads on the foot arches, knee ligaments and lower back associated with long-term body damage.

By going through these steps, you’ll be checking and rearranging the alignment markers that make for better whole-body use while standing at your workstation.

Step 1: Feet forward

Align the outside edges of your feet with a straight edge, like a book or the edge of a mat. When standing still, this position optimizes the leverage of the foot’s arch-making muscles in the feet and hips. Later, in Step 6, you’ll learn how to rotate your thighs, but you won’t be able to do that unless your feet are ‘neutral’. Because you’ll be on your feet for a long time, you’ll want the muscles supporting your structure to be ‘on’ and active. In most people, the lower leg turns out as a result of excessive sitting and footwear use while growing up.

Step 2: Feet pelvis-width apart

Place your ankles the width of your pelvis apart. Your hipbones should be directly over the centre of your ankles. If your feet are closer together or farther apart, you’re creating particular loads on the knees that are associated with knee degeneration. Keeping your ankles at the correct width allows you to hold yourself up with the major muscle groups that do this job best, rather than relying on passive structures like your ligaments. Also, to (eventually) walk in better alignment, you need your feet to be pelvis-width apart to engage both the lateral hip and glute musculature needed to walk with good posterior push-off (as discussed about treadmills).

Step 3: Legs vertical

Your pelvis (which contains your centre of mass while standing) should be back over your heels instead of out over the front of your foot. When looking at yourself from the side (in profile), your hip joint, knee joint and ankle joint should all stack up in vertical alignment. The soft tissues in the middle of your foot can’t bear your weight as well as the giant heel bone in your rear foot, and standing with your pelvis out in front of your foot puts unnecessary loads on your quadriceps and psoas muscles which, in turn, puts unnecessary strain on your knees.

Step 4: Pelvis neutral

The pelvis is made up of the anterior superior iliac spines (ASIS), which are the most prominent anterior (front) superior (above) bony projections on the right and left side of your pelvis. People often refer to these points as the hipbones (as in ‘put your hands on your hips’). The pubic symphysis (PS) is the midline joint where the two hipbones come together at the front of the body. It is the lowest bony prominence before your pelvis wraps around to the undercarriage.

Align your ASIS and PS vertically. Your pelvis sets the stage for your spine. Just as a vase can’t sit properly on a tilted table, your spine cannot sit optimally, relative to gravitational forces, unless your pelvis allows it to do so. Alignment of the pelvis is important when you’re standing all day long because the integrity of your spine (vertebrae, discs and spinal ligaments) depends on it. The tilt of your pelvis also affects the muscles that attach to it. Of particular importance when you’re up on your feet are the abdominal muscles. To keep your trunk muscles firing, they have to be at a length that optimalizes their ability to generate force.

Excessive tucking in of the pelvis (or untucking it—also a problem) reduces the intramuscular leverage and, thus, the stability of the spine when maintaining a single position over time. You’ll want to be moving your pelvis (and whole body, for that matter) throughout the day but, in general, when you’re in place, maintaining a neutral pelvis means you’re allowing your lower back to maintain the appropriate amount of curvature for your particular stature (which means less back pain).

Step 5: Ribs down

After aligning your pelvis, place your hands on your waist, then slide your hands up so they encircle your ribcage. With each hand, feel for the lowest part of your rib in the front of your body and drop those protrusions (each side being its own ‘point’) until the front part of the lowest rib is stacked vertically over the front of the pelvis. Your ribs should sink right into your abdominal flesh.

Your spine is connected to your ribs, so when you thrust and/or lift your chest, you’re bringing your spine along too. You can’t have a neutral spine without first having a neutral ribcage. When you lift and jut your chest out (which, I know, is often given as a misguided tip for better posture), you’re actually shearing some of the vertebrae in your lower back and forcing the vertebrae in your neck to adjust unnaturally as well. Lowering your ribs also adjusts the fibre length of your diaphragm, allowing for better breathing.

Step 6: Knee-pit neutral

Stand with your legs bare, feet straight and your back to a mirror. Now turn around to look at the backs of your knees (your knee pits) and you’ll see four lines (two on each leg) that mark the tendons of your hamstring muscles. Ideally, all four of these should align. Lower your ribs to neutral, and keep your knee pits directly behind you as your feet point straight ahead.

This means that your ankles and knees can best hinge in the direction you are walking, which is typically forward. Unfortunately, in most cases, these hamstring tendons don’t line up. To get them straight, most people will need to externally rotate their legs (rotate the front of the thighs away from each other). Do this while watching in the mirror, rotating them until you’ve brought all four lines to a neutral position.

Please note that it’s unlikely that your right and left legs will need rotating to the same degree. The turnout of our feet is rarely symmetrical, which means the correction won’t be either. When you’re first starting to align your feet and then your knees, it’s almost impossible to keep the sole of the foot in contact with the ground. Ideally, your feet should be much more mobile—but wearing shoes has clumped all the joints of the mid-foot together. For now, don’t force your feet to stay down when externally rotating your thighs.

Step 7: Kneecap release

The position of your kneecaps is not fixed, but subject to the pattern of muscle tension in your thigh muscles. Balanced standing (that is, where all the muscles are encouraged to participate) doesn’t require constant tension in the front of the thigh. This means that, if your patellas (kneecaps) are locked into a knee-pit-neutral ‘pulled-up’ position, then your quads are doing too much of the work. Drop them by anchoring your weight back into your heels (which is where it should be in any case), thereby turning off the gripping motion of the quads.

Why should your knees be unlocked? Having ‘locked knees’ is a leg position that subjects the body to blood-flow-altering configurations—either hyperextension (when the knee joint sits behind the vertical line established by the hip and ankle) or constant tension in the quadriceps muscles. Just as your band teacher or military sergeant might have warned you, locking your knees all day long is one way to lose necessary blood flow. If you’re going to try and spend more time being upright during the day in the name of health, you’ll want to make sure that you stand correctly, so that all of you is healthier for it.

Step 8: Head ramped up

Once your ribcage is in a neutral position, slide your head back toward the wall behind you until your ears stack up over your shoulder. But don’t pick your head up by the chin and don’t lift your ribcage to achieve this position. Each of these efforts is created by a lot of movement about a single hinge in the neck or back, which is not a good idea.

What’s better is to let the ramping motion be created by the efficient interaction of many joints. When you’re looking to fix the curvature of your spine—at any point between your head and pelvis—it is helpful to remember that curves are created by the actions of many parts. Ramping not only helps to restore the neutral curve in the neck, but also alleviates the excessive curvature of the upper back—a problem you may have only discovered you have when you aligned your ribs correctly.

Big movements to do at your desk

The following are exercises that will probably require you to take a work break. By taking three- to five-minute exercise breaks throughout the day, you can either practise just one of these movements per break, or you can flow through all of them in one break period. The results are entirely different, although both are beneficial in their own way. On some days, it’s good to work on each individual exercise so that you can reach a deeper level of proficiency. On other days, you can flow through all of them at every break to mobilize more of you more often.

Thoracic stretch

Place your hands on your desk or the wall. Keeping your hands in contact with the desk or wall, walk backwards, dropping your chest toward the ground. Keeping your feet straight, push your pelvis up until your hips are behind your ankles, legs are straight (quads relaxed), and your tailbone lifted. Make sure you’re not thrusting out your ribs. For an added bonus, turn your palms and ‘elbow pits’ (the inside of your arm opposite the bony elbow) up. This is a great way to gently load the tension in the shoulder joints and de-mouse your arms!

Wall angels

Stand with your back against a wall with your feet about three to four inches away from it. Bring your hips and ribcage back until they touch the wall; this will stop you from thrusting your ribcage. Reach your arms out to the side, making a T, with your palms facing out (not toward the wall). Slowly, while keeping the backs of the hands and wrists against the wall, move your arms until they’re over your head, stopping once the arms or ribs pull away from the wall. Repeat in a smooth fashion, just as if you’re making snow angels against the wall.

Double calf stretch

This move places a great load on the tissues that keep your pelvis in a tucked position. Place your hands on the seat of your chair or on your desk. Line up the outside edges of your feet and straighten your legs all the way (quads relaxed). Back your hips up to behind your heels and make sure all your toes are liftable. While stopping your knees from bending and your ribs from thrusting, untuck your pelvis until you feel the muscles down the back of the leg. To intensify this stretch, externally rotate your thighs to neutral (alignment step 6) throughout this exercise to bring even more of your thigh muscle fibres into the stretch. Want even more? Place the front of both feet up on a half-round foam roller or rolled towel.

Stand Up for a Better Back

What Doctors Don’t Tell You is launching a ‘Stand Up for a Better Back’ campaign, to encourage our readers to stand up and vary their positions while working.

To kick off the campaign we thought we’d better walk (stand?) the talk ourselves. Three of us with aching backs from long hours at desks have worked for a month using Varidesks (available from uk.varidesk.com), which enable you to sit or stand at various positions, with a simple mechanism that moves the desk height up and down.

Here’s how we’ve fared thus far:

Trevor Jayakody

Trevor, aged 36, our advertising manager, suffered from ongoing knee, peck and lower back pain. Although his lower back was stiff after an hour of standing at his desk during the first week, he was surprised to see how readily his body adjusted.

By week three and four, he was standing for four or five hours at a time. He now feels far more flexible and has less tightness in his lower back and hamstrings, and has noticed improved seated posture. “Lower back pain feels a lot more stable,” he says. “Knee pain is much less severe and only happens after around four hours of standing.”

Joanna Evans

Jo, 34, our managing editor, was suffering with pain in her lower back, right shoulder and right hand, which an osteopath identified as related to poor posture at work.

Since switching to a standing desk, and varying her positions, “I did get some more intense lower back pain initially,” she says, “but after gradually increasing the amount of time standing I found my back felt a lot better. I also get less shoulder, neck and hand pain.

“Now when I don’t stand up at my desk I really notice the difference: all the aches and pains come back!”

Lynne McTaggart

Lynne has had intermittent lower back, hip and postural issues, which got exacerbated when she hurt the tendons surrounding one knee during a high intensity workout. Months of limping resulted in some intermittent sciatic pain. Starting on a standing desk a month ago has been part a holistic treatment using exercise and pulsed electromagnetic fields, which have healed the knee and ended pain. Although standing for more than 45 minutes caused aching legs at first, she is now able to stand for several hours at a stretch. “Remembering to vary position during the day and evening, even while watching TV, has also helped.”

Your challenge

Vary your position at work, and if you don’t have a standing desk, just pop your computer on top of a box or some books so it is eye level when you stand. Increase the time you spend standing every week. Write to us (letters@wddty.co.uk) to let us know whether it’s helped your back.

Dynamic Sitting

In this third installment on NeuroMovement®, Anat Baniel offers three exercises to keep your brain and body awake while you sit

The human body is built for motion. Our bodies have more than 640 named muscles, 206 bones and 360 joints, which make for an enormous number of possible configurations of movement. More and more it is being recognized that some of the most potent mechanisms at the root cause of chronic disease are caused by inactivity, because the body needs frequent muscle activity to optimalize blood flow, hormone secretions and the millions of other functions that keep us healthy.1 Prolonged sitting is a health risk independent of physical activity.2 In other words, if they sit for long periods of time, even people who are avid exercisers may
still demonstrate the same negative effects—what has been labeled “active couch potatoes”.3

Standing for many hours with little movement, including standing at a work station, can also stress the body in ways that can have negative consequences.4 It’s not the position, such as sitting or standing, but rather the lack of motion and variability of movement that’s the real culprit.

The necessary muscle activity, including while we sit, does not happen at the muscle level alone. It is the brain—with its 100 billion neurons, its estimated trillion glial cells and trillions of connections between neurons—that organizes and executes all movements. And it is the wakefulness of the brain that determines, to a great extent, the level of activity of the muscles and, thus, our health and experience of wellbeing.

In one 2010 experiment, ageing rats that were no longer able to figure out a maze (even though they were still eager to get the food at the end of the maze), and too weak to run on a treadwheel, were rewarded when they noticed specific changes in auditory stimulus.5

The task of noticing these changes in auditory stimulus focused on brain activity, promoting brain differentiation—a central function of the healthy brain—rather than trying to get them to exercise their muscles in an attempt to make them stronger. After a month of this new brain differentiation training, there was nearly a complete reversal of the previously observed physical and cognitive impairments.

We derive from this research that it’s not sitting in its own right that is so detrimental to our muscle activity and our health. It is inactivity in the brain that leads to inactivity of the muscles, resulting in negative metabolic, physical and cognitive changes. Think of it as though the brain ‘goes to sleep’, to some extent, once a person sits down for a long stretch of time. For example, when sitting at a computer, the focus is on the screen and on the fingers that are typing. The rest of the body ‘disappears’ from the brain, and stops participating dynamically with the movements of the hands and fingers.

Another culprit contributing to the brain’s reduced wakefulness, which leads to reduced muscle activity in sitting, is the way many chairs are designed. The front of the chair seat is often higher than the back, so the slope pulls the sitter backwards; this encourages slouching, and makes it difficult to use the back and pelvic muscles. People then tend to lean into the back of the chair, essentially telling their brain they’re probably not going to be moving much, so the brain stops activating muscles in large areas of the body.

A few years back, I was asked to work with musicians in a world-renowned orchestra. I was told that over a short period of time, a large number of these musicians were unable to play due to a variety of injuries and debilitating pain.

In my first session with the orchestra members, I noticed that their chairs had a pronounced backwards slant. As a result, many musicians were leaning into the backs of their chairs as they played. Their arms were moving a lot while the rest of their body hardly moved at all. When I pointed this out to the music director, I learned that they had just purchased those chairs. I suggested they return the chairs and buy different ones with a seat parallel to the ground, which they did.

I also learned that their conductor did not like his musicians to sway in their seats or move their bodies much while playing. He had instructed them to try and sit still as they played. They obeyed.

What the conductor didn’t know is that it’s not only the arms, hands and fingers that need to move while playing an instrument. The brain needs to account for and organize the whole body at all times for every action we do. Often the pain and limitation people experience while sitting, as these musicians did, is due to insufficient differentiation and insufficient mapping of the body to
the brain.

Very quickly, as the musicians learned how to bring their back, pelvis, chest, legs, feet and head into their sitting and playing, their pain stopped and they experienced greater ease and comfort while playing, and the quality of their performance improved.

For sitting to be healthy, it needs to be what I call dynamic sitting. The brain has to stay awake and manage the whole body as we sit, whatever the activity may be. It’s not about doing large movements or stretching; it’s about creating a fuller map of the body in the brain while in a sitting position. This leads to an ongoing sense of presence and increased wellbeing.

The three NeuroMovement lessons below promote increased differentiation and greater representation of the body in the brain. You can do these exercises at work or at home, at your desk or away from it. The first lesson is done in a standing position, while the second and third lessons are done while sitting.

Do the movements gently, slowly, with minimum force, always seeking comfort, and—very importantly—pay close attention to what you feel in yourself as you move; this helps to wake up your brain and gain enhanced freedom of movement, greater ease in sitting, fewer aches and pain, and enhanced wellbeing—both physically and mentally.

Lesson 1

How to wake up your lower back

In this lesson, you will wake up your lower back and chest to help you sit tall and move freely while sitting. You will also get a few minutes break from sitting that, by itself, is very useful. As a bonus, bending down will become much easier for you.

1) Stand up with your feet spread comfortably, then gently bend down and let your hands drop toward your feet. Notice how far you can go without forcing, and come back to standing.

2) While standing with your legs spread comfortably, bend your knees a little, and place your right hand just above your right knee on your thigh and your left hand just above your left knee. Now lean on your legs with the weight of your upper body resting on your hands. Begin to round your back and, at the same time, pull your belly in and look down at your belly. Then gently arch your back, push your belly out, lift your head and look up. Do this back and forth four or five times.

3) Come back to standing, then simply bend forward and drop your hands down towards your feet. Is there some change already?

4) Stand with your feet spread apart and your knees slightly bent, but this time lean with both hands on your left leg just above the knee as before. Very gently and slowly, round your back and look down, then arch your back, free the belly muscles and push them out, and look up. Do this back and forth four or five times, then stand and rest for a moment. Feel how you’re standing.

5) Stand with your feet spread apart and your knees slightly bent, but this time lean with both hands on your right leg just above the knee as before. Very gently and slowly, round your back and look down, then arch your back, free the belly muscles and push them out, and look up. Do this back and forth four or five times.

6) Stand with your feet spread apart comfortably, then bend down and feel if you can bend more easily and farther than before. Are your toes closer to your hands?

Lesson 2

How to boost vitality in your chest, hips and spine

Sit comfortably on the edge of a chair with your feet flat on the floor and spread comfortably, your knees apart, and do the following movements.

1) Place both your arms between your knees and let them hang down towards the floor. In this position, bend your head so that your hands move closer to the floor, then come back up. Do the movement three or four times. Make sure to move gently and slowly, and notice how far down you can go without stretching or forcing. Sit up and stop for a moment.

2) Gently bend your head and shoulders sideways to the right a few times. Stop and rest for a moment.

3) Bend your head and shoulders to the left a few times. Stop and rest for a moment.

4) Gently twist your head, shoulders and back to the right, then round and straighten your back while twisted. Do the movement three to four times and rest.

5) Now twist your head, shoulders and back to the
left, then round and straighten your spine. Repeat three to four times and rest.

6) Round your back and pull your belly in and, in this rounded position, gently turn your head and shoulders to the right and left, three or four times.

7) Sitting with your head and shoulders in a central position, lift your right shoulder to your right ear and lower it, then lift your left shoulder to your left ear and lower it. Alternate this movement a few times and then stop for a moment.

8) Round your back, pulling the belly in, then arch your back, rolling your pelvis forward and pushing your belly out. Repeat a few times. Feel whether your pelvis is now free to move forward and support your spine and head, and whether your breathing is freer.

9) Now simply bend down and see whether your hands come closer to the floor without forcing or stretching—and with less pain if you experienced pain earlier.

Lesson 3

How to free your shoulders, arms and wrists while sitting

1) Sit on the edge of your chair, buttocks well supported and feet flat on the floor at least a foot apart, with knees spread at about the same distance. Rest your hands palms down on the tops of your thighs. This is the neutral position for this lesson.

Take a moment to pay attention to your right shoulder, then your left one. Do they feel relaxed? Feel how far your right shoulder is from your right ear and your left shoulder is from your left ear.

2) Still sitting on the edge of the chair, lift your right arm up towards the ceiling without forcing it. Be aware of what it feels like and how far you can lift your arm easily, without strain or pain, so that you can later evaluate and compare any changes brought about by this exercise. Bring your right arm down and rest your hand on your thigh as before. Now lift your left arm and be aware of how far you can comfortably lift it.

3) Continue sitting on the edge of the chair. Now gently and slowly, move your left shoulder forward, then bring it back in place. Don’t move your left arm or elbow, just your shoulder. Do this movement gently, without forcing, four or five times and stop. Be aware of any movement elsewhere in your body as you move your shoulder forward.

4) Now move that same left shoulder backward, very gently and slowly, and then come back to your neutral position. Do this four or five times—remembering to be aware of how your body is moving the entire time.

5) Still sitting on the edge of the chair, shift your weight slightly to the right buttock and slide your left hip forward and back. Note as you do this that your feet stay in place each time you move your left hip forward. Your left knee moves forward as your left hip and buttock move, and you arch your lower back on that side. Do this movement four or five times, gently. Rest for a moment. Feel the contact of your right buttock with the chair and compare it with the left.

6) Now shift your weight to your right buttock again and move your left hip backward, then return to neutral; do this four or five times. Be aware of what happens throughout your back and spine as you do this movement. Rest for a moment.

7) This time, simultaneously move your left shoulder and left hip forward, then move them back to neutral at the same time. Become aware of your whole body as you move. Do this movement four or five times. Rest for a moment.

8) Still sitting on the edge of your chair, move your left shoulder and left hip in opposite directions. When you move the left shoulder forward, move your left hip backward, and vice versa. Here you need to pay close attention to make sure you’re doing what you think you’re doing. Repeat the entire movement three or four times. Rest for a moment.

9) Now simply sit on the edge of the chair and be aware of how your left shoulder feels; is it lower than when you started this exercise? It is more relaxed? Compare your left and right shoulders. Lift your left arm up towards the ceiling; does it feel different? Does it lift higher? Better? Easier? Now lift your right arm toward the ceiling; you might feel how different it is compared with your left arm.

10) Repeat steps 8 and 9, but with your right shoulder and hip.

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Chain gangs

Three highly successful back pain therapies, all from the US, have been fixing ‘incurable’ back pain by activating a group of muscles that usually get ignored in modern living

The latest innovation in back-pain treatment is less interested in where it hurts than in which of your movement habits, built up over a lifetime, are responsible for the pain.

The theory is that when major muscles shorten in one direction, there is an immediate compensatory adjustment in both nearby and distant muscles of the body. Rather than massaging or stretching the hurting section itself, the treatment is focused on ‘muscular chain therapy’ (MCT), which aims to change posture to ensure that all those muscles are firing synergistically.1

Global postural reeducation, as it’s also known, can ease the pain not only of specific syndromes like ankylosing spondylitis, an inflammatory condition of the spine that can lead to fused vertebrae—where calcification of the ligaments and discs cause the vertebrae to join together, becoming rigid and inflexible—but also of generalized chronic low back pain. One study of this approach in 61 patients with chronic low back pain found that, after 12 weeks of weekly sessions, there were improvements in pain, physical functioning and general vitality.2

In 100 patients treated with either MCT or ultrasound, just a single session of MCT provided relief.1 It’s also proved superior to segmental stretching, which aims to stretch one muscle at a time.3

Here’s a rundown of the most popular postural reeducation therapies with the greatest evidence of success.

Egoscue

Egoscue was started in the late 1970s by physical therapist Pete Egoscue of San Diego, California, who, after a bout of intense physical debilitation, was determined to find natural self-healing.

Combining postural analysis with specific corrective exercises, Egoscue not only healed himself of chronic pain and dysfunction, but ended up founding an entire system of self-healing.

After recording a client’s symptoms, Egoscue practitioners identify problem areas by visually assessing both the person’s posture and gait while walking. Photos of the client’s posture are taken from the front, back and side, then fed into a computer, which compares these images with the correct postural stance. After analysis, the programme provides a list of individualized corrective exercises that the practitioners then tweak, based on the patient’s input and their own visual assessment.

“We look at the body as one solid unit,” says Crystal Sallee, director of Egoscue University in San Diego. “If you have a symptom in your knee, for example, we acknowledge that symptom. But we’re looking for the underlying cause. And we look at the entire body to see where that symptom is originating from.”

After the initial visit, which takes around two hours, there are follow-up assessments where the exercises, which can take up to an hour a day, are changed to match the patient’s progress.

Currently, there are 25 Egoscue clinics across the US. The first UK one is scheduled to open this year, but there are hundreds of practitioners and trainers worldwide. Sallee says that, recently, there has been an influx of Western surgeons and doctors of physical therapy. “They’re coming to us to supplement their practices,” she says. “Some are switching practices altogether.”

Matthew Carratu, a former Berkshire osteopath, is typical. Disappointed by the “rudimentary exercise prescriptions” available for patients in standard osteopathy or physiotherapy, he wanted a way to bridge treatments with effective rehabilitation to help people recover from the effects of long-term sitting. Egoscue proved to be what he was looking for.

“Muscle and bone as living tissue are shaped by our activities and expression and, as a result, a considerable number [of patients] now present with lifestyle strains,” says Carratu. A sitting posture, he says, creates a “kyphotic tendency”—an extreme curvature of the upper back commonly referred to as a ‘hunchback’.

In 2008, he tested the effects of long-term sitting in 40 18-year-old schoolboys in Windsor with lung and diaphragm tests. Compared with the averages from 10 years ago, the boys were 18 per cent down on tidal volume (the amount of air inhaled during relaxed breathing) and 12 per cent down on power (peak flow, the maximum speed of exhalation).

“From my 26 years of professional work, I attribute that to laptop/iPad/phone use,” he says. “School leavers are demonstrating thoracic patterns that a dentist with 30 years of bending over patients expresses.”

In a 2014 thesis by Zachary Vehrs at Brigham Young University,4 Egoscue corrective exercises proved to be effective for easing chronic knee and hip pain. Vehrs is now a certified Egoscue practitioner, trainer and clinic owner in Seattle, Washington. He says Egoscue can either stand alone or be used in conjunction with other healing methods, such as chiropractic, which also aims to achieve a similar outcome through better postural alignment.

“We’re just taking a different approach by addressing the muscles that are holding your alignment in place,” he says. “The bones do what the muscles tell them. So if the muscles are always pulling your bones out of alignment, then we have to address the muscles for the alignment to stay in good position and to achieve lasting relief.”

One of the main differences between Egoscue and other alternative therapies for back pain, such as chiropractic and massage, he says, is that the practitioner is not manipulating, changing or doing anything to a client’s body.

“We believe that everyone is their own personal expert. No one knows more about you than you. You’re the one in your body feeling what effect the exercises are having. And based on that feedback and how your intuition and your body feels doing the exercises, that’s what guides the therapy process.”

One of his patients, Martha Ritz (not her real name), a 67-year-old woman in Salem, Oregon, had scoliosis and a long history of back pain. Doctors had given her a back brace, and she was taking up to six painkillers a day just to be able to function. Most of her time was spent lying down with a heat pad to ease the pain.

“After one week of doing her Egoscue exercises, she no longer needed her back brace and was able to stand for longer periods of time,” says Vehrs. “After eight sessions, she was golfing, dancing with her granddaughter, bowling and was no longer reliant on pain medication.”

According to both Vehrs and Sallee, at least 90 per cent of Egoscue clients improve if they do their exercises consistently and attend their follow-up appointments. Some patients feel better within a few weeks, although others can take a lot longer.

Dr Nancy Wright (not her real name), 58, a dentist in Coos Bay, Oregon, has mild multiple sclerosis. Her right hand used to go to sleep at work on a regular basis and her back was always in pain. She also had peripheral neuropathy (numbness and pain in the feet and hands). After three weeks of the exercises, her hand was no longer falling asleep and gone was the back pain, but it took three months before her neuropathy diminished significantly.

Shannon Robinson, a photographer in Reading, Berkshire, had been experiencing severe back pain for years and could find no relief from painkillers. Chiropractic adjustments, acupuncture and osteopathy had also all failed. “Egoscue was my last resort,” she says. “I just wanted to be pain-free.”

After five months of working with Berkshire Egoscue practitioner Nicole Parsons, she was mostly pain-free at last. “I very rarely had slight pain after long hours at the desk. But nothing compared to how bad it was,” Robinson says. “Egoscue changed my life and introduced me to a pain-free way of living. I have taken up yoga and spinning, which complement my Egoscue exercises, and my fitness is improving.”

“All we’re doing is teaching the body how to move properly and retraining the muscles to hold the bones in a proper position,” says Parsons. “Age is definitely not a limitation.”

The Gokhale Method

This technique also uses healthy posture and movement to heal back pain and other problems. Like Egoscue, it was founded by a practitioner whose own health issues forced her to find new solutions.

Crippling back pain during her first pregnancy and unsuccessful back surgery set California-based acupuncturist Esther Gokhale on a crusade to find the root cause of back pain. She traveled to Brazil, Portugal and India to examine the native populations and discovered that, unlike Westerners chained to their desks, people involved in less restrictive daily activities not only had no back pain, but also an entirely different kind of posture, which she dubbed ‘primal posture’.

As she writes in her book 8 Steps to a Pain-Free Back, “It’s quite different than American spines. If you look at an American’s spine from the side, it’s shaped like the letter S . . . That S-shape is actually not natural. It’s a J-shaped spine [where the lower back is not another curve, but more vertical and upright] that you want.”

Unlike Egoscue, the Gokhale Method has no lengthy exercise regime. The focus is on retraining patients how to sit, sleep, stand, walk and bend in ways to prompt the spine back to its natural J-shaped primal posture. As the muscles and bones realign, pain and disability are eventually cleared, Gokhale maintains.

Says Bristol practitioner and yoga instructor John Carter, “The principle is if we can get extra length in our typically compressed spines while going about our lives, that changes sitting [or walking or bending] from something that hurts to something that heals.”

To attain ‘correct’ posture, patients are asked to take a deep breath and notice how the ribcage lifts, making them taller. They maintain that lift as they exhale. Repeating this several times adds extra length to
the spine.

Another subtle spine-stretching exercise uses a lightweight object, such as a folded cloth, balanced on top of the head. Pushing the head up against the cloth while making sure not to lift the chin, the spine automatically lengthens and the ribcage lifts.

Another exercise imagines a ‘sky hook’ attached to the top of the head gently pulling you upwards, which also adds length to the neck. These exercises can also be done while sitting, standing or walking.

One item of basic equipment is a Stretchsit® cushion, recommended for office chairs and car seats, to get hours of gentle stretching in the back while driving or working—but a simple folded towel hung over the back of the seat would also do the trick.

Claire Robinson, 43, of Bristol, lived with myofascial pain and trigger points (‘knots’) in her muscles for over 10 years. She tried lots of traditional treatments, including strong painkillers, plus acupuncture, physiotherapy, osteopathy, chiropractic, yoga, Pilates, Putkisto, meditation, Trigger Point Therapy, X-Pain method, pain management, massage, reflexology and Alexander Technique—all to no avail.

“Since I started practicing the Gokhale Method, my symptoms are now virtually non-existent,” she says. “The method has enabled me to know my limits and work within them.”

But it didn’t happen overnight. Robinson says it took a long time to create new habits of sitting and moving again. But the payoff, she says, was worth it. “It’s amazing how knowing what it is to have good posture can make you look taller, slimmer, feel more confident and, above all else, not be in pain.”

Foundation Training

Created by American chiropractor Eric Goodman, Foundation Training (FT) is another exercise/postural approach that started from an alternative therapist’s personal experience of crippling back pain.

At age 26, Goodman was a student at a chiropractic college when multiple herniated discs on his lower spine sent him to a conventional doctor. Told he needed spinal fusion surgery, he instead became obsessed with figuring out why his back had degenerated.

Eventually, he realized that incorrect movement, plus all the sitting he’d been doing while studying, had placed undue strain on his spine because the posterior chain muscles—the spinal erectors, gluteals, hamstrings and calf muscles—were not being used. He then started to strengthen these back muscles through exercises he developed (see box, page 59) and, within a year, he was pain-free with no surgery.

Goodman says that going to a doctor to get rid of back pain often only makes things worse, because surgery and painkillers do nothing to fix the cause of the problem. “We really have no idea how to treat these things and it’s because they can’t be treated,” he says. “They have to be changed.”

Decompression of the spine, anchoring and hip hinging are the three main principles of FT. Decompression is through active breathing: the patient inhales to expand and lift the rib cage away from the pelvis, and then holds it up as he exhales by tightening the abdominal muscles.

Creating space between the ribs and pelvis allows the lower spine to decompress while opening up the chest and pulling the shoulders out of their commonly rounded position.

Anchoring is about stabilizing the pelvis downwards using the adductor (inner thigh) muscles. “The majority of people have externally rotated hips due to the positions our modern lifestyles pull us into,” says Aberdeen FT practitioner and certified instructor Mora McGovern. “This means the external rotators are tight, which inhibits movement of the hips and lower back, thus causing compensatory movement patterns which, in turn, cause pain or injury.”

Hip hinging teaches the brain to make the hips the centre of movement and to activate the posterior chain muscles for good posture. McGovern says that most people lift things up using the spine as the centre of the movement. But what FT teaches patients to do is to pull the hips back while lifting the chest, thus activating the back muscles, stabilizing the spine and taking the strain off joints.

Like both the Egoscue and Gokhale Method, FT claims to work for around 90 per cent of patients when practiced regularly and correctly. It requires no equipment, and McGovern says that people of any age and fitness can do the 15–20 minutes of daily exercises. Positive results are rapid because, unlike other exercise forms, FT specifically targets the entire posterior chain as a single muscle system.

“It occurs very quickly because we are simply teaching the muscles to do what they are designed to do,” says McGovern. “Once the posterior chain is activated, the exercises continue to strengthen these muscles with continued benefits.”

Tom Webster of Aberdeen had a history of back problems and back pain. Chiropractic, massage and visits to the osteopath gave temporary relief, but the problems always came back. With FT, he says, “I felt improvement almost instantly. Even the breathing exercise seems to pull everything together and you feel the stretch.”

Webster says he hasn’t felt so good in years. “I’ve started cycling, kettle bells and even taken up slacklining, which would have been near-impossible a few months ago.”

The Founder Exercise

According to Eric Goodman, this is the primary exercise in FT—the key that unlocks the posterior muscle chain that runs down the spine and legs, and reinforces proper movement while strengthening the entire back. “If you find yourself sitting for long periods of time, take a break every hour or so and do the exercise. It only takes a minute and your back will definitely thank you,” he says. Dr Goodman also walks you through the exercise on www.youtube.com/watch?v=BWV6keJUDeo

The exercise

1) Start with your feet about 24 inches apart, knees slightly bent. Make sure your weight is on the heels of your feet.

2) Pull your hips back to make a straight line from the knees to your ankles. As your hips pull back, the chest lifts.

3) Reach your arms back, fanning the fingers and opening up the front of the body as much as possible. From this position, you should feel a lot of tension in the lower spinal muscles.

4) Take a deep breath in and, as you exhale, lift your arms up in front of you, keeping the hips back and not letting your knees come forward, weight still on your heels. Take a big breath while holding this position.

5) Exhale, knees bent, and stretch your arms down until your hands touch the floor, still keeping your weight on your heels behind you, and really stretch the hamstrings.

6) Take a big breath in this position and hold for 10–15 seconds.

7) Run your hands up your shins while pulling your shoulders together, then lift your head, arching your spine as you lift your upper body. Once the spine muscles feel braced, reach your arms behind you, fanning the fingers again. Make sure your weight is on your heels, the knees are back, the chest is high and the lower back muscles are really tight.

8) Slowly bring your arms all the way up in front of you again, and increase the tension as much as you can for around
10–15 seconds.

9) Stand up straight, pressing through the heels and dropping your arms.


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