To Fix That Pain In Your Back, You Might Have To Change The Way You Sit

Aug 13, 2018
Originally published on August 13, 2018 11:49 am

My back hurts when I sit down.

It's been going on for 10 years. It really doesn't matter where I am — at work, at a restaurant, even on our couch at home. My lower back screams, "Stop sitting!"

To try to reduce the pain, I bought a kneeling chair at work. Then I got a standing desk. Then I went back to a regular chair because standing became painful.

I've seen physical therapists, orthopedic surgeons and pain specialists. I've mastered Pilates, increased flexibility and strengthened muscles. At one point, my abs were so strong my husband nicknamed them "the plate."

All these treatments helped a bit, at first. But the pain never really went away. So a few years ago, I decided to accept reality: Sitting down is — and will always be — painful for me.

Then back in November, I walked into the studio of Jenn Sherer in Palo Alto, Calif. She is part of a growing movement on the West Coast to teach people to move and sit and stand as they did in the past — and as they still do in other parts of the world. For the past 8 years, Sherer has been helping people reduce their back pain.

I was interviewing Sherer for a story about bending. But she could tell I was in pain. So I told her my story.

Her response left me speechless: "Sitting is a place where you can find heaven in your joints and in your back," she says. "It's not sitting that's causing the pain, it's how you're sitting.

"Do you want me to show you how?"

Do hunter-gatherers sit less than we do?

Recently there's been a lot of talk about how much Americans sit.

There's a perception that we sit way more than any other culture out there — or even any culture throughout time. For the first time in human history, we sit for these long stretches, day after day.

Anthropologist David Raichlen at the University of Arizona says that is not accurate.

"No. Not from our data," says Raichlen.

Raichlen studies modern hunter-gatherers called Hadza, in Tanzania. They live primarily off wild foods, such as tubers, honey and barbecued porcupines. And to acquire this food, there's no doubt they are active.

They climb and chop trees to get honey. They dig for tubers and pound nuts.

"They do a lot of upper body work," Raichlen says. "And they spend quite a bit of time walking — at a pretty high rate of speed."

On average, Hadza adults spend about 75 minutes each day exercising, Raichlen says. That amount is way more than most Americans exercise. Many of us can't muster a measly 2.5 hours each week, as recommended by the Centers for Disease Control and Prevention. So there's no doubt the Hadza are in better cardiovascular health than most Americans.

But do the Hadza actually sit less than we do?

A few years ago, Raichlen and colleagues decided to find out. They strapped heart-rate monitors onto nearly 50 Hadza adults for eight weeks and measured how often each day, they were just, well ... sitting around. The results shocked Raichlen.

"The Hadza are in resting postures about as much as we Americans are," he says. "It's about 10 hours a day."

By comparison, Americans sit about nine to 13 hours each day, on average, a study reported in 2016.

But here's the thing: The Hadza don't seem to have the back issues that we Americans have, even as they age.

"Not that we have found," Raichlen says. "There hasn't been a ton of studies looking into muscle and joint pain in the Hadza groups, but people are highly active across the life span. There are some declines in activity with age but nowhere near what you get in the U.S."

Not how much, but how we sit

So maybe Sherer is right. Maybe the problem, when it comes to back pain, isn't how much Americans are sitting, but the way we're sitting.

"Yes, I think that's probably a big part of the story," Raichlen says.

Orthopedic surgeon Nomi Khan agrees.

"Most of us do not sit well, and we've certainly been putting a lot more stress on our spines," says Khan, who operates on spines at Sutters Health's Palo Alto Medical Foundation.

If we change the way we sit, Khan says, it will help to decrease back problems.

"We should sit less, and we should sit better," he says.

Over the past century or so, many Americans have lost the art of sitting, he says. Most people in the U.S. — even children — are sitting in one particular way that's stressing their backs. You might not realize you're doing it. But it's super easy to see in other people.

Here's how: Take a look at people who are sitting down – not face-on but rather from the side, in profile, so you can see the shape of their spine.

There's a high probability their back is curving like the letter C — or some version of C. Or it might make you think of a cashew nut, sitting in the chair. There are two telltale signs: Their shoulders curve over and their butts curve under. That posture is hurting their backs, Khan says.

"Most people tend to round out their backs when they sit," Khan says. "Their spine is in an improper position, and they will tend to have more back problems."

Back problems crop up because sitting like a C — or a cashew nut — can damage the little shock absorbers in the spine, called the intervertebral disks.

"You can think of a disk as a jelly doughnut," Khan says. "Sitting like a C puts a lot more pressure on the front of the doughnut than on the back."

And what happens when you press down on one side of a jelly doughnut but not the other side? Jelly can squirt out.

Your spinal disks aren't much different. Sitting in a C-shape, over time, can cause disk degeneration. Or one side of a disk can start to bulge. "The disk can then push against nerves, or it can rupture," says biomechanist William Marras, who directs the Spine Research Institute at Ohio State University.

"When the disks get messed up, you've got real problems," Marras says. "So everything we do in biomechanics is to try to protect the disks."

Straightening out the C

At Sherer's studio, she pulls a up a photo of gray-haired man sitting at a loom. He must be at least in his 60s.

"This is taken in Rajasthan, India," Sherer says. "The man sits at the loom weaving, for hours and hours every day, just like we do at a computer," she says. "And yet his spine is still elongated."

Elongated is an understatement. This man's spine is straight as an exclamation point. His shoulders are rolled back. His muscles looked relaxed and flexible.

I've seen similar sitting postures in other rural pockets around the world — for example, in eastern Liberia during the Ebola outbreak and in the Yucatán countryside. (Basically anywhere people still do a lot of hip-hinging when they bend over. Because what do you do when you sit down? First you bend over.)

In fact, you don't have to go back very far in history to find the same posture here in the U.S. Photos and drawings from the early 20th century show that many Americans sat with straight backs and shoulders rolled back, similar to the man at the loom. Today, you can find a similar posture with babies and young children.

So what happened?

One of the problems, Sherer says, is our culture focuses on trying to fix the upper body. "Sit up straight," parents and teachers say, and most of us immediately stick our chests out.

But that's the last thing you want to do, Sherer says.

"Even just hearing the word 'spine' makes people lift their chest because they want to have 'proper posture,' " she adds. "But when I see it, I'm like, 'No! That's what causes back pain. Lifting your chest is going to make your back pain worse.' "

Instead of focusing on the chest or shoulders, Sherer says, we need to turn our attention to a body part that is lower down, below the waist: the pelvis.

Or to put another way — your butt.

"The most important thing to change to reduce back pain is your pelvis position," she says. "It's like a stack of toy blocks. If the blocks at the bottom aren't sturdy, then the top has no chance."

Pull your tail out so it can wag

Sitting in Sherer's studio, I glance over at my profile in the mirror. And right away, I see the cashew shape. It doesn't look pretty. My shoulders are rolled over my chest, and my pelvis is tucked under my spine.

To figure out how to shift your pelvis into a healthier position, Sherer says to imagine for a minute you have a tail. If we were designed like dogs, the tail would be right at the base of your spine.

"When you sit with a C shape in your spine, you're sitting on this tail," Sherer says. "It's kind of like a dog with its tail between its legs, who is scared and frightened."

To straighten out the C shape, Sherer says, "we need to position the pelvis in a way that this tail could wag."

In other words, we need to untuck our tails. To do that, Sherer says, you need to bend over properly when you go to sit down.

"Bend over?" I ask. "Do I bend when I sit down?"

"Yes!" Sherer exclaims. "Every time you sit down, you bend somewhere."

And where you bend determines how you will sit.

If you bend at the waist, which many Americans do, then you will likely sit with a C or cashew shape.

If you bend at the hips (as we learned about in a previous story), you're more likely to sit correctly with your tail untucked.

"Bending at the hips can be hard for many people to figure out," Sherer says. "It's a bit counterintuitive."

But she has a trick to help people learn.

"Stand up and spread your heels about 12 inches apart," she says. Now, put your hand on your pubic bone — like a fig leaf covering up Adam in the Bible, she explains.

"When you bend over, you want to let this fig leaf — your pubic bone — move through your legs," she says. "This creates a crease between your pelvis and legs."

This action also pretty much pokes your butt out, behind your spine. "Now go ahead, sit down," Sherer says.

Now my butt — or my imaginary tail — is behind my spine.

The next step is to relax the muscles in your back and chest. "Stop sticking your chest," Sherer says. Then the rest of the spinal vertebrae can stack up in one straight line, like an I instead of a C.

The crazy part, Sherer says, is that when the tail comes out, some of the tight muscles in your legs will actually start to relax or stretch.

"If you untuck your pelvis while you sit, your quadriceps muscles can relax, and then your hamstrings can stretch," Sherer says.

I could definitely feel my quads relax. The muscles felt like butter set on a warm pan: They softened and seemed to melt.

Man, this felt good. "Oh wow!" I exclaimed, as a chill went up my body.

If you don't feel your hamstrings stretch — and your quads don't relax — you're probably not doing the action correctly, Sherer says.

"Then you're probably using your lower back muscles to push your butt out," she says. "That can cause more back pain. You don't want to do that."

How am I sitting now?

After leaving Sherer's studio, I realized that I had been sitting with my tail — or pelvis— tucked for decades. And it wasn't easy to fix. I had to return to Sherer's studio for many appointments and work hard, every day, to learn how to untuck my pelvis while sitting at my desk.

But little by little, the muscles around my hips started to loosen up. The pain began to dissipate, very slowly.

After mastering the new sitting position, I decided to visit Khan to get his opinion. "Do you want to look at my pelvis and see what you think about how I'm sitting?" I asked the spine surgeon.

Khan took his hand and placed it on the base of my spine, right at the top of my pelvis.

"You're sitting perfectly," he said nonchalantly. "Because you're basically sticking your butt back and creating this little curve at the lower part of your spine."

"If you sit like this, you're going to put a lot less stress on your spine and have less back issues," Khan added.

And as an added bonus, I feel like I'm following the spinal pose of Jennifer Lopez: curvy on the bottom and straight on top.

Copyright 2018 NPR. To see more, visit http://www.npr.org/.

DAVID GREENE, HOST:

Researchers have been looking at how Americans are sitting and how bad it is for our health. Some have even called sitting the new smoking. And they say it's contributing to an epidemic of back pain. But what if the problem isn't how much we're sitting but the way we are doing it? NPR's Michaeleen Doucleff explains how Americans have lost the art of sitting and how they can get it back.

MICHAELEEN DOUCLEFF, BYLINE: There's this idea that Americans sit way more than any other culture out there, that for the first time in human history we've created a sitting culture. But David Raichlen at the University of Arizona says that's not actually correct.

DAVID RAICHLEN: No. I mean, not from our data.

DOUCLEFF: Raichlen is an anthropologist. He studies modern hunter-gatherers.

RAICHLEN: We work with this group, the Hadza, out in Tanzania.

DOUCLEFF: The Hadza's lifestyle is about as close as you can get to seeing how early human ancestors might have lived. Today the Hadza live off wild food - think tubers, honey, barbecued porcupines. And to get this food, there's no doubt they are active.

RAICHLEN: They climb. They do a lot of upper body work when they pound nuts and they do a lot of digging and that kind of a thing.

DOUCLEFF: On average, they spend about 75 minutes each day exercising, which is way more than most Americans do. But do the Hadza sit less than we do? No one had actually gone out and measured it, so Raichlen and his team strapped heart rate monitors onto nearly 50 Hadza adults, then measured how often each day they were just, well, sitting around. The results shocked him.

RAICHLEN: It's, like, 10 hours a day. So it's about as much as we are.

DOUCLEFF: Ten hours each day - that's basically what I do at my desk each day. But here's the thing. The Hadza don't seem to have the back issues that we Americans have even as they age.

RAICHLEN: People are highly active across the lifespan. You know, there are some declines in activity with age, but nowhere near what you get in the U.S.

DOUCLEFF: So I asked him if he thinks the problem isn't how much Americans sit but the way we sit.

RAICHLEN: Yeah, I definitely think that that's probably a big part of the story.

DOUCLEFF: Now, I know what you might be thinking. Raichlen is an anthropologist, not an expert on backs or back pain. But Dr. Nomi Khan is. He's a spine surgeon at Sutter Health's Palo Alto Medical Foundation. And he agrees with Raichlen.

NOMI KHAN: Most of us do not sit well. So we've certainly been putting a lot more stress on our spines.

DOUCLEFF: So do you think if we change the way we sit it could help to decrease back problems?

KHAN: Yes. I think we should sit less, and I think we should sit better.

DOUCLEFF: That's a key difference between us and the Hadza. They, unlike us, know how to sit. Khan says that most people here, even kids, have gotten in the habit of sitting in one particular way that is hurting our backs. You might not realize you're doing it, but it's super easy to see in other people. Here's an experiment. Go over to somebody sitting down or look across the office. Don't look face on but from the side so you can see the shape of their backs. There's a high chance their back is curving like the letter C. The shoulders curve over, and the butt or bottom curves under.

KHAN: Most people, they round out their back when they sit.

DOUCLEFF: For some people it looks more like a cashew nut than a C. But Khan says it's still bad for the back.

KHAN: So that's the improper way of sitting. Their spine is in an improper position. And they tend to have more back problems.

DOUCLEFF: The back problems crop up because over time, sitting like a C can damage spinal disks. William Marras directs the Spine Research Institute at Ohio State University.

WILLIAM MARRAS: So this is this little shock absorber in between the vertebrae that allows you to move and bend and twist. And when that thing gets messed up, you've got real problems.

DOUCLEFF: You can think of the spinal disks as these little jelly doughnuts stuffed with soft, gooey jam. Sitting like a C presses on one side of the doughnut. If you do it long enough, some of the jelly can squirt out.

MARRAS: That's very bad for the disks because it can push against nerves, and it can rupture. And - so everything we do in biomechanics typically tries to protect that.

DOUCLEFF: So how do you straight out the C and start protecting those disks? Jenn Sherer has been helping people do just that for eight years at her studio in Palo Alto. She says our culture focuses on trying to fix the upper body. We hear people say sit up straight, and the first thing we do is stick our chest out.

JENN SHERER: You say the word spine, and that's what everyone does, is they lift their chest 'cause they want to have proper posture. And I'm like, no, that's what causes more back pain.

DOUCLEFF: That's going to make things worse?

SHERER: Yes, it makes things worse.

DOUCLEFF: Instead, Sherer says, we need to focus on another body part, one that's farther down, below the waist.

SHERER: The pelvis.

DOUCLEFF: Or another way to put it - focus on your bottom.

SHERER: The most important thing to change to reduce back pain is your pelvis position. It's like blocks. If the blocks at the bottom aren't set and aren't sturdy, then the top has no chance.

DOUCLEFF: So to fix your pelvis, Sherer says you have to imagine that you have a tail just like a dog right at the base of your spine.

SHERER: We need the pelvis to be positioned in a way where if you had a tail, it could wag.

DOUCLEFF: In other words, for proper spine alignment, your bottom needs to be out behind your spine. Sherer says right now most people do the opposite. We tuck our tails under when we sit.

SHERER: Sitting within a C curve, you'd be sitting on your tail.

DOUCLEFF: So it's kind of like a dog that has his tail between his legs.

SHERER: Yes, very scared or frightened.

DOUCLEFF: And so then how do we get our tail out?

SHERER: Do you want me to teach you?

DOUCLEFF: Yeah, sure, sure, sure.

Sherer says before you sit, have your legs about 12 inches apart. As you sit...

SHERER: Poke your butt out.

DOUCLEFF: Toward the back of your chair so when you land on the chair, your bottom is behind your spine. You can kind of put your hand back there and check. Sherer says that when that happens, your tail untucks, and some muscles in your legs will start to relax.

SHERER: Can you feel that?

DOUCLEFF: Ooh, yeah.

And for me, this muscle relaxation felt really good.

SHERER: You feel all those releases?

DOUCLEFF: Ooh, it's tingling. It's tingling, like, up my body. Wow.

For decades, I've been sitting with my pelvis tucked in. And it wasn't easy to fix. But I've had a lot of back pain, so I was motivated to try this. I spent months working to get my tail to come out so it could wag. And after mastering it, I thought I'd give Dr. Nomi Khan visit to see what he thought.

KHAN: You're sitting perfectly because what you're doing is you're basically sticking your butt backwards.

DOUCLEFF: Which allows my spine to stay straight, protecting those all-important spinal disks. Michaeleen Doucleff, NPR News.

(SOUNDBITE OF VUREZ'S "GLORIOUS CRYSTAL GLEAM") Transcript provided by NPR, Copyright NPR.