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Hi, I'm Dr. Chalk, DC

Exercise is not only important to good cardiovascular health and muscle tone but it is also significant to posture.  When muscle tone in the back is good, we naturally have better posture and without thinking about it.  The muscles in the back are what help to hold the spine erect.  Our shoulders are relaxed and not up around our ears when we have good muscle tone and when we free ourselves from stress through methods such as relaxation techniques and exercise.  All without thinking we are naturally assuming a better posture and it is a comfortable position.

The Affect on Muscle Strength & Bone Density

Remember your mother telling you to sit up straight or your back will stick that way?  It wasn’t that the spine would permanently grow into a slouched position, but the muscle tone would become so weak that it couldn’t hold the spine up.

A great deal of research has gone into the skeletal and muscular effects of exercise.  In a conference on osteoporosis prevention, Dr. Robert A. Marcus reported on the impact of exercise on both muscle tone and bone density, and how that impacted overall health.  The research revealed that Bone Mineral Density (BMD) didn’t necessarily increase with moderate exercise, but without it, it most assuredly decreased.  It took the very high impact activities such as jumping and running to increase BMD.  However, even just standing helps hold on to current levels of BMD.

Even without increasing BMD, muscle strength can be increased with exercise.  This is especially important for the elderly who cannot engage in most other activities that promote increases in BMD.  Just by toning muscles, especially leg muscles, even those in the 90s are able to reduce the risk of serious injury if they fall, even without increasing BMD.

The only group of people in the research conducted on BMD that had differing results was children.  The time when a person is usually most active is childhood.  Children are able to build a reserve of BMD that provides benefits throughout life.  An inactive child might have problems with BMD as an adult.  In order for any adult, however, to maintain good BMD, they must continuously exercise throughout their life.

Some good exercises for strengthening the back and improving posture include strengthening many other muscle groups.  Some of these are:

  • Abdominal
  • Hamstrings
  • Quadriceps
  • Gluteus
  • Front Neck
  • Scapula (shoulder blade) supporting muscles

There are many effective exercises for each muscle group and for any level of fitness.  Any exercise that flexes the muscle and stretches it gently is good.  When doing an exercise, it is better to do shorter repetitive sets than to completely exhaust the muscle.  Doing 10 or 12 repetitions is good for each group to start.  Then you can gradually increase the number as the muscles become conditioned.  

You never want to overwork the muscles.  It will just lead to soreness, at the very least, and even more serious injury.  If, for example, you were to lift weights using one muscle group, you would want to rest those muscles for a day before repeating those exercises.  This is especially true as you get into heavier weights for resistance.

Pilates

There are different types of exercises, some as old as 5000 years that provide good strength to muscles.  Pilates is a back friendly method of toning that focuses on all of the large muscle groups.  It not only strengthens muscles, but increases flexibility in a gentle and effective way.  It is an easy program to adopt no matter at what fitness level you are starting.

Joseph Pilates developed the exercise program as a way to first of all strengthen his own body.  He was a sickly child and unable to do many of the other childhood activities others enjoyed.  During World War I, he further tested his strengthening concepts as a nurse and used his exercises to increase mobility in disabled veterans.  

Today there are over 500 different Pilates exercises that focus not only on strengthening the core muscles, but centering and breathing.  Together, with concentration, those who implement Pilates exercises will quickly see improved posture and flexibility, along with the ability to balance in positions holding their center of gravity.

Ergonomics

Ergonomics is a science which studies the way in which the human body responds to the forces of nature put on the body through physical activity.  In Greek the terms ergon (work) and nomoi (natural laws) are combined to create the English word, ergonomics.

The goal of ergonomics is to reduce injuries by being aware of how the everyday activities in which we engage affect our joints and muscles.  There are three basic rules to ergonomics that, if applied, would greatly reduce stress or repetitive movement injuries common in the workplace.  They include changing positions often to other healthy positions, using the largest muscle group for any type of force exerted, and only working joints to the mid-point of their range of motion.

When speaking of ergonomics, it is important to understand that there is static work and then there is force.  The static work refers to those tasks where you are required to maintain the same position or small movement for extended periods of time. This may include typing, standing at lab bench while bending over a microscope, or sitting in a truck with one hand on the steering wheel day after day.

Force as it relates to ergonomics is all about how much the muscles have to work.  If the wrong muscles are used for the job, then there can be injury.  This is not limited to lifting heavy objects, but can even include flexing the neck muscles to bend the head forward or backward from the upright position.  This action alone, adds four times the force on the lower neck vertebra.  So if you have a job where your head is bent down looking over paperwork, you are putting excessive force on your neck.

The way to counteract the impact of static work and force on the muscles and bones is to become conscious of each movement and change positions frequently throughout the day.  Also using the largest appropriate muscles for any task minimizes the risk of injury.

Ergonomics takes thought.  Thinking about your posture and the different positions you assume in any given task is not something we naturally do.  We simply try to be comfortable.   Really the only time we give thought to our position or posture is when we are uncomfortable.  We then seek to change to a more relaxed way of feeling good and relieving the discomfort.  Again, there is not much thought given to the process, we just move until it feels good.

Since we naturally put little thought into ergonomics, doctors and scientists have been doing it for us.  They have worked to create tools and methods to ease the stresses we put on our joints and muscles.  Some of the most notable inventions of the 20th century included the foam strip at the base of computer keyboards which raises the wrists to a better position for the wrist joints.  This reduced the cases of carpal tunnel syndrome experienced by typists who often spend several hours each day in that position. 

 Likewise, office chairs with lumbar support encouraged better posture for desk dwellers.  We also saw an increase in the use of headsets for receptionists who, prior to that, would often cradle the telephone receiver between their ear and shoulder while taking notes.  In many workstations you will see the semi-seated workstation.  This is a type of chair where you are neither sitting nor standing.  It keeps the lower back aligned with the rest of the back and actually promotes good posture.  That, in turn, relieves pressure on the spine and alleviates back pain, especially in the lower back.

Ergonomics goes even further into our everyday lifestyle than for that of office workers or others who engage in repetitive movement for the majority of their day.  Simple changes in the way we carry out everyday activities can make a difference in how well our backs and joints are protected.  Each applies the three basic principles of ergonomics stated earlier: adopting differing positions; using the largest muscles for a task; and staying within the mid-point in a joint’s range of motion.

Applying Ergonomic Principles

Lifting

Lifting anything applies the rule of ergonomics related to using the largest muscle group.  The group, erogonomics.org, refers to this as the “largest appropriate muscle group.”  Obviously you wouldn’t use your forearm to push a light switch when an “appropriate” muscle is the finger.  To lift heavier objects or move heavier items is where this principle is mostly concerned.

Most people are well aware that if you lift a heavy box by bending over and pulling up with the arms, your back is going to take the brunt of the weight, and by doing most of the work, risk the greatest injury to the back.  That is why movers will wear thick belts.  This supports the back and actually prevents the back from doing the work.  The largest muscles in the body are found in the upper legs.  These should always take most of the weight and exertion when lifting.  Here are some important tips when lifting:

  • Bend down, not over.  If you are squatting, then you must naturally use your legs to rise and lift the object with them.
  • Work with a partner.  Whenever possible, lighten the load by getting someone else to lift with you.
  • Keep the back vertical.  When the trunk is horizontal it actually adds hundreds of pounds of pressure on just a small section of the spine that then acts as a fulcrum. 
  • Keep objects you are lifting close to the body.  The stress on the spine is exponentially related to the distance the object being lifted.
  • When lifting a heavy object from above your head to lower it, get up close on a step stool to avoid holding the weight overhead with your arms.  Again, closer is better when lifting.

Carrying Children

Many of the same principles that apply to lifting heavy objects apply to lifting and carrying children.  You will often times see an infant or toddler perched on a mother’s hip.  Think about her posture.  Is her trunk vertical or is it skewed to one side to compensate for the added weight on her hip?

There are many great devices to help make carrying children easier and safer.  The best and safest choices are ones that allow the weight to be evenly distributed and that keep the trunk and spine in a good vertical alignment.   An example of this is the over-the-shoulder sling that holds an infant up to almost chest level in front of the parent.  This shouldn’t be used for extended periods of time, or after the baby gets to be so heavy that the parent is forced to bend forward or backward to compensate for the added weight.

When carrying older or heavier children for any length of time, it is best to carry them on your back, piggyback style.  A back pack carrier is good for walks or hikes because its waist straps distribute more weight to the hips than the back – again, using the larger muscles to carry the load.

When lifting a child out of a crib or pack ‘n play, get as close to the side as possible.  If the sides to the crib can be lowered, always do that first so that you do not have to lift above your head as much.  Wrap your arms around the child’s midsection with one arm supporting their lower body, and bring them close to you before lifting upward.  You may have to bend over to cradle an infant lying on his back, but you can still bring him close to you before moving upward.

Standing up

When was the last time you thought about how you were getting out of bed in the morning or standing up from sitting in a chair?  You probably never give it any thought unless it is uncomfortable or even painful.  There are methods of standing up that relieve pain and prevent strain or injury to the back.  Some of these apply the ergonomic principle of staying within the mid-range of joint motion.

Start the morning out right by getting out of bed the right way.  Instead of springing up by arching the back and jumping to the floor, start by sitting straight up with your legs out in front of you.  Then swing your legs over the edge of the bed until they touch the floor.  From this seated position, then, you can use your thighs and arms together, if necessary, to push yourself to a standing position. 

If you have the time, it is even better to do some simple stretching even before sitting up.  You can extend your arms up over your head and at the same time stretch your legs out so your spine, arms, and legs all get a good stretch before being worked for the day.

When getting out of a chair, you can use the same steps as from the sitting position step of getting out of bed.  If you are sunk deeply into a soft chair or sofa, scoot to the edge so your feet are firmly planted on the floor before standing.  This way you are doing more pushing with your legs, than throwing with your back for the added momentum needed to get up from that sunken position.

Getting in and out of a car can also put a strain on the spine.  We tend to get in by putting one leg in, swinging our back and twisting to a seated position, then bringing the other leg in.  The same is true in reverse for getting out of the car.  Instead, try going in backside first.  It may look a little funny, but once you are seated, then you can bring both legs around at the same time to face forward.  Getting out, you can swivel the whole torso and legs simultaneously until they are on the ground outside the car, then rise to a standing position.

Shoveling

Depending on how much dirt or snow you need to move, shoveling can lead to some major back problems, not only by the weight of what is being moved, but the repetitive nature of the movement itself.

Think about how you would shovel snow from a walkway.  Everyone uses one hand down low on the shovel handle, and their prominent hand up at the top.  We bend at the waist, pick up the load, and then twist and throw it some place else.  This is absolutely one of the easiest ways to injure your back!  The combination of weight and twisting motion are a real killer for backs.  One small section of the spine carries all the weight and force of motion.

Here are some better ways to make shoveling safer for your back:

  • Bend at the knees to scoop up a small amount and throw it straight ahead instead of twisting to the side.  Position yourself so that you don’t have to twist to unload the weight.
  • Shovel deep piles of snow or dirt in layers.  Don’t try to lift too much weight.  It not only strains the back, but can put serious stress on the heart.
  • Change your grip on the shovel.  By doing so, you will reduce the repetition to the same set of muscles and joints.
  • Take time to stand up straight and rest.  Give your back and arms a good stretch every few minutes.
  • If possible, when shoveling snow, scrape small accumulations before they are deep enough to require shoveling.  This way you can simply push the snow away with the shovel like a snowplow.

Backpack Syndrome

You have, no doubt, seen small children going off to school with a backpack that goes from the top of their heads, clear down to the backs of their knees.  You can only imagine what those poor children are carrying that probably matches their own body weight!  Backpacks themselves are not bad.  In fact, they are a good way to carry a substantial load.  The back and hip muscles together are a strong group.  The problem with backpacks, and even heavy pocketbooks or brief cases, is how we carry them.

Whenever carrying a backpack it is important to use both shoulder straps.  Also, use the waist strap if there is one, since this helps distribute the weight from the back to the hips.  If you must carry it on one shoulder to look “cool” or for convenience, then switch shoulders often.  Try to lighten the load whenever possible.  Figure out what you really must carry and what can be left at home, school, or the office.  For briefcases, messenger-style bags or pocketbooks, you can put the strap over your head and across your chest to better distribute the weight.  Carrying heavy bags on each side so you are balanced out with the weight will also help reduce strain on the back caused by trying to compensate for more weight on one side of the body than the other.

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