The secret to improving your posture | FF Recommends

July 24, 2021 | FF Daily #432: Advice from a physiotherapist

Founding Fuel

[Photo by Garett Mizunaka on Unsplash]

Good morning,

Maintaining a good posture is most people’s kryptonite. 

Everyone knows the benefits of it. The way to do it seems theoretically straightforward too—all you need to do is sit properly and not slouch. However, putting it in practice remains a modern-day superpower.

Its importance has only been accentuated in recent times as many of us are working out of our beds rather than on desks. Physical activity has taken a backseat too.

So, what are some easy first steps to learn this superpower?

Dr Sheetal Mundhada, a practising physiotherapist and co-founder of YourPhysio, shares some practical tips that actually work.

The secret to improving your posture

By Dr. Sheetal Mundhada

The challenges of poor posture were visible much before the pandemic started. Every time I would go to a wedding, I couldn’t help but notice that there’s hardly even one woman past her fifties that walks properly (yes, especially women because of the additional burden of household chores). The subtle difference may not be visible to everyone, but the eye of a physiotherapist can quickly spot if someone is putting disproportionate pressure on one foot, or has dropped shoulders or is slightly limping.

I fear the pandemic has magnified this problem. With most of my practice moving online, parsing data has become much easier. So, I can, unfortunately, confirm that there’s a marked increase in the number of patients with cervical (neck) and hip pain, followed by back and knee pain. 

I was initially intrigued as to what was driving it. As I investigated further, it became clearer that it shouldn’t be a surprise since all the necessary ingredients are there: 

  • Our screen time has shot through the roof. The screen has become the sole conduit to our work and social lives. 
  • Physical activity has come down significantly. Earlier, at the least, the journey to the office or the in-office meetings resulted in some amount of walking. That has completely paused. Most people have limited space at home, which makes exercising unlikely.
  • Cleaning floors, washing utensils and cooking aren’t substitutes for exercise. Instead, they can lead to injuries. Standing for long periods, lifting weights and bending more frequently puts excess pressure on our bodies. We also lack core muscle strength needed to pull them off, since we weren’t used to these activities.
  • We are also sitting for long hours in one place. Many of us don’t have the luxury of a proper workstation, and even if we do, we often (incorrectly!) prefer working out of bed.

This problem is affecting everyone, especially those in the 20-40 age group. However, I am observing three categories of patients where the occurrence is more frequent:

  1. The elderly, especially if they suffer from severe diabetes and other comorbidities, where physical activity is critical to prevent muscle weakening. However, this has paused due to fear of catching Covid, often under strict instructions from their children to not step out.
  2. Women, especially those who have had to shoulder a disproportionate amount of household work in the absence of external help and family support. Indian cooking takes longer than other cuisines and standing for long hours is causing knee pain. 
  3. School going children, especially in 8th-12th standards—who are spending significantly more time on screens and whose physical activity has come down drastically. I wasn’t used to treating these patients earlier.

So what can you do?

Here are some simple shifts you can make. I have bucketed them into three categories and sequenced them in increasing order of behaviour change needed. You need not implement all of them in one go. Take it at your own pace. However, to make this into a permanent superpower with life-long returns, the last segment is critical. 

A. Low hanging fruits, yet they deliver substantial impact

The three tips listed below are the simplest ones to implement—they don’t need much behaviour change, yet, they are the most important. So, if you were to take away just one piece of advice from this article, I highly recommend this set of three.

1. Get an inclined footrest: More than upgrading your desk and chair, it’s important to get a good footrest to place your feet. If your feet aren’t touching the floor (or a footrest), they are likely to swing back and forth. When that happens, it is difficult for you to keep your spine erect. 

Ideally, the footrest should be inclined as shown in the picture. I will spare you the science. But in short, this results in your pelvis being straight with a maximum tilt of 10 degrees.

[A custom-made inclined footrest]

2. Keep the monitor at eye level: The biggest reason for neck pain, back pain, vertigo and subsequent productivity decline is that the height of the monitor isn’t at eye level. People get bored sitting in one place, so they keep shifting to sofas or beds.   

Even when we sit at a table, the laptop isn’t tall enough and hence we often stare down at it. Please use some books or pillows or even a carton to make sure the height of the screen is elevated to eye level. It shouldn’t go below a maximum of 30 degrees.

If you are 40+ with presbyopia, I also recommend using progressive lenses.

3. Get the right chair: While buying a chair, five things are important as the picture below illustrates. 

  • Height of backrest: While we love executive chairs, I highly recommend not using ones where the backrest reaches your neck. This subconsciously results in you leaning back. To avoid slouching, I highly recommend using a backrest.
  • Circular-shaped backrest: This is important as it mimics the shape of your spine. The backrest also adjusts, basis the pressure you apply.
  • Adjustable height: This will allow you to manage the monitor height, place your arms comfortably on the desk and ensure your feet can comfortably touch the footrest (or floor).
  • Soft cushion, for comfort.
  • Side handles, to rest your arms.

B. A little more effort—it will take you a long way

This next set of tips will require you to carve out some time and change some habits. But they will reap long-term dividends.

4. Walk during your business calls: The American heart association recommends 10,000 steps a day for your health. This is not just critical for your cardiac health, it’s also important for your hip mobility.

I recommend a simple shift if possible—walk during your business calls. Even if I take a conservative estimate, a 60-90 minute phone call will get you 5,000 steps easily.

5. Simple exercises: If you spend over 4 hours on your screens each day, you are at risk of your S-shaped spine slowly turning into C-shape due to slouching. 

[C shape spine vs S shape spine]

While you need to focus on your posture throughout the day, spending 15 minutes on the following exercises will be extremely beneficial. 

I would have loved to explain to you the importance of each exercise using an anatomy chart. And why they matter, based on your personal context. However, it’s not possible in this medium. 

All I can say is they work and can help you emulate the spine of an army officer or a model on the ramp. I hope that’s a good incentive to start. Why don’t you try it for one day, to begin with?

For children, to compensate for the lack of physical activity, I highly recommend picking an alternative such as cycling, playing games at home, skipping or stair climbing.

If you have comorbidities such as diabetes, or hypothyroidism, your muscles weaken faster. Walking or any form of physical activity is a must.

6. Working from a bed should be your last resort: The pandemic has made us fall in love with our beds. While for many it’s a compulsion due to the lack of a workstation, there are also those of us who enjoy the warmth of a bed. 

I will strongly advise against it. 

This is because when you sit on your bed as opposed to on a chair, your knees get raised above your hips. This will cause your tummy and belly muscles to protrude. Also, it’s almost impossible to maintain the screen height at eye level. Over time, this substantially weakens your back muscles and increases the chances of getting a slipped disc.

If you are, however, forced to work out of bed, there are a few things you can do. As I mentioned earlier, use pillows or cartons to manage the screen height as much as possible. It’s very important.

Use pillows to support your back. If your budget allows, use a half roller or a pillow that compliments your spine. Practice cross leg sitting and use study tables that allow you to occasionally stretch your legs. And make sure you take a stroll every hour. 

C. Securing your life 25 years from now 

Geriatric care is a key part of my practice. While this may seem unrelated to you at this stage, it’s an inevitable future that awaits you. 

Medical science has improved longevity. However, it doesn’t guarantee the quality of life you will have. Imagine if it is taking some of today’s 40-year-olds four months of intense physiotherapy to correct posture, what is your future at 80?

No amount of financial security will be able to help you. Your children will not be able to help you. And no nurse will be able to help you.

I often explain to my patients how this is a concept of debit and credit. If you accrue the debt of poor posture over several years, one single influx of credit will not resolve it. The only way is to invest each day.   

This is even more important for the current generation, those who are in their 40s and 50s—as you have been exposed to screens at a much younger age than the elderly of today.

While thinking of ourselves 25 years from now is a rare phenomenon, I am happy to report that I have seen a new breed emerge in the past three years.

These are usually people who have an integrated vision of their future, much beyond attaining financial security. They are thinking about what habits and behaviours they should build today so that at 70 they have a great independent life and aren’t bothered by trivial issues of knee pain.

Some of them are CEOs of large firms across south Asia. When I probed on what motivated them to join preventive physiotherapy, in addition to the reasons I cited above, they said they enjoyed how light their body felt. And how they couldn’t risk missing a couple of days from work. 

I hope their examples motivate you to invest in your physical fitness. If you do get motivated, here are a few things to keep in mind:

  • Progression of exercises is key to building habits: I am often asked if wearable devices that vibrate when you slouch can help in building a permanent habit around straight posture. I haven’t experimented with them enough to give a conclusive answer. However, in my 30 years of practice, one thing that patients have found success with is the progression of exercises. Typically, we treat a patient in three phases. First to relieve pain; second to strengthen the muscles of the area of pain; and finally to strengthen muscles of adjacent and interconnected areas for holistic strengthening of the body. Once you invest in the complete cycle, your muscle memory automatically results in a better posture. This is the sustainable change you should strive for.
  • Evolve a personal plan for yourself: The cloth needs to be cut to the size. Every individual is different. And your exercise plan needs to be developed accordingly. Your age, your nature of work, your hereditary history and most importantly, your vision for yourself—all play a role in developing your exercise plan. If they haven’t already, please ask your physiotherapist or coach to curate an exercise plan keeping your context in mind.
  • Investing in a guided session is well worth the investment: Having an expert guide you is well worth the investment. They would be able to monitor and review your progress and evolve your exercises accordingly. The tendency to postpone or skip also reduces in these situations.
  • If you are doing it on your own: I have been very happy to see many people take up gym, yoga, running and cycling. I would encourage you to evolve a personal plan for yourself based on your vision. Choosing the specific exercises for you might require a conversation with a professional. You then need to constantly reflect if your plan is meeting your goals. Also, please avoid overdoing it. I have a few patients who are runners with severe knee pain because of excessive running. This eventually turned out counterproductive to their vision. 

I hope these suggestions turn you into Barack Obama. I love how perfect his posture is, which was especially visible during his presidential walks. It’s an example that always puts a smile on my patients’ faces. I hope you are left with a similar feeling. 

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