Back maintenance 23 Jan 2019
One of the biggest issues in today’s society is sedentary work. This results in long periods of (in) activity in one position. To briefly summarise the terminology, your back is straight when in a standing position, extended when you lean back and look towards the ceiling and inflexion when you are in slump sitting. Professor Stuart McGill who is a professor of spinal biomechanics stated that you need to even out the flexion and extension pressures on your back through the day. This isn’t a 1:1 ratio, however, it is a 2:1 ratio of extension to flexion position. If you sit for 1 hour you need to be standing or walking for 2 hours.
If you think about a possible typical day it may involve sitting on the way to work on the tube or in the car, sitting at work, getting home and sitting down for dinner. This is a 2:1 ratio the other way, with lots more flexion than extension.
So how can you change this
- Be mindful of the following positions and work to even them out.
Below is a chart of typical flexion and extension exercises and positions:
| Flexion | Extension (or straight) |
| Slumped sitting or relaxed sitting | Standing |
| Foetal position sleeping | Walking |
| Sitting on the toilet | Running |
| Sitting in the bath | Swimming |
| Rowing (if hip movement reduced) | Lying face down |
| Cycling (if hip movement reduced or in aerodynamic position and on T bars) Look at these 2 positions | Sleeping face down or on back |
| Sit ups | Sitting with a supported lumbar support |
| Yoga: Child’s pose, Cat stretch, pilates roll down | Yoga: Cobra, Locust, Sphinx, upward facing dog Plank, Birddog |
None of them are wrong to do but try to even out the positions through your day to even the flexion and extension strains on your back
How does it work over 24 hours?
Flexion Example: Man with back pain, worse when sitting. Wakes up and has a shower, sits on the tube on the way to work, sits down for the majority of the day at the computer and sits for lunch either at his desk or in the local café. Sits on the way home. Occasionally goes running x 1 a week and cycles at the weekend for 2-3 hours. Generally watches 1-1.5 hours of TV in the evening.
The changes
Example changes:
Maintains the shower (extension), stands on the tube (not sit), speaks to work to get a standing desk so he can even out the pressure through the day and vary his position. Stands for lunch and on the tube of the way home (extension) and ran x 2 a week in lunchtime. In the evening he varied his position every 20 minutes to sitting supported on the couch to lying face down on the floor when watching TV. He also went for a bike fit, to find his best position. These changes allowed him to maintain his ability to do his 2-3 hours of cycling at the weekend (which was his nirvana!).
Think about your flexion to extension back ratio. Is there anything you can change within your day. Small changes have a cumulative effect on your back. Knowledge and awareness is key to self- maintenance. Good luck