 Welcome back to Movement Matters. I'm your host Christine Lenders, physical therapist and board certified orthopedic clinical specialist. When did posture become such a major health risk? The introduction of laptops started it and then cell phones came and put the nail in the coffin. We all need to focus more on our posture. It's a fact. When you sit up straight, you look better. Your outlook for life is better. You feel more confident and improves your mood. But more when you sit in poor posture and you're not aware of it, you set yourself up for pain and injury to your neck, your shoulder, and your back. What you will learn today is how improving your posture will help you prevent neck and shoulder pain as well as back pain. Or if you already have it, we will help you to get rid of it fast. Let's go to image number one. So in this image, you will see the gentleman on the left. This is how he came into the clinic a few months back. And I actually told him to sit up straight because I said this is the one place that you come in that you should be more mindful of your posture. You should be sitting up straight because you know that's something that I have mentioned you to do. And he has terrible headaches and he has shoulder pain. So the left side image shows him slouching. He just was relaxing looking at his phone. And then I corrected his posture. And one of the things that's so important is that we don't realize that we're slouching or we don't realize that you're out of a good posture. You look at him sitting relaxed. And to all of us, it probably looks slouched. But to him, it just felt relaxed. And he didn't know that that was the reason why every day he woke up with a lot of headaches and why he was having shoulder pain when he had to reach over his head at his work to do some wall work. So that is something so huge that I wanted to call out today because not only does posture set your spine up for pain, but you can get tingling down your arm. You can get shoulder rotator cuff tendonitis and you can get back pain. Let's go to video number two to learn more. So you've got some neck pain, pain in the tops of your shoulders, or you've got pain or numbness and tingling down your arms from sitting at your desk. One of the first things that you can do to get yourself in a better posture because you've more than likely been sitting with your head kind of forward like this where these muscles get super tight and these muscles get super long and weak is to stretch out the tight structure. So you want to sit up very tall, take your right hand, the opposite hand, grab at the base of your head and pull up towards the ceiling and then over. It's important not to just take your hand and pull it like this and compress all this. Rather, you want to take your hand and pull it up towards the ceiling and then over. You can also tuck your chin down a little bit to get more of a stretch. So from the side, you would be pulling up towards the ceiling and over and then nod your chin down to get more of a stretch in here and then you repeat to the other side. Reach behind your head, pull up towards the ceiling to lengthen here and then tuck your chin to get the stretch. So now that you've alleviated some of the tightness from that bad position, you want to start strengthening these deep neck flexors which stabilize your spine and help you to decompress the nerves that are causing pain down your arm or that are preventing you from being able to do this, getting the joints open up because you can't turn without pain on one side. So you want to lay down on a surface, a bed is fine, you want to get a flat pillow or you could do the first one without a pillow and it's called a chin tuck. So you basically nod your chin down like that, nod your chin down and that opens up the space. It causes the joints to slide in case you have pain backing up from it with your car and you've got pain on one side of your neck. So you do 10 chin tuck, release chin tuck, release. This is also great for headaches. If you get headaches from that poor posture, open up that space, open up the space around the nerves. Now you're going to tuck your chin. Exercise number two, tuck, squish the pillow. Tuck, squish the pillow. You don't need to tuck super hard or you don't need to squish super hard. You just do a chin nod and then you squish the pillow. Chin nod, squish the pillow. So that not only strengthens the front neck flexors but also moves your head back over your shoulders where it should be instead of forward like it was. Try those. I apologize for the blurriness of that video but listen to the message when you watch this of what I am saying. Let's go to video three where I show you how to do the chin tuck press. Here's a closer look at those chin tucks. So first one, nod your chin down, nod your chin down, let those joints slide. Great for arthritis, great for headaches, great for neck pain or tingling down your arm. Number two, the chin tuck press or chin tuck and squish. Tuck your chin down, engage those deep flexors, stretch the back, now bring that head back over your shoulder. Tuck down, bring the head back over your shoulder. A common mistake is to tuck and then lift your chin. Don't lift your chin then you're just shortening those muscles and compressing the space around the nerve, jamming those joints together, nod and squish, nod and squish and enjoy. So I mentioned how sometimes it can be painful to turn your head to view traffic. I had an older woman come in and she had a terrible pain in her shoulder. It was right over here and she said when she backed up she just couldn't turn her head and she had this awful pain in her shoulder when she came in and she came in and she was slouched with a little bit of that kind of hump on the back. She likes to do lots of crossword puzzles and look down a lot and so one of the things that I worked on with her was the chin tuck. The chin tuck press to help bring her head back but also I taught her about her posture and how that was clamping down the joints in her neck and so when she was slouched and turning her joints just pitched themselves. When she was upright and turning she had no more neck pain and she actually came in the other day and said she's really been focusing on her posture and she had no idea what difference that made and so I'm going to hammer that home to you is that she didn't know that she was slouching all these years. She didn't know that she was looking down too much or looking down had changed the shape of her spine and she could do something about it. She thought it was a problem with her shoulder so big point of the show is I want to call your attention to how your posture can be causing all these problems. In addition to neck pain or nerve compression tingling down your arm poor posture or improper posture can be causing a very vulnerable situation for your shoulder that can lead to rotator cuff injuries even tears, bicep tendonitis and more shoulder pain. Let's go to video four to learn more. A very large component of shoulder pain and injury is poor posture and the reason being is this when you are sitting up straight your ear falls over the line of your shoulder and it sits like right in between the rounded part of your spine. That's a natural rounded section right in here and there's a natural backward section right in here. When you slouch forward this becomes more rounded and you can see the center access point of my shoulder move forward and that puts a strain on your rotator cuff tendons but also when you're in this position your pecs that attach to your shoulder blade back here from the front directly through when you're in this position they're held in this shortened position they run like this the peck minor in here they're held in a shortened position to your shoulder blade they go from the ribs back towards the shoulder blade and so now when you try to sit up straight they're holding your shoulder blade forward which again you sit up straight but then your shoulder stays forward now you go to reach or lift weights pick up your baby go to get your clothes on wash your back and you've got impingement a potential rotator cuff injury or painful tendonitis. That's a huge point because many people come in especially during the pandemic with rotator cuff tears rotator cuff injuries bicep tendonitis or all of a sudden my shoulder hurt I'm not sure I was doing more gardening I was working from home and a lot of people had improper setups at home that they didn't know because they were sitting on their sofa sitting at the table hunched over a laptop versus maybe having a proper chair or desk setup but one of the first things that physical therapist addresses with shoulder pain if somebody has parpasher is to relieve the tension and create an abnormal length I mean create a normal length in that peck minor because it is holding them forward so every time they go to reach the ball is pinching up on their rotator cuff underneath or the bicep tendon that runs in the front that stabilizes the ball on the socket a lot of therapists call it a golf ball on a tee and so when you are forward that golf ball is rolling forward off the tee and so the bicep tendon is over here trying to hold it back so if you're slouching in poor posture and you're reaching or doing pretty much anything during the day it could be typing on your laptop that bicep tendon is on trying to keep that golf ball on the tee and it eventually gets super painful and then everything you do hurts many people are suffering that and the same thing with your supraspinatus tendon I would tell people that supraspinatus tendon reaches out and holds on to that ball and when you slouch forward that ball moves forward and your rotator cuff your supraspinatus tendon is now straining to hold on to that ball to keep it where it needs to be so it doesn't fall off the tee and that puts abnormal tension on the rotator cuff then and as well as when you raise your arm it drives it underneath this pointy bone up here and then you get impingement that way and you can get tears over time so let's go to video number five when we learn how to stretch stretch your pack at home to improve your posture fast all you have to do is stretch out those tight chest muscles it'll help your shoulder it'll help your neck you don't even help your back if you've gotten very forward and tighten here so you just need a doorway you stretch your arms wide like you're the letter T keep them straight on the doorway put one foot in front of the other and then you're gonna push with the back foot bend the front leg lift your chest and breathe in and then exhale push lift your chest breathe in you'll feel all the tightness here opening up and then after you've done three or four of those you can switch feet do the same thing change the angle of stretch a little bit on your chest muscles and then you could just stand there bend the front leg just to get some tension and turn your head to the right that will stretch your left more and breathe in exhale enhance the stretch three times this way and then you're gonna switch the other way you can switch your foot again breathe and stretch perfect lie that stretch it is one of the most simple chest openers that you can use and you can also massage yourself don't be shy you're not going to harm yourself massaging yourself maybe your hand will get fatigued but a great way to massage the pec minor is just to massage it in here so I can hold on to this wall here and keep my arm straight so my shoulder is safe it's in the plane of my body like this it's not behind my body it's right here you keep it right there so it's safe there's no strain and then you just massage that muscle it's right inside the shoulder bone you can kind of grab it too and and bend it but massage your chest you don't even need to stretch it just massage this area that will help you to stretch it more when you get more blood flow by massaging it before you stretch it so another problem with poor posture is that that middle section of your back where your neck ends the next section of the spine is called the thoracic spine and so when you are slouching for years that part of the spine can get very stiff I like to call that part of the spine the rock in the hard place because your neck moves and your low back moves because it's the bottom but this middle section that is stabilized around with your rib cage to protect your internal organs on your lungs doesn't move as much if you are sitting in an improper posture over time and the problem with that is you need that part of your spine to move so that your shoulder can raise up you need that part of your spine to move so that your neck doesn't get kinked here and you don't start getting compression in the cervical nerves that can send pain and tingling down your arm terrible pain and tingling and weakness so we want to now if you've been sitting in poor posture fix that thoracic spine so you can get rid of your neck pain your shoulder pain and your back pain let's go to video number six to learn how so let's say you've been sitting like this on your laptop or looking down over your phone for five or ten years and now you go to sit up and the hump is still there because your spine has gotten stiff from spending too many hours in that position over a duration of time such as five or ten years what do you do a quick way is to interlace your fingers at the base of your neck pull your neck up to elongate your neck so there's no compression and then squeeze your shoulders back you can see that extends that middle section of my back that thoracic spine you can also as you're pulling up squeeze your elbows back and lift one up to the ceiling and breathe and really open up that rib cage get that thoracic spine to extend make sure you're not still leaning forward when you're doing it lift your chest lift one elbow up and breathe to really get some extension in that middle this middle middle section of your back to enable your shoulder to raise fully try it slouch and raise your shoulders that's as far as it goes now sit up straight and watch what happens your shoulder needs your ribs to rotate up in order for that to happen and if your thoracic spine is stuck in this position your ribs will not rotate and you will jam your shoulder up into your rotator cup tendons and you will impinge them and end up with pain especially you have an overhead job you can also stretch on the foam roll but you have to be very careful about this on how you do it so if you have osteoporosis if you're loose doing to don't try this but if you're a stiff back you may have already tried something like this you put it around your roster up region not below because you don't want to hurt your low back i'm not sure if you can see that right there and your hands behind your head so you cradle your head you keep your butt on the floor your stomach sucked in to protect your low back you're not arching your low back you're keeping your low back stable and you just lean back a little bit like that just to get some mobility then you can move it up a vertebrae and lean back again suck your stomach in don't let your butt come up move up a vertebrae lean back you can do some breathing to get that stiff thoracic spine again my stomach is sucked in i'm not letting my low back move that is a great stretch to do to get some mobility in your thoracic spine to save your shoulder i suggest everybody try that bit where i show how you're slouching and you raise your arms up it's not a trick you can't go any further and then as soon as you sit up straight and you get that thoracic spine up the arm goes much higher it might not go all the way up and everyone because we all have different ranges of motion and maybe you don't stretch and you've gotten stiff over time but i suggest you try it to see where you are at interestingly enough after preparing for the show yesterday my started at seven and my first five patients all were posture i first gentleman came in at seven and he had neck pain and tingling down his arm it was the first time i'm meeting him and i asked him about his posture and he said oh yeah i slouch all the time so at the end of our session i told him okay i educated on everything that you've learned today and i also told him your job today is to not slouch set a timer for your phone for 20 minutes and at 20 minutes i want that timer to go up and you to go sit up straight put your hands behind your head squeeze your shoulder blades back do something to get your posture upright stand against the wall for 10 seconds reset the timer for 20 minutes and then go back and sit down and i told him the next day maybe you can do 30 minutes so it's not so irritating during your day 30 minutes and see if you're starting to correct yourself other people i've told him to set it for five minutes because there's such bad slouchers and their condition was so severe whether it was tingling down their arm or tingling down their leg from from low back pain in poor posture another gentleman came in i think he was about 38 to 40 he'd been doing great and i said how are you doing he goes well everything's doing good in my middle back but my neck is really started to hurt the last couple weeks and he was sitting like he's not the same person but he was sitting like the gentleman that i showed you in the first image and i said well you're coming in and you're slouching on the table right now have you been slouching or are you focusing on your posture and he said you know what i haven't been focusing on my posture as much the past couple weeks i've been sitting working on a project in that v position with his legs up on his desk slouching back into his chair and so i told him okay so now you know what to do you need to focus a little bit more on your posture but i also said you need to have some slouchy postures that you can sit in that are supported so i told him that's a bad position for his back more than his neck but let's just compromise let's put a couple pillows behind his back so we can enjoy a slouchy posture as long as he's not having pain and get him back on when he does sit up sitting up straight i told him to do the doorway chest stretch that you learned and i told him a little bit more about some exercises that you'll learn in a few minutes but also i had a 90-year-old gentleman come in and he said over the last two weeks his low back pain has been getting worse and worse and worse and i was telling him how posture is a habit and it's a habit that he's not been in so it's really hard to remind him and he has a very supportive spouse that was there that said she's been helping him to remember but i also said for him listen you're spying a little more stiff by now so you need to get the pillows in the right place to set yourself up for having better posture so that you can sit up straight and we ran through a bunch of the exercises and he was standing up much straighter but now today when i'm not with him he needs to try to remember so you can ask your spouse to remember you can set alerts on your phone or some device that you have available to you i want to know now how are you doing with your posture here's kind of a quick test that you can do at home to see let's go to video number seven okay so to get an idea of where you are with your posture you can just simply stand against a wall put your butt against the wall your feet forward and see if you can touch your shoulder blades but not your low back against the wall and after you do that if you can get your shoulders all the way back to the wall or within an inch you want to see can you get your neck back to the wall and don't be surprised if when you try to do this your butt pops off if you've got it in this slouch position you may look like this on the wall and you might say oh i can't get them back and you try to and your butt pops off or you try to get your head back and it's like this you don't want to do that you want to work on squeezing your shoulder blades back and opening up that space and re-educating the muscles on the back and how you do that is you do shoulder blade squeezes you can do them this way and try to get your thumbs to touch the wall you can do them this way to try to get your thumbs to the wall that kind of looks like a w position like this and then finally you want to try to get your head back so i tell people use their hand and say you're like this see how many finger widths you are away from the wall and practice the exercise i showed you earlier or actually just practice tucking your chin and trying to push back here you couldn't put a small towel there and try to push in there to re-educate your posture while you're standing anywhere any of my family members love that wall test with the fingers and i use it a lot with my older population patients at the clinic because it's sometimes it's hard to find a place at home to do these exercises but you can find a wall and stand up against a wall you don't have to sit you don't have to lie down you can just be in a comfortable position use the wall as your guide to work on posture exercises so now let's re-educate those muscles that that that video showed the test and some exercises let's go to video number eight where we learned some more exercises so now you want to re-educate those postural muscles now that you've stretched out you're aware of your posture to hold your posture there so while you're at your desk at work you can do these you can sit you can stand you can lie down to do them grab an exercise band keep your elbows in squeeze your shoulder blades back and then rotate your hands apart great for next great for shoulders great for backs you can also straight in the mouth if it's pain-free pull straight back till it's your chest straight back till it's your chest there's another one that i like to do where you start up high here and then you pull down till you hit your chest if you don't have an exercise band if you want to strengthen your muscles all you have to do is squeeze your shoulder blades back like this at your desk squeeze your shoulder blades back like this at your desk or clasp your hands and press your elbows back like this to get that thoracic spine to extend you can also grab opposite elbows or arms and press your head back into your arms and breathe and stretch and lean to stretch anything to get your shoulder blade muscles back to re-educate your posture i like to give a lot of options for exercise because i realize some people don't like them or everybody's body's different so while you know this this might work for somebody then this might work better for other people there's so many different exercises that you can do just pick one pick two and try them just so that you can be better you don't have to be perfect just better a little bit better every day and then you get to not have neck pain not have shoulder pain not have back pain or you get to eliminate the tingling done your arm as soon as you put yourself in a good posture and then you forget you go into a bad posture and then you do a couple exercises all your symptoms are gone and you get to enjoy a better feeling body let's look at a couple bad postures i mentioned laptop starting the problem and then cell phones just putting the nail in the coffin of where posture became a major health risk and these were illustrations that my dad drew of people sitting in these postures the gentleman on the left was probably in his fifties when he first got a laptop and he was sitting on a squishy sofa working this wonderful machine that now we have access to in our homes that you can sit anywhere and use and the other picture was a 14 year old girl who had a lumbar spine a low back fracture from sitting like that on her phone on her bed studying all throughout her day and that's actually how she was sitting when she came in on the plinth on the table in physical therapy and i just said to her oh my gosh my back hurts looking at you but these put the low back and the neck in such a harmful position that at some point you it's not about whether you are going to have pain or if you're going to have pain you will have pain you will damage your spine if you sit like that so take a few of the little messages from the instructional videos that i gave you today and and use them enjoy them and let's go to video i mean let's go to image 10 where you can see how you should be sitting on your nice squishy sofa so it's a little bit hard to see but i do have a pillow behind my low back and i also put a vertical pillow that ran from my low back all the way up so i'm not in perfect posture but it's pretty darn good and i think it's really important to have some of those fun postures of fun positions that you can be in like i'm sitting in the sofa at home it feels very comfortable and i've supported my back i've compromised i'm not going to slouch into the sofa like the previous drawing but i'm going to sit up and support my curve so i can feel slouched on my sofa and very comfortable while i work on my laptop so everyone today your job is to try not to slouch today your job is to try to pay attention and note how you are have a family member take a picture of you from the side have a co-worker swing by and take a picture of you from the side when you're not paying attention so that you can first develop that awareness of how is your posture is your posture poor or are you doing pretty good if it's poor and you don't have pain that's fantastic fix it now do the doorway stretch once a week at work do a couple exercises halfway through your day if you do have pain take it to heart choose one or two or three of the exercises here put some sticky notes set some timers on your phone and start to get yourself into a better posture so you can end your pain fast thank you so much everyone for joining us today and thank you to think tech Hawaii and all of our sponsors and donors for allowing us to be here with you today and as always life is better when you listen to physical therapists aloha everyone