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A large part of our role as physical therapists is to investigate and educate our patients about what activities or incidents contributed to their current pain or dysfunction. In the case of an acute injury or a trauma the causative factors involving the injury are generally straightforward. However, in cases where there is an insidious onset of symptoms (symptoms that seemingly arise out of the blue), we have to thoroughly investigate what activities clients perform on a daily basis to accurately determine which of these activities may be contributing to their symptoms.
Many times, when symptoms begin through insidious onset, discussion of daily activities can reveal the true cause behind your pain or symptoms. Now, you might wonder what I mean by activities of daily living as one person’s daily activities can vary drastically from another’s. For the sake of this discussion we are going to stick to two activities that are common to most people including: sitting and standing.
Certain positions we put ourselves in throughout the day can result in muscle overload and wear and tear on our joints. As we have discussed in earlier blog posts, muscle overload can result in the development of myofascial trigger points and fascial mobility restrictions causing pain and dysfunction. Further, as we all know, wear and tear on our joints, also known as degenerative joint disease (arthritis), can result in pain and dysfunction. It is important to note however, that this is not always the primary limiting factor.
With this in mind, let’s take a look these two activities we all do on a daily basis and examine how they may contribute to muscle overload and joint damage. (1) Standing: quite frequently people will stand with their backs arched (excessive lumbar lordosis) and their weight shifted forward through their toes which can cause low back muscles to over-work and may stress the ligaments that maintain vertebral alignment. Over time, standing like this becomes a habit, resulting in the over reliance on low back muscles and the under utilization of abdominal and gluteal muscles. This position also stresses the joints of the spine and the intervertebral discs as they are constantly placed at the end range of extension versus a neutral resting position. Proper standing posture when viewed from the side is with the ear, hip, and ankle all in line. To be sure you are in this position, you should be aware that your low back is relaxed, your weight is directed more posteriorly towards your heels, and you are aware of your gluteal, hamstring, and abdominal muscles working slightly.
(2) Sitting: many people will sit perched at the edge of their chair. Like standing with your back arched and your weight forward, sitting at the edge of your chair places excess demand on your low back muscles which may result in pain or limited flexibility. The proper way to sit in order to decrease stress on the low back, hips, and pelvis, is to sit with your back supported against the backrest and your knees at hip level. It is however important to note excess lumbar support may also result in improper sitting posture as this again places the spine in too much extension causing wear and tear on the vertebrae and intervertebral discs. This position also causes overloading of the spinal extensor muscles.
In terms of keeping this blog post a manageable length, I am going to limit this discussion to proper standing and sitting. However, throughout the day, we spend a significant amount of time sitting and standing and can therefore significantly change pain and dysfunction by making sure we are performing these activities properly. Further activities of daily living are covered in our activities of daily living pamphlet, which can be accessed via the following link: ADL Brochure. For a more in depth evaluation of what activities may be contributing to your pain or symptoms, consider scheduling a physical therapy examination at one of our locations!