
         ------------------------------------------------------------
                     POSTURE, FATIGUE AND SPINAL CURVATURE 
         ------------------------------------------------------------
       
       This chapter includes general posture information as well as a 
       "secret" to greater comfort for computer users who suffer from 
       back pain. I have put this little secret towards the end of this 
       chapter since you need to absorb ALL of it rather than seeking 
       only a "quick fix" for your back pain. 

       Improper curvature of the spine and poor posture are the largest 
       sources of most back pain. In fact if you wanted to read only 
       two chapters of this tutorial to achieve fast relief from back 
       pain, this chapter and the chapters on exercises would probably 
       provide the most immediate relief. 

       Posture governs the relation of the body's structures whether we 
       are standing, sitting or prone. Obviously the shape of the spine 
       is related to the muscle groups and is of critical concern. 
       Things are not necessarily what they appear to be when you 
       examine the topic of proper posture. For example, when a person 
       stands we often think of the old advice to "put your shoulders 
       back and stand tall." Good advice? 
       
       Not really. When you force your shoulders back, the stomach 
       usually moves forward to counterbalance the effort. This results 
       in excessive curvature of the frequently painful lower lumbar 
       area. Not a terribly good idea for optimum spinal curvature and 
       back support. 

       When a person is in an erect standing position a more ideal 
       posture would display reasonably slight bending of the primary 
       and secondary curves of the back. Good posture would provide a 
       mild lumbar (lower back) curve, abdomen and buttocks not 
       prominent or protruding, and head carried erect with shoulders 
       not sagging or rounded. Obviously weight and height would adjust 
       this picture which is for the most part an ideal. A person with 
       reasonably good posture is also less likely to suffer sudden or 
       chronic trauma when lifting, sitting or driving a car. Good 
       posture tends to distribute sudden or chronic load on the back 
       EVENLY rather than CONCENTRATING damaging forces in one region 
       of the back which leads to eventual injury. 

       An ignored principle of physics... 
       
       When you apply a force to a curved surface, the greatest force 
       buildup or stress is exerted on the CONCAVE or inner curve of 
       the surface. Thus the inner curves of a poorly positioned spine 
       suffer the greatest wear and risk for injury. The spine has 
       cleverly evolved with specialized primary and secondary curves 
       to counterbalance most of the forces of our erect existence; 
       however, excessive curvature and poor posture contribute to wear 
       and tear due to this imbalance. If you sit or walk with slouchy 
       shoulders, rounded back or flabby abdominal and buttock muscles 
       you WILL sooner or later experience back pain. 

       Posture extends to other activities such as sitting and 
       sleeping. This requires muscle tone and for some folks a 
       conscious decision to lose weight and do some exercises. No 
       amount of surgery, pain medications or good intent can have as 
       much benefit as these simple changes in posture mixed with a 
       dash of simple spinal exercises. 

       Just what is good erect posture? While standing or walking this 
       involves lifting your head up and tucking the chin slightly 
       which flattens the upper cervical curve mildly. The crucial 
       lower back (lumbar) curve where most back pain occurs needs 
       special attention. Usually this means tilting the pelvis forward 
       slightly as you walk or stand by contracting the powerful 
       muscles of the buttocks. Relax your buttocks too much and the 
       pelvis tilts rearward and the lumbar curve increases rapidly. 
       Some involvement by the abdominal muscles may be needed to help 
       the buttocks achieve the proper tilt of the pelvis. Simply 
       taking a walk for 15 to 20 minutes twice a day may painlessly 
       increase the strength of the buttocks muscles. A conscious 
       effort to try the specific back-strengthening exercises 
       described elsewhere will accelerate the process. 
       
       Head forward and high, pelvis tilted forward and buttocks tucked 
       in. Things may be a little stiff at first, but the relief in 
       pain should be worth it. 
       
       Try it right now: stand, tilt your head forward and tilt your 
       pelvis forward by tensing your buttocks. Hold the position for a 
       good 30 seconds and you should begin to feel a little tingling, 
       almost pleasant feeling as your spinal muscles "stretch and wake 
       up." 
       
       Now slouch back into the old bad position and notice the 
       difference. Try to memorize the sensation of how it FEELS and 
       repeat this "reminder" when you are standing at the supermarket 
       checkout or waiting for an elevator, after a while it will 
       become your normal correct posture. Practice and good muscle 
       tone goes a long way to relieve back pain. The idea is to 
       slightly flatten excessive lumbar (lower back) and cervical 
       (neck area) spinal curvature. 

       Back pains from all other causes such as trauma, pregnancy, disc 
       injury and other causes are frequently traced to poor posture 
       and spinal curvature which weakened the structure of the back 
       and led to the related problem. In the study of back pain, 
       posture really is the starting point. 

       Here's a simple test to check your posture. Stand with your back 
       against a wall and your feet about 10 to 12 inches apart. Bend 
       your knees slightly and lean forward just a bit so that only 
       your buttocks touch the wall. Now slowly tilt backwards so that 
       vertebra by vertebra you flatten each inch of your back against 
       the wall. As you start to press your middle back against the 
       wall you will notice that the lower lumbar section tends to lift 
       or pull away from the wall. Temporarily try to hold the lower 
       lumbar section against the wall as you continue to press the 
       remainder of your spine against the wall as well. Keep your 
       knees slightly bent during this time. Finally straighten your 
       knees and keep your back flat. Finally walk away from the wall 
       slowly while you maintain this position for a few moments. 
       
       Study the sensation. This posture is probably too exaggerated 
       for most people to hold for very long, but it will give you an 
       idea of the "feeling" of a more erect posture. A little exercise 
       and conscious effort to maintain a more straightened, less 
       slouchy posture goes a long way to relieve pain. 

       What about sitting? Good posture suggests sitting in a 
       relatively firm chair with your back snug against the back rest 
       and both feet flat on the floor or slightly elevated. If you 
       have a tendency to lean, it is better to lean slightly forwards 
       rather than backwards since the latter increases the lumbar 
       lordosis or swayback curvature which is so damaging and painful. 
       
       The excessive curvature of the lower lumbar area or "swayback" 
       inwards towards the stomach of is probably the most common 
       damaging posture misalignment. 
       
       Swayback sufferers tend to be unusually susceptible to lumbar 
       (lower back) pain. Remember that the spine is a vertical stack 
       of bony vertebrae each cushioned by a shock absorbing disc. When 
       a swayback condition persists, the rear or back edge of each 
       vertebra is forced closer together and, over time, nerves which 
       lie in that region can be painfully compressed and add to muscle 
       spasm. A painful "locking" or "catch" in the lower back may 
       develop, commonly referred to as lumbago. Shooting pains can 
       sometimes radiate downwards into the legs (sciatica) as the pain 
       intensifies and the compressed nerves react. Swayback or 
       excessive lumbar lordosis is a condition which obviously should 
       not be allowed to persist for these reasons. It can usually be 
       corrected by conscious attention to posture, and mild exercises 
       to strengthen weakened muscles. 
       
       When driving, sit close to the wheel so that your legs do not 
       stretch out. Another trick which relieves back pain on long 
       drives is to occasionally lift your left foot and rest it on the 
       edge of the door-jam next to the driver's door. This slightly 
       raises your left knee and surprisingly adds comfort. While you 
       drive occasionally tense your buttock muscles and try to reduce 
       the swayback curve of the lower back if it is sagging due to 
       fatigue. 

       Sleeping posture is also important. Unless specifically 
       recommended by a doctor, NEVER sleep on your stomach. This 
       exaggerates the lumbar curve of the lower back and is the worst 
       sleeping position. A relatively firm mattress is recommended for 
       most people. Waterbeds and overly soft mattresses usually are 
       generally not good for the curvature of the spine. Especially if 
       you suffer from back pain in the first place. 
       
       The best sleeping posture is to lie on your side with both knees 
       slightly pulled upwards and tucked together. A small pillow or 
       towel between the knees can lesson the bony contact between each 
       knee joint. If you must sleep on your back, a slight elevation 
       of the knees is the preferred position and some people place one 
       or two small pillows underneath both knees to elevate them 
       properly and thus flatten the lower lumbar curvature. During the 
       night you will move and toss a bit, but if you train your body 
       to sleep either on your side or back (or a little of both), 
       gradually this will be the position you will adopt and your back 
       will be more comfortable in the morning. 
       
       Speaking of awakening in the morning, another trick which is 
       useful for some people is to try to do the back exercises we 
       will present in a later chapter upon arising from bed and 
       perhaps soon after a "warm up" shower. 
       
       This is because in the morning the spine is at its greatest 
       anatomical length and is most supple and flexible at this time 
       of the day. Also, the spine is usually not fatigued and tense 
       from standing or sitting all day. Try this wakeup idea and see 
       if it reduces back pain for you. It may take one or two weeks to 
       adopt to these "new" postures and exercise suggestions; but they 
       are medically sound and your only recourse is more pain and 
       intervention by a physician or surgeon. 

       Back to standing posture. Most folks notice that after standing 
       for extended periods of time gradually a lower (lumbar) backache 
       appears and to a small extent an upper backache. This is almost 
       ALWAYS caused by the gradual unconscious relaxing of the muscles 
       of the buttocks and abdomen. You sag and slouch into a "more 
       comfortable" position only to find it less comfortable in the 
       end. 
       
       A simple trick to avoid this if you must stand for long periods 
       of time is to place a small stool or footrest in front of you 
       and alternately put one foot or the other on the footrest as 
       time passes. This small trick takes a little strain off the 
       lower back and keeps the lumbar curve somewhat straight and thus 
       prevents fatigue. Bars and taverns usually have footrests in 
       front of bar stools because it is more comfortable on your lower 
       back so you will usually stay longer and perhaps buy a few extra 
       drinks. No kidding! 

       Here is my "secret" to back comfort for those of you who spend a 
       lot of time with computers. Computer users will do just about 
       anything to alleviate back pain. It is our most constant 
       complaint. Here is my unorthodox method to reduce backache: 
       
       I frequently spend 8 to 10 hours daily working with computers. 
       Obviously, I am a good candidate for backaches. First, I sit for 
       perhaps half an hour in a good quality chair with my feet just 
       slightly elevated, torso slightly leaning forward. After half an 
       hour I move both my monitor and keyboard to an elevated platform 
       (old piano bench placed on the desk) which sits to one side of 
       my desk. I then stand with both feet on a shock absorbing pad 
       and alternately move either my left or right foot onto a small 
       footrest as I stand and type. Periodically (every ten minutes or 
       so) I consciously tense my buttock and abdominal muscles to keep 
       the lumbar curve comfortable and tilt the pelvis forward into 
       correct position. 
       
       The footrest and shock absorbing footpad go a long way to 
       alleviating back pain and lately I spend about 40% of my time 
       standing and typing and the remainder seated. I have found that 
       these adaptations to life with the computer produce better 
       attention, more work and are comfortable at the end of the day. 
       Computing while standing has become a fairly comfortable 
       regimen. It also has the advantage of allowing me two positions 
       (seated and standing) from which to work rather than one. I 
       usually find the standing position workable at the beginning of 
       the day and gradually move into a seated position as the day 
       progresses and fatigue sets in. But I still try to alternate 
       between the two positions regardless of the time of day. Try 
       these ideas yourself, but allow a week or two of "practice" to 
       achieve pain reduction results. There are no fast cures for 
       heavy computer users and office workers. 

       Lifting and proper posture is a neglected topic. Most folks 
       generally recall something about "lifting with your back 
       straight." But there is a lot more to it than that. 
       
       Generally locking your knees straight and bending from the waist 
       to pick up anything is an invitation to to increase stress as 
       the critical lower lumbo-sacral joint. The heavier the object, 
       the greater the chance of stressing a muscle or joint either 
       temporarily or permanently. 
       
       To lift something heavy, squat to the floor, both feet about a 
       foot apart and "hug" the object close to your body. One way to 
       visualize this is to pretend you are hugging a small child who 
       wants attention but does not want to be picked up - the child 
       wants you to SQUAT and come down to its level. 
       
       Keeping the object "hugged" close to the body minimizes the 
       leverage applied on the lower back. Lift STRAIGHT up with the 
       powerful leg muscles and NOT the back muscles. This is one 
       procedure you should practice a few times when you can 
       concentrate on the fundamentals and not when you have to lift a 
       heavy truck tire in the pouring rain some dark evening. You have 
       to discipline yourself to lifting properly since all of us 
       unconsciously lift the wrong way (bending at the waist) because 
       it is quick and easy. And dangerous. 
       
       A few words about posture and women. Although a woman's pelvis 
       is slightly wider than a man's, the principles are the same when 
       is comes to a discussion about posture. During pregnancy, as we 
       will discuss in a later chapter, the tendency of the lower back 
       to bend into a "swayback" position with an exaggerated lumbo-
       saccral curve can be pronounced. Additional lower back exercises 
       may be prescribed by a physician to bring the spine back to its 
       normal curvature after the woman has given birth. 
       
       Another sensitive area of discussion concerning posture concerns 
       the formative teenage years during which some young women can 
       develop psychological sensitivity and embarrassment about 
       developing breasts to the point that a pronounced "slumping or 
       hunching" of the shoulders takes place. This psychological 
       reaction produces poor posture (shoulders slumped forward) to 
       "hide" developing breasts and may unconsciously continue into 
       adulthood. This posture adjustment can produce back fatigue and 
       severe pain and should also be corrected by consultation of a 
       woman or teenager with her physician. In most cases simple back 
       exercises and posture adjustments are sufficient as corrections. 
       
       Severe back pain has also been reported in medical literature as 
       occasionally related to breast implants and their effect on 
       posture. In these reported cases, women who have poorly 
       conditioned muscles of the back, abdomen or buttocks suddenly 
       suffer extreme backaches with the additional weight or size of 
       enlarged breasts. The reaction is not metabolic or based on the 
       immune system, but is simply mechanical fatigue of the back and 
       lower lumbar region due to the additional breast weight. In most 
       cases a proper exercise regimen will correct the back pain. This 
       is obviously a sensitive topic but might be considered by some 
       women and discussed with a physician. 

       Curiously, shorter people tend to have the best posture and, on 
       average, a lower frequency of back pain. Perhaps this is due to 
       decreased weight loads placed upon the back which is inherently 
       an unstable structure. This may also be due to the psychological 
       tendency to "stand tall" as a mild psychological compensation 
       for short stature. Tall people typically suffer greater chance 
       of backaches. 

       Additional posture-related diseases have also been reported in 
       the medical literature. Poor posture can affect the primary 
       dorsal curve of the upper back and the higher cervical curve of 
       the neck region. 
       
       This usually develops from the same poor habits of standing or 
       walking with stomach protruding, chest in and buttocks muscles 
       out of tone. If the primary dorsal curve in the upper back 
       begins to curve strongly for these reasons it can negatively 
       affect the cervical curve and lower lumbar curve as well. 
       Excessive dorsal kyphosis describes this condition. Also 
       associated with this defect in the dorsal curve is a condition 
       known as Scheuermann's disease which, although rare, is noted 
       most frequently in teenage males. It is not entirely clear if 
       this disease is caused by poor posture, genetic defects, diet or 
       if in fact the disease causes the poor posture. 

       Another relatively rare disorder is scoliosis which does not 
       affect the front to back curvature of the spine but the side to 
       side or lateral curvature. This condition is found most 
       frequently among teenage girls, as reported within medical 
       literature. When seen from the front or back, the spine of 
       scoliosis sufferers bends in an S shaped curve which may vary 
       from mild to extreme. The cause of the disease is not entirely 
       understood. Back braces and physical therapy are frequently 
       prescribed. Surgical correction is also attempted in some cases 
       and bone to bone vertebral fusion is the usual procedure. 
       
       Historically, polio also caused some forms of scoliosis. If 
       scoliosis is allowed to run its course in advanced cases, 
       impairment of pulmonary (breathing) and cardiac (heart) 
       functions take place as the chest cavity assumes a 
       characteristic sunken shape and compresses internal organs. 
       
       Good posture begins in two primary areas: the pelvis (controlled 
       by buttock and abdominal muscles) and head (neck and shoulder 
       muscles.) Align those two and the rest of the spinal structure 
       usually falls into line. The lower lumbar region of the back 
       usually causes the most pain, so it is the area to work on. This 
       means exercise and conscious effort to strengthen these areas 
       plus conscious posture changes. 
       
       This tutorial is merely a starting point! For further 
       information on back care and back pain, be sure to register this 
       software ($25.00) which brings by prompt postal delivery a 
       printed, illustrated guide to back pain written by a physician 
       plus two software disks. From the main menu select "Print 
       Registration Form." Or from the DOS prompt type the command  
       ORDER. Mail to Seattle Scientific Photography (Dept. BRN), PO 
       Box 1506, Mercer Island, WA 98040. If you cannot print the order 
       form, send $25.00 to the above address and a short letter 
       requesting these materials. End of chapter. 

