We are a product of our environments. A high proportion of the population now spends their days sat down, staring at something in front of them on their desk, often in a badly designed chair. We sit in this position often between 6 and 8 hours a day, then go and sit in a car or a bus to get home. We may exercise and go to the gym to lift weights, or maybe go for a run or cycle, maybe a pilates or yoga class. If you work 5 days a week and are sat down 6 hours a day then that is 30 hours sat down plus all the sitting in your leisure time, that is a lot of time that your brain and body become used to and you adapt to become even better at it. So you become really good at sitting.
Posture is sub-conscious and is affected by the environment we are in, how long we spend there, how much we do to counter act and offset it and previous injuries we may have had. Our brains and bodies thrive on challenges and new stimuli that it is required to adapt to. If you do not have variety in your activities then you are likely not doing enough to offset the amount of time sat in that slumped position at your desk. Typically people do not realise that the 3 to 6 hours of exercise they do a week is not varied enough or stimulating enough to result in your brain and body to pull itself out of that super specialist slumped position that you are consistently working on for 6-8 hours a day.
The links between posture and pain are unclear, but it seems pretty obvious that if you are not in a relatively neutral alignment then there is going to be additional stress in parts and on structures of the body where that stress is not designed to be. So it would logically follow that this increased stress has the potential to make it more likely that you will experience pain or discomfort. In the picture below you can see 4 different types of posture that will each place stress in different places of a persons body. This stress will mostly be placed on the soft tissues of the system including the ligaments, muscles, intervertebral discs etc. but will also impact the ability of the organs to operate efficiently if there is an increase in tension of the fascia that holds them in place, or if the space they occupy is closed down by skeletal position. This increase in tension of soft tissues can then itself go on to cause problems such as migraines, feelings of 'tightness', disc protrusions and so on.
You may think that the affect of a slight forward of neutral head position may seem negligible but you can see in the picture below how head position changes the relative weight and stress on your neck.
There are a number of conditions or syndromes or descriptions of different types of postures and the type of pain that is often associated with them. One of these is called Upper Crossed Syndrome which is a corresponding tightening and stretching of opposition muscles in the upper body and neck.
As stated earlier the link between posture and pain is not clear – what appears to be more of a problem though is if you are stuck in that position and do not have available range of motion to move out of it. Due to a sedentary lifestyle a lot of people develop a forward head posture which means their neck is in a relatively extended position almost all the time (see the 2nd pic of the 4 types of posture). They become unable to extend their thoracic spine (the middle bit) and when you ask them to do this their brain creates an illusion that they are doing it by either pulling their shoulders back or pushing their hips forward. Often these people struggle with tilting their hips as well, as their backs have locked down and become unused to moving. This inability to move an appropriate amount through each joint is a problem as if that part is stuck the body will likely just go and get that movement from somewhere else in your body – in this case often the neck. So you end up with an unstable neck because your middle back has become stiff.
As an activity now I would like you to stand up, put your chin to your chest and then keeping your chin there and without moving your hips I would like you to look up to the horizon – the only way you can do this is to extend through your back. Can you do it? What does it feel like? When the body becomes unable to move in a certain direction it starts to compensate in other places and also to create the illusion to the individual that it IS able to do it – hence the tendency for people to move their hips or forget to keep their chin down when trying to this exercise / test.
The skeleton should create opposition through itself as it moves through the gait cycle, for example when the hips anteriorly tilt the rib cage typically posteriorly tilts and then the skull anteriorly tilts. And when the hips posteriorly tilt, the rib cage should anteriorly tilt, and the skull posteriorly tilt. These are normal and desirable spinal mechanics. We find that a lot of people have lost the ability to separate their hips from their backs and the ability to integrate movement through different sections of their vertebral column. When people are unable to separate these movements they will instead start to 'borrow' movement from somewhere else by creating a compensation. This can often appear as a hinge point in an individual's back or lower neck as rather than extending over a section of the back they get all the movement from one vertebral joint! This can obviously lead to more problems as suddenly a joint is moving much more than it was designed to to make up for other things that aren't moving as much as they should.
The first step that we usually take with clients to start integrating normal sagittal plane spinal mechanics back into their systems is lying hip tilting. Lie on your back with your knees bent, and feet flat on the floor. Start by anteriorly tilting your hips (arching your lower back) and let this movement at your hips lead the movement higher up through the back. Ideally this should cause your chest to rise up and pull your chin in towards your chest and stretch the back of the neck (this position is effectively the opposite of a sitting position). Then from this position tilt your hips the opposite way so that you are effectively tucking your bum under, rounding your lower back against the bed, chest drops and neck extends. Common problems that we find are an inability to tilt the hips initially, a feeling of pinching in the lower back (this is indicative of a particular problem which should be looked at), an inability to synchronise movement of the hips with the back, and then also the head moving in the wrong direction with what the hips are doing. As previously mentioned an inability to extend the thoracic spine (posteriorly tilt the rib cage) often results in a cervical hyperextension to compensate and so this needs to be smoothed out.
There are a number of things that you can start to do to work out inefficiencies and kinks in your body that you may have developed. Start by bringing more variety to your activities. And this doesn't mean you have to stop what you are doing – just maybe if you run 3 or 4 times a week switch 1 or two of them to go and do a circuits class or boot camp. If you are a fan of lifting weights then start incorporating rotation movements on cable machines and some crawling and rolling patterns for your warm up. Go join a Tai Chi group that will get you moving in every different direction you can possibly think of and more. Start incorporating simple movements into your lives that you can do at your desk or before you go to sleep or when you wake up that involve taking your joints through their available ranges of motion, such as the lying hip tilting discussed above. This will certainly act as a good start that your body will thank you for.