Can a series on posture ever be complete without considering the sleeping or lying down posture?
The best posture lying down is the supine posture, that is lying on your back, in anatomical position or with arms and legs relaxed and legs turned out slightly at hip joints. This enables maximum support to the body, allowing the postural muscles engaged in maintaining the upright position to relax. A pillow under the head and neck supporting the cervical curve allows muscles in this region to relax. If the hamstrings or hip flexors are tight, it helps to put a pillow under the knees to relieve tension in these muscles and maintain the spine in neutral position. In a physical therapy clinic, supine posture is employed for manual therapy on various limb joints and muscles, to train the abdominals as well as, increase awareness of diaphragmatic breathing.
Side-lying is another position one can assume in recumbent position. While lying on the side, a straight (neutral) spine and slightly bent knees is ideal. To maintain a neutral spine, it may be necessary to place a pillow between the knees to prevent side bending. Yoga practitioners say lying on the left side post-lunch helps the liver function well and aids in food digestion and making one alert. Also, when lying on the left side, breathing occurs predominantly through the right nostril and when lying on the right side, it takes place through the left nostril. In a physical therapy clinic, side-lying position is employed to balance and bring awareness to asymmetries.
The prone position is when one lies in face-down position, on the chest or stomach. It helps open the alveolar sacs in posterior lungs, which have a large surface area. This position may predispose to stress in the lumbar spine if the trunk muscles have decreased tone, putting uneven pressure on the inter-vertebral discs and nerve roots as they exit from the foramen. In this case a small, thin, pillow under the abdomen/pelvis helps maintain the curve in lumbar spine and prevent excessive lumbar lordosis. Also in this position, the head needs to be turned to one side, which impacts the cervical spine. In a physical therapy clinic, the prone position is employed to train the back extensors and upper quadrant muscles, including the scapular muscles and cervical extensors and in stretching the chest/pectoral area if tight. Often times prone exercises are encouraged on exercise ball, which is found to decrease trunk muscle co-contraction by nearly 1/3rd as similar exercises on a mat, and is obviously beneficial in gentle and progressive strengthening in case of back injury.
A lot of studies are conducted on sleep and the profound impact poor sleep can have on an individuals’ life. Whatever the posture adopted in lying down, it is essential to be comfortable to allow deep sleep so that all the cells in the body can rest and rejuvenate. In authentic yoga, it has been observed sleep requirement naturally decreases and body rejuvenates faster and effectively with fewer hours of sleep.
Ever wonder when you go to a physical therapy clinic, why there are plinths or mats? Though evaluation of posture in various positions reveal many things to the trained eye, the muscles are most relaxed in the lying position and hence allow a true assessment of the range of motion of joints and in some instances, it helps determine whether the problem lies in the joints or in the soft tissue surrounding them. In the lying position, the soft tissue and joints can be influenced and worked with employing manual therapy, allowing the individual to experience a normal functional movement and increasing awareness of the same, thus making conscious change possible. This very much determines the effectiveness of therapy and has significant bearing on the outcome. Lying down is the position which allows you to focus attention on your breath. It is very helpful in increasing awareness of dysfunction and re-training a good breathing pattern or even in aerating selective parts of the lungs by lying on one side or orienting the lungs and airways to inflate maximally. This is because the effort, which goes towards maintaining stability in an upright position such as sitting or standing, is eliminated. In other words, the surrounding trunk postural muscles relax, making it easier to shift attention to muscles and motion involved in breathing.
In summary, lying down and going into restful sleep allows rejuvenation, both physically and mentally. Lying down in the wakeful stage enables one to make conscious changes to breathing, posture, and movement. As the saying goes “Let him sleep for when he wakes, he will move mountains.”
Discussion of posture cannot be complete without the standing stance. Most of our activities are done in some variation of standing posture. In fact, standing posture is very closely related to balance and agility.
In day to day life, we perform many activities while standing that require bending, turning on stable feet, and overhead reaching while standing on ball of feet. Athletes, dancers, and gymnasts may even perform these activities on a single leg, challenging balance and the ability to stay stable and execute these motions smoothly on a narrow base.
Over the years, sports (such as football and basketball), dance forms (such as ballet and folk dances from around the world), and gymnastics/acrobatics have reached new levels of evolution- Cirque du Soleil shows such as the “O”, “Ka,”and “Mystere” are vibrant example of feats the human body can achieve. In daily life, the feats achieved by the human body, the wonderful and utmost sophisticated machine that it is, are no less.
Let’s take a look at the normal standing posture:
• Feet are the base of support and a good base is keeping the feet hip/shoulder width apart
• Hip, knee, and ankle joints are in a straight-line alignment when viewed from the side.
• Feet are face forward with toes and heel in line, although a slight outward pointing of feet (5-10°) is within normal limits.
• The plumb line through the center of gravity (COG) of the body falls slightly in front of the ankle joints. Good feet arches help distribute weight equally over balls of feet and the heels.
• The spine has the natural curves and is free of stress while facing straight forward. This allows the spinal cord to pass through the spine stress free and function optimally.
• The shoulders are neutral and relaxed with the neck elongated (chin tuck).
How about trying this out practically? Choose a firm, level surface to stand on.
Bring your awareness to the position of your feet. Are they hip/shoulder width apart?
Are both feet pointing forwards?
Did you notice if you are taking more weight on one leg than the other?
• In this case, the leg with the hip jutting out and a straight knee is doing more weight bearing, while the other leg is relaxed with some bending(flexion) at hip and knee.
• Common deviations may be a narrow base of support or knees touching each other.
Bring your awareness to the spine. Is it elongated?
Good natural curves?
Are shoulders rounded?
• This indicates excessive kyphosis in thoracic spine
• If you notice this, see if you can imagine a string from the ceiling pulling you upwards from the crown of your head. Then squeeze the shoulder blades a little closer.
Is your chin tucked in and cervical spine elongated?
• If not, you likely are thrusting head way forward as is the case with people having desk jobs or working on computers when seated for long periods. Tuck the chin and elongate neck upwards while maintaining a straight forward gaze.
Is breathing regular or shallow?
• Normal respiratory rate is 8-16 breaths/minute. If you are breathing faster, you are probably not getting in as much atmospheric air in lungs as needed for good air exchange.
A bad posture can impact functioning of other body systems. A good static standing posture translates to overall well-being with body systems, such as the respiratory, nervous, and digestive systems, functioning efficiently.
"An ounce of prevention is worth a pound of cure." And in fact truth be told, sitting is really effortless. When the spine is stacked properly one segment over another, it needs the least energy and muscle work to maintain upright position. The ligaments and other soft tissue relax and are rejuvenated through oxygen exchange, during this still period. When one does not pay attention to good posture, joints and ligaments are taxed, muscles are stretched at places and tightened at others. Hence the importance of a “neutral spine.” A neutral spine is not a rigid or fixed position and does not mean maintaining a specific joint angle. It varies from person to person. Then how do you know when you have a neutral stress free posture? You simply know it is good since you are most relaxed in that position.
It is important to differentiate this, (and I cannot stress this enough), from a temporary relaxed posture, which may feel good at the time (perhaps even put you to sleep when you should not), however is not based on awareness of good body position or neutral joint position. If you have experienced any sort of back discomfort/pain, (do you wake up from sleep with pain or discomfort?) you know what I am saying. Good posture actually means being alert and attentive to the present moment allowing one to put in their best at work.
Ready to try the seated posture? Cross legged sitting on the floor is best for you. If you like, you can pull a chair- the intention here is to sit without back support.
• Base of support should be wide and stable- here it is all the area between feet on the floor to ischial tuberosity (bony prominence of the pelvis in buttock area)
• Spinal column should be elongated so that the intervertebral discs between the vertebrae are decompressed- imagine a string hanging down from the ceiling to the crown of your head, pulling you upwards. This results in normal spinal curves with neutral spine- lordosis in cervical and lumbar spine and kyphosis in thoracic spine and sacrum. It is only a matter of bringing awareness to a neutral spine.
• Gaze should be fixed straight ahead.
• Now breathe. Inhale and make sure the lungs are able to inflate to their maximum. Slowly exhale as long as you can and let air out- consider analogy of inflating/deflating(slow) balloon.
You could be reading or working on computer in this position. Be aware of posture and neutral spine and get up or change position, stretch if you have to. You may start sitting for 5 minutes and build it up to 15-30 minutes. The longer you hold, the better, since at that time, your body is converting white fast fibers into slow, red postural fibers and it only gets easier to sit longer periods. Concurrently, you will see effortless translation of this good posture into activities of daily life and that you do not have to do anything special - your awareness in general will increase when at work, or seated at home.
Enjoy the weekend!
What is posture? “Posture may be defined as, ‘the position of one or many body segments in relation to one another and their orientation in space’ (Ham et al, p.26).” It is the position in which one holds the body while standing, sitting or lying down. Traditionally these three positions are the main ones adapted by the body, however there are multitude of intermediary postures to assume these three final positions. Postures can also be classified as static or dynamic based on whether you are moving or relatively in a still position.
Posture can be impacted by several factors, most basic of which are joint position, muscle tone and gravity.
Nowadays a lot of attention is being given to good posture since, with all the technology available, we are doing less walking and upright activities and more sitting. Heard of the popular phrase, “Sitting is the new smoking?” This phrase was coined by Dr. James Levine, director of Mayo-Clinic at the Arizona State University. This is not literally true. In fact, “sitting” is being compared to “smoking” to bring home the point that the side effects of sitting for more than 6 hours a day are equivalent to the health hazards caused by smoking. For example, their study reveals prolonged sitting can predispose to heart disease, and even certain types of cancer. In that context, standing desks may be a blessing.
From a physiological point of view, our body has different types of muscle fibers. And since prolonged sitting calls for holding a posture, it employs what are the slow-twitch (type I) muscle fibers, or the red fibers, which have a profuse blood supply to permit aerobic metabolism. The other type of muscle fiber, the fast-twitch (type II), or white muscle fiber, (so called due to fewer blood vessels and anaerobic metabolism), is employed for power activities needing greater force and speed like sprinting. The good news is that with endurance training, human skeletal muscle fibers can show increased blood supply. Studies on fish’s white muscle fibers show these fast twitch muscle fibers, when subject to slow low frequency stimulation, behave like slow red fibers with increased blood supply. This is where training comes in and thus, listen to your physical therapist when they say practice for “x” repetitions and do “y” number of sets. With early intervention, the process, if followed diligently, can reverse effect on the muscle fibers! That is why it gets easier to sit, or the achiness and soreness experienced in muscles decreases with postural exercises. Extrapolating this, sitting may actually be a boon- ever wonder why meditation (in other words maintaining a posture for prolonged periods) is found to have beneficial effects? The body never ceases to amaze us, does it? Anyway, the point I want to make is don’t get hung up on what the body does, go beyond.
Ami Gandhi is a licensed physical therapist in the state of California. She is the owner of StableMovement Physical Therapy, a small boutique practice in San Jose that offers patient centered, one-on-one, hands-on physical therapy.