Copyright 2002, E. Franklin Livingstone, M.D.

Human posture, as it has developed, was designed for upright standing. Yet, how much of our days do we spend sitting, reclining or lying? In all of these positions, we tend to reverse the normal curvature of the low back. Normally, the lower back (the "small" of the back) has an inward curvature called lordosis. The back was meant to function with this curvature. When we spend time in positions that reverse this lordosis ( "slumping"), such as poorly supported sitting, lying or reclining, our backs are stressed and there is increased tension in muscles and ligaments, and abnormal pressure in the bones and discs. Our backs were not designed to withstand these abnormal stresses, especially not over lengthy periods.

Postural stresses such as these account for many back-aches and aggravations of back problems. If you have a "bad back", you will not likely tolerate poor posture for long periods without increased stiffness, aching or discomfort. You must learn the causes of these problems and how to counteract them or avoid them. You must be ever vigilant to prevent preventable causes of chronic back pain.

Posture is human behavior related to years of development. In other words, your posture has developed over the years of your life, and is due to your body characteristics and activity patterns. You must now pay attention to your posture because if it is causing aggravation, it will not allow complete healing. You will continue to have problems, perhaps for many more years.

Did you know that the common cold has been surpassed by back problems as the leading cause of work absenteeism in the United States? What is even more interesting is that most back injuries and back-aches can be prevented! Understanding the causes of back injuries and discomfort provides the knowledge to develop your own prevention program. If you are truly interested in improving the condition of your back, then you will learn from your mistakes and control your behaviors and activities to prevent reinjury and overuse (over-doing it). You must make note of and remember the causes of injury and discomfort so that you do not keep making the same mistakes over and over again. There is always a reason for injury or discomfort, ie. prolonged positioning, muscular overuse, poor body mechanics with minor reinjury, or a myriad of other possible factors. You must get good at pin pointing the cause of your increased discomfort. This will require presence of mind and daily effort. You must prevent aggravations until you are healed.

Your posture can be improved with appropriate exercises and attention from you. Remember, your improved posture requires daily concentrated effort and vigilance. Exercises will help improve the mobility and flexibility of your back and if you are doing the right things, you may regain normal curvature. Your program should include exercising and varied activities, and should include at least twice per day walks.

While sitting, it is more difficult and requires more effort to maintain normal posture. This is particularly difficult if one tries to sit without back support, and may be as bad for your back as "lazy" posture, slumping, or excessive lordosis "swayback". When standing, the back and trunk musculature supports the back in normal curvature. Most of this back and trunk support is lost or reduced with sitting, reclining or lying positions. The back tends to "round," tilting the pelvis backwards which tends to cause more rounding of the back, or "slumping". This puts prolonged stress on ligaments and muscles, and increased bone and disc pressures which were not meant to be and cause progressive injury. You should learn the pelvic tilt maneuver from your therapist, and you should use it in your exercise program and periodically throughout your day.
Sometimes, elimination of poor posture as a chronic aggravator of back discomfort is all that is required to eliminate backaches altogether. In most instances, posture does play a role, but may be one of many different factors that tend to make the discomfort continue for many years. These factors will often include behavioral and activity related factors, psychological and emotional issues, and usually, difficulties with sleep.

Whenever you are sitting, you must find a comfortable sitting position that is consistent with good back posture. You will find few seats designed to help you with this and you will find it helpful to make or purchase a back support cushion that works well for you. There are many styles and types, but you should first experiment with a homemade cushion before purchase, so that you will purchase the right cushion the first time.

An economical support cushion can be made from a bath towel and a role of duct tape. Fold the towel in half lengthwise and roll it up to a firm consistency. Then wrap the rolled towel with duct tape so that it will maintain its firmness. Experiment with positioning, firmness and size and then if you feel like purchasing a cushion, you will have a good idea what will work for you. In positioning the cushion, you should place it near your belt line, the tendency may be to position the cushion too high in the back. It should be situated over the upper pelvis, as well as the low back.

Manufactured back support systems are many and varied. They range from a simple shaped pillow to inflatable models which can be easily and nonpermanently attached to seat backs, and can be adjusted for position and amount of inflation or support. If you need any further information on these you may contact a reputable hospital equipment or home nursing supply store.

You must treat sitting and posture seriously. Every chair that you approach to sit in is a potential enemy of your back and may cause increased discomfort if used incorrectly. You cannot continually reaggravate your back and expect it to heal and function without discomfort.

Since most chairs or seating systems are not designed for your back, or anyones' back for that matter, you must be cautious especially with overstuffed, plush or soft furniture. You must always assure yourself of appropriate back posture and provide support when needed. You must pay attention to your back, not allow it to become progressively aggravated with prolong poor posture. You should be able to tell almost immediately that there is increased tension in your back and this should just as immediately trigger you to deal with it positively and effectively by changing position, standing up, stretching thoroughly, walking about and then sitting back down with proper posture and support. In an office or waiting room situation, magazines can be rolled up and held with a rubberband, making an excellent, make shift back support. Begin using your ingenuity and creativity to prevent discomfort. There is always a way to deal with these types of issues positively and effectively, but the path of least resistance requires no specific concentrated effort and assures continuing back discomfort.

A few patients with low back discomfort will have the opposite problem. When they sit, the inward low back curve or lordosis is increased, or "swayback". In this situation, slumping or slight rounding of the lower back is desired when sitting. The back support cushion will be positioned differently. It should be placed lower, mostly behind the pelvis, below the small of the back. This helps to tilt the pelvis backwards, reducing lordosis.

If you have a job that requires sitting most of the time, particularly if you sit in a moving vehicle much of the day, you are at risk for a variety of back disorders. Optimizing your posture can do a lot toward preventing the progressive and cumulative damage and deterioration that can occur over years. You must pay attention to your back, it is always communicating with your brain. Learn to pick up early cues of oncoming back problems so that you can treat it immediately and effectively, before it becomes severe. Improving your sitting posture and back support can minimize and eliminate this important and almost universal cause of back discomfort.

Picking chairs with reclining seat backs, if used properly aid back posture, reducing the effort that is required to sit correctly for extended periods.

Seats that are "sculptured" or have the custom fit look are tempting but looks can be deceiving and usually are. They are designed for the average person, but I'm not sure I've ever seen an "average person."

In general, you should try to avoid prolonged positioning when possible. Periodic standing, stretching, and moving about are simple and effective in preventing progression of back problems. This set of activities should be done frequently, every 15 to 20 minutes. Arm rests or arm supports can also be a tremendous help in preventing back stress both in upper and lower back regions. Use arm supports whenever possible in sitting.

When sitting, DO NOT bend far forward and reach forward to perform lifting or other activities. This puts your back at about its worst mechanical disadvantage, you are easily injured in this situation.

Your must understand and know this information in detail. The more you know about your back and discomfort, the better position you will be in to control this problem so it no longer has control of your life. You are the key, not your doctors or therapists. Only you can learn to prevent the continual and usually daily aggravations which prevent healing and promote long term problems. If you are unwilling to make the changes necessary to control your back problem then you will continue to have it, so be it.

REMEMBER, in relation to your back discomfort problem, the sentence: "IT DOESN'T MATTER HOW YOU GOT IT." has only three important words, the last three. YOU GOT IT, What are you going to do with it? If you want to deal with it most effectively, you'll put into practice what you are learning and you will always strive toward better understanding and control. You must not quit trying even though you will make mistakes and your course may have ups and downs. Learn from your mistakes and always strive for better control.

Copyright 2002, E. Franklin Livingstone, M.D.

Permission is granted to use this information for personal use. Any other use requires expressed written permission from the author.