By Heather Rozen PT
Alignment beats everything. Forget about what you were told about good posture. Telling people to sit up straight has only made things worse. I typically follow the philosophy of Gray Cook, a physical therapist who created the FMS, which is “first move well and then move often.” But with a lot of my clients, I would like to take it a step further and tell you to sit well first and stand well first. There are traditional societies out there today who do not have back pain, or any chronic pain for that matter. They sit differently, they stand differently, and they move differently than we do here in this culture. Esther Gokhale is a woman who lives now in California and has developed the Gokhale method for treating pain. She developed debilitating back pain and was on a quest to find the root cause of back pain. She traveled to parts of the world to live among people in cultures who do not have chronic pain but who do perform physical labor and in fact sit for different types of work. She lived in Burkina Faso, rural parts of Portugal and also fishing villages in Brazil. Her insights helped her develop a step by step guide to help people suffering from back pain, but more than that has transformed what we know as good posture.
In this culture, over the years we have developed very poor sitting and standing posture. Gokhale believes that the changes started in the 1920’s as the fashion industry took hold. A slouched, relaxed posture became vogue, and even furniture started to change to accommodate a slouched relaxed sitting posture. If you notice paintings or photographs taken prior to the 1920’s in America, you will notice a much different sitting posture.
We typically tell our kids to “sit up straight” so they sit straight for a short time into a very upright rigid, tense position which becomes very uncomfortable, so they return to slouching. Furthermore, children are programmed to take their cues from the adults around them. In other words, they already learned their poor posture from watching you. They USED to have good posture when they were toddlers but then took on the postural habits that their parents have (and were also then put in a chair in school to be bored to death for hours at a stretch).
I’ve been working in the healthcare field for 20 years, and I can assure you that collectively we have not done a very good job with understanding posture although it does seem to be turning around. We took the average poor posture and called it normal. It’s not. Most of our car seats, lumbar support cushions and even the braces that we use for people with back pain exacerbate our misalignment by increasing the curvature in the upper lumbar spine and flattening the natural lumbo-sacral curve (in the lower lumbar spine) as well as forcing our heads into a forward position.
As you can see with orange shirt guy (why an orange shirt with green pants?) in the picture in the middle he is relaxed and slumped in a c-shape which is how a lot of us sit. Our butts are tucked under us. In the picture on the far left, he is arched and tense, overcorrecting and trying to “sit up straight.” He ends up flaring his ribs and exaggerating the curve in his back. Esther Gokhale has found that the pain-free societies tend to sit like the picture on the far right which is more of a taller, lengthened spine. The pelvis is slightly rotated forward and more importantly the ribs are flush with the abdomen vs. being flared up or down.
Another way to look at the ribs from the side view is to see them in the shape of a bell as explained by Julie Wieb, another posture therapist. The picture on the far left shows “bell rung up” and the picture in the middle shows “bell rung down”. Ultimately, you should be able to eventually relax into a tall, lengthened position (orange shirt far right) without exaggerated curves in sitting or standing. It does take some getting used to but I’ve seen great results with people who decide to work on improving their posture. There are other things to think about with posture but the pelvis and ribs are a good place to start.
