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Posture : Its significance, Mumbai (2026)

23/05/2020

How does one develop a Poor / / / /

Every activity of an individual requires to keep the neck in forward position, thereby creating shortening of the structures on the front of the neck. The muscles on the back of the neck will remain stretched in this position, more the bend, more the stretch. These stretched muscles on the back of the neck have to work when the individual wants to straighten the neck & it has to counter two forces to do so, the tight structures on front and gravity. Muscles are like elastic rubber band, the more you keep it stretched they will lose their elasticity gradually & will be unable to perform their function optimally. These lax muscles will try their best to maintain an erect posture by overworking. They will continue to overwork, if the same environment & working conditions persist, but slowly & surely they will lose their potential to maintain erect alignment. The balance will tilt in favour of the tight structures (front of neck) & gravity initiating the start of poor posture.

Thus, we see development of poor head, neck & upper body posture in students, desk workers, sedentary and those involved in work which requires bending forwards. Smartphone & laptop use has exaggerated this cosmetic issue.

These lax muscles are still working to maintain an erect posture and they are giving their best and becoming weaker slowly but surely in the process.. When their efforts cross their tolerance capacity, they start feeling fatigued & tired. If appropriate rest is given, knowingly or unknowingly, they will recover & work again. But most of the times, they will continue to work in this fatigued state and will progressively be called upon to continue their duty in this tired state. This will irritate them and make them angry. Their anger will be manifested initially by a sense of heaviness, occasional aches/pains, spasms, restriction in movements & giddiness which will resolve within few days. Any treatment in form of rest, knowingly or unknowingly, will help tide over the immediate crisis for few days. But as there has been inadequate education regarding application of ergonomic principles in every daily activity, the patient will continue to promote the imbalance, tight muscles on front and stretched on the back of the neck.

The stretched/weaker muscles will keep on feeling irritated and angry, thereby becoming more and more stiffer and progressively limiting their flexibility and increasing the handicap of the person. Injuries can be either acute (due to accidental stretching of the tight structures - whiplash, spasms, tilted neck) or sub-acute/chronic (recurrent or persistent neck pain, jaw pain, tingling on back of neck, headaches, vertigo/giddiness, restricted movement, inability to sleep).

Conventionally, the focus is on strengthening the weak muscles of the neck & there is no arguments for the need to do so. But the timing is important. A patient approaches the clinician in a state where the muscles are in an angry state. Trying to strengthen those muscles is like making sense in an angry individual, which by itself is a lost cause. The need is to first settle the anger within the muscles (rest + medications), give them an appropriate environment to stop irritating them further (ergonomics) and correct the stubbornness by reducing the tightness of the front structures and the stiffness in the angry muscles (stretching exercises).

07/09/2017

Sitting

Sitting is a difficult task and prolonged sitting, the need of the hour, is associated with multiple risks. In today’s lifestyle, time spent while sitting takes away a major chunk of our daily time. Sitting is seen as a risk factor for various “lifestyle diseases” but in addition it has a huge influence on the aches and pain arising in the spinal column and the lower limbs. The working environment (table height, type of work) and working habits influence the development of aches and pains in the upper limbs.

Chair sitting takes the maximum time while working and thus we will take that as an example and understand the various difficulties one faces while sitting. It may sound unusual but sitting on a chair is an art by itself. In addition to it being an art, it has its fair list of challenges as well. The challenges are determined by the size of the user, the size of the chair, the various dimensions of the chair, the working table, the type of work and the surrounding environment.

The interactions and the adjustments done while sitting create areas of mechanical overload and muscular imbalances which then lead to aches and pains, commonly labelled as Musculoskeletal Disorders (MSD). Spinal column pain, pains in the lower limbs and upper limbs can all be grouped under the umbrella of MSD as all of them happen due to the muscular imbalances which exert their influence on the skeleton. They take a long time to evolve and as it seems to be an innocent activity, sitting is not seen as a cause for MSD. In the further posts I will try to show the correlation (the way I see it) between sitting, the various adjustments and the MSD’s.

Good Sitting requires the following attributes:

1. Adequate depth so that the thigh is supported completely and a fist gap is between the edge of the sitting surface and the back of the knee

2. The knee and hip should be at the same level or the hip can be a little higher than the knee.

3. The entire spine should be supported by some form of a back rest such that other attributes are maintained.

4. The arm rests should be of adequate height so that the upper body is well supported.

5. The arm rests should be properly placed so that the shoulders remain as near to the body as possible.

6. The chair height must be such that it helps work in a position that is comfortable to the spine, upper limbs and lower limbs.

7. The feet must be grounded completely or a foot rest must be used (maintaining the other attributes)

8. The knees must be kept at an angle such that the toes of the feet are seen.

9. The tasks undertaken while sitting must be done in such a way that the involved joints work in as neutral a posture as possible.

17/08/2017

The general belief is that posture is relevant to spine only and the posture related problems are manifested around the same. It would be interesting to know that each body part has its own functional zone of working which can be labelled as "neutral posture" for that joint. There would also be a "functional zone" for every joint, the zone within which maximum functional tasks are performed. For movement to occur in one direction the group of muscles performing the muscles need to shorten in the direction of the movement and the opposite group of muscles have to lengthen. Thus, the joint movement is determined by a) the flexibility of the muscles that are supposed to lengthen for the movement to happen, b) the strength of the muscles supposed to perform the movement, and c) the state of the joint.

How a particular joint is held through the day while performing activities of daily living have a huge influence on the gradual development of knots or tightness in those muscles. Stiffness in one group of muscles will create a situation where the opposite group of muscles need to overwork to compensate for the lack of flexibility so as their destined action takes place.This gives an occasional feeling of dull ache or heaviness. If continued then this heaviness becomes more regular and then progresses to pain. A particular task may trigger a severe cramp (in either muscle group) on the background of this vulnerable environment.

For example; holding a mobile with wrist in flexion. This flexion position of wrist leads to gradual tightness of flexor muscles in the front of the forearm. On the contrary, all functions of the wrist happen with the wrist being in some degrees of extension (by action of the extensor muscles on back of forearm). The ease with which the extension movement has to happen will reduce due to tightness of the flexors, requiring the extensors to work more for the functions to be undertaken. Slowly and surely with the persistent use of mobile in the same provocative position of flexion (and other similar activities), the demands on the extensor groups will keep on increasing making them stiff, tired and painful. The extensors will continue to lose their flexibility and thus the flexors will require more effort to hold the gadget making them more stiffer and thus the cycle will continue. These stiff muscles will exert a tension effect on the bone of their origin at the elbow; inner (medial epicondyle) for flexors and out (lateral epicondyle) for extensors. Depending upon the area that the user will complain he or she will be labelled to be suffering from Golfer's elbow or Tennis elbow respectively. Thus, whenever one is dealing with pain on one side of a joint, then the muscles on the opposite side must also be evaluated for a holistic treatment.

This cycle of muscular imbalance is responsible for most aches and pains in the body and these have an influence on the skeleton from where this muscles origin and insert and significantly on the joint (s) that they work upon and the joint a muscle crosses. To prevent recurrence for these problems, the risk factors involved and the muscular imbalances developed need to be addresses adequately.

In the above example. The muscles on both sides of the forearm need to be evaluated for flexibility, irrespective of the presentation and soft tissue release need to be undertaken. The mobile use needs to be complimented with regular and deep stretching. Once the flexibility is restored (the wrist movements are near normal), then the muscles must be strengthened.

20/06/2017

It has been a long time since the last post and I promise to write it more regularly.

Today let us focus on the use of hand held gadgets, specifically the mobile phones, tablets, kindle, and other similar devices which are required to be held in the hand (can include the remote as well). This may seem a very innocent activity but it has very far reaching implications in evolution of a musculoskeletal disorder (MSD) or progression of an existing MSD.

There are multiple ways of using a mobile and it is completely dependent upon: a) size mismatch between the hand of the user and the size of the mobile; b) proficiency in using the mobile; c) purpose of use of the mobile; and d) duration of the use of the mobile.

Based on the above features, the mobile may be held in one hand and the other hand may be used for undertaking the tasks (texting, gaming) or the mobile may be held by both hands between the thumb and index finger and the thumb used for all practical purposes, or held in one hand and use of the same hand's thumb for undertaking the tasks.

While doing so, the muscles, bones and the joints of the used hands are working in various ways to undertake the tasks. The muscles that are stationary will be under static loading (working without any movement), muscles that are moving will be under dynamic loads (small amplitude repetitive), the joints will be held at odd angles and thus exerting pressure on the joint themselves and the muscles around those joints, and pressure effects due to holding the gadgets.

The dominant or non dominant upper limb will be involved in different ways and thus the use of gadgets and their influence of MSD must be considered. Pain/swelling around the shoulder/arm/elbow/forearm/wrist of the non dominant hand, pain in the thumb/fingers/wrist in the dominant hand and/or tingling numbness in the hands can be the exclusive presentation of gadget use. But the dominant hand is exposed to various other tasks and thus they also need to be taken into consideration while evaluating a MSD.

In addition to the upper limbs involvement due to holding and use of the gadgets while talking, reading and texting/gaming, the posture the person assumes while looking at the gadget can influence the aches and pains in the spinal column and lower limbs.

A detailed analysis by the clinician will help identifying the culprit immediately and ease in convincing the patient about the same. If the clinician will ask to stop using the gadget, then the patient may change the clinician rather than changing his or her habit! Thus, it is appropriate that the clinician educates the patient regarding the proper use of the gadget and the necessary precautions associated with the same.

Apart from the risks of developing aches and pains, persistent gadget use is creating poor posture profiles and making an otherwise smart individual look less smarter. Good posture enhances the physical appearance of an individual and poor posture does the opposite.

P.S.: Please feel free to ask any queries regarding the same or any other aspect. Do let me know if any particular article needs to be written.

28/06/2016

We have till now seen the importance of posture on the various aches and pains that one suffers. But there is another aspect of poor posture that is more prevalent and is obvious much before one experiences aches and pains. And that is the personality of the individual. This is more pronounced by those who have a forward head posture along with rounded shoulders. This is especially more prevalent in young children nowadays who carry heavy bags on their shoulders, are studying lots and using gadgets for their educational and recreational purposes. These produces a progressive deformity at the neck which goes forward compared to rest of the body and the shoulders start coming closer from the front thus narrowing the body.

Children need to be aware about these aspect of posture as well and the parents have to be vigilant about the same. This can be done by providing a tailor made working environment, proper use of gadgets and regular exercises. The younger generation is grappling with poor posture on a larger scale compared to their parents and with more and more academic competition and increased dependence on gadgets the situation is very alarming.

17/02/2016

Pain at the coccyx (tail bone)

History:
1. 26 years old, short NRI female, settled in Australia
2. Suffering from tail bone pain since 4 years only on sitting. Patient using a ring since 4 years but there is no relief. Mother and patient stressed due to her pain not getting relieved. Taken multiple opinions, investigations, physiotherapy advice (in India and Australia) and local steroid injections. Injections provided gradually reducing relief after each shot (relief achieved by reducing only the pain leads to abuse of that area and the pain relapses with renewed vigour).
3. Pain in the entire spinal column on sitting and also on the buttocks.
4. Works on laptop for 4 hours a day and has a standing cm walking job otherwise.

Postural faults:
1. Works on the laptop (sits on the ring): thus has to reach out in front and can’t maintain an erect posture while working (with the ring). This produces pressure areas on her buttocks contributing to the pain.
2. While sitting without the ring she tends to sit at the edge of the surface due to her short stature so that her feet can touch the floor. This produces stiffness in the spinal muscles in its effort to keep the spine erect and she tends to sit more on her tail bone producing more pressure.
3. She is happy to stand and walk but experiences low back ache on prolonged standing.

Advice offered:
1. IN an effort to maintain a good posture while sitting she has to sit in such a way that her back is supported, body weight is distributed on her seat bones (buttocks) and her legs are rested on a foot rest.
2. At home she was suggested to remove the ring and sit using a back rest and a foot rest. Use an external keyboard/mouse and use the laptop screen as a monitor kept at eye level. She was advised to come at the edge of the seat while getting out. For some days she was suggested to eat keeping her plates in the hand (reading, mobile use) so that there is no forward bending and rocking to preventing loading of the tail bone.
3. Otherwise she was suggested to carry pillow or a bag which can be used as a foot rest that enable her to sit completely supported.

Outcome:
Within a period of two weeks of using the body in appropriate posture her pains are significantly on the decline and is well educated about monitoring and correcting her pain.

25/11/2015

Posture is the key in development of all musculoskeletal problems. Our knowledge of posture is related to only spine but that is not the case. Each and every joint of the body ha its own comfort zone of functioning and working in that zone happens when that particular joint is maintained in that posture. For example; shoulders besides the body, elbow around 90 degrees, knees less than 90 degrees and similar examples. The joints are also designed to tolerate a particular amount of load. Working the joints beyond their functional zone and exposing them to abnormal loads can lead to mechanical overload in due course, injury and then pain.

If experience any pain in the body then evaluate how that body part is used and exposed to various mechanical loads for it to give pain. Pain is a good symptom and has to be seen as a friend as it is a mechanism of the body to intimate us about it's discomfiture and requesting us to take remedial steps.

19/11/2014

Pain at the forefoot:

A 45 year old SHORT female working as a bank employee complained of pain in her forefoot since last 9-10 days.

There was no history of injury or trauma. There has been a change in her sitting arrangement in recent past following which her pains have begin. Her occupational history revealed that she sits with all her body weight distributed at the joints of her toes keeping them hyper-extended. This was due to the fact that she is short in height and by adjusting the chair height to a level where it is possible for her to work at the bank counter, her feet are not completely planted on the floor. This necessitates her to put all her weight on the toes which are placed on the base of the chair. To add to the misery she sits at the edge of the chair and undertakes multiple rocking movements in the chair putting more stress.

Similarly at home while working on the kitchen she has to stand on her toes to get her work done and while sitting on elevated surfaces she may be sitting with her toes hyper-extended.

She may as well be wearing heels to compensate for her height which can exert more pressure on her toes.

Her pain would manifest by end of her work which would disappear on resting in the afternoon. Again by end of the night after working in the kitchen she has pain which disappears on sleeping. On lying down the pressure on the toes is removed and she gets up all fresh and without any pain.

The feet on examination did not have any swelling but there was tenderness at the toe joints where the toes meet the feet, known as the metatarso-phalangeal joints.

She was advised the necessary radiographs which were normal. No other investigations were advised as in all probability it was thought be a musculoskeletal disorder where the awkward posture at the toes along with abnormal pressure while sitting/standing have contributed in the repetitive nature of the problem and thus pain.

She was advised to sit with her feet planted on the foot rest in her bank. She was advised to stand on a raised structure while working in the kitchen so as to raise her height. Within 2-3 days of implementing these changes her pain subsided completely.

This is to drive home the point that the height of the person and the activities of daily living have a bearing on an area that is painful. As those activities have been going on for years they are not seen as contributing to the problem. Thus there is a tendency to identify a disease in a body that becomes painful suddenly. The fact is that the repetitive nature of the stress over the years makes that area vulnerable to damage and then pain due to the same activity.

17/10/2013

Let's restart the educational series once again on Posture. When I started this page the focus of posture was only on the spine and related issues.

Now we will try to see case histories on a regular basis about the role of posture also in other areas of body. All joints, muscles, tendons of the body have their neutral and safe zone of functioning like the spine. Any diversion from this is detrimental to the proper functioning of those structures. This can be as simple as working on the mobile, using a keyboard, cooking, riding a bike, etc. How comfortable is one while doing these activities, how much loading is undergoing, at what odd angles the joints are made to work, all this issues have to be considered. This repetitive stressful movements or activities of daily life play an important role in the development and management of the pains. In addition to paying attention and addressing the structural issues of a particular painful condition, the focus must be on identifying and modifying the functional aspect of pain. Functional means, what are the probable activities of daily life that are responsible for the structural changes and how can those functions be modified. As in the end, it is the function of the particular part that is what is important to the patient.

We will analyse some patient stories where focussing on the functional component gave satisfactory results in chronic pain situations.

19/04/2013

A young 35 year old female presented in the clinic with complaints of severe neck pain since months. She had visited an orthopaedic surgeon before but without significant relief.

Her neck pain used to start in the late afternoon and become more severe as the day progressed being worse by the end of the day. The pain would make her cry. She had undergone the simple radiological investigations which showed some early signs of wear (spondylosis). She had taken some sittings of physiotherapy but not with significant improvement and she was quite disturbed due to her pain.

She was a teacher who used to teach to primary school students in the day time and would come home in the afternoon and then get hooked to the mobile. She was a voracious mobile user texting continuously. Her pain would occur only when she starts using the mobile and continuous to do so. She used to completely slouch while using the mobile and her neck would be constantly in the flexed position for hours. She also used to use her laptop in a poor posture.

She had a forward head posture at the neck, her shoulders were round and was sitting in a slouched posture.

After due deliberations, she was convinced that her neck pain is probably due to her mobile use in a poor posture. She also had other problems in the hand which were attributed to the mobile use and the mismatch between her hand size and the smartphone size.

She was advised to refrain from continuous mobile use and was advised regarding the way she should use her mobile. She was advised the necessary postural correction instructions and exercises. Other pertinent don'ts and do's were also advised to her with some medicines to take care of the severe pain and advised to follow up after a week.

During the next follow up visit after approximately 10 days she had improved of her complaints and was feeling better. She was advised the next set of exercises to improve the posture and other instructions to maintain the posture.

There is a term coined as "text neck" for neck pain occurring in those who are compulsive mobile users.

This elaborate example was given to show that how poor posture plays a significant role in the evolution of the complaints. The biggest challenge is to identify the activities that are responsible for the poor posture, creating an awareness to the patient and then rectifying the postural faults in a graded manner for a holistic rehabilitation.

People employed for desk work are experiencing increased incidences of neck and back pain due to working in poor posture. People usually tend to assume poor posture due to lack of awareness and most importantly due to undertaking their domestic and professional tasks in an improper way in an improper environment.

We will look into the basic anatomy of the neck (cervical spine), common activities which are liable to develop neck pain, common postural faults, why it occurs and how it can be addressed.

15/04/2013

Starting this week, every week, will try to present an interesting case study of patients who are managed with advice regarding their posture and working. Today we will look in brief as to why the aches and pains in various body parts occur and what are the broad management principles.

There is an increased incidences of musculoskeletal pains in the younger and younger population. It is all attributed to the changing lifestyle but this is very vague. Changing lifestyle is attributed to altered dietary habits, reduced physical activity and mental stress but for me the changing lifestyle is the need for SITTING PROLONGED and sitting in poor posture and poor ergonomics.

How, where, how much and on what does one sit and how he or she undertakes his or her activities while sitting plays a significant role in developing of musculoskeletal aches and pains, especially in all those involved in prolonged sitting.

The focus on rehabilitation (pain relief and functional improvement) should be more on the functional aspect (what all activities are causing the pain) of the problem rather than the structural (spondylosis, arthritis etc) only. The structural changes in the tissues should be taken into consideration but I feel the functional aspects have a strong influence on the structural changes in the body parts and the patient presents to us for the functional problems rather than structural problems. Thus an approach of simultaneously addressing both the aspects is important.

The problems occur due to repetitive stress on a body part and a detailed history and evaluation can help in identifying the stressful activity or activities. But the question always arises that if there are many who are doing the same tasks, for example, in a corporate office, then why only some develop problems? This may be due to many factors but one of the most important factor is the working environment. People of various sizes and shapes having to work in an uniform environment or have to undertake a uniform task and the impact is different in different users. Also people continue to work in stressful and habitual positions in spite of those positions giving discomfort or producing pain, thus insulting the tissues more and more. This happens due to lack of awareness. The other important factors are the repetitions, force, vibration, etc. which are again individualized.

As we give tailor made uniforms to our employees, we have to work in a tailor made working environment. Working in a compromised environment compels the user to work in a compromised posture and a position of disadvantage. This is particularly true where working in a compromised environment has to be done for a prolonged period of a day, for example desk work. These create stresses on various body parts depending upon the work needed to be done and this cumulative stresses lead to development of repetitive stress injuries, the root cause of musculoskeletal pains. Where there are intentional or unintentional breaks of good duration, the impact of working in a compromised environment will be quite delayed.

This can be true at home as well as at office. At home the furniture is designed as per the ideas of the designer and looking at the aesthetic value. The designers design considering the laid down guidelines but the users are all different in different houses. And within a house the users are of different sizes and shapes. Similarly in any office, bank, school etc where desk work is required, the work stations are uniformly designed based on certain guidelines but the users come in various sizes and shapes. The work station will be ideal for the user to whom the guidelines suit but the other users will have disadvantages. The same criteria are relevant in jobs requiring standing and other manual laborious which are done for prolonged duration.

The impact of domestic furniture is less and happens in the long run as the need to undertake tasks for prolonged duration is limited. But in the corporate offices that necessitates continuous sitting (or any job that requires to undertake activities for prolonged duration in a non ergonomic environment) these variables play a significant role and have a huge impact on the onset of the musculoskeletal problems. The need is to work in a good ergonomic environment which will facilitate good posture and exert minimal stress on the body parts.

The activities required to be undertaken in the disadvantageous positions will have an impact on that body part and create a repetitive stress and trouble later on in form of repetitive stress injuries (RSI). This does not happen overnight but after months to years of working in such an environment. Creating a tailor made work environment for the user is the best solution and if not, converting the work environment as per the needs of the user is the next best solution. This is known as ergonomics.

The awareness about RSI and ergonomics has happened in last decade or so because the increased incidences of musculoskeletal pains in desk workers at younger age groups. But I feel that all the musculoskeletal pains otherwise also are a type of repetitive stress and the principles of ergonomics are relevant there as well.

In addition to this, the emphasis on taking frequent breaks and stretching exercise at regular intervals should be stressed with full authority.

06/12/2012

The next post on the common reasons for development of poor posture in children. Before attributing any aches and pains to poor posture, an orthopaedic evaluation to rule out any pathology should be undertaken.

http://repetitive-stress-injury.blogspot.in/2012/12/postural-problems-in-teenagers-causes.html

Posture : Its significance

23/05/2020

07/09/2017

17/08/2017

20/06/2017

28/06/2016

17/02/2016

25/11/2015

19/11/2014

17/10/2013

19/04/2013

15/04/2013

06/12/2012

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