Sitting at the desk can be a real pain in the %$*&
It's one of the most common questions we get in the clinic - what is the best sitting posture?
To be honest, it would be ideal if we didn't sit as much of the day as we do, but given the society we live in it's going to be a while before we all get to go primal.
We have all had a think about it and the overwhelming advice we give revolves around optimal sitting postures and reducing the amount of time you sit altogether.
So what can you do?
We all need to become big softies. Softening your neck, shoulders and upper back will go a long way to reducing pain and dysfunction around that area.
Start by dropping those shoulders.
Whether you sit, stand or kneel you're still going to get a sore neck and shoulders if those upper back, neck and shoulder muscles are working hard for hours on end. They have to work hard any time you have your arms out in front of you for long periods of time. For instance, when you are tapping at the keyboard, driving the car, crocheting, and then throw in the added tension that stress creates. A neat trick that seems to help is to tuck your elbows to your sides, this lets the shoulders relax a little more and keeps you mindful. Always try and rest the weight of your forearms on the desk or chair if you are sitting.
Some other good ideas to help you soften through your upper back neck and shoulders include:
1) Breathe and Release - most people find it easier to drop the shoulders, soften and release on an exhale.
2) Driving - hold the wheel on the two lower quarters and let your shoulders rest when you are in a more relaxed stage of a drive.
3) A Trigger - find a trigger during the work day to consciously soften through the trapezius and drop the shoulders, e.g. hanging up a phone call, sending an email, etc.
I'm sure you've noticed the recurring theme is 'letting the shoulders drop'.
If you are quite conscious of this over a period of three weeks, there is a sense of 'retraining' your brain to release your shoulders and neck tension automatically.
There are definitely more optimal sitting posture than others.
We have included some photos of the good, the bad and the plain ugly. Some sitting positions are extremely sloth-like but extremely comfortable, and that's ok. But always remember the more comfortable you are in the position the longer you can hold it - and that can be the problem.
The thing about maintaining good "posture" or sitting more upright is that the "better" your posture the more energy intensive and the harder it is to hold so then you move away from that position - therefore it’s better for you. Moving more is better for you - it is that simple.
Other simple tricks for the desk jockey:
1. Stand to talk on the phone wherever possible
2. Look out the window at something small and distant (like a bird in the tree) - this is good for your eyes.
3. Have walking meetings outside wherever possible. Who said a meeting had to be sitting down?
The Massage "Affect" on Anxiety and Depression
JUST GET A MASSAGE
I know many people feel that booking in for a massage is an indulgence. They wait for a gift voucher from a loved one, or save up once a year for their birthday.
Many benefits of massage are still disconcertingly uncertain but while everyone is discussing those, a somewhat proven benefit is its positive effects on mood (1).
Massage has been shown to:
1. reduce depression
2. reduce anxiety
ANXIETY AND PAIN
How often have you noticed your neck pain is at it's worst when you're under a lot of stress? It will build up and up until you finally lean over to pick up your toothbrush and 'bam' you can't move your neck.
Anxiety is a potent factor in all types of pain. And in the case of lower grade anxiety and depression, the kind we all seem to be living with every day, massage can make a valuable contribution to your well being.
MASSAGE TO INTERRUPT THE CYCLE OF PAIN AND IT'S EFFECT ON MOOD
Although the neurophysiological effects are complex, the simple negative cycle that emerges when people are depressed or anxious, is that it's hard for them to do anything when they feel miserable. As you continue to feel miserable, this leads to doing less, which in turn, leads to feeling worse.
There is a boatload of evidence to support enjoyable movement and exercise to improve mood but how about not getting to the point of feeling miserable or trying to find someone to help you crawl out of that hole?
Most massage therapists are pretty nurturing types of humans. They can provide a therapeutic support role through 'recovery' and encourage paced activity to incorporate self-management.
IS MORE MASSAGE BETTER?
A leading researcher in this field is Christopher Moyer PhD who is a behavioural scientist primarily interested in the role of massage therapy on anxiety and depression or the human affect.
I'll let him speak about the research he has accumulated on the subject about whether more massage is better:
"We made an interesting discovery concerning the effect of the treatment on the state of anxiety. When a series of massage therapy sessions was administered, the first session in the series provided significant reductions in anxiety, but the last session in the same series provided reductions that were almost twice as large. This pattern was consistent across every study we were able to examine, which strongly suggests that experience with massage therapy is an important predictor of its success, at least where anxiety is concerned. To put it another way, it is possible that the greatest benefits come about only when a person has learned how to receive massage therapy." (2)
SO STOP FEELING GUILTY
You can all stop feeling guilty. If you enjoy getting a massage then book one now and do something good for your mental health. Give yourself a pat on the back for being proactive about your wellbeing. Well done you!
(1) Christopher A. Moyer, PhD, Research Section Editor, IJTMB, Assistant Professor, Int Journal Therapeutic Massage and Bodywork. 2008; 1(2): 3–5. Published online 2008 Dec 15.
(2) Moyer CA, Rounds J, Hannum JW. A meta-analysis of massage therapy research. Psychol Bull. 2004;130(1):3–18.
Five tips for a better night's sleep.
Sleep is a tricky topic. How many hours should we get? Seven, eight or nine? What has been the impact of television/screens/ipads? Should we sleep more like our ancestors in two big chunks (Bi-modal sleep)?
The overwhelming response from most people would be that they'd really just like a bit more of it.
Here's my top five tips to get a better night's sleep:
1. Stop unhealthy habits before bed
Finish eating or drinking at least two hours before you try to lie down.
Get off that computer or off the couch at least one hour before bed - seriously.
Check any nighttime medications* don't have caffeine in them.
2. Clear your bedroom of unhelpful items (make a checklist)
Get a blackout curtain if a street light shines in (it's not just for toddlers).
Is your room too warm or too cold?
Get rid of your shining alarm clock. No one needs to see the time in neon.
Turn off your mobile phone. I mean it.
Children and pets are warm, nurturing creatures but they don't always need to share the bed with you. We often get shoved into a cold corner of the bed to accommodate them. Restore your boundaries.
Is your mattress more than 8-10 years old? It might be time for an upgrade.
Do you love your pillow? (see my post on pillows)
Covers too heavy or restrictive?
Spouse or partner that is restless, noisy, or generates too much heat - um, acceptance?
Some medical conditions❡ interfere with sleep.
3. Do you love a daytime nap?
Do not daytime nap for more than 45 minutes
No napping after 3 pm
4. Exercise
A few surprises. A 2010 (1) study found people with no previous sleep difficulties slept better the night following exercise. But for people who had been diagnosed with insomnia, a fairly comprehensive study from 2013 (2) found people had to exercise daily and consistently for up to four months before there was a measurable benefit.
Put simply:
Consistently do a bit more physical activity during the day.
Expose yourself to bright light on waking – tell your body it's daytime.
Expose yourself to bright light in the afternoon to keep your body awake longer.
5. Consistency of sleep habits
Wake up at the same time every day - almost the hardest one to implement for anyone, especially an insomniac.
Develop a flexible before bed routine. It might include a warm shower or bath, meditation or a calming book.
In-bed routines - breathing techniques, progressive muscle relaxations (that's a whole other BLOG)
Reduce fluid consumption in the evening to avoid the need to wee all night.
(1) Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep Med. Oct 2010; 11 (9): 934-940. Kathryn J. Reid, PhD, Kelly Glazer Baron, PhD, Brandon Lu, MD, Erik Naylor, PhD, Lisa Wolfe, MD, and Phyllis C. Zee, MD, PhD
(2) J Clin Sleep Med. 2013 Aug 15;9(8):819-24. Exercise to improve sleep in insomnia: exploration of the bidirectional effects. Baron KG1, Reid KJ, Zee PC.
* Some medications that can interfere with sleep:
- Antihistamines: Benadryl (daytime drowsiness)
- Sympathomimetic Amines: bronchodilators and decongestants
- Antihypertensives and Beta blockers: Clonidine, Aldomet, Reserpine (daytime drowsiness)
- Steroids: Prednisone, dexamethasone
- Thyroid medications:
- Anti-epileptics and antipsychotics (daytime drowsiness)
- Parkinson medications: (daytime drowsiness)
- Stimulants for ADHD
- Anticholinesterase drugs for Alzheimer's
- Antidepressants: Prozac, Fluoxetine
- Analgesics: opiates, Tramadol, Ultram
- Chemotherapeutics: (nausea and vomiting)
- Diuretics: (frequency at night)
❡ Some medical conditions that can interfere with sleep:
- Respiratory disorders
- Cardiovascular disorders
- Gastrointestinal disorders
- Musculoskeletal pain and dysfunction (Book Online)
- Diabetes
- Renal disorders
- Prostate problems and small bladder causing urinary frequency
- Cancer
- Dementia
- Dental disorders
- Restless leg syndrome or Periodic Limb Movement Disorder (PLMD)
- Fibromyalgia (alpha wave intrusion)
NOTE: People who do shift work have special challenges as they consistently interrupt their diurnal rhythms. It is outside the scope of this post.
Pillow, pillow on the bed, which is the best one for my head?
Which pillow shall be crowned in glory?
I am frequently asked about pillows. Most people who ask me ‘Should I get a new pillow?’ have arrived seeking treatment for a sore neck, insomnia or morning headaches. They don’t like their current pillow and have at some point flung it across the room in frustration. They may have paid a lot of money for one or many different kinds of pillows.
What is the perfect pillow?
I’m sorry, but I’m here to disappoint you, there is no perfect pillow. On a good day or given enough time, you can adapt to nearly anything. Over the last hundred years or so humans used rocks, horse hair and straw to help us sleep comfortably through the night. Before that we slept mostly on the ground, bereft of any pillow.
If we tried that now, out of the blue, then you’d be much like my twenty-four year old osteopathic colleague, Whitney, who recently went camping in Ballarat and slept on the cold hard ground, with only a thin, inadequate mat between her and the dirt. She was complaining this morning of sore shoulders, sore hips and an aching low back. Her whole body was yelling at her to march herself right back home to sleep on her $2000 mattress and contoured feather pillow. Unbelievably, she hadn’t spent any time at all progressively sleeping on less comfortable surfaces over the preceding weeks to get her body prepared for her camping experience. And really who would do that?
Our bodies and the bones, ligaments and muscles that make them up, respond to the activities that we ask of them. If we ask them to sleep on an extremely comfortable, forgiving surface every night then they’re just going to find it a bit of a struggle adjusting to a hard, cold, dirt floor. Your discomfort is not in your imagination.
So back to the person asking me about the perfect pillow. The one who has a sore, tight neck and shoulders and is struggling to adapt to anything. What do I tell them?
Your pillow is a support device.
Your pillow is there to provide support - it’s an orthotic for your head and neck.
A pillow that is unforgiving and asks you to adapt should be pushed to the side. It is meant to provide comfort and adapt to what you need, not the other way around.
This is not a sales pitch but we do sell a pillow at the clinic and it is the one I recommend to people if they’re genuinely in the market for a new pillow. It has a contoured cotton cover stuffed with polyester fill. The reason I like it is simple. It’s adaptable. It has a zip on one end that you can pull out stuffing or put more in as the polyester filling loses it’s ‘lift’. At night, you you can move the stuffing around if you punch it, or shove it into the headboard to make it higher when you roll from your back to your side. And in a couple of years when the filling bunches up and is full of saliva, dead skin and microscopic creatures, you can pull out the stuffing, wash the cover, stuff some new stuffing in and start again.