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Howtosolveposturalproblemsof

sittingofficepeople Name: Claudia Holbach-Schieder 2.8.2016

Course: CTTC Januar 2016 Body Intellect, Pretoria, SA

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1 Abstract In a 2007 paper in the journal Sports Medicine titled „ The Evolution of Marathon Runnung“, authors Daniel Lieberman (Harvard) and Dennis Bramble (University of Utah) report that "for marathon-length distances, humans can outrun almost all other mammals and can sometimes outrun even horses, especially when it is hot." Indeed, when we look at the human body, it is easy to see that it is not made to sit, it is made to move. The body moves and functions at its best when it is in proper balance. The idea that all muscles are strong relative to each other. But when we look at reality we see a sitting society. We sit at work all day long in front of a computer, we sit when we eat, when we drive, we sit to entertain and to relax and even when we do sports like cycling. Today, more than ever, people are inclined to sit for hours in isometrically contracted postures without adequate physical activity and certain postural problems can be predicted. With this research I specially want to look at ordinary people who mainly do office jobs and are sitting all day long in front of a computer, the postural problem that can occur and how Pilates can help.

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2 Contents

1 Abstract......................................................................................................................2

2 Contents.....................................................................................................................3

3 TheBodyAlignment-Anatomy..................................................................................43.1 TheBodyAlignmentProblemsforsittingpeople.................................................................................43.2 Imbalanceofmuscles.........................................................................................................................................53.2.1 Pectoralismajor/minor.................................................................................................................................63.2.2 Hipflexors..............................................................................................................................................................63.2.3 Spinalextensors...................................................................................................................................................73.2.4 Calves.......................................................................................................................................................................83.2.5 Abdominals............................................................................................................................................................83.2.6 Shouldergirdlemuscles...................................................................................................................................93.2.7 GluteusMaximus.................................................................................................................................................9

4 ClientCaseStudy......................................................................................................114.1 Client’sposturalassessment........................................................................................................................114.2 Peter’sPostureProblem#1:Anteriorhiptilt......................................................................................114.3 Peter’sPostureProblem#2:Excessivecurvatureoftheupperbackwhensitting.............124.4 Peter’sPostureProblem#3:RoundedShoulders..............................................................................134.5 Peter’sPostureProblem#4:Tightcalves..............................................................................................135 ConditioningProgramforPeter................................................................................145.1 AcomprehensivePilatesProgrammforPeter.....................................................................................146 Conclusion................................................................................................................16

7 Bibliography.............................................................................................................17

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3 TheBodyAlignment-AnatomyA good body alignment shows the head, torso and pelvis aligned above one another. And if you looked at a right profile of the spine (as opposed to the left profile) it would follow an "S" shape. The S-curve and shoulder and pelvis alignment are supported with muscles balancing. The spine naturally curves in the neck, upper back, and lower back to help absorb shock and support the weight of the head. The muscles on the left and right side of the body should be equally strong and it requires balanced back muscles and chest and abdominals muscles.

3.1 TheBodyAlignmentProblemsforsittingpeopleHowever „an increased curve in the thoracic region is particulary common“.Typically the upper back appears curved with rounded shoulders - the scapula are protracted (positioned further away from the spine) and a forward head posture - the chin pokes forwards rather than being tucked in – can be seen. This occurs in all sections of the population. In the sports world cyclists have to hold postures for long periods while leaning forward reaching the handle bar and carrying all the weight of the head as well as people sitting/ in front of a computer reaching the keyboard.

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This postural syndrom of the upper back and neck is called Kyphosis. Kyphosis occurs when this natural arch is larger than normal.

Picture A Picture B

3.2 ImbalanceofmusclesAn imbalance of muscles occur. Eventually, the soft tissues of the anterior chest (mainly the pectoralis major) become short and tight and the shoulder girdle muscles in the back ( trapezius, latissimus dorsi and rhomboids) become weak and overstretched, allowing gravity to curve the thoracic spine and jut the head forward. With the back muscles lengthened and not engaged, they lose their ability to hold us upright. Looking at the seated position in picture B we can see that some muscles are held in a shortened position, while other muscles are held in a lengthened position. When muscles are continually held in a shortened position these muscles tend to become shorter, thicker, and tighter. On the other side, when muscles are continually held in a lengthend position, they tend to become longer, thinner, and looser. As a result, some muscles become short and tight while others become long and loose.

Generally speaking, the muscles that flex and push the torso including the chest, shoulders, abdominals, and hip flexors get weaker and shorter from sitting. While the muscles that extend the body and pull, including the scapular retractors (rhomboids, trapezius, etc.), erector spinae, gluteals, and hamstrings get stretched out, longer, and weaker.

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3.2.1 Pectoralismajor/minor

The pectoralis major is a thick muscle, situated at the chest of the human body. It makes up the bulk of the chest muscles. The pectoralis major has following actions which are primarily responsible for movement of the shoulder joint.

• Shoulder adduction • Movement of humerus across the chest (horizontal adduction) • Internal rotation of the humerus

The pectoralis major is also responsible for keeping the arm attached to the trunk of the body. Underneath the pectoralis major is the pectoralis minor, a thin, triangular muscle. The pectoralis minor is primarliy responsible for

• Drawing the scapula forward, downward and inward. The pectoralis minor is a major contributor to rounded shoulder posture which we have when sitting and typing in front of a computer. Staying in this isometrically contracted posture for hours the pectoralis minor muscle tightens and shortens and pulls the shoulders forward.

3.2.2 Hipflexors

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For a sitting position we need to flex the hip. The hip flexors are a group of skeletal muscles that act to flex the femur onto the lumbo-pelvic complex, i.e., pull the knee upward or sitting on a chair. The hip flexors are: Primary muscles for this movement, collectively known as the iliopsoas or inner hip muscles:

• Psoas major • Psoas minor • Iliacus muscle

Secondary muscles • Sartorius • Tensor fasciae latae • Pectineus • Adductor longus and brevis • Gracilis

The flexing of the iliopsoas muscles is a concentric contraction – the muscle is shortening. When hip flexor muscles become too short/tight, they exert force on the pelvis, causing it to tilt anteriorly, throwing the hips out of alignment. An anterior pelvic tilt increases the lordotic curve of the lower back.

3.2.3 SpinalextensorsWith an increased lordotic curve the spinal extensors in the lumbar region are shortend and getting tight. The increased curve in the upper back lenghtens the muscles.

The spinal extensors are a pair of a muscle group of the back which extends the vertebral column. The spinal extensors can be divided into three groups: erector spinae, semispinalis and deep posterier spinal group, one of them is the multifidus. The most powerful of the spinal extensors is the erector spinae, with the spinals, longissimus and iliocostalis. Strengthening this muscle group can help prevent the common tendency for a slumped upper back posture. While the deep multifidus is particulary vital for stabilization the whole spine.

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3.2.4 CalvesThere are two major muscles in your calves – the gastrocnemius muscle and the soleus muscle. The gastrocnemius muscle is the one that’s most visible while the soleus muscle lies a bit deeper. The soleus muscle is an important postural muscle that helps you maintain an upright position when you stand. The soleus and gastrocnemius muscles lift the heel up when walking or running and are used to stand on tip-toes or jump. The Achilles tendon attaches these muscles to the heel.

When seated with the knees bent (flexed at 90 degrees) and the feet in a plantar-flexed position this brings the calves to a shortened position and make them tight.

3.2.5 AbdominalsThe abdominal muscles are located between the ribs and the pelvis on the front of the body. The abdominal muscles support the trunk, allow movement and hold organs in place by regulating internal abdominal pressure. There are four main abdominal muscle groups. The rectus abdominis muscles is a paired muscle running vertically on each side and on top of all others. The external and internal obliques along each side of the rectus abdominus for twisting the trunk.. The transverse abdominis, which is the deepest abdominal muscle layer, wraps around the sides and sits underneath the internal oblique muscles. Its main roles are to stabilise the trunk.

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The abdominals weaken easily. As they are the opposite muscle group tp the erector spinae they are squeezed together in a slumping sitting position and therefore get weak. But they also weaken when lengthend due to a lordotic posture. So strengthening the abdominals is vital for getting balanced muscles in the front and the back of the body

3.2.6 ShouldergirdlemusclesThe shoulder girdle consists primarily of the scapula bone and the clavicle bone which move together as a unit. The shoulder girdle muscle are those which attach to and move these two bones.

Muscle Location Action Trapezius

• Upper • Middle • lower

Posterior • elevation & extension of head • elevation, adduction & upper rotation • adduction, depression & upper rotation

Rhomboid Posterior Adduction, downward rotation & elevation Levator scapula Posterior elevation Serratus anterior Anterior Abduction & upward rotation Pectoralis minor Anterior Abduction, downward rotation & depression

We can see that the middle and lower Trapezius muscle and the Rhomboid works as antagonist to the Serratus anterior and Pectoralis minor which round the shoulders forward when leaning forward to the computer and reaching the keyboard. So these muscles need to be strengthend to bring the shoulders back into a nutrual position.

3.2.7 GluteusMaximusThe glutes consists of 3 muscles:

• Gluteus maximus • Gluteus medius • Gluteus minimus.

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The Gluteus maximus is the largest and most superficial of the three gluteal muscles. It is the extensor and outward rotator of the hip joint and helps stabilizing the hip joint. It supports the trunk for an erected position and is therefore an important muscle for a correct posture. The Gluteus medius and minimus are responsible for hip abduction.

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4 ClientCaseStudyMy client, let’s call him Peter, is 44 years old. He is working long hours in front of a computer or slumbing in meeting chairs. After work he goes mountainbiking and there he feels back pain in the lumbar spine. That was the reason for him to try out Pilates.

4.1 Client’sposturalassessmentHis standing postural assessment showed me that he has deviations from the plumb line (ideal alignment). His lobe of the ear aswell as the mid of the neck are in front of the plumb line. He shows a lordotic posture with an anterior tilt of the hip. The sitting postural assessment showed a very round upper back (c-shape spine). It is hard for him to sit straight. To sit comfortable his heels are lifted from the floor.

Overall Peter has a Kephotic-Lordotic Posture.

4.2 Peter’sPostureProblem#1:Anteriorhiptilt

Q

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Sitting long hours a day without activity or stretching Peter’s hip muscles shortend and tightend. The result is a forward hip tilt (anterior pelvic tilt) which forced his lordotic posture which shortens and tightens his lumbar back extensors. In the opposite the hip extensors along with the gluteus maximus are lengthend and therefore getting weak as well as his abdominals which lengthend and weakend. Aligning the hip needs a well balanced excersise program of the pelvic stabilisers. Solution:

• Stretching exercises for hip flexors • Stretching and strengthening of lumbar spine • Strengthening the gluteus maximus and harmstrings • Strengthening the abdominals

4.3 Peter’sPostureProblem#2:Excessivecurvatureoftheupperbackwhensitting

Sitting hunched over a computer screen forces Peter’s pectoralis major to tighten, which causes an excessive curvature (kyphosis) of the upper back (thoracic spine). In opposite his upper back muscles Rhomboideus and Trapezius are lengthend which makes them weak and lose. Luckily Peter’s Kyphosis is not excessive. It is more a hunchback when sitting. Solution:

• Excersis to stretch and open tight chest muscles • Strengthening the upper back postural muscles

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4.4 Peter’sPostureProblem#3:RoundedShoulders

I used the “Pencil Test” to analyse if Peter has rounded shoulders. This involves holding a pencil in each hand. As shown in the photo above, if the pencils are pointing straight forward with your arms comfortably at your sides, that indicates correct posture. If on the other hand the pencils are facing each other, or are rotated at an angle, then you have internally rotated shoulders. Long hours in front of a computer with elbows held at a 90-degree angle and a medial rotation for touching the keyboard the shoulder inward rotators (subscapularis and teres major) are always contracted. Solution:

• Excersis to stretch and open tight chest muscles • Strengthening the upper back postural muscles

4.5 Peter’sPostureProblem#4:Tightcalves

A test shows that Peter has little flexibility in his ankles. This is due to tight calves muscles (gastrocnemicus and soleus) and a thight achilles tendon. Solution:

• Stretching the calves muscles and achilles tendon.

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5 ConditioningProgramforPeter Though Peter is a sportive person, he has no experience in Pilates or any other controlled body work. For that reason I start with a BASI Comprehensivw Fundamental program which I will build up over the weeks we are working together. I will use modifications to facilitate or intensify the BASI exercises according to his level. In respect that Peter is a man I stick to the clear and focused exercises and rather modify them than choosing highsophisticated exercises. Peter’s objective is not to have lower back pain when cycling. In summery the following shows the objectives for Peter seen as a whole. Strengthening:

• Back extensor strength (lumbar and thoracic) • Shoulder extensor strength • Gluteus maximus/Harmsting strength • Abdominal strength

Stretching: • Hip Flexor stretch • Chest stretch • Lower Back stretch • Calves stretch /Achilles tendon stretch

Mobility • Spinal mobility

5.1 AcomprehensivePilatesProgrammforPeterAccording to the progressive layering of the Block System I have worked out following programm considering Peter’s issues and personal objectives over the next 21 weeks. The repetitions will be increased on a regular basis and where appropriate I will guide Peter to do some isometric contraction to improve endurance.

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1-10 11-20 21+ 1 2 3 4

WarmUp

Mat:•Rolldown•Rollup•SpineTwistSupine•DoubleLeg•SingleLeg

AlternateprosessionwithCadillac:•WarmupSeries

x

-HarmstringandGlutealstrength-Abdominalstrength

FootWork

ReformerFootWorkSeries:ParallelHeelsParallelToesVPos.ToesOpenVHeelsOpenVToesCalfRaisesPrancesSingleLegHeelsSingleLegToes(Prehensile)

CadillacFootWorkSeries:ParallelHeelsParallelToesVPos.ToesOpenVHeelsOpenVToesCalfRaisesPrancesSingleLegHeelsSingleLegToes

WundaChairFootWorkSeries:ParallelHeelsParallelToesVPos.ToesOpenVHeelsOpenVToesCalfRaisesSingleLegHeelsSingleLegToes

x

-StretchingCalves-Strengtheninglegmuscles,speciallyharmstrings

AbdominalWork

ReformerHundredPrepHundred/Coordination

CadillacBreathingwithPTBBottomLiftwithRUBRollUpBottomLoaded

WundaChairSittingPikeStandingPikeReverseFullPike x

-AbdominalStrength-SpinalArticulation-Awarenessforbreathing

HipWork

ReformerSupineLegSeries:FrogCircledown/upOpenings

x

-Strengtheningharmstringsandadductors

SpinalArticulation

CadillacTowerPreporWundaChairPelvicCurl

CadillacTowerorWundaChairJackKnife

x

-Stretchlowerback-Abdominalstrength-Calvestretch(intowerprep/towerlastphase)

Stretches

LadderBarralGlutealHarmstringsAdductorsHipFlexor

LadderBarrelShoulder1Shoulder2orCadillacShoulderstretchprone

LadderBarralGlutealHarmstringsAdductorsHipFlexor x x x

-Deltoid/Pecstretch-Shoulderextensor/flexorstretch-StretchHarmstringandHipFlexors

FullBodyIntegration

CadillacThighstretchwithRUBorKneelingCatstretch

ReformerKneeStretchGrouporUpstretch2 x

-HipFlexorStretch-Shoulderstretch-Awarenesstrunkstabilization(AbsandBackExt.)

ArmWork

ReformerShoulderPush/SingleorArmSittingseries(box)

WundaChairTricepsProneFrogback

ReformerArmKneelingSeries

x

-BackExtensors-UpperGridleStrength

FullBodyIntegration

CadillacBalanceControlFrontorSittingBack

x x-ShoulderGirdlestrength-Shoulderstretch

LegWorkWundaChair/ReformerHarmstringCurl

WundaChairFrogFront

ReformerSkatingSingleLeg x

-Harmstringstrength-GlutealStrength

LateralFlexion/Rotation

WundaChairSidestretchorReformerMermaid

LadderBarrelSideliftorWundaChairSideKneelingstretch

ReformerSideoverboxorCadillacButterflyorWundaChairSidePike

x

-Abdominalstrengthwithobliques-Spinemobility

BackExtension

ReformerBreaststrokepreporWundaChairSwanBasic

WundaChairSwanonFloororLadderBarrelSwanPrep

ReformerPullingStraps1/2orBreaststroke

x x

-Upperbackextensors-openingchest

Mat:•Rolldown•PelvicCurl•SpineTwistSupine•ChestLift•ChestLiftwithrotation

AlternateprosessionwithCadillac:•WarmupSeries

CadillacSupineLegSeries:FrogCirclesdown/upWalkingBicycle/ReverseorReformerSupineLegSeries:FrogCircledown/upOpenings

ConsideringPeter'sissuesBlock Peter'sObjectives

Excersisesinweek

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6 ConclusionSitting in a wrong posture for a long time causes muscles imbalance typically resulting in poor posture and pain. The sitting position weakens all muscles. Along with this weakness comes a loss of motion and function. Unfortunately many people are not aware of their poor posture. They only wake up if they are feeling pain, so is Peter. It is important for these clients to gain body awareness and that they understand the chain reaction that caused their pain. It is important for people to understand the necessity of balanced muscels in the whole body to keep a good posture and avoid pain. All in all I think that Pilates is the right way to achieve these goal. The body awareness they receive from Pilates, will help clients move better while performing all the tasks of their day. Pilates helps to rebalance the body and counteract the prolonged sitting and high stress of the typical office job. It shows us to move the body correctly in everything we do, reducing muscle pain and strain, and improving overall body awareness. In Peter’s case, he can feel an inner strength and a better overall mobility. When mountainbiking he can feel better endurance in his shoulder girdle and when sitting upright he is able to do it for a longer time without suffering from muscle aching. Peter is happy that he started the Pilates workout and will go on with it.

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7 Bibliography Pilates in the workplace http://themethodpilates.com/articles/pilates-in-the-workplace/ Posture in the office http://whatsyourposture.com.au/whats-your-posture/office/ Anatomy and pictures http://en.wikipedia.org/wiki/ Common posture problems / pictures http://www.builtlean.com/2011/11/28/posture-problems/ Research on Roundback and Low back pain http://sport1.uibk.ac.at/lehre/lehrbeauftragte/Huber%20Reinhard/rundr%FCcken_verbessert%5B1%5D.pdf http://cdn.intechopen.com/pdfs/36705/InTech-Stabilization_exercise_for_the_management_of_low_back_pain.pdf Isacowitz, Rael and Clippinger, Karen (2011) Pilates Anatomy BASI Study Guide – Mat Work Course

An evolutionary issue.