Most people think that suffering through each day with neck, back, and other joint pain is just a fact of life. But it doesn't have to be that way. Author Jeff LaBianco, a doctor of physical therapy and certified strength and conditioning specialist, explains how simple tweaks in your posture can dramatically reduce pain caused by arthritis and other ailments. In this guidebook, you'll learn how to change your positioning to optimize your health; maintain good posture in the workplace; choose shoes that are comfortable; and design exercise protocols that promote good posture. The suggested exercises are easy to do and can be incorporated into your daily routine. By focusing on postural awareness at all times-when you are sitting, standing, walking, lying, and lifting-you can reduce stress and pain and improve your health. Discover key concepts in stretching, strengthening, and conditioning that can dramatically improve your quality of life. You can start Defying the Pains of Gravity.

Defying the PAINS of GRAVITY

USING PROPER POSTURE TECHNIQUEBy Jeff LaBianco

iUniverse, Inc.

Copyright © 2012 Jeff LaBianco, DPT, CSCS
All right reserved.
ISBN: 978-1-4759-5713-6

Contents

Preface....................................................................................ixAcknowledgments............................................................................xiIntroduction: The Three Causes of Discomfort...............................................xiiiChapter One: The Essence of Proper Posture.................................................1Chapter Two: Proper Sitting and the Ergonomically Correct Work Station.....................12Chapter Three: Proper Standing Technique and Lying Postures................................28Chapter Four: Dynamic Movements: Walking, Bending, and Lifting.............................44Chapter Five: The Importance of Proper Footwear............................................53Chapter Six: Muscle Matters: Stretching and Strengthening..................................59Chapter Seven: Two-Step Stretch and Strengthening Protocols................................67Chapter Eight: When to Seek Professional Help..............................................96References.................................................................................99

Chapter One

The Essence of Proper Posture

Posture. The dreaded P word. Brings back memories doesn't it? "Put your shoulders back," your mother would insist as you slumped in your chair as a child. "Stand up straight," your teacher would whisper while you pledged allegiance to the flag. Well, believe it or not, they had a point. Posture is important! Maintaining proper posture helps prevent aches, pains, arthritis, degenerative changes, and even neurological dysfunctions.

The reason why many individuals have so much difficulty keeping themselves in the correct position is related to a simple rule of physics. There is a force constantly pulling down on us—a force commonly known as gravity. So why wouldn't we slump down? It's easier than sitting up straight. We're designed to adapt to our surroundings, and because of this we take the path of least resistance, unconsciously allowing ourselves to slouch and fall into typical poor posture. The problem is that, when poor posture is sustained day in and day out, some of our tissue structures—including ligaments, tendons, and muscles—become weak and lengthened while others become weak and shortened. This unbalanced push-pull effect will eventually cause degenerative changes within our joints because our tissue structures will become unable to absorb the same amount of force they normally do when they are at their proper length.

The Key Players in Joint Protection

Cartilage, ligaments, tendons, and muscles naturally act as shock absorbers in our bodies. They help prevent damage to the bone structure of our joints as we locomote.

Our bodies contain two main types of cartilage. Hyaline cartilage surrounds every joint in our limbs. It is present at each end of our bones so that when bones connect to form a joint, they are able to glide over each other just as easily as a piece of ice sliding over a frozen pond. Thick, dense fibrocartilage is located between the vertebrae of the spine. This type of cartilage is responsible for preventing impact and allowing mobility throughout the spine.

Ligaments are short bands of tough, flexible, fibrous connective tissue that connect bone to bone. I like to refer to them as joint connectors. They aid in the stabilization and shock absorption of the joint. Tendons, which connect muscles to bones, are flexible but inelastic cords made up of strong fibrous collagen tissue. Each muscle contains one tendon on each end, and each tendon connects the muscle to small attachments on a bone. Most muscles in the body cross at least one joint, allowing us to move our trunk and limbs once the muscle is contracted.

These tissue structures are located around each joint and have a similar job as the shocks on a bike.

A good bike will have strong shocks that are able to absorb pounding forces as the rider bounces along the rough pavement. The shocks will attenuate the forces produced from the ground up, preventing damage to the bike frame and unwanted vibration. The tissues that surround your joints play the same shock-absorption role for your body.

Understanding Arthritis

Strong, well-positioned muscles will lead to optimal shock absorption. Muscles that are poorly positioned due to improper posture will be unable to absorb shock at their optimal capacity. This is detrimental to bone and joint health. Even though the cartilage is still able to perform its duty, putting the muscle at a mechanical disadvantage will place extra force onto the ligaments and onto the joints, leading to joint breakdown—in other words, arthritis.

Yes, the infamous arthritis! Have you ever wondered what arthritis really is? Well, before going any further, I need to clarify what type of arthritis I am talking about. The arthritis I discuss in this book is osteoarthritis, which is nothing more than joint degeneration. (This is not to be confused with rheumatoid arthritis, which is an autoimmune disease in which one's immune system mistakenly attacks healthy cells.)

That's right—arthritis is not some magical disease we must be confused about any longer. Arthritis is only found within joints. With the breakdown of hyaline cartilage, you don't have that smooth ice-on-ice texture within the joint that I described above. With arthritis, the bones that form the joint rub onto each other and cause degeneration. One thing to remember is that arthritis is a normal physiological process and we all get this wear and tear within our joints. Problems arise, however, when there is too much arthritis in the joint, resulting in discomfort and restricted motion. Having proper posture and knowing how to strengthen and stretch muscles through their full ranges of motion will help slow down the process of the inevitable arthritis.

The Cumulative Injury Cycle

I picked a box up from the floor and pulled my back. The box wasn't even heavy. Why does it hurt so much? This is a typical question I hear in the outpatient clinic. It's amazing how easily people hurt themselves. I have had patients (even some who work out at the gym at least three days a week) come in complaining of "stupid injuries" like pulling their backs after bending down to tie their shoes. So what's going on? Is it that people should be working out more than three times per week? Not necessarily. It is not that people are weak; the issue is that they have muscle imbalances. Their strength is in the wrong places, and they have set themselves up for muscle strain through prolonged insufficient positioning. The concept of pattern overload explains the problems with poorly positioned tissue structures in a little more detail.

Pattern overload arises when someone repeats the same pattern of motion over and over (whether actively or by remaining in a position for a prolonged period), which leads to overuse stress on the body. This concept will teach you how one's poor posture can cause internal physical problems.

Let's take the example of picking an object up from the ground. A common action that gets people in trouble is using their backs instead of their lower bodies while bending forward. The length of your muscles will determine how efficiently you will perform the motion. If your back muscles become stretched and stressed, your body will recognize this stress within the connective tissue and will initiate a repair process known as the cumulative injury cycle. Tissue trauma or stressed tissue creates inflammation, which activates the body's pain receptors and initiates a protective mechanism. This protective mechanism increases muscle tension and causes muscle spasms to develop in order to protect the body from further harm. Highly active muscle spindles, sensory receptors within the belly of a muscle that detect changes in the length of the muscle, create microspasms that form adhesions or knots in the soft tissue.

These adhesions form a weak bond that decreases normal elasticity of the tissue; this then leads to muscle imbalance because less movement occurs in the muscle. When altered due to muscle imbalance, the joints will not move as fluidly, which can cause permanent structural changes, improper shock absorption, and increased potential for arthritis.

The Upper and Lower Extremity of the Body

Now that you understand how and why we experience pain, let's start exploring how the body functions as a whole so that we can learn how to eliminate pain.

The term posture refers to a combination of body parts arranged in specific positions. Proper posture is the arrangement of those body parts in an optimal biomechanical position. In order to attain proper body mechanics, a person must place himself or herself in the appropriate position. Posture is like a collection of puzzle pieces, and the human skeletal structure is like a complicated puzzle. Different pieces, when put together correctly, show a complete and pleasant picture. If arranged improperly, the picture will become distorted, and the edges will not fit. Through knowledge, strength, and proper habits, we can reeducate our muscles to reposition our bodies from altered postures into proper postures similar to the way we would shift puzzle pieces around to fit correctly in their spaces.

In order to produce that appropriate and complete picture, we need to know what "pieces" or components make up posture. For ease of understanding, I divided the body into two major groups consisting of the upper extremity, anything above the waist, and the lower extremity, anything below the waist.

The Upper Extremity

We can sort the upper extremity into four body parts:

• Head

• Neck

• Shoulders

• Back

An important concept to understand is that all of our body components are connected to each other and affect each other through multi-joint muscle connections. When one joint changes position, it affects the position of the other components; so in order to keep optimal posture, we must assure that every component is in the ideal place.

The Lower Extremity

We can sort the lower extremity into five body parts:

• Hip

• Pelvis

• Knees

• Ankles

• Feet

Again, all of these components are directly or indirectly connected to each other, and they never work separately from one another.

The Spinal Column

Success depends on your backbone, not your wish bone. So, before we move on, let's briefly discuss a very important body component that extends through and connects the upper and the lower extremities: the spinal column. The spine is comprised of thirty-three small bones called vertebrae. These protect the spinal cord and support the body, allowing us to stand erect. Between each vertebra are discs made of fibrocartilage that act as shock absorbers, support the torso, and allow flexibility throughout the spine. Without these discs, there would be no motion in the spine, and the vertebrae would compress upon each other, causing extreme joint degeneration.

The spine is broken into five separate columns. The two lowermost columns, the sacral spine and coccyx bone, connect to the pelvis, which forms the hip. The other three consist of the cervical spinal column, the thoracic spinal column, and the lumbar spinal column. These are the main segments that allow both stability and mobility to occur throughout the spine.

The cervical spinal column is comprised of the seven vertebrae associated with the neck. These spinal vertebrae are smaller and more angled than the thoracic and lumbar vertebrae.

The small size and greater angle of these vertebrae allow for greater neck movement, compared to the back movement allowed by the thoracic and lumbar vertebrae.

The thoracic spinal column is comprised of the twelve vertebrae in the midback and torso. It connects the rest of the spine with the upper and lower extremity. This segment of the spine has the least movement out of the three main segments, but is just as important as the others. The ribs connect to the vertebrae in the back and to the sternum in the front of the body. The shoulder blades, which attach to the ribs, are part of the shoulder complex. These bony connections enforce the superior stability of the thoracic spine.

The lumbar spine is comprised of five vertebrae. These lumbar vertebrae are significantly larger than the cervical and thoracic vertebrae. Their position is also more neutral, allowing for greater rotation and movement to occur there than in the thoracic spine, but offering less freedom than in the cervical spine. The large vertebral bodies are constructed to accept and absorb the bulk of the ground forces and body weight. Since the cervical spine is only supporting the weight of your head, which weighs between about eight and twelve pounds, it will have more freedom of motion compared to the lumbar spine whose job is to support the majority of your body. Just feel for yourself! Rotate your head from side to side and compare that to rotating your trunk near your hips from side to side.

The Importance of the Thoracic Spine

I want to quickly touch upon the importance of the thoracic spine's motion. As described previously, the thoracic spine is connected to the upper and lower segments of the spine as well as the shoulder complex and can cause problems in these areas if not stretched properly. If the thoracic vertebrae are tight, movement in the thoracic column will be restricted, and because the body is very good at getting the motion it needs to perform a task, it will find extra motion in another joint. Since the cervical and lumbar spinal segments are closest to the thoracic spine, they will take up the motion that the thoracic spine cannot provide. If too much movement is placed on one particular joint, that joint can become hypermobile and overstressed.

With more mobility comes less stability, and less stability can lead to greater wear and tear of the joints. That's why it is important to keep the thoracic vertebrae properly stretched to allow for full and proportional spinal column function. Sitting thoracic mobilization is a common and simple do-it-yourself exercise for the thoracic spine that we will get to in the next chapter.

Common Symptoms Associated with Poor Posture

Many of my patients come into the clinic and tell me that their doctors told them they have sciatica. Okay. Now what? It seems many people know the word but do not understand the concept of this diagnosis. So let's review. Sciatica is a set of symptoms consisting of pain, numbness, and/or tingling caused by compression and/or irritation of one of five spinal nerve roots that form the sciatic nerve. Sciatica can occur from spinal stenosis, which is the narrowing of the spinal canal (the space through which the spinal cord runs). When this narrowing occurs it may cause cord compression and lead to the symptoms described above. But how does spinal stenosis occur? You guessed it—arthritis.

Sciatica can also occur from disc herniation. The disc can bulge back enough to push on and irritate a nerve, sending aggravating sensations past the lower back and into the buttocks and lower extremities, all the way down to the feet and toes. Before moving on, I'll review disc herniation because this is a common and annoying issue. Most poor postures, whether they occur while sitting or standing, place the spine in a more flexed or forward bent position. Even correct posture places a minimal but measurable stress on the vertebrae. These stresses on the vertebrae guide the movement of the disc. An improper constant forward position adds a compressive stress to the front of the disc and adds a stretching or tensile stress to the back of the disc.

The picture on the previous page illustrates the stresses that poor posture places on a disc. In this example we are looking at a disc herniation in the lumbar region. The arrow shows the disc material pushing against a lumbar nerve. This same concept can relate to a disc in the cervical or thoracic spine.

Think of the disc between each vertebra as being like a jelly doughnut and pretend that the vertebrae above and below the disc (the doughnut) are your hands. If you were to evenly squeeze down on the doughnut, the forces would compress the doughnut and disperse the jelly evenly.

Now, if you were to add the same amount of force, but squeeze down at only one end of that doughnut, the jelly would bulge out in the opposite direction. This would produce an uneven dispersion of force. With enough uneven force, the disc can herniate, adding pressure to the nerve endings of the spine resulting in pain, tingling, or numbness in the lower back.

Sciatica, though commonly associated with spinal stenosis and lumbar disc herniation, can also occur because the actual sciatic nerve is irritated or pinched due to a tight piriformis muscle or because the sciatic nerve is rubbing against the greater sciatic notch of the pelvic bone. This occurs in only about 10 percent of people with sciatica symptoms.

Similar sciatica-like pain running down the neck into the arms, hands, and fingers can be associated more commonly with cervical spinal stenosis, cervical spine disc herniation, and tight cervical musculature. Be aware that the pain, tingling, and numbness in the upper extremity is not sciatica; the sciatic nerve only exists in the lower extremity.

The Postural Control System

To finish up the chapter I would like to touch upon the fact that your posture is not just about your muscles. So what else is involved with posture? There are three main systems that are known as the postural control system. We just reviewed how ligaments, tendons, and muscle (which together form the skeletal muscle system) have a role in joint protection and postural control. But what actually controls our muscle movements? To discover this we need to look into the two other systems that make up the postural control system: the central nervous system and the sensory system. The central nervous system contains more nerves; they run throughout our bodies, sending and receiving signals to and from the brain via the spinal cord and controlling our muscle actions. Once

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Excerpted from Defying the PAINS of GRAVITYby Jeff LaBianco Copyright © 2012 by Jeff LaBianco, DPT, CSCS. Excerpted by permission of iUniverse, Inc.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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