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| Sitting and Back Pain For many people, sitting poses no problem at all. Sitting in any position for any length of time produces no ill effects. However others are not so lucky, as sitting for even short periods can be painful. The pain may occur while they are sitting or afterward, when they try to get up to stand and walk. Many, many variables can create these conditions of pain, so trying to generalize regarding prevention and treatment can be difficult and potentially misleading. Being aware of your options can create a huge shift in the pain that you suffer. We are constantly being told what a correct sitting posture looks like. These images tend to be one of the buttocks pulled back into the chair back, a mild lumbar curve in the small of the back (often supported by the lumbar support of the chair or a lumbar cushion), and feet flat on the floor. You may strive for this posture, but continue to suffer back pain during and after prolonged sitting. Next, you might purchase an "ergonomically correct" chair with no real change. What might be missing? In my practice, when a patient is experiencing back pain with sitting or coming up to stand after sitting for a period of time, I always pay close attention to the hip flexors (psoas). The function of the hip flexors is to...flex the hips. When you stand or lie down and contract the hip flexors, your thigh will move up toward head. However, if there is shortness of the hip flexors, due to the upper attachments of the hip flexors, standing will cause the low back and pelvis to pitch forward. When lying on your back the shortness will increase the arch in your low back. Both of these scenarios frequently lead to back pain and even more serious disorders of the discs. So where does sitting fit in? Numerous studies have show that sitting creates more pressure in the discs of the spine than does standing. Further, sitting with the trunk pulled forward over the hips (as in leaning forward while working at a computer) creates more pressure than sitting with your back against the chair back. Opening the hips into a more open angle (reclined back) further decreases the pressure in the discs. A great summary of some of these findings can be found here. Also, when you sit with your back and pelvis forward for a length of time, the hip flexors will shorten. Returning to stand will pull on the lumbar spine and discs, eventually leading to failure and pain. Thus, the shortness of the hip flexors can create back pain when arising from sitting and improper sitting posture can create an increase in pressure of the discs. Neither scenario is desirable While many resources exists (both in print as well as on the internet) that address various views on proper sitting posture, few address the background muscle tone that takes place while a person sits on various surfaces. One very important topic that I address in my practice is the amount of contraction that the hip flexor assumes during sitting. If the hip flexor is held in a contracted state for extended periods of time, one will experience difficulty coming to stand, not to mention the long term changes that can take place in a muscle that shortens over a period of time. Given the attachment of the hip flexor to the lumbar spine and discs, these are issues that are vital to back health and comfort, both short and long term. Altering your holding patterns while sitting can reap great benefits, both for comfort as well as for long term diminishment of back pain. At the Pain relief Center, I take care to address both the shortness of the hip flexors as well as educating you on how to hold your body for maximum relaxation of these very important areas. For more information, please contact me. For related articles on the Internet, see: The Psoas - Hidden Influence on Posture The Psoas Muscles and Abdominal Exercises for Back Pain The Importance of the Psoas Muscle Ilio-psoas muscle strain -- The Filet Mignon of backaches |
Walt Fritz, PT Copyright 2009-2010