So everyone has been ordered to stay home and twiddle their thumbs until this whole thing blows over so I'm willing to bet my decent internet connection that someone will tell you "sitting down will give you poor posture and poor posture will give you bad back pain!".
At the start of the century this was what everyone was told, but I like to think that we, as a society, have learnt a little bit more since then.
I should mention before we go any further: I am not a physiotherapist. I am not qualified to diagnose or treat pain and injuries. A big part of my job as a trainer, however, is to be able to find ways to train clients around pain, and as such, I try to keep on top of this topic.
As I briefly mentioned in the last article, bad posture does not automatically mean back pain. It's been well established in the research that spinal degradation is present in high numbers of asymptomatic individuals and that imaging such as MRI scans do not match up with clinical presentations (1,2). That means that someone could have the most horrendous looking posture in the back, scans showing 3 disc protrusions and that person could have absolutely no pain whatsoever. To put that simply: bad posture does not equal back pain. Back pain is a more complicated topic than that.
That being said, the altered curve in the spine that comes with sitting for too long does have some impact on our training. When a client first walks through the door with an excessive curve in their upper back and a forward head (the telltale signs of kyphosis, or "sitting posture") they will almost always say they have a recurring back pain or hip pain which they've been dealing with for years. When I hear this I immediately think of two things which seems to clear up these issues: anterior release and posterior strengthening.
The spine naturally has 4 curves in the cervical, thoracic, lumbar and sacral regions. Kyphosis is when the curve in the thoracic spine (upper chest area) is excessive and is the result of sitting hunched over a computer or phone for too long. It is increasingly common given our modern way of life.
Anterior release: often, but not always, the front of the body is tight from remaining in a flexion based position for large periods of the day. Because of remaining shortened and overused they can benefit from a form of release such as massage or stretching. The major muscle groups to target are the pectorals and the hip flexors.
Posterior strengthening: often, but not always, the back of the body is weak from being kept on stretch and rarely being used the muscles. These muscles can benefit from strengthening exercises so they can build enough strength to keep your body in an upright, extended posture. The major muscle groups to target are the upper back and the glutes.
Loosening the tight muscles can sometimes have a knock on effect on back pain within hours. I've seen people with a sore back do the half kneeling hip flexor stretch (explained below) and hours later claim they haven't had any back pain since. This is because when we sit for too long muscles such as our hip flexors can become shortened and they can also tighten up. When the hip flexor muscles are tight this causes them to pull on their attachment sites on the hips which can offset the back and start a whole cascade of misalignments and pain where certain muscles are having to take more load than they can handle. Stretching the tight muscle allows it to extend and relax which can lessen the pull on the spine leading to the reports of less back pain. Obviously this isn't the case with everyone who has back pain.
Neglected muscle groups can have often have challenges "hearing the message" sent from your brain saying that they need to fire on to do a movement. This leads to compensation, or using other muscles to complete a motion which can be harmful when these other muscles are less suited to the job. When a muscle is asked to perform more work than it can handle it can often lead to pain. By training our muscles we can "switch on" the muscles we want more effectively to reduce compensation and nudge the workload that our muscles can handle a little bit higher meaning we can take on more stress (e.g. sitting down with poor posture at work) without feeling sore.
Now this does not mean you have to fix your kyphotic posture. You're not broken. Different people have varying degrees of kyphosis, we all sit on the scale somewhere. But it can be beneficial to swing yourself back towards the neutral spinal position as it is the most biomechanically advantageous position (we have Charles Darwin to thank for discovering natural selection) and it can help our training by both improving our range of motion and sometimes eliminating the little niggles during movements especially in the overhead press or the lunge position. And I mean hey, it's never a bad idea to strengthen your muscles and reclaim your range of motion.
So if you find yourself worried that you've been sitting a lot recently and want to reverse any potential side effects this can have on your pain, your range of motion or anything else your grandmother claims bad posture can cause here are some extension-based exercises and stretches you can implement:
Upper body:
Thoracic extension:
This movement involves practicing your thoracic extension - the exact opposite movement to what sitting places you in: thoracic flexion.
Lie face up with a foam roller across your shoulder blades. Keeping your chin tucked in to your chest, slowly extend your upper chest making sure not to get too much movement from your lumbar spine (lower back).
This movement can be performed in your warm up or as a mobility drill. Complete 6-10 reps, twice per day.
Here is a video from fellow trainer Tony Gentilcore explaining the drill and some common errors to avoid. He's basically just me with more experience in the industry (and without my luscious hairdo).
Foam roller pectoral (chest) stretch:
Lie on your back with a foam roller vertical between your two shoulder blades. Make sure the foam roller supports your head. Have your knees bent and your arms straight out to the side at 90 degrees to make a T shape. Let your chest relax and sink into the stretch. Hold this position for 30 seconds and do this twice each day.
Standing Pectoral stretch:
Stand in a doorway, bend your elbow to 90 degrees and place it on one side of the doorway at 90 degrees from your torso. Place your opposite foot further forwards than the door and your closest foot slightly behind the door. Putting pressure into the doorway through your elbow, turn to face away from your elbow. You should feel the stretch in your chest if not, creep your feet forwards a little bit and turn a little bit further away. If you're still not feeling the stretch re-read the instructions, chances are you're not doing it correctly.
Pec foam rolling:
This movement is great for getting a massage on your tight chest without paying $60 for a masseuse (Ha! Imagine getting that close to someone else! #isolationgang).
Lie face down with your arm out to the side, palm facing down. Place the foam roller under your armpit parallel to your spine. Slowly roll across the chest putting mild pressure on the roller as you go. When you find a tender spot hang on it for 6 seconds, relax into it and keep moving. Fellas, you can go all the way across your chest and back to the armpit. Ladies, you often will not be able to go all the way across the chest, go as far as is comfortable for you. You can also use a hockey ball to get in deeper to the chest if the foam roller doesn't do it for you or if you just like feeling pain... I don't judge.
SA DB BO rows (Single arm dumbbell bent over rows)
Any form of row is going to be super beneficial to anyone with a kyphotic posture but I would argue this is the single most beneficial exercise for countering the rounded posture. It hits your shoulder blades with the weight but it also engages your postural muscles in the lower back to keep a straight posture. Single arm with a dumbbell helps to eliminate any compensation and highlight any weaknesses while adding in rotational forces to deal with too (as opposed to the more common barbell BO row).
Knees bent and pushed out to the side. Fold forwards from the hips keeping the lower back straight, you're aiming to get your chest parallel with the floor or close to it. Opposite hand goes in the middle of the bench/chair. As the dumbbell comes up, puff your chest out to meet it. Let the scapula reach forwards on the way down, but try to limit rotation in the upper body. Stand up before swapping arms to give your back a quick break.
Other row variations you can try: Seated row, split stance band row, band pull-aparts, unsupported row, BB BO row
Bent over T's
Similar to the previous exercise but with less muscles involved.
Knees stay relatively still as you fold forwards using your hips, aiming to get your back parallel to the ground. Arch your lower back so it stays in a straight line as you go down. Palms facing forwards, squeeze your shoulder blades together as your arms come up.
Cat-cows
This is a great movement for the upper body and lower body I've stolen from the practice of yoga. The cat-cow pose allows you to experience a full range of motion in flexion and extension at both the pelvis and the spine.
Start on your hands and knees on the ground with hands directly under shoulders and knees directly under hips. Push the ground away so your shoulder blades rise up and at the same time round your lower back by tilting your pelvis posteriorly. Eyes should move between your knees. Gently approach the end range of motion here then return back to neutral. Let your shoulder blades come together as you puff your chest out, eyes to the wall in front of you and arch your back by tilting your pelvis anteriorly. Return to neutral and that is one repetition. Go through the movement about four or five times twice a day.
I like to spend a second in the neutral position each time I go through the movement which is about halfway between the two end positions and is where your body should be throughout the day. Find neutral and try to stay there long after the stretch.
Why on earth are these called cat-cows?!? Both positions could possibly be a cat but neither of them look like a cow!!! Stupid, sexy yoga people.
Lower body
Half kneeling hip flexor stretch
A very basic stretch for the front of the hip you've probably done before. You might think "oh this stretch is ok but I dunno I don't really feel it that much" but I bet you've probably been doing it wrong this whole time. Here is how to do it in a joint-friendly manner that will blow your mind (and your hip flexor flexibility!).
Get into a half kneeling position with one knee down and an angle of about 90 degrees on both knees. I like to use a cushion to be a bit more friendly towards my knee. From this position tuck your hips under your body, squeeze your down leg glute or scoop up the water with your hips as I like to say, whichever cue works for you. You should be feeling the stretch on the front of the down leg hip and you should also be working overtime with that same side glute. If you're not shaking from this stretch you're not squeezing hard enough I always say.
I'll let our old friend Tony explain the common errors and why this is the correct way of performing the hip flexor stretch. He has good lighting for his videos... oh and he explains it really well too.
Alternatives: Standing hip flexor stretch
Glute bridges
Glute bridges are the best place to start for switching on an over-seated booty. They should be one of the first exercises all beginners should master as it provides an excellent base for correct movement patterns and it can be progressed into more challenging exercises or regressed into a warm up drill.
Start with feet hip width apart, knees bent at 90° at the bottom position. Drive your elbows into the ground. Squeeze your glutes and push your hips to the ceiling. Don't overextend the lower back, just get your body in a straight line from your knees to your shoulder blades.
Variations to try: glute bridge holds, single leg glute bridges, feet elevated glute bridges glute bridges with adduction, glute bridges with abduction
Romanian deadlifts (RDLs)
The hamstrings are another muscle group which are often tight with excessive sitting, luckily the RDLs place the hamstrings on loaded stretch which is one of the best ways to gain range of motion. This exercise also requires you to squeeze your glutes (DOUBLE WHAMMY!) and calls upon those stabilsing muscles in the back again (TRIPLE WHAMMY!!).
You'll need a barbell and some weight for this one, it also requires good technique so I recommend attempting this one with someone who knows what they're doing. Pick up the weight and take two steps back. Pin the shoulder blades back and down. Fold forwards from the hips keeping the back in a straight line. Keep the weight right up against your legs as you go down. You should feel a big stretch in your hamstrings and this should be the limiting factor for range. Squeeze your glutes as your reverse the movement to stand up tall again.
Single leg RDLs
Sometimes called "arabesques", the single leg RDLs can provide a stretch for the hamstrings and a squeeze in the glutes without needing any weights, providing a good starting position for beginners.
With a slight bend in the knee, fold from the hips keeping the back arched in a straight line. Feel the stretch in the hamstrings at the bottom. Lock it out by squeezing the standing leg glute. Opposite hand reaches towards the wall in front, opposite foot reaches towards the wall behind. Toes point straight down (not out to the side).
Too easy? Hold a 10kg weight in your opposite hand
So that was just a few exercises that I use to "counter" kyphotic or sitting posture. Feel free to use these in any way that you feel helps, any extension based exercises will be helpful too. Two-three times a week for the exercises, twice a day for the stretches will see the fastest benefits but that might be overkill for most people so just find whatever feels right for you. Personally I stretch if I'm sore about once every two days in the areas I'm feeling tight or more often if I have a specific goal I'm working towards. (Current goal: hip internal rotation because I currently have about 5 degrees of movement there...)
Social isolation is in full swing around the world right now, which means a lot more sedentary activity (if you need proof, areas hit hardest by corona virus are seeing huge spikes in Netflix usage. Hmmm I'm sure there's a conspiracy theory there if you keep digging...). Hopefully this article and the previous one have encouraged you to keep moving and given you some movement tools to combat the consequences of sitting.
I was concerned that staying inside would mean people are paying less attention to their physical health but it appears that people are still as interested as always in keeping their body healthy, which is great to see. If that's you, and I'm guessing it is if you're still reading this: Well done! Keep up the good habits. Make the most of the current situation and you'll come out the other side in a better place.
Stay safe and keep moving!