- Personal Health Information & Self-Help
Back Pain? Three Positions That May Change It All
Statistics show that 80 to 90% of Americans have or currently experience some sort of back pain, and most of the time being in the low back. And this is not because of the increasing number of aging Baby Boomers. Those complaining of back pain can range from adolescents to those in their 90's, and more often than not, it is not due to trauma such as a motor vehicle accident.
Poor posture. Ok, so you've heard that before and you try to stand and sit up straight. But what is straight? What is correct posture? Just pull your shoulders back and chest out. Not exactly... And did you know that sleeping can make or brake your back? It is not just your mattress; it is also your posture while sleeping.
Being a licensed therapist in the profession of Physical Therapy, I work with patients on how to manage and maintain certain levels of physical function to prevent injury or re-injury on top of rehabilitation current injuries. We do not just treat current symptoms on patients with back pain, but we also educate them on how to prevent from seeing us, doctors, massage therapists, chiropractors, etc. for the rest of their lives. Over $1 billion is spent each year on medical expenses and supplies on people with back pain in the United States. Don't you want to keep that money?
NOTE: If your pain at all radiates down a leg or both legs or even into your arms, please see a physician. And, if any of these positions cause your pain to start radiating, please see a physician.
The human back is not supposed to be technically straight. When viewing the spine from the side (lateral) view, it should have 3 natural curves:
In short, correct posture when standing is: your ear almost directly over your shoulder, your shoulder almost directly over your hip, and your hip and ankle lined up. This is what we call a "plumb line."
The "plumb line" rule changes very little for sitting and lying down. But while doing any of the 3 activities, you want to try to maintain these curves to not stress your muscles, bones, ligaments, nerves, or the discs (that lie between each backbone).
Position #1: Standing
Here are some common incorrect postures due to weak muscles, compensation, insecurities, or sometimes just plain laziness:
It is hard to notice this yourself. Try having someone or yourself (using a camera with a timer) take a picture of you from the side while standing at your normal, "relaxed" position. Then draw a line from your ankle bone upward using a straight line. Does that line pass through your hip bone, shoulder, and ear? Take a look at your low, middle, and upper back including your neck. Do you seem to have increased or decreased curves? If so, stand in a mirror, correct your posture so your reference points line up, and then try to hold that position for 1 minute or longer.
Notice your muscels working? Some people even report back "pain" sooner because they are not use to standing up correctly. Remember what this feels like, and if you keep consciously standing in correct posture, it will soon become second nature.
Position #2: Sitting
This position is not so easy to maintain, especially if you work throughout the day at a computer and/or desk. Sitting, actually, is the worst position for your back due to the difficulty in keeping those 3 important curves. However, maintaining those curves as well and as long as possible will help you a lot!
Here are common poor sitting postures:
Due to inadequate chair options, we sit in a plethora of positions, especially if we are sitting for a long period of time. Your body subconsciously tells you to shift because it is becoming uncomfortable, or you may have a very concious pain alarming you. But, just a few chair adjustments, and you won't have to shift and change positions or as often.
Take a look at the picture below:
First, notice that the ear shoulder, and hips are aligned. Obviously, the ankles do not have to be aligned under the hip, but it is best to try and keep the hips and knees at 90 degree angles with feet flat on the floor. Adjust the height of your chair or place something solid under your feet to provide the angles at the hips and knees, and to allow your feet to be flat. If you are too tall or legs are too long for your chair at its tallest height (knees are higher than your hips), you may need to sit on something. Ergonomic seat cushions are available to help with this.
Elbows are also bent at 90 degrees with wrists and fingers able to do what they need to do, and the shoulders are relaxed...not scrunched up towards the ears or forward towards the computer. Adjust the height of armrests and/or keyboard to allow correct angles, and sit closer to the keyboard to prevent poor shoulder posture.
Neck and head are not forward or backwards but rather perfectly aligned over the shoulders. The chin is not tucked or forward keeping eyes level with the computer monitor. To prevent head tilt, adjust your computer screen so the top of the monitor is at eye level.
A lot of offices are beginning to offer ergonomic chairs or chairs that will adjust. The chair in the picture is designed to keep the lower back curve, but if your chair does not have this, it can be fixed with nothing more than a towel:
Manufacturers all over the world produce "lumbar rolls" or different types of back support devices for chairs. You can purchase one, but all you really need is a rolled up towel. You and your chair will determine how thick the roll should be, and this may require some trial and error to see what helps you the best. By placing this one roll along the small of your back at about belt line, it will automatically help sustain your low back curve (which is the hardest to keep while sitting). Then, like a chain reaction, the other two curves in your back fall into place, especially if you are consciously practicing other correct sitting posture techniques.
Position #3: Lying (Sleeping)
Everyone has a preference on what position they prefer to sleep in at night. You may consider yourself a back, side, or stomach (tummy) sleeper. Companies now produce pillows specifically for what type of sleeper you are, and these pillows do help a little for your neck and shoulders. But what about your back?
Hate to break it to you stomach sleepers, but you are sleeping in the WORST position imaginable. Take a look at the following picture:
We will examine this position from head to toe. In order to breath, you must turn your head to the side, putting your neck in an extreme position. And, as a lot of you probably do, you then put your arms up under the pillow or above the pillow putting your shoulders in an awkward position. Many people begin to pinch muscles and tendons in the shoulder by keeping their arms in the position for long periods of time, and over time, you can develop shoulder problems.
Now the spine. There is no way the spine has all 3 curves in a well supported position while sleeping on your stomach. The middle and lower back sag into the mattress, placing your spine into "hyperextension" or over-stretched.
Here is the BEST position to sleep in, whether you are a side, back, or stomach sleeper:
This position keeps the back aligned with a well supported 3 curves due to the pillow under the knees helping with the lower and middle spine. And a pillow under the head which is thick and firm enough to keep your head and neck aligned with the rest of your spine. Also note, the shoulders are in a relaxed, non-stressed position.
But if you just HAVE to sleep on your side or stomach, this is a better way of doing so:
By placing a pillow between your legs, and having a pillow of correct thickness for your head, your spine will align from head to toe with less stress in the neck, lower back and hips. Please avoid placing your arm under the pillow (as shown) to prevent shoulder irritation.
Body pillows are a great idea to allow you to place it between your legs, and have support for your top arm and neck.
This is still not a therapist's first choice of sleeping positions, especially those with back and/or neck pain. However, if you must sleep on your stomach, place a pillow under your hips/lower abdomen to bring your lower and mid-back out of hyperextension (over-stretch). To decrease the torqued position of the neck, try to sleep towards the edge of your pillow instead of the middle of it to bring your neck and head into a slanted or diagonal position. As for your shoulders, just try to keep your arms closer to your sides than up by your head.
Also, look at your mattress. Is it a box spring, pillow top, foam, firm, soft...? You don't want a mattress that is TOO soft, but you don't want one that is TOO hard.
The Temper-Pedic and Sleep Number beds are the best due to their ability to conform to your body, and they do not wear out unevenly or as quickly. But, like me, there are a lot of us who cannot afford such a mattress.
Here are just some typical guidelines when purchasing or examining your mattress:
Remember, posture is not everything when it comes to back health, but it is a good starting point. Exercise, strength, and flexibility play large roles in preventing back pain. Also, correctly lifting and carrying objects (light or heavy), something we therapists like to call "body mechanics," is also a crucial part of maintaining a healthy back.
Ask your doctor, physical therapist, or any other professional health care provider about exercises and body mechanics to maintain a healthy, strong back!