Posture and respecting one's back

Posture

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Introduction
Why Do We Have a Bad Posture?
What is Correct Posture? Why is it Important?
Stomach Exercises
Back Exercises
Stretching
Cardiovascular Exercise Tips
Lifting Heavy Objects
Carrying Bags
Carrying a Wallet
Household Sofas Encourage Bad Posture and Over-Reaching
Baths
Sleeping Posture
Sitting at Your Desk
Driving
Pat's Challenge

Introduction:

This section is dedicated to looking at posture and how to improve it. It is not specifically concerned with any particular health condition, such as CFS, but looking at postural issues that affect everyone. As with the rest of this site, the purpose is to save you the reader many years of further abusing your mind and body! Of course, if you are not abusing it already, then I applaud you and do not wish to patronise you. As with anything else, it is easy to aggravate one's physical problems and to injure the muscles and tendons attached to the skeleton without even knowing it. If you have spinal problems and are receiving treatment, you may be doing certain things unknowingly to aggravate and prolong your condition.

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Why Do We Have a Bad Posture?

Our culture and society tells us many conflicting things about posture and exercise, some of which is very useful and some of which is misguided and harmful. Coupled with this, it is also not very easy to maintain perfect posture in modern living, which such emphasis on sitting down, especially in awkward environments. We are often ignorant of what we should exactly be doing, and if we do know, we do not value doing the correct thing enough or are too impatient to do things correctly. We also may not have the bodily awareness to tell exactly what our posture is like at any given moment in time, save for those at the pinnacle of martial arts for example. One does not tend to notice that which is habitual.

It is funny how we value endless amount of exchanging words with no emotion, endlessly restructuring electronic data and writing on things, which only have any beneficial effect on us because we associate feelings with these events, yet we don't value using our bodies correctly and really getting the most from ourselves physically. It is funny that we live in a society that is so sick that people can't even be bothered or are too weak to physically support their own upper bodies, but slouch and sprawl themselves onto chairs and sofas for a large number of hours in a day, contorting our bodies and using the lower back as a chair to slouch onto and prop your upper body up against. We do this rather than developing the muscles needed to do the job properly, to actually support our bodies the way nature intended (and that babies do until their minds are corrupted.) Babies are highly flexible and naturally keep an excellent posture. It is instinctive in humans to do so, if their abstracting minds and negative attitudes did not divert attend away from the physical body. Do animals sit around feeling depressed and slouching? Most people lack the muscle development to actually sit up straight all day, and end up slouching from one seat to the next, driving from one seat to the next, with minimal walking in between. Most of us always needing a back rest to lie back against. Why is that? Back rests, unless flawlessly designed and virtually customised to your back, are inevitably going to encourage a poor posture and slouching to some extent. You need to feel your own back and support it to be aware of where the weight is centred and whether the spine in straight or not. I would like to impress upon you the importance of respecting your body so it can serve you well into your twilight years with vigorous exercise. It is indeed possible, as ageing is largely the result of cumulative abuse of the body. Too many people start falling apart and begin a downward spiral in their 20s or 30s. Don't let this be you!

Society and peer pressure makes us feel like geeks, wimps, squares, uptight, militaristic or uncool if we have a correct posture. Society and peer pressure usually tends to be towards something negative towards our bodies across the board. If you always want acceptance from people around you, then get over it, as it is never going to happen! People don't like to make a fuss about themselves, and often only really care about making a fuss for other people. Prioritise your own life! Take control! Feel good! Live long and with energy into your old age.

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What is Correct Posture? Why is it Important?

The spine is meant to be straight at all times, with a nice arch/curve in the lower part of the back. The neck is designed to be straight and in line with the spine. That's the bottom line. Of course, the spine and back are meant to be very flexible, and can move in all manner of different directions, but the idea is that if you do, it is only for short periods and without much force involved. You don't have to read the rest of this section! It's that simple! However, if you want to know how to apply this to exercising and daily routines, please read on.

If you are sitting and curve your spine (ie slouch) then you are putting 2-4 times more pressure on your one side of your vertebrae of your spine and neck. In short, whenever you are sitting down or standing up or exercising, you should have a straight back at all times. Because of the increased loads that you put on your skeleton and muscles during exercise or stretching, it is even more important than when resting to have a straight back.

Most tension goes to the lower back, and this can result in problems with the legs, for example the knees, the achilles tendons, the hamstrings etc. If we experience problems in the lower body, we go to a physiotherapist to treat these injuries when the root of the problem is our back! Approximately 30 -50% of adults have lower back problems. Unfortunately most of us don't make the connection. It is not rocket science.

Below is an example of a person standing correctly on the left and a person dropping their hips forwards on the right (with the resulting over-curvature in the spine).

Excessive dropping (forward rotation) of the hips can be a result of 'overcompensating' to maintain an arch/curve in the back as a result of trying to correct a slouch.

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Stomach Exercises:

The stomach muscles are very important for supporting your lower back. The abdominal muscles and back muscles work synergistically. It is important to have strong abdominal muscles as well as strong back muscles. Don't focus on one at the expensive of the other. Unfortunately, the normal 'crunch' exercise is very bad for your lower back. From this moment on, never do them again! Or do so at your own risk. The number one rule applies when exercising your stomach - always keep the back straight and maintain the natural curve in the lower spine. By doing a crunch and curving the back the other way, you are stressing your spine and tightening up your lower back muscles in the wrong way. Crunches are particularly bad as most people do so many repetitions and sets in the gym. They would be better off not doing them at all ironically.

The correct way to perform a 'sit up' or 'crunch' is to wedge your toes under something very secure on the floor (that will support your body weight and that does not lift up). Keep your knees bent with your heels about 6 inches from your bottom. Keep your back straight with a slight curve in the lower back. Keep your neck straight and look at the ceiling. Now lift your whole torso off the ground 1-2 inches, keeping your back straight the entire time (maintaining the curve in the lower back), using your pelvis as the pivot, and then lower. Keep your hands on your chest. If you just lift your chest and keep your lower back on the floor then you are just doing a 'crunch' and this is incorrect. Once you can comfortably perform 100-150 repetitions, then you can either carry on using your body weight (increasing the number of reps and sets ad infinitum) or you could try to increase the resistance slightly by holding a light weight to your chest or by increasing your muscle mass of your upper body!

You can use weights machines in general to train your stomach, if you want to, as long as you keep your back straight. However, if you can't do more than 100 repetitions of the above exercise using just your own body weight, then you may want to wait with the weights machines until later. It is of course to you how you structure your programme.

It is best to avoid 'abdominal rolling bars' i.e. the type that support your head and are used on exercise mats, as they only allow a 'crunch'. If you have one of these, then take it to the rubbish tip and have it recycled.

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Back Exercises:

To exercise the back muscles, there are a number of exercises you can do. The upper back is exercised by doing a seated row, with a straight back of course, or by pulling dumbells towards you whilst lying on your stomach on a weights bench (very similar exercise as seated row, but does not involve the legs). A third alternative is to stand with a shoulder width stance, knees slightly bend, with your back straight and horizontal, and to hold a barbell or set of dumbells (very light to start with) and lift towards your sides and lower. Repeat. Increase the weight once you reach 10 repetitions comfortably for your next session. It is best to avoid using 'weights machines' where you are strapped onto a machine in a sitting position and push a bar backwards with your back. These machines can put unnecessary strain on the lower back if one's alignment is not perfect (which invariably it is during a certain part of the overall movement). They are not necessary so there is no point bothering with such machines.

To train the lower back, you can focus on two exercises.

For the first lower back exercise, lie on your back on an exercise mat. Bring your feet close to your bottom, with your heels about 6 inches from your bottom. Keep the feet close together. The idea is to use your feet and shoulders as the point of contact with the floor and to lift your pelvis into the air, until the thigh and spine are in line, and then lower. To achieve this anchoring position you must be on an exercise mat or other mat and gripping it with both hands (straight arms). Do as many repetitions as possible or until you feel any discomfort. Ideally you should do as many of these repetitions as you do for the stomach exercise. When you are highly proficient at this, you could try to increase the resistance slightly by wearing a light weight belt. Or just stick to your own body weight and keep increasing the number of repetitions and sets.

The second back exercise is more advanced and is not recommended for beginners or for those with a weak back. For this second lower back exercise, lie on your stomach on the floor, keep your neck in line with your spine (ie look down) and bring your arms in front of your so your palms are facing down and in front of your face. Keep your legs straight. Simultaneously lift your legs and your chest off the floor keeping the lower abdomen and pelvis on the floor. And then lower. Repeat (repetitions) as many times as possible or until you feel any discomfort.

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Stretching:

When it comes to stretching, it is a general guideline to not stretch until it hurts but to breathe deeply and remain relaxed. Achieving the maximum burn humanly possible is an 'all or nothing' approach that is unhelpful and destructive! This is often when muscle or tendon damage occurs.

Don't do the hamstring stretch where you sit on the floor with straight legs and pull yourself forward, or with one leg up on a bar and leaning into you, holding your foot and pulling yourself forward. Any stretch where you touch your toes and pull yourself towards your toes is REALLY bad for your back, whether you are sitting or standing. You invariably curve your whole back forwards and put massive pressure on one side of the lower back vertebrae (the outside or back side, as opposed to the inside or front side). Whenever you do this, the body's reaction is to compensate and stiffen the muscles down the hamstrings and the back, so you are fighting against the body's natural instinctive response. If you are trying to stretch out a bad hamstring injury, then you are likely to do more harm than good.

You need to isolate the hamstring, and not involve the back, but keeping it straight and happy. Instead, lie on your back and bring your straightened leg back with a towel, or alternatively put your leg out in front of you on the floor, extended, with the foot pointing forward, and lean forwards into it with a straight back of course. If you do the stretch with a towel, then it is clearly possible to hyperextend the knee joint backwards if one exerts too much pressure, so when one is performing more advanced stretches in this fashion, one may wish to put a slight bend in the leg to ensure this does not occur. One wants a ever so slight bend in the knee to avoid stretching a straight leg to hyperextension of the joint. Similarly, if one is standing up, sometimes if we are lazy or just tired, it is tempting to hyperextend the knee join (further back than straight) and put out weight onto it, so we don't have to use the leg muscles so much to support ourselves. Of course, this is a bad habit and can result to irritation and/or injury to the knee joint. Best avoided.

Bear in mind that whilst performing leg/pelvis stretches whilst lieing on your back, it is of course possible to pull the pelvis upwards and thus create a strong curve in your back. This is not advised, for many reasons (you simply end up 'cheating') and you should aim to keep your back as straight as possible, whilst performing the stretch to the maximum benefit (i.e. not harm) and extent, whatever that might be, rather than sacrifice the back in order to fool yourself into thinking you are getting that little 'extra', which partly comes from contorting your entire posture rather than isolating the muscle you really want to target. One example of such a stretch is the pelvis/gluteal stretch where you bend one leg with the foot on the floor and place the ankle of the other foot on the thigh of this bent knee, and pull both towards you (when doing this, it is recommended to try to support both legs so as to not put adverse pressure on the knee joint of the buttock you are stretching).

So in general, try to perform regular and gentle stretches, ensuring that your back is straight throughout the programme, and that you are maintaining the curve in your lower back throughout. Take it gently and focus on your breathing and relaxing into the stretch. It is best to seek advice on stretching from an experienced osteopath or BSR practitioner. Use your head and know when you are receiving good advice and bad advice. Analyse the stretch and think about whether it is stressing your spine or neck or not. You will invariably receive a great deal of bogus advice about stretching during the course of your life often from well meaning fitness instructors at well-respected gyms and health clubs.

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Cardiovascular Exercise Tips:

As a general rule, one should warm up before one's exercise session. Do your stretches, then do your exercises, do a slight cool down exercise, and then complete your stretching. It is best to have a day 'off' in between your exercise days, i.e. exercise on alternate days. If you have been doing weights on any particular day, it is generally best to do a cardiovascular session afterwards to eliminate most of the lactic acid build up from your muscles.

Some theories say that the best cardiovascular exercise is between 130-150bpm for 20 somethings. Maintaining a very high heart rate above this for long periods of time (e.g. 200bpm) is not providing you with any health benefits. Formulae for calculating your maximum and optimum heart rate for cardiovascular exercise are listed below.

Maximum Recommended Heart Rate = 220 minus your age.

Aerobic Heart Rate (aerobic rate at 70% of your maximum capacity) = 180 minus your age. If you are suffering from illness or are on medication, subtract at least another 10bpm.

Minimum Aerobic Heart Rate = Your Aerobic Heart Rate above minus 10bpm. Try to keep your heart rate in between the aerobic heart rate and minimum aerobic heart rate during the core part of your aerobic work out.

Warm up and cool down Heart Rate should be roughly 100bpm plus or minus 5bpm depending on your age. A warm up or cool down should ideally be 10-15 minutes.

We look at some daily situations of back abuse below.

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Lifting Heavy Objects:

The worst thing you can do to your back is to lean fowards, bending your back and then turn to lift something. Try never to do this! Always keep a straight back when lifting/using force and if something is to the side of you, turn to face it first, then lift, then rotate your entire body in the desired direction using your LEGS! That's what your legs are for. People tend to use the back to do most of the work as they can't be bothered to move the rest of the body.

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Carrying Bags:

Never go around with a conference bag/trendy one arm DJ bags slung over one shoulder, particularly if it is very heavy. If you do you will be carrying a load and twisting your spine, which is a definite no no. Wear a rucksack instead. There are many cheap or expensive and trendy looking rucksacks around, depending on your inclination. One should aim to distribute the weight evenly, so you can carry as heavy items as you want without causing spinal problems. If you are carrying heavy shopping bags, try to carry an equal weight in each arm, so that the spine is straight. You can pack each bag in the supermarket so that it is roughly the same weight as the next.

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Carrying a Wallet:

Carrying a huge, bulky, heavy wallet in one pocket of your trousers or jeans is not only uncomfortable (especially when sitting down - for men! You know what I am talking about!) and annoying, but is bad for your posture and may subtly affect the way you stand or walk. It is particularly bad if carried in one's back pocket when sitting down - and you are more likely to get pickpocketed! A particularly funny take on big wallets is George Costanza's character in the Seinfeld episode Reverse Peephole. Watch it!

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Household Sofas Encourage Bad Posture and Over-Reaching:

When you are slouching on a really bad sofa and stretch forward to reach the remote because you are too lazy to get off your backside and sit up/stand up properly (putting the force through your legs as you stand up), you are hugely increasing the risk of slipping a disk. Don't do this!

When you get up from a sofa, try to keep your back straight and use your legs to take the force, don't lean forward and take half of the force through your lower back. If you are aware, you can feel how bad this feels on your lower back.

It may be possible to support your back more with enough cushions behind you, but even then, most sofas sit very low, and the pelvis is often below the knees in height, which is not conducive to a great posture.

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Baths:

As much as everyone likes to have a nice, long, hot bath, the act of having a bath is probably the worst thing you can do to your neck! The heat is great for your neck and back. But unless you have an extremely long bath tub, where you can rest your head in line with the spine, you are tilting your head forwards at an extreme angle and holding it there for up to an hour. This is not good at all! Avoid baths unless you can have a straight neck! Take nice, hot showers instead (unfortunately shower heads are placed really low too, making tall people contort themselves to get a hot jet in the face. Bathroom designers and builders, you know who you are)!

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Sleeping Posture:

There are so many bad ways to sleep that are bad for your back and neck. If you think about how long are you in a sleeping position, it is no wonder that people develop stiff backs or necks. Our bodies are often used to sleeping in certain positions and we feel uncomfortable when we sleep in a slightly different position. Remember that although we may prefer to sleep in our usual position, this does not mean it is a posturally correct or healthy posture, and in most cases, it means we are reinforcing a pattern of years of twisting and contorting our skeleton. Many people confuse the concepts of luxury and health, as luxury somehow means being 'more looked after' or cossetted. If a mattress or pillow is more luxurious, it may often result in encouraging a lazy posture, which comes more naturally to our conditioned bodies.

So let us examine a healthy sleeping posture. You want to try to keep your spine and neck in alignment the whole time you are in bed. There are in other words two skeletally healthy sleeping postures. Your ability to achieve these is largely dependent on you adopting the correct body position, the performance and suitability of your mattress and the height and nature of the pillow(s) you are using.

With regards to posture, then the two recommended sleeping positions are:

On your back, with your neck in line with your spine, looking upwards. In other words you should be looking straight forwards.

Do not use too thick a pillow so your neck is bent forwards. The pillow should be just the right height to allow your neck to be straight and in line with your spine. You can always raise the height of a pillow by putting a towel or folded vest or t-shirt inside the pillow case (on the underside). Or buy a slightly thicker pillow. Some orthopaedic pillows will have a raised height around the neck to provide more support to the base of your neck. However, those pillows designed for sleeping on your side may not be suitable as the base is too thick/raised and they will exert too much pressure on your neck and may result in your neck/throat being raised up and your head tilted back. In addition, it may be hard to find the perfect orthopaedic pillow, and I am yet to find one I actually find comfortable. The reason for this is that there are 2 vital measurements to consider, the width of your head and the distance from your shoulder to your neck. Such pillows are often based on an average build and if the head part of the pillow is the right height, the neck support may not be (and may stick into your neck), and vice versa. I have a Secret Spring pillow, which, whilst not living up to the hype of lasting a lifetime, does seem to be adequate (whilst not providing any neck support as such). At the end of the day, if you cannot find the perfect pillow, then it is best to buy one that is slightly too low, then place a folded pillow case or similar inside the pillow case at the underside of the pillow, to raise the height of the pillow. A pillow that is too low can be raised in height, but a pillow that is too thick is basically useless, and can only really be used for resting your leg on or similar. Try before you buy, don't buy over the internet based on dimensions alone, and don't buy unless you are 100% happy with it, or at least it is just on the low side but still comfortable.

Do not turn your head to the left or right when you sleep on your back with your cheek and side of your face resting on the pillow behind your head. If you spent half of your day with your head turned to one side, it would be extremely uncomfortable. Whilst the neck joint is designed to move, the neck is not intended to rest or remain in the turned position for long periods of time, but seconds at a time. The more severe/pronounced the turn, the more pressure you put on your neck vertebrae. Some pillows have a natural hollow for the head and provide more lateral support, so the body does not have to try so hard to keep the head in the same position. If your pillow is not laterally supportive then you could perhaps consider using a pillow to place on top of the pillow your head is on, but propped up against the side of your head (by your ear), to give your head some support. Your mattress and bed should not ideally sag so your bottom and hips sink too low, meaning your whole back is curved the wrong way - similar to slouching on a sofa.

On your side, with your torso, shoulders and hips perpendicular (i.e. at 90 degrees) to the bed. The lower leg (in direct contact with the bed) should ideally be straight out and extended, with the upper leg bent with the knee out to the side, preferably supported on some pillows (if necessary, depending on your mattress), and with a high orthopaedic neck pillow under your head so your head isn't tilted to one shoulder or the other). The head should be facing forwards and be perpendicular to your shoulders, and not turned to one side (into the pillow or looking up at an angle at the ceiling). The pillow should support the neck (which is higher up than the side of your head), and should be the correct height. A low pillow can always be raised up to the perfect height as mentioned above with a t-shirt or small towel. There is nothing you can do with a pillow that is too high. The upper thigh should ideally be parallel to the bed, as should the side of your face.

If your head is in not tilted to the left or right shoulder and you have the perfect height pillow, it is possible to tuck in your chin too much (in a similar way to looking down or tilting your head forwards when you are standing up). This again will prevent your neck being straight and in line with the spine and may result in neck ache long term. Try to have a positive posture and look straight away from your body. The more you dip your head and tuck in your chin, the more likely the rest of the back is to follow suit and curve also. It is common for tall people or those who are shy or with low self-esteem to habitually look down or tilt their head forwards/down in this way. Some pillows may rub against your nose if you have your head in the correct position, encouraging you to bring your head in more towards the body to avoid the nose rubbing which can be irritating. If this is the case, you may want to consider changing the pillow or sleeping with your head on one side of the pillow so your face is on the edge of the pillow with nothing rubbing up against your face, but still getting enough support from the pillow so your head is at the correct height.

A variation of this posture is to have both legs semi-extended and together, with a cushion between your knees. If you don't have the cushion between your knees, after a few nights you may find that you develop pains on the contact areas on your knees that will stop you sleeping. The above posture is preferred however. With the knees together posture, in order to provide enough balancing support, the tendency is to bend your knees more, which can result in bending the knees more in front of you, then curving the whole spine (in a slouching sofa style), which is clearly not good for your back. It may also end up in the foetus position, which is posturally and psychologically unhealthy!

If you don't use a pillow under your upper knee, then the tendency is for the upper thigh to taper down towards the mattress, with the knee and shin/calf and foot on the mattress. This tends to exert a pressure/stretch on the gluteal muscles on your upper buttock and to pull on the hips on one side, which usually results in some twisting and your hips not being perpendicular to the mattress anymore. The torso and shoulders tend to compensate by tilting towards the bed more (maybe 45 degrees or more) and it results in your neck getting twisted slightly. If not, then you will put a constant torsional twist on your spine during your time in bed. Both of the above are incorrect or lazy ways of sleeping on your side. They are bad for your neck.

Some people are unsure what to do with their arms/hands when sleeping on their sides. It doesn't really matter too much. You may have the lower arm extended out to the side in some fashion with the upper elbow resting on your side and the forearm resting on the mattress or on your lower arm. If you have your lower arm extended out to the side, be careful not to have the joint hyperextended, as often it will put pressure on the elbow and cause inflammation over time. There are pros and cons with each position, as too much pressure on the lower arm from the weight of your upper arm may be uncomfortable result in frequent changing of position, and may reduce circulation in your lower arm. In addition, you may be tempted to hug your lower shoulder or similar, resulting in a slight pull on the upper shoulder and tilting the shoulders towards the mattress more, which can result in similar problems to the above scenario. You may find using some kind of pillow or cushion in front of you may be helpful for supporting some of the weight of your upper arm. This does add additional pillow complexity to your bed arrangements, and you'd have to presumably switch the pillow to the other side if you roll onto your other side to sleep in that position for a while. You may well find that you can get used to not using a pillow like this and it keeps life simpler! Any number of pillow configurations are possible, and it is likely you will have more the worse quality/suitability your mattress is.

Some of you may read the above and think, I'm not doing that, it's too regimental, it's far too neurotic and I want to do whatever I like in bed. You will probably find that it takes a few nights to get used to it, but once you are used to it, you will become aware of how the old posture was bad for you and how uncomfortable the old posture is (immediately upon taking it up or suffering pains a day or two later). You are of course free to do whatever you want, and if you choose to ignore the skeletal and physiological consequences of that, it is up to you. They may not annoy you now, but later in life you may regret it. Good posture is noted as resulting in improved blood circulation, less tossing and turning, and deeper sleep, which will result in better health and greater daytime energy levels. Sleep is very important for the body's healing and recovery, and a good posture during sleep will help the body's organs and biochemistry work and function better.

Some people complain about orthopaedic pillows, as they are only really comfortable when sleeping on your side and if you happen to roll onto your back during the night, then your head will be too elevated relative to your body and they will give your neck ache and neck problems. However, not having an orthopaedic pillow or raised pillow will result in neck ache and poor posture and skeletal alignment when sleeping on your side! So if you ALWAYS adopt one sleeping posture. However, most people tend to stick to one sleeping posture for most of the night, with another posture being a secondary posture, less frequently used, but usually reverted to for at least some of each night. This being the case, you really need two pillows, one neck pillow and one low pillow. The key is to swap pillows or move slightly to the side where the right pillow is for the posture you want to adopt. If you share a bed with your partner or spouse, then you may need 4 pillows laid out at the top of the bed and there may not be room for this. The trouble is with using 2 different pillows is when you are half asleep or too tired to physically move once you have adopted your new sleeping posture and use the wrong pillow for the job! However, not everyone who changes position goes from the side to the back and vice versa. Some people change from the left side to the right side and vice versa, in which case no change of pillow is necessary or desired.

If you do tend to wake up frequently during the night and to change sleeping position, i.e. turning from sleeping on your left side to sleeping on your right side, and vice versa, then try to avoid twisting your torso too much, as this may greatly tighten up the muscles in your lower back, pelvis and the gluteal muscles. Try to keep your torso and pelvis in line, as one unit as you gentle roll over from one side to the other. The other thing to avoid is to 'pivot' on your head, i.e. lifting up your torso with your head - this puts half your body weight through a bent neck and is not a good idea! Try using your hands, arms or shoulder.

The foetus position is of course very bad, not only as you roll your back and neck but also because psychologically it is very damaging and disturbing! You may observe some people who like to have baths and/or who sleep in the foetus position and their backs are permanently arched. Baths and sleeping at the two biggest bad habits we have that put strain on our lower back and neck.

Please see the Mattress Comparison & Buying Guide page for a detailed look at the pros and cons of different kinds of mattress. Your choice could well affect your health over many decades.

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Sitting at your Desk:

You may find that if you have your chair too low to the ground, then the body will naturally tend to slouch. This is cured by raising the chair up (so that your knees are in line with your pelvis or lower than your pelvis) and you fill find keeping an upright posture very easy indeed. If you tend to keep your feet underneath you rather than directly below the knees with your feet on the floor, this may cause tension in the body as well as encourage a bad seating position. In addition, it may be helpful to have the base of the seet either flat or slightly sloping forwards to help you keep a straight back. A seat base the slopes backwards, where your pelvis is lower than your knees, is conducive to slouching and it is very hard to maintain a proper posture in this position.

Some office chairs or stools are of the kneeling variety. These may seem like the ideal solution to sitting at a desk with a straight back. The chair ensures that the knees are below the pelvis. This is good. However, with a regular office chair, the weight of the body is mainly carried on the buttocks and upper hamstrings, and partly on the soles of the feet. With the kneeling chair, the pressure is taken mainly on the knee caps and top of the shins and to a lesser extent on the tips of the toes if the feet touch the ground. The knee pad is there to minimise pressure but as you can see the effect is to push the lower leg backwards and and not up into the knee joint as it would be when standing. Thus the pressure on the knee, apart from the head on pressure, is also a lateral pressure. It depends how much of the weight is on the knee cap and how much is on the upper shin. Either way, it is not ideal for the knee. Of course, short durations in such a chair may be acceptable, but all day regular usage may simply shift back problems to knee problems. In my opinion you are better off with a regular office chair, albeit one that is sufficiently wide/long and padded to accommodate your body shape, and one with enough adjustment for height and tilt to allow for the 'perfect' sitting posture.

If you are using a computer, for example, right now most probably, then it is important to keep your forearms as horizontal as you can and in line with the wrists. If you have a kink in the wrist with the forearms sloping down towards the keyboard, then this is likely to aggravate your forearms over time and potentially lead to tendonitis. The top of the monitor screen should be in line with your eyes (sitting up straight). A good trackball mouse is also recommended, rather than a traditional mouse. They may take a few minutes or hours to get used to, but after this they are much easier and more relaxing to use. The trouble with mousing is that it tends to tense up one shoulder and use more of an arm movement when moving the mouse across the table. An example of a very good and cheap trackball mouse is Logitech's Marble Mouse. An optical trackball may be preferable, however in some cases the actual 'ball' is quite heavy to move.

It is best to avoid keeping bulky objects in your pockets, as this is not only awkward, uncomfortable and potentially stressful when trying to sit upright, it also tends to encourage one to slouch more so that the thick wallet does not stick into your pelvis. Find what works best for you.

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Driving:

Getting out of the car: Remember what we said about bending and twisting? You have to rotate yourself so you are facing the door opening and then get out. If you twist and get out, your back will not like it! The Lotus Elise was probably designed by osteopaths to increase their client base (joke). I have personally put my neck out virtually every time I have climbed out of a Lotus Elise or Vauxhall VX220. They may be fun to drive. But how can you call these cars? I have found a go-kart easier to get in and out of, cheaper, in some cases faster and always more fun to drive!

The risk with most driving seats if that if you are too tall you have to tilt the seat right back, and then you are slouching excessively as there is no lumbar support. I find that just off the 90 degrees setting helps keep the back straight. Like a rallying driving seating position. Not that I am encouraging drifting your car around wet roundabouts! Having enough headroom is therefore critical. Ideally the knees should be below the level of the pelvis, not above it! However, this is not normally possible in saloon cars (particularly sports saloon cars) or sports cars, but usually only in , trucks or MPVs with very high rooves. Hatchbacks may have enough headroom to have an upright posture, but it is unlikely that the seat can be raised enough to allow the hips be in line or higher than the knees. Of course, this may well be possible in most cars if you are short. If you are tall, this is much more difficult. Please bear in mind that many car seats have a life of 3-6 years depending on usage and after this they tend to sag, especially at the base, as the padding and springs are mechanically worn. A good upholsterer can cheaply modify your car seat by taking the plastic back off the seat and inserting additional foam padding into the seat lumbar area, for example, to improve the lumbar support of your car seat. Or by removing all the relevant padding and springs and replacing them with new units. The correct seat parts can be purchased from your car dealer, or an independent official parts supplier, including foam inserts and the base unit including springs, depending on specification. These can be fitted by the upholsterer of your choice to keep costs down. The more expensive alternative is to buy a new car or physically change the entire driving seat.

Whether we like it or not, driving is bad for your back, no matter how expensive or inexpensive a car you drive. The art of going around a corner results in some tightening of the muscles around the lower back and rib cage. Modern cars are able to go around corners faster and faster, and in addition, modern lifestyles and impatience means that often we drive around corners or roundabouts faster than we perhaps should. In addition, some roads are fully of bumps and potholes, particularly in the UK, which jostle you about in the seat and result in the body tightening up in various places to protect itself. Clearly the faster you drive over potholes the harder the thumb will be. You may want to drive more slowly and in a more relaxed manner, so you have time to react and avoid the biggest potholes. Try to notice where you tighten muscles when you drive. Try to adapt your driving style to not tighten up your back. With each contraction and release of muscle tension when you tackle a corner, you are not releasing all muscle tension, but storing some up in your back. The effect is exaccerbated by mini-roundabouts, which require a very tight turn to negotiate. Driving around corners fast may be fun for some, but it does nothing for your back or mental relaxation. Couple this with the tendency for the driver to not move their back or pelvis at all whilst behind the wheel. A speed bump is a form of ramp, a traffic calming measure that are designed to slow down vehicles, but actually increase fuel consumption and noise levels. They are also known as sleeping policemen - perhaps they ate too many doughnuts! Driving over speed bumps in towns too girate the whole spine every time you drive over them, and jossle passengers in the car, especially in our modern cars with unergonomically designed seats for taller drivers, and increasingly firm suspension and hard low speed ride. Our roads are being tranformed from smooth roads to obstacle courses. Is this progress? Just remember that by driving fast and in an aggressive manner, you are only saving maybe 10-15% of the journey time, but transforming it from a relative calm experience to a stressful one and it may affect your state of mind for many hours afterwards and indeed result in increased muscle tension that you might not immediately notice. The cumulative effect is however very significant. The ego always likes to drive fast and 'beat' everyone else. It is not worth it and very childish. Ask yourself why you drive fast when you aren't in a hurry! It is often a default mode we go into.

I am beginning to understand the USA's obsession with SUVs, as they are a good height to step into, they encourage you to drive around corners more slowly, and have plenty of suspension travel for nasty speed bumps! Maybe this is why we see so many off road vehicles in towns in Europe! Have you ever become irritated or stressed whilst driving a car? Perhaps this is a stupid question. The stress of driving, inconsiderate driving, heavy traffic etc. no doubt are a huge contributor to neck, shoulder and lower back tension. It is ironic that people claim to love driving so much, yet it is probably the largest cause of daily stress in their lives.

Those engaging in motorsport or kart racing are abusing their back much more. This is assuming they don't spin off ever (sure, we believe you!) and put undue stress on their necks or spine. Driving around a corner on the limit or just below the limit every five seconds or so, and putting those g-forces through your spine are not healthy, and the amount of muscle contraction we need to maintain to keep your torso still and not be jiggled around in the racing seat clearly cause our backs to stiffen up very quickly! This is why seasoned racing drivers and kart racers all speak highly of their osteopaths and physiotherapists. They really do need them! I am not discouraging people from pursuing motorsport as a money burning hobby, but that if one does, one should know the consequences! Crashing should be the least of your concerns.

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Patrik's Challenge:

I tried an experiment one time. As none of the chairs in my house had a good lumbar back support, such that I would sit upright with no back support all evening watching television etc and during the day at work also, scanning the body every so often to feel whether I was maintaining the curve in the lower back (but not over compensating so as to tilt the pelvis down and curve the whole spine the other way).

If you find you are tilting your pelvis forwards and down too much, resulting in creating too much curve in the lower back, then you can correct this by thrusting your hips and groin forwards (!) and engaging your buttock muscles a little. If you relax your buttocks and stomach too much, you may find your pelvis tilting forwards and down. Try to develop an awareness of where the ears are in relation to the shoulders, whether you are dipping your head too far forwards and downwards or not (common in tall people and those with low self-confidence or depression); whether the shoulders are raised or relaxed; where the shoulders are in relation to the hips; and whether the hips, knees and ankles are in line (whilst standing). You may find it helpful to stand upright or sit upright adjacent to a full length mirror and observe your posture and neck/spine/pelvic alignment.

It was total agony for about 3 days as I wasn't used to working these muscles, but after that I had gotten used to it, and after that I could sit upright without any back support all day without feeling uncomfortable or any muscle ache in the lower back. One needs to eradicate one's bad habits over time though, as the body is so used to going back into a bad seating posture. This is why it is important to be aware of what the body is doing when sitting down and standing up. After a few days, instead of the back aching when one is sitting upright for any length of time (as the muscles haven't been fully used for many years), the back will now start to ache if one slouches or bends forwards incorrectly for more than a few seconds. Ironic isn't it? The natural order is now restored, and the necessary muscle tone has been developed.

Try it! I dare you! Can you really stick it out for a couple of days? I don't think you have got the guts. I think you are too lazy, too indisciplined, too pathetic. You really think you can do it? [just using reverse psychology here] JUST DO IT! You don't even have to get up from your seat and away from the television either! You can do it sitting right there on your 'ass'!

Leaning back on any chair is going to make you slouch to an extent. It's not too bad if the base of the chair allows you to push your bottom/base of spine under it, so your chair back helps to preserve the lumbar curve, but generally it's better to just sit up by yourself all the time. I never use a chair back. It's totally pointless. Apart from driving of course.

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