Framing Your Body Mechanics

1. W. Mark deGruchy B.S., D.C. Brent E. Burton B.A.Hon., D.C. 81 Metcalfe Street Suite 801, Ottawa, Ontario, K1P 6K7 Tel: 613-564-9000 Framing Your Body Mechanics

2. Outline • Introduction to Posture • What Factors Affect Posture? • Forward Head Posture • Office Posture • Lifting/Carrying Posture • Sleeping Posture • Building a Good Base of Support • Chiropractic Correction

3. “As a twig is bent the tree inclines” - Virgil Introduction to Body Mechanics What is posture? • The position of the body in space. Why is Posture so Important? • It is the first step to either good or poor health, e.g. more difficulty with deep breathing when slouching. • Improved body self-awareness. • Decreased risk of injury during activities. • Decreased risk of chronic diseases such as osteoarthritis, low back pain, neck pain, headaches, etc.

4. Mechanical (function) Postural Structural Example:Upper-Cross Syndrome1 (Tight & Weak muscles) Example:Poor Sitting Posture Example:Osteoarthritis2 Structure vs. Function?

5. Factors Affecting Posture: Forward Head Posture • Very common in office workers, students, whiplash injuries/accidents • Direct relationship to computer monitor usage. • Average weight of head (approx 8-12 lbs). • Every inch forward places further strain on muscles, ligaments, and joints.

6. Factors Affecting Posture: Forward Head Posture • Prolonged contraction of muscles used to support head in forward position  Chronic Shortening and Tightening and Pain2 • Dysfunctional muscles at back of head, front of neck, top of shoulders and front of chest can lead to headaches, numbness and tingling into arms.

7. Factors Affecting Posture: Forward Head Posture • Easy exercise: Brügger’s postural break4. • Balances muscles so that poor work posture does not become permanent. • Hold for 8-15 seconds, 1x/every hour sitting.

8. Factors Affecting Posture: Office Posture • Slouched posture straightens spinal curves and puts uneven wear on discs (especially low back). • Prolonged sitting leads to strain of muscles, ligaments, and joints. • Incorrect mouse, phone and keyboard positioning leads to strain of neck, shoulder, elbow and wrist, e.g. carpal tunnel syndrome.

9. Repetitive Strain Injuries:Stages of Pain5 Early: • The body aches . • Feel tired at work, but symptoms disappear during time away from work. • The injury does not interfere with the ability to work. • The injury will heal completely if dealt with properly at this early stage. Intermediate: • The injured area aches and feels weak soon after the start of work, until well after work has ended. • The injury will completely heal if dealt with properly. Advanced: • The injured area aches and feels weak, even at rest. • Sleep is affected. • Even light duties are very difficult.

10. How to Correct Office Posture • Adjust seat so that hips, knees and ankles are at roughly 90°(knees at level of seat, you may need a footrest). • Allow 2-3 fingers space behind knees. • Rest back against backrest. • Constantly change positions. • Sit close to work. • Reduce time seated to 75% of workday.Try to alternate sitting, standing and walking every 30 minutes.6 • Adjust lumbar support so that it is in small of back. • Keep chin, shoulders and low back aligned (don’t slump).

11. How to Correct Office Posture • Armrest Height – Should be at elbow height with relaxed shoulders and elbows at 90 º. • Place keyboard and mouse within comfortable reach at same level as armrests. • Wrists should not be extended or flexed and relaxed (don’t lift baby finger or thumb). • Monitor should be 40-79cm away from face. • Monitor should be positioned so head is neutral when reading the top row of text onscreen (may be lower if you wear bi-focals). • Hold phone with hands, not shoulder. Switch hands.

12. Factors Affecting Posture: Lifting/Carrying Posture • Lifting and twisting together place enormous strain on spine. • Lift with knees and hips, then turn with feet. • Hold loads close to body. • Reduce loads whenever possible. (Adolescents should keep loads below 15% of body weight)7. • Distribute weight towards bottom of bag. • Alternate shoulders/arms if carrying a purse, carry-on bag, satchel.

13. Factors Affecting Posture: Sleeping Posture • Comfortable sleep is very important since we should be spending about 1/3 of our time sleeping. • Many people have neck pain from sleeping face-down. Chronic strain on muscle and joints of neck. • Many people snore/breath poorly sleeping on their back. Side-lying appears best for snorers/sleep apnea.

14. Factors Affecting Posture: Mattresses and Pillows • Research lacking on mattresses and pillows.8 • Now accepted that firmer support is not necessarily better. 9 • Recommendation is usually a medium-firm mattress as it reduces the likelihood of low-back pain.9 • However: Sleep quality of each mattress appears to be based on the individuals needs.10

15. Factors Affecting Posture: Mattresses and Pillows General principles when buying a mattress or pillow: • Ensure that contours of spine are supported separately. • Ensure there are no points of excess pressure/discomfort. • Ensure you spend at least 15 minutes lying on the mattress you intend to buy. • Ensure there is a return policy incase you don’t like the mattress.

16. Building a Good Base of Support • Average steps/day = 8,000-10,000. • Eyes will always try to be level with gravity. • Problems in ankles, knees, hips, back? Start by looking at your feet! • There are 52 bones and 66 joints in your feet! • If you have problems with any of the following, have a qualified doctor look at your feet/posture: • Pain in feet, knees, hips, low back • Excessive shoe wear • Low or high arches • Knock-knees or bow-legged • Arthritis or diabetes

17. Building a Good Base of Support: Shoes10,11 • Find out whether you are neutral, a pronator (flat-footed) or supinator (rigid arch). Buy shoes accordingly. • Shoes should be comfortable when you try them on. Don’t break them in! • Make sure shoes are wide enough in toe box and there is 1/2” between end and longest toe. • Make sure your heels don’t slip. • If you wear an orthotic, try a neutral shoe, with your orthotic in it (take out the insole). • Try not to wear high-heels constantly. • Try on shoes at end of day.

18. Building a Good Base of Support: Shoes Testing Running Shoes When Buying • The Shelf Test: • Pinch Grip Test: • Fold Test: • Dish-Rag Test:

19. Building a Good Base of Support: Orthotics • Orthotics can be used to treat a variety of health concerns. E.g. diabetic foot, flat feet, etc. • Main functions of custom orthotics: • Correct poor foot mechanics. • Stabilize and support foot during gait. • Shock absorption/comfort. • Protect joints and muscles from over-use. • Provide feedback to your nervous system about where your foot is in space. • Correct Posture. • Prevent Injuries E.g. ankle sprains, foot fractures during sports. • Can be made for specific shoes: Running, skating, skiing, dress, sandals, etc. Note: Not everyone requires custom orthotics (even if you have foot problems). Speak to a qualified doctor!

20. Chiropractic Correction • Purpose of chiropractic treatment is to not only rid patients of pain, but to reduce/correct postural/mechanical stresses and strains. • Evidence shows chiropractic treatment is also useful for increasing range of motion12,13, and increasing postural symmetry14. • Chiropractors use a variety of techniques, exercises, physical therapies, and devices to restore normal muscle, joint and nerve function. • Focus on functioning of entire body, not just area of complaint.

21. References • Janda, V. 1988. Muscles and cervicogenic pain syndromes. Physical Therapy of the Cervical and Thoracic Spine. Churchill Livingstone. London. pp.153-166. • Harrison DD, Jones EW, Janik TJ, Harrison DE. 2002. Evaluation of Flexural Stresses in the Vertebral body Cortex and Trabecular Bone in Three Cervical Configurations with an Elliptical Shell Model. J Manipulative Physiol Ther. 25(6): 391-401. • Moore, M. 2004. Upper cross syndrome and its relationship to cervicogenic headache. JMPT. 27(6):414-420. • Liebenson, C. 1999. Advice for the clinician: the brugger relief position. Journal of Bodywork and movement therapies.3(3):147-149. • Workers Compensation Board - Alberta. 1999. Office Ergonomics: Remembering the Basics. • Juul-Kristensen, B. and C. Jensen. 2005. Self-reported workplace related ergonomic conditions as prognostic factors for musculoskeletal symptoms: the “BIT” follow up study on office workers. Occup. Environ. Med. 62: 188-194. • Chansirinukor, W. 2001. Effects of backpacks on students: Measurement of cervical and shoulder posture. Australian Journal of Physiotherapy. 47:110-116. • Buckle, P. and A. Fernandes. 1998. Mattress evaluation – assessment of contact pressure, comfort and discomfort. Applied Ergonomics. 29(1):35-39. • Kovacs et al. 2003. Effect of firmness of mattress on chronic non-specific low-back pain: randomised, double-blind, controlled, multicentre trial. Lancet. 362:1599-15604. • American Academy of Orthopaedic Surgeons. 2000. If the shoe fits, wear it. http://orthoinfo.aaos.org/fact/thr_report.cfm?thread_id=104&topcategory=foot. • Asplund, C. and D. Brown. 2005. The Running Shoe Prescription. Physician and Sports Medicine. 33(1). • Martinez-Segura et al. 2006. Immediate effects on neck pain and active range of motion after a single cervical high-velocity low-amplitude manipulation in subjects presenting with mechanical neck pain: a randomized controlled trial. JMPT. 29(7): 511-517. • Cassedy et al. 1992 . The effect of manipulation on pain and range of motion in the cervical spine: a pilot study.JMPT. Oct;15(8):495-500 • Childs et al. 2004. Immediate improvements in side-to-side weight bearing and iliac crest symmetry after manipulation in patients with low back pain. JMPT. 27(5):306-313.