18

Ergonomics

LIFTING AND CARRYING THINGS

Only two areas of the body are really designed for carrying heavy weight: your back, especially close to the spine, and the top of your head. If you can carry weight from those places, you are safer. The farther away a weight is from your spine when you lift it, the more vulnerable you are. Lots of people injure their backs lifting things incorrectly. There are two main reasons, one well known, the other not.

1. When you lift something, you should bend your knees and ankles so you are using your gluteus muscles, not your lower back. Stretching into a forward bend with straight legs and lifting weight with the back can throw the lower back muscles into spasm.
2. Don’t lift with your arm bones out of their sockets. See the Shoulder section for details of this. Keep the arms firmly in the joint, so you work the muscles of the upper back. When the shoulders are overstretched, you may not only damage your shoulders and neck but can also overstretch your lower back muscles, sending them into spasm.

When you use one arm to lift something in front of your body, pull the bottom tip of that shoulder blade down your back and drop the shoulder as you lift your arm. That way, you will use the muscles in the upper back that are designed for the job. Your arm will move as a lever against the dropped, pressed-down-and back scapula. This will create space in the shoulder joint for the head of the humerus to rotate freely (see fig. 11.1).

The more common way is to lift the upper trapezius and raise the entire shoulder up. This is an appropriate way to lift heavy objects. However, you can see how this way of lifting allows less space for the head of the humerus to rotate and sends the shoulders up to the ears, creating tension. Only lift this way if you must lift a weight that’s really too heavy for you, and keep that weight as close to the body as possible. For example, if you’re in a store and you realize you have bought some things that are actually too heavy to carry, but you’re stuck with them (we’ve all done that), raise the shoulder of the carrying arm as I describe here, and you’ll protect your back and neck. Then alternate sides. If you let the heavy package stretch your shoulder down, you can cause a compensatory spasm.

When you lift things with your shoulders, expand your chest. If the chest collapses, you may injure your neck.

Carrying bags can cause many problems. Carrying any weight on one side of the body, especially if you have scoliosis, creates a distortion in the movement of the vertebra as you walk. The thoracic vertebra will not rotate properly on the side you carry your bag on. The shoulder on that side will tend to rise up and move forward to hold the bag. Usually, people carry their shoulder bags on one side only because on the other side, where the shoulder is lower, the bag slides off ! If you have to use a shoulder bag, switch sides frequently.

Avoid shoulder bags completely if you have scoliosis or any right/left distortions in your spine. If you carry weight in your hand, use your biceps to slightly curl in the arm. Again, use alternate sides. A backpack is okay too, although it also prevents free rotation in the spine on both sides by pressing into the back. Make sure the straps are even and carry the backpack a little higher on your back than you would probably do automatically, so the upper back supports more of the weight.

SITTING CORRECTLY

Sitting in chairs is just about the worst habit you can get into. However, since most people spend a lot of time sitting in a chair, here’s how to do so with the least damage.

Sit with your weight mostly on the front inside part of your sit bones (the bottom of your pelvic bones). Don’t cross your legs. The pressure on the two bones should be equal; if it is not, shift your weight around until it feels more even. Press the sit bones slightly into the chair, lengthen your spine in one straight line and hinge forward only from the sit bones when you need to lean forward. All of your movements should be initiated from these bones. Don’t fold or hinge from your waist or your C7. Keep the front and back of your body equally long.

When you need to look down and forward, you must move forward on the sit bones, maintaining the lumbar curve. Move your eyes, not your head. You can look down without compromising your neck.

Sitting tends to use the body in fragmented, tension-producing ways because the immobilized lower back and pelvis let you use the neck and arms without properly involving the back and pelvic muscles. Try to involve the whole body in what you are doing as much as you can to counteract this tendency.

Some chairs are better than others, of course. The Balans chair (fig. 18.1, top right and bottom) helps keep alignment—you can’t sag or fold forward in this position—but I don’t like the way your knees can’t move. My own favorite is the physio ball chair (fig. 18.1, top left), which is just a big physio ball with a chair built onto it—do not use the backrest, though. Your pelvis is on the bouncy, curved surface of the ball, which would engage some pelvic muscles and could actually strengthen the core. It’s irresistible not to bounce up and down on the ball, which is a good break from sitting anyway and helps realign the spine as well.

Fig. 18.1. Supportive chairs

If you can’t change your chair, you can use a back support. I suggest the kind that you place under your pelvis, rather than the ones you lean back into, so your back stays engaged. If you have any serious back problems or a very weak back, use the supports that go in the back of the chair, such as the back support made by Therapeutica.

Sitting cross-legged on the floor (alternate the crossing of your legs, of course), follows the same general principles. Sit with the weight on the front of the sit bones, keeping the lumbar curve. Feel the diagonal line between the front of your sit bones and the bottom of your rib cage (fig. 18.2).

Fig. 18.2. Sitting correctly on the floor

Lengthen that line, lifting the back ribs away from the front of the pelvis. Keep that openness in the back and lift the chest, widening the collarbones. Align the soft palate with the middle of the pelvic floor. If you tip your body forward too much, your psoas is probably tight. Sitting correctly will help to stretch your groin and psoas. If your back is weak, you may want to fold forward at the waist. If your back is tight, you may want to tip back in this position. Try the Wall Hang Stretch.

BEDS AND PILLOWS

Strange things happen to the sleeping body, as you’ve probably noticed. Most people wake up tighter and stiffer than when they went to bed, even if they are feeling rested.

The weight of the head is as much a factor when you’re lying down as when you’re standing. The head will tend to tip forward if you sleep on your side or backward if you sleep on your back and will distort the neck and upper back if you are a stomach sleeper. Most people need a pillow to support the head, and possibly one of those ergonomic double-roll pillows that support the neck as well. If you sleep on your side, the most common position, make sure your pillow is hard enough and high enough to keep your head in line with your spine and prevent it from tipping forward (fig. 18.3). Soft fluffy pillows are a disaster for the neck, because the weight of the head will compress them and you will end up with a misaligned head and neck. This configuration is the cause of most stiff necks and upper back spasms in the morning.

Fig. 18.3. Sleeping on your side: correct head support

If you sleep on your back, you will probably want a very small, flat pillow, just so the head doesn’t pull back. Stomach sleepers can use those big, fluffy pillows under their stomachs and chests, so their necks don’t get twisted during the night (fig. 18.4). If you go to a hotel, throw the fluffy pillows off the bed and roll up some towels to suit your pillow needs. Rolled-up towels make excellent pillows, and they are much cheaper than the ergonomic kind.

Fig. 18.4. Sleeping on your stomach

Many of my clients have bought ergonomic pillows and found that what their friends find useful doesn’t work for them, so I can’t suggest a universal “good” pillow. What I do recommend is testing out what kind of configuration works for you with rolled-up towels, and then, if you want, buy a similar pillow. Or just save money and stick with the towels.

If you sleep on your side, your toes curl under during the night, as the spinal muscles and hamstrings tighten to accommodate the weight of the head. This can lead to an aggravation of plantar fasciitis, which is always worse after sleep. If you have severe plantar fasciitis, you can try strapping the foot into a boot that forces it into flexion. If you don’t want to resort to this solution or if the problem is not that bad, stretching the hamstrings, back, and Achilles tendons (here and here) may be sufficient to alleviate the curling of the toes. Experiment to see the difference in the stretch of these muscle groups in the evening and then again right after you wake up. The upright position tends to tighten the front of the body; sleeping tightens the back.

The hands may also curl under, in the same fashion. However, the cause of this is usually pressure on the shoulder from an incorrect pillow (usually not high or firm enough). If you are a side sleeper with broad shoulders, you’ll need a higher pillow.

Numbness and tingling in the arms in the morning can also come from pressure on the shoulder. Compression in the cervical spine and the upper back can cause nerve pains in the hands.

If you have knee or lower back problems, sleep on your side with a pillow between your legs, so that your knees and hips are on the same level. Or if you sleep on your back, put a large pillow or bolster under your knees, so that they are higher than your hips. Stomach sleepers can put a small pillow under their shins.

Sleep on whatever kind of bed you find comfortable. I find the idea of sleeping on metal springs disturbing and prefer futons; some people find futons extremely uncomfortable and need the support of a mattress. There are all kinds of fancy orthopedic mattresses on the market that have their adherents. This is fine, but just be aware that even expensive mattresses will need to be changed regularly. Ordinary mattresses should be thrown out after five years. They will get saggy in the middle and show wear patterns. The same goes for futons.

SHOES

All shoes are bad for the feet to some degree. I understand that you have to wear them some of the time. I also discuss (here) how the hard, flat surfaces we walk on deform our natural foot development. That said, here are some suggestions.

The best shoes I’ve found are the MBTs (Masai Barefoot Technology), developed by a Swiss engineer to imitate walking on rolling terrain as the Masai tribal people do. They have been touted as calorie burners, cellulite reducers, and so on, because they do use more muscle than regular shoes. I don’t know how well they tone your legs, but they feel wonderful, and over time, they will improve your feet and balance your body in other ways too. The downside is that other shoes feel awful after you get used to the MBTs.

If you prefer a very minimal support shoe, I recommend Softstar shoes, which are designed with a very thin flexible structure and allow your feet and ankles to work. They are similar to the Five Finger shoes, which separate your toes, but I find that the toes being rigidly separated can actually give them less mobility. The toes can move freely in the Softstar barefoot shoes.

If you have to wear high heels, you will need to stretch your Achilles tendon, your hamstrings, and your psoas much more assiduously than someone who does not wear them. Wearing high heels occasionally probably won’t do much damage. Wearing them habitually may distort the shape of the spine, cause organ prolapse as the viscera are pushed forward by the angle of the spine, and give you bunions. A Mexican doctor I worked with told me he attributed the high rate of reproductive organ problems in the Hispanic population he worked with to the habitual use of very high heels from adolescence onward.

People always ask me about the advisability of orthotics in their shoes. Orthotics will compensate for weakness in the foot and can help back problems caused by that weakness. In that way, they can be a real help. However, they are a crutch. The real issue is still usually the weakness in the foot, so while enjoying the relief the orthotics give you, try if possible to correct the fundamental problem with exercise and bodywork. If the orthotics don’t help, don’t use them. Supports that don’t help you are not neutral in their effect on you; they are actually harmful. They can negate the natural body intelligence that will attempt to balance you and cause even more problems. This is actually a general principle of alignment—don’t fix what isn’t broken. Adding an unnecessary prop or support in an exercise can actually send a muscle into spasm.

So if your orthotics don’t work well for you, ask your health practitioner to redesign them, and don’t use them unless they make you feel better. That way, you can work on strengthening the appropriate foot muscles while your body learns from the orthotics to maintain a better alignment.

Please also see Mary Bond’s wonderful book, The New Rules of Posture (listed in the bibliography), for more ergonomic and alignment ideas.