(Courtesy photo)

(Courtesy photo)

Sit up

Kevin R. Stone, MD

Sit up. Just like your mother told you to. Sit up straight. Stand up straight—and feel healthy and powerful. Improving your posture does a world of good for you and for others.

Upright posture in both sitting and standing has a long history of military, political, and interpersonal messaging. The messages include, “I care about myself. I project my health. I project power and confidence, and I am fit. I am strong. I am ready to go.”

Slouching sends the opposite message.

But is there a true health benefit to erect posture? A few recent, poorly researched articles have suggested that the slouch—a curved back sitting posture, with slumped shoulders and sagging belly—has no negative health effects. Much like the anti-vaccine nutcases, grasping on to this shred of poor evidence (or the lack thereof) can lead to justifying poor behavior.

Here is what we see from a fitness and back pain perspective.

To sit and stand up straight requires a conscious decision to place your pelvis, abdomen, chest, shoulders, back, neck, and head in a specific set of positions optimized for your body. This is a choice that takes a conscious effort at first, and subconscious awareness always.

Why? Because a relaxed position, with no muscle tension, leads to a cascade of structural collapses. The pelvis rocks forward, while the low back curves, and the shoulders fall inward. The neck curves downward and the head falls forward of the vertical plane. When these positions are maintained, the muscles holding these physical structures (the hips, for example) can shorten or lengthen chronically, contracting to restrict motion.

And it is freedom of joint motion that determines much of the mechanical efficiency of the human body. A curved pelvis, with weak abdominal (core) muscles and elongated lower back muscles, limits the hip joints’ range of motion, even for everyday activities. Over time these joints contract even further, restricting pelvic motion and making it more difficult to rotate the pelvis under the spine to the erect position. This, in turn, limits the hips’ extension during motions that involve gait and balance: both critical when walking, running, or even standing.

The shoulders suffer the same contraction when slouched in a forward position. The two scapula bones (i.e., shoulder blades) stay in the forward and upward rotated positions, lengthening and weakening their attachments to the central spine.

It then becomes more difficult to rotate the shoulders back over time. Contracted shoulders make it challenging to lift objects overhead.

Back pain is ubiquitous in our aging population. While its causes may not always be known, it is almost always accompanied by weak and tight abdominal and para spinal muscles. Years of sitting in a slouched position, or walking with the curved posture of less-evolved humanoids, makes resolving the pain a long process requiring trunk rebalancing, muscle strengthening, and range of motion exercises.

So roll your pelvis forward. Sit and stand up straight. Place your shoulders in line with, or behind, your hips. Stick your chest out. Tilt your chin up. Hold your belly button in. Breathe deeply with every breath. And don’t forget to smile.

These simple exercises—if begun in kindergarten and continued through life—are the best personal trainers you will ever have. And they are free.

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