81 Metcalfe Street Suite 801, Ottawa, Ontario, K1P 6K7 Tel: 613-564-9000 W. Mark deGruchy B.S., D.C. Brent E. Burton B.A.Hon., D.C. Framing Your Body Mechanics.

81 Metcalfe StreetSuite 801,Ottawa, Ontario,K1P 6K7Tel: 613-564-9000

W. Mark deGruchy B.S., D.C.Brent E. Burton B.A.Hon., D.C.

Framing Your Framing Your Body MechanicsBody Mechanics

OutlineOutline

1. Introduction to Posture2. What Factors Affect

Posture?a) Forward Head Postureb)Office Posturec) Lifting/Carrying Postured)Sleeping Posture

3. Building a Good Base of Support

4. Chiropractic Correction

Introduction to Body MechanicsIntroduction to Body MechanicsWhat is posture?• The position of the body in space.

Why is Posture so Important?• It is the first step to either good or

poor health, e.g. more difficulty with deep breathing when slouching.

• Improved body self-awareness.• Decreased risk of injury during

activities.• Decreased risk of chronic

diseases such as osteoarthritis, low back pain, neck pain, headaches, etc.

“As a twig is bent the tree inclines” - Virgil

Structure vs. Function?Structure vs. Function?Mechanical

(function)

Example:Upper-Cross Syndrome1 (Tight & Weak muscles)

Postural

Example:Poor Sitting Posture

Structural

Example:Osteoarthritis2

Factors Affecting Posture: Factors Affecting Posture: Forward Head PostureForward Head Posture

• Very common in office workers, students, whiplash injuries/accidents

• Direct relationship to computer monitor usage.• Average weight of head (approx 8-12 lbs).• Every inch forward places further strain on muscles,

ligaments, and joints.

Factors Affecting Posture: Factors Affecting Posture: Forward Head PostureForward Head Posture

• Prolonged contraction of muscles used to support head in forward position Chronic Shortening and Tightening and Pain2

• Dysfunctional muscles at back of head, front of neck, top of shoulders and front of chest can lead to headaches, numbness and tingling into arms.

• Easy exercise: Brügger’s postural break4.

• Balances muscles so that poor work posture does not become permanent.

• Hold for 8-15 seconds, 1x/every hour sitting.

Factors Affecting Posture: Factors Affecting Posture: Forward Head PostureForward Head Posture

Factors Affecting Posture: Factors Affecting Posture: Office PostureOffice Posture

• Slouched posture straightens spinal curves and puts uneven wear on discs (especially low back).

• Prolonged sitting leads to strain of muscles, ligaments, and joints.

• Incorrect mouse, phone and keyboard positioning leads to strain of neck, shoulder, elbow and wrist, e.g. carpal tunnel syndrome.

Repetitive Strain Injuries:Repetitive Strain Injuries:Stages of PainStages of Pain55

Early: • The body aches .• Feel tired at work, but symptoms disappear

during time away from work. • The injury does not interfere with the ability to

work.• The injury will heal completely if dealt with

properly at this early stage.Intermediate:• The injured area aches and feels weak soon

after the start of work, until well after work has ended.

• The injury will completely heal if dealt with properly.

Advanced: • The injured area aches and feels weak, even at

rest. • Sleep is affected. • Even light duties are very difficult.

How to Correct Office PostureHow to Correct Office Posture• Adjust seat so that hips, knees and

ankles are at roughly 90°(knees at level of seat, you may need a footrest).

• Allow 2-3 fingers space behind knees.• Rest back against backrest.• Constantly change positions.• Sit close to work.• Reduce time seated to 75% of workday.

Try to alternate sitting, standing and walking every 30 minutes.6

• Adjust lumbar support so that it is in small of back.

• Keep chin, shoulders and low back aligned (don’t slump).

• Armrest Height – Should be at elbow height with relaxed shoulders and elbows at 90 º.

• Place keyboard and mouse within comfortable reach at same level as armrests.

• Wrists should not be extended or flexed and relaxed (don’t lift baby finger or thumb).

• Monitor should be 40-79cm away from face.• Monitor should be positioned so head is neutral when

reading the top row of text onscreen (may be lower if you wear bi-focals).

• Hold phone with hands, not shoulder. Switch hands.

How to Correct Office PostureHow to Correct Office Posture

Factors Affecting Posture: Factors Affecting Posture: Lifting/Carrying PostureLifting/Carrying Posture

• Lifting and twisting together place enormous strain on spine.

• Lift with knees and hips, then turn with feet.• Hold loads close to body.• Reduce loads whenever possible. (Adolescents

should keep loads below 15% of body weight)7.

• Distribute weight towards bottom of bag.• Alternate shoulders/arms if carrying a purse,

carry-on bag, satchel.

Factors Affecting Posture: Factors Affecting Posture: Sleeping PostureSleeping Posture

• Comfortable sleep is very important since we should be spending about 1/3 of our time sleeping.

• Many people have neck pain from sleeping face-down. Chronic strain on muscle and joints of neck.

• Many people snore/breath poorly sleeping on their back. Side-lying appears best for snorers/sleep apnea.

Factors Affecting Posture: Factors Affecting Posture: Mattresses and PillowsMattresses and Pillows

• Research lacking on mattresses and pillows.8

• Now accepted that firmer support is not necessarily better. 9

• Recommendation is usually a medium-firm mattress as it reduces the likelihood of low-back pain.9

• However: Sleep quality of each mattress appears to be based on the individuals needs.10

Factors Affecting Posture: Factors Affecting Posture: Mattresses and PillowsMattresses and Pillows

General principles when buying a mattress or pillow:

1. Ensure that contours of spine are supported separately.

2. Ensure there are no points of excess pressure/discomfort.

3. Ensure you spend at least 15 minutes lying on the mattress you intend to buy.

4. Ensure there is a return policy incase you don’t like the mattress.

Building a Good Base of SupportBuilding a Good Base of Support1. Average steps/day = 8,000-10,000.2. Eyes will always try to be level with

gravity.3. Problems in ankles, knees, hips,

back? Start by looking at your feet!4. There are 52 bones and 66 joints in

your feet!5. If you have problems with any of the

following, have a qualified doctor look at your feet/posture:a) Pain in feet, knees, hips, low backb) Excessive shoe wearc) Low or high archesd) Knock-knees or bow-leggede) Arthritis or diabetes

Building a Good Base of Building a Good Base of Support: ShoesSupport: Shoes10,1110,11

• Find out whether you are neutral, a pronator (flat-footed) or supinator (rigid arch). Buy shoes accordingly.

• Shoes should be comfortable when you try them on. Don’t break them in!

• Make sure shoes are wide enough in toe box and there is 1/2” between end and longest toe.

• Make sure your heels don’t slip.• If you wear an orthotic, try a neutral

shoe, with your orthotic in it (take out the insole).

• Try not to wear high-heels constantly.• Try on shoes at end of day.

Testing Running Shoes When Buying

1. The Shelf Test:

2. Pinch Grip Test:

3. Fold Test:

4. Dish-Rag Test:

Building a Good Base of Building a Good Base of Support: ShoesSupport: Shoes

Building a Good Base of Support: Building a Good Base of Support: OrthoticsOrthotics

• Orthotics can be used to treat a variety of health concerns. E.g. diabetic foot, flat feet, etc.

• Main functions of custom orthotics:– Correct poor foot mechanics.– Stabilize and support foot during gait.– Shock absorption/comfort.– Protect joints and muscles from over-use.– Provide feedback to your nervous system about where your foot is in

space.– Correct Posture.– Prevent Injuries E.g. ankle sprains, foot fractures during sports.

• Can be made for specific shoes: Running, skating, skiing, dress, sandals, etc.

Note: Not everyone requires custom orthotics (even if you have foot problems). Speak to a qualified doctor!

Chiropractic CorrectionChiropractic Correction• Purpose of chiropractic treatment is to not only rid patients of pain, but to reduce/correct

postural/mechanical stresses and strains.• Evidence shows chiropractic treatment is also useful for increasing range of motion12,13, and

increasing postural symmetry14.

• Chiropractors use a variety of techniques, exercises, physical therapies, and devices to restore normal muscle, joint and nerve function.

• Focus on functioning of entire body, not just area of complaint.

ReferencesReferences1. Janda, V. 1988. Muscles and cervicogenic pain syndromes. Physical Therapy of the Cervical and Thoracic Spine.

Churchill Livingstone. London. pp.153-166.2. Harrison DD, Jones EW, Janik TJ, Harrison DE. 2002. Evaluation of Flexural Stresses in the Vertebral body

Cortex and Trabecular Bone in Three Cervical Configurations with an Elliptical Shell Model. J Manipulative Physiol Ther. 25(6): 391-401.

3. Moore, M. 2004. Upper cross syndrome and its relationship to cervicogenic headache. JMPT. 27(6):414-420.4. Liebenson, C. 1999. Advice for the clinician: the brugger relief position. Journal of Bodywork and movement

therapies.3(3):147-149.5. Workers Compensation Board - Alberta. 1999. Office Ergonomics: Remembering the Basics.6. Juul-Kristensen, B. and C. Jensen. 2005. Self-reported workplace related ergonomic conditions as prognostic

factors for musculoskeletal symptoms: the “BIT” follow up study on office workers. Occup. Environ. Med. 62: 188-194.

7. Chansirinukor, W. 2001. Effects of backpacks on students: Measurement of cervical and shoulder posture. Australian Journal of Physiotherapy. 47:110-116.

8. Buckle, P. and A. Fernandes. 1998. Mattress evaluation – assessment of contact pressure, comfort and discomfort. Applied Ergonomics. 29(1):35-39.

9. Kovacs et al. 2003. Effect of firmness of mattress on chronic non-specific low-back pain: randomised, double-blind, controlled, multicentre trial. Lancet. 362:1599-15604.

10. American Academy of Orthopaedic Surgeons. 2000. If the shoe fits, wear it. http://orthoinfo.aaos.org/fact/thr_report.cfm?thread_id=104&topcategory=foot.

11. Asplund, C. and D. Brown. 2005. The Running Shoe Prescription. Physician and Sports Medicine. 33(1).12. Martinez-Segura et al. 2006. Immediate effects on neck pain and active range of motion after a single cervical

high-velocity low-amplitude manipulation in subjects presenting with mechanical neck pain: a randomized controlled trial. JMPT. 29(7): 511-517.

13. Cassedy et al. 1992 . The effect of manipulation on pain and range of motion in the cervical spine: a pilot study.JMPT. Oct;15(8):495-500

14. Childs et al. 2004. Immediate improvements in side-to-side weight bearing and iliac crest symmetry after manipulation in patients with low back pain. JMPT. 27(5):306-313.