Tuesday, April 22, 2014

The bad neighbor..

PART II of "It's all in the hips"
The body is a mobile object
The body needs to move in every direction to accommodate our daily living activities, as well as any other activities we put it through. Each portion of our body contributes to the overall movement , as each instrument plays it's part in an orchestra. The body will steal from adjacent joint to accommodate the movement. In rehab, we call this "substitution". It's a normal event that occurs all day every day with each of us, whether we are "in shape" or not so much. When substitution occurs, the hips refuse to move causing the lower back to move too much to accommodate it, the hips become what is essentially a "bad neighbor".

Everything in moderation is all right
We all need to sit, but altering the position needs to become a priority. Substitution in excess will lead to poor biomechanics, so it's important we do what we can to avoid letting the hips get stuck in that seated position. In my last entry we discussed hip mobility and the effects static positions have on the hips. Any body part left in the same position for too long will soon loose it's ability to move, because of neurologic motor control principles.  An extreme example is where a joint is cast/immobilized for weeks and the patient has little to no movement when it's finally removed.

Ergonomics; fitting the individual to the workstation
No two people are the same, each individual has unique needs and characteristics that must to be taken into consideration when dispensing ergonomic advice. In general terms, we can look at what ergonomic help we can get to lessen the effects of prolonged postures.

In a kneeling chair or in a perched position (sitting at the edge of your chair) we improve not only is the hip angle, but also restore the natural and beneficial low back curve. Another beneficial effect is the glutes will "turn on" in this position, as sitting typically turns the glutes off forcing other muscles to overwork in a majority of the lower back pain syndromes.  Other chair substitutes in the past have included sitting on a physioball, however a recent study showed no improvement in posture and an increase in discomfort.(1).  As we stated earlier, changing positions has been shown to decrease physical stress and improve pain patterns.  There are some wonderful apps you can use as a reminder to take a "micro break", 30 seconds to a minute to perform some yoga like restorative stretches. For those who are confined to a car; the seat back should be altered often to alleviate the stress being placed on the hips. 

Get up stand up
In a similar vein, standing work stations are now being offered for some when your doctor recommends them to your HR department. The newest of these stations are actually adjustable putting the user at an optimal position in either the standing, perched or seated position. OSHA provides these guidelines to standing work stations, in this example it's for food handlers but it applies to any type of work. (2).  
Next post we will be discussing active sparing strategies and corrective exercises of the hips and lower back. 

1.Stability ball versus office chair: comparison of muscle activation and lumbar spine posture during prolonged sitting.

Gregory DE1, Dunk NM, Callaghan JP.

Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders. He teaches continuing education and operates a private practice. More information can be found at Kinetx.org and feel free to like us at our facebook page.

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