My treatment philosophy is guided by 2 core principles: 1. I optimize my patients' time frame of recovery as much as possible. 2. I empower my patients to be as independent in their rehab as much as ...
Before you start reading this article, please do something for me. It will make sense later on, I promise. Whether you’re reading this at your desk, in the subway, or in the toilet, sit straight. Pull your shoulder blades back, contract your lower back, and imagine that a string is tied from your head to the ceiling, forcing you to hold your head high.
Great, now hold this position and read on.
If I had a loonie every time I heard one of these phrases from patients coming to me with neck or back pain while sitting, I’d probably be able to afford a new work setup myself.
Desk jockeys, have you ever said or thought of any of these phrases? Well, whether you did or you’re lying to yourself, this article is for you.
Lawyer, physical therapist, or gamer… Whoever you may be, if you clicked on this article, then chances are you spend the majority of your day sitting and will benefit from this read.
By reading this article, you will obtain a realistic sitting hygiene routine that you can implement immediately. We will also demystify some common posture tips and myths so that you may customize the routine in a scientifically-backed way.
A good sitting hygiene protocol is the same as any good training program: it has to be realistic and progressive.
Here are some bad ideas:
What do all these ideas have in common? They implement changes that are either unnecessary or too drastic. This all goes back to load management (“How was load management used in Ms. T.’s rehab?” in my tennis elbow article).
Going from sitting for 8hrs to standing for 4hrs is just too drastic. Is standing for 4 hours bad? Of course not. But over the years, your muscles, tendons, and bones would’ve gotten used to being loaded in the sitting position for the majority of the waking day. To go from that to now being loaded in the standing position, which is much more demanding, could lead to musculoskeletal issues.
What an extreme case, right? I mean, who would really go from 0 hours standing at work to 4 hours in one go?
This might seem like an exaggerated example, but I have treated at least 3 cases who started experiencing back pain after effecting a transition of the sort due to a well-intentioned but misguided desire to better their sitting hygiene.
In physical therapy school, we called it forward head posture. On social media, it is also called text neck or tech neck. I’ve even seen it called military neck in older publications. Whatever you may call it, common society has made having a forward head posture synonymous with having a bad posture. The vast majority of my patients complaining of neck pain while working at a desk will point to their forward head posture as the main culprit.
They often find it surprising when I tell them that there is actually no association between forwarding head posture and neck pain. This is a bold claim I am making, but I would not be making it if it was not backed by modern scientific research.
A study conducted by Richards et al. in 2016 looked at 1108 adolescents (a demographic often accused of having terrible posture due to their usage of cellphones) and concluded that “no association between cluster membership and neck pain and headaches challenges widely held beliefs about the role of posture in adolescent neck pain” (cluster memberships meaning having a specific posture).
But what about low back pain? If not neck pain, could “bad posture” cause low back pain? Unlikely. What is even more surprising is that even having a nice rigid posture can lead to low back pain according to this 2015 case-crossover study and this 2015 randomized pilot trial.
Okay, so we just busted a few myths. What should you take away from all this? Does this mean that everyone should walk around with their heads slumped forward like Gollum from Lord of the Rings?
Heavens no. Sitting straight with a head held high is perfectly fine and many people feel more confident and comfortable that way. The point of debunking the myth that bad posture = neck and back pain is simply to say that when constructing a sitting hygiene plan, the emphasis should not be placed on having a straight posture.
This is great news for you because you can’t have a perfectly straight posture for 8 hours straight. I can’t either. In fact, no one can.
Also, treating neck pain is much more complex than simply telling someone to sit straighter. Here is an example of how I treated a recent desk worker with neck pain.
We’re more than halfway through with the article. Are you still sitting straight? If not, that’s fine, you’re just like the rest of us. If you still are, congratulations on your dedication. Now imagine staying like that for the entire day. If you’re scoffing right now because you’re used to sitting straight like that for entire days on end, text me at 438-801-0417 to impress me.
Here is an example of a realistic sitting hygiene protocol that I would give to someone complaining of stiffness during their workday (or gaming session).
This is not the perfect plan for you. It is well made, has been tested many times, and is made by a man on the internet with good intentions but zero knowledge about your medical history or your needs. If you’d like a custom-made sitting hygiene plan, give me a call or book an appointment. I’d love to help you out! Now, let’s get into the steps of the sitting hygiene protocol.
Now that you have this sample sitting hygiene protocol, it is time to customize it. But remember the earlier points made on realism! Do not make any drastic changes in a short period of time. A good guideline for making changes is to not make a change of more than 10% during a 1-week period.
This means that if you’re currently sitting for 8 hours at work and just purchased a standing desk (or can move your laptop to a standing height), start by just standing for 40 minutes in total every day next week. This can be broken up into 2 periods of 20 minutes at the start and end of your day..
If any of the information or stories in this article speaks to you, feel free to check out my profile to read more of my articles or to book a 1-hour private room evaluation with me.
If you’d like to discuss any of the points raised in this article in more detail, I would love to speak to you. You can contact me by email at firstname.lastname@example.org or by phone at 438-801-0417. I currently offer free no-strings-attached 15-minute phone call sessions to discuss how I can best assist you.
Here are some suggestions of articles I have written recently, organized by topics.
Knee pain: case study 1
Shoulder pain: case study 1
Elbow pain: tennis elbow case study
Correia, I. M., Ferreira, A. de, Fernandez, J., Reis, F. J., Nogueira, L. A., & Meziat-Filho, N. (2020). Association between text neck and neck pain in adults. Spine, 46(9), 571–578. https://doi.org/10.1097/brs.0000000000003854
Damasceno, G. M., Ferreira, A. S., Nogueira, L. A., Reis, F. J., Andrade, I. C., & Meziat-Filho, N. (2018). Text neck and neck pain in 18–21-year-old Young Adults. European Spine Journal, 27(6), 1249–1254. https://doi.org/10.1007/s00586-017-5444-5
Kent, P., Laird, R., & Haines, T. (2015). The effect of changing movement and posture using motion-sensor biofeedback, Versus Guidelines-based care, on the clinical outcomes of people with sub-acute or chronic low back pain-a multicentre, cluster-randomised, placebo-controlled, pilot trial. BMC Musculoskeletal Disorders, 16(1). https://doi.org/10.1186/s12891-015-0591-5
Physical activity guidelines resources. ACSM_CMS. (n.d.). Retrieved September 29, 2022, from https://www.acsm.org/education-resources/trending-topics-resources/physical-activity-guidelines
Richards, K. V., Beales, D. J., Smith, A. J., O'Sullivan, P. B., & Straker, L. M. (2016). Neck posture clusters and their association with biopsychosocial factors and neck pain in Australian adolescents. Physical Therapy, 96(10), 1576–1587. https://doi.org/10.2522/ptj.20150660
Steffens, D., Ferreira, M. L., Latimer, J., Ferreira, P. H., Koes, B. W., Blyth, F., Li, Q., & Maher, C. G. (2015). What triggers an episode of acute low back pain? A case-crossover study. Arthritis Care & Research, 67(3), 403–410. https://doi.org/10.1002/acr.22533
Images courtesy of: Massage Therapy Journal, The Lord of the Rings, Amazon, Back Intelligence