Tips From Your Kirkland Chiropractor
People are sometimes curious about what they can do to self-manage their aches and pains. While chiropractic and massage are very effective at resolving and keeping many musculoskeletal issues at bay, my philosophy here is that patients should take an active role in taking care of their bodies to mitigate and hopefully even prevent problems. It's not all inclusive of the issues I treat, but below is a helpful primer of tips that I think speaks to a large majority of patients and issues I see. A disclaimer - If there's something seriously bothering you, don't put it off by self-diagnosing and wasting time. Seek help. From me, or even another practitioner.
-Dr. Frank Wen
Tips for People Who Sit at Work
Like it or not, desk jobs are a large part of our workforce now. People working at a desk not only make up the largest proportion of patients we see, but are also those with the most issues. Having worked at a desk in my past career, I know the impact it can have on your body. The muscles in your upper shoulder and neck will get overworked from suspending your head (about the weight of a bowling ball), shrugging your shoulders to type, or both. This leads to stiff necks and shoulders. Patients will make comments like "I can't turn my neck to talk", "I can't turn my neck to drive", and "If I don't move, it doesn't hurt”. I've had days like this too, and it's not fun.
And while you may think that sitting is an effortless activity, it can lead to issues on the lower half of your body. Your hips are subjected to a constant state of contraction while your glutes stay relaxed and inactive so you can sit. This prolonged behavior eventually leads to complaints from patients about their hips and glutes and I'll hear things such as "my hips snap" or “I think I have sciatica”. It’s also not uncommon to have low back pain from sitting for prolonged periods as our posture degrades and we start to stretch our back extensor muscles and spinal ligaments. Whether you are at a desk job or just sit a lot for work, the following are some simple but useful things you can do to help yourself.
5-10 minutes every hour to get up and walk around isn't going to kill your productivity. Our bodies weren’t meant to sit around all day (I'm sure you've seen the reports in the news by now about how "sitting is killing us"). While taking a break you should try to keep yourself upright- your head and neck included because you want to give those muscles a break from all the looking down and shrugging you’ve been doing. That means you need to put the phone away too if you want to really rest those muscles. Go do some real socializing and grab coffee with a co-worker or go for a brisk walk around your office. Not only will your neck and shoulders appreciate the break but so will your hips and glutes because they get to unlock and move.
Raise your monitor up higher than eye level. Many people will say they have their monitor at eye-level but are looking down most of the time. Even if the monitor is close to eye-level, our application focus is toward the middle and lower half of the screen generally which is why I prefer it higher. Just think of what our natural positioning would be for our head and shoulders when we are walking. Have you ever met anyone that said their neck and shoulders got sore from walking too much? I think this is one of the simplest and easiest things that will make a difference. If you look around the office, most of us probably resemble the guy I drew on the left (below). This positioning requires two muscles (our upper traps and levator scapulae) to help suspend our head, which is not their primary job and leads to the same complaints in this population of people. It can also lead to rounded shoulders from your pecs being in a shortened position (not good if you like to play sports or workout). If your monitor doesn't raise up or you have one of those all-in-one's I like to stack printer paper packs, books, or a plastic stand to bring it up to a good level. And if you find yourself leaning into your monitor where you are turtle-necking, it's probably is too far away for you to see. So either turn down the resolution or slide the monitor a bit closer. And if you've been stuck with a laptop, do yourself a big favor and get an articulating laptop mount (one of many examples) and bluetooth keyboard.
Tweak Your Workstation
You have to survive an 8 hour day so your strategy needs to be how you can reduce the amount of work your body needs to exert to survive it. This can be achieved by making some simple tweaks to your workstation. I've seen a lot of ergonomic solutions, but many don't always address the issue completely. Here are my tips below:
Get your keyboard to around waist level. I've seen a lot of setups where the monitor is at a decent height, but then the keyboard sits at the same level as the base of the monitor. Imagine if the entire table was raised up in the picture to the left so that the guy's neck can be in a neutral position. It would still not be ideal because he would ultimately end up shrugging to get the forearms and hands to be able to type at the level of the keyboard which just perpetuates the issue of upper shoulder tightness by keeping the upper traps and levator scapulae in the game. This is why I recommend having an adjustable keyboard tray to help keep the keyboard low to keep shoulder elevation out of the picture.
If you have the ability to alternate between standing and sitting at work because you have an adjustable table, do mix it up. Just make sure that you follow the points discussed above as you alternate between standing and sitting. If you must sit, then it is important to note that your chair positioning can affect how your upper body will respond. My preference is to start with the thighs parallel to the floor with the chair at a height that allows the knees to be about 90 degrees. I then recommend arm rests to be as low as possible if you have them (again, trying to keep shoulder shrugging out). If your seat has a pitch option, just set it to what feels most level to you. The last bit is the backrest. Some sources will say to recline slightly to take load off of the lumbar spine, but the problem I have with reclining your seat is that you'll likely end up with forward head flexion along with your arms reaching forward more to compensate for the distance you are displaced from your monitor, even if you do pitch your screen down. The lumbar spine is best in a neutral, lordotic position. Therefore you should lock the backrest and I recommend using a simple lumbar support cushion or rolled up towel behind the small of your back if needed.
Massage and chiropractic adjustments are very effective in reducing tension and restoring movement, but you'll really capitalize on your treatment and get better long term results if you incorporate simple changes and some homework to give you good muscle balance. Having a good exercise routine is not just helpful to keep your body balanced and limber- it's also a lot more fun. If you are on the Eastside or don't mind a drive, we will happily recommend a local gym.
There are some simple exercises that can help and rather than reinvent the wheel, we can take advantage of some great content on YouTube. Below are a few that I like and often give to my patients as well. Why do we want to do these exercises? Because your soreness is created by overactivity of certain muscles, we need to help to activate the muscles that are inactive to simultaneously quiet the ones that are too active (Here's some background info if you want to know why: Reciprocal Inhibition)
Unfortunately this one doesn't have any audio. But the purpose of this set of exercises is to activate your deep neck flexor muscles to balance out activity of your neck extensors. Instead of performing reps, you can hold the neck in a flexed position for 30 seconds to a minute.
Deep Neck Flexor Exercises
As mentioned above, most people who work at a desk have upper traps that are too over active and tight. To balance their activity and tone them down, we need to work out the lower traps.
Lower Trap Activation
I always tell my patients that if you have tight hip flexors, you need to activate & condition your glutes to get them to relax. For some of my patients with low back pain, tight hip flexors (iliopsoas) are sometimes a contributor to the pain because their attachments are directly on the lumbar spine. One modification for this exercise I like (when it's too uncomfortable to do it this way)
If you find yourself with stiff neck muscles (scalenes in particular), it might be because you are using your neck muscles to sniff the air instead of using the primary muscle designed to help you breathe. It can be caused trying to maintain a good figure or stress. This is a nice video that teaches you how to belly breathe.
Tips For Low Back Pain
Low back pain is ubiquitous so I decided to break it off into it's own discussion. Whether studying, being at work, or even walking around town, I've felt the ache in my low back many times before. I'm fortunate that I've been able to gain control of this issue through my education, but the average person usually doesn't know what to do as they haven't been required to obsess over the details of this topic. While there are many causes of low back pain, the majority of patients I see for low back pain are uncomplicated cases of localized pain due to poor mechanics, rather than something more serious such as a disc blow out. If you are having serious back pain with symptoms into your legs or worse symptoms, I advise you to seek help immediately as these tips may not be appropriate for you, for now.
In a nutshell, there are two simple ways we can irritate our low back- being bent forward or arching backwards in the lumbar spine too much. Prolonged bending forward causes the back muscles to stretch and tire out, leading to irritation. They can also become very tense and bulky from having to work hard to support your upper body. If this continues over time, spinal ligaments and the posterior part of spinal discs may also be irritated and weakened (potentially setting you up for a disc herniation). Slouching while sitting or bending over improperly while doing things can do that. This video illustrates the stretching of the posterior spinal disc with flexion, or bending over of the back.
With arching backwards, due to the orientation of the lumbar joints, we end up compressing the joint surfaces against each other, leading to pain. While your lumbar spine has a natural curve (lordosis), it can be over-accentuated with poor mechanics. This can occur from having too much anterior pelvic tilt from tight hip flexors and weak glutes, making you have to arch your lower back more to stand up straight (I'll get to that down below). Sitting too much can cause this to happen. The second video on the right illustrates the approximation of lumbar joint surfaces (facet joints) during extension, or arching of the back.
Overall, I believe sitting is a common denominator to many low back problems in our society. An effect of sitting so much is we lose motor control of low back, hips, and glutes and create muscle firing patterns in our brain that are not conducive to normal movement and athletic activities. While chiropractic treatment is very helpful in treating low back pain, research continues to show that incorporating exercise will produce better long term results. Because the reality is, if you don't address the root cause of the low back pain, it will continue to return so the recourse for most people is regular treatment. That doesn't make you a bad individual or failure if such is the case, but at least you are informed. With that said, below are helpful exercises to help establish good muscle balance in the low back and hips.
This is an easy place to start because it requires the least effort and is easy to do. The iliopsoas is your primary hip flexor and it is often short and tight in many of my patients because they sit a lot. Below on the left an illustration I created to demonstrate the attachment points of the muscle in a standing and seated position from a sideways view. It's actually two (technically three) muscles that eminate from your lumbar spine and inner pelvis and fuse before attaching to your true hips. The contraction and shortening of the muscle is what allows you to sit. While my illustration is more "linear" in nature, these muscles can produce a force on the low back that's compressive in nature. And if you're sitting a lot, the brain will get used to keeping the muscle short and tight, so when you stand up up it will put additional stress on the low back in along with reducing hip extension, requiring you to make up for it with lumbar extension, which can be irritating to the low back. Many patients often get relief from their back pain with a combination of soft tissue work to this muscle along with home stretches.
Stretch Your Hip Flexors
The glute max is a primary hip extensor and helps you advance forward when walking, running or hiking. Often though, it is weak because of inactivation from sitting or our hamstrings are too dominant. The hamstrings are limited by design in the amount of hip extension they can generate, so if your glute isn't doing the job, your low back extensors may jump into the picture to try to help generate extension, which introduces additional stress to the low back. This exercise should be done in combination with the iliopsoas stretch to help restore the balance of movement across your hip.
Work Your Booty
Lastly, it's good to get control of your core to help protect your spine and keep it stable so you can create movement through your hips instead of your low back. These are pretty standard exercises given to people.
As always, if you're looking for a chiropractor in Kirkland, we are here to help.