One of the most common complaints I hear from my patients is difficulty with sitting. Every day I do my best to educate people about how to sit properly. Like most things I have learned, it is not as straightforward as I was taught in PT school. 

Through the years I have tried suggestions ranging from what I learned about ergonomics in school, to what I learned at my McKenzie training and more recently what I have read from the research I could find on posture and sitting posture in particular.

Let me make my point clear from the beginning...there is no “ideal” posture that will work for every person. 

What works the best is the posture that works the best for you as an individual. We are all made differently, different shapes and sizes. We do not fit chairs the same way. We do not have the same health conditions. We all need our own unique posture and because it is not possible for us all to have a custom made chair to sit in, we have to learn how to find the best position for ourselves individually given the surfaces we are given to sit on.

I will sometimes say for example, a person with severe stenosis does not benefit from sitting the same way as someone that has severe sciatica. Nor does someone with a compression fracture benefit from the same recommendations as a person with no history of any injury or previous back pain. These are spine-related examples, but it is also true someone that is 6’ 4” does not fit a chair the same way a person that is 5’ 4” does. I think you can get the point...we can’t find what works for others...we must find what works for ourselves. 

Much like my view on most things, there is no “ideal” way that magically works for everyone and not everyone fits into the category that most everyone else may fit into. This is part of the problem with ergonomics. It is a good idea in concept, but in practice it simply does not work. 

Through the years we have seen millions of dollars being spent to develop the “ideal work station” for office workers. We have seen car and furniture manufacturers invest tons of money into “comfortable” seating surfaces. We have also seen our understanding of the spine start to change from thinking heavy lifting is worse than sitting in an office...now it is not so clear.

We have tried to steer workers away from physical jobs into more sedentary jobs thinking we would be helping them with their back pain...unfortunately now we know that negative effects of sitting are not just to the spine, but to our overall health. 

The American Medical Association adopted a policy in 2013 to encourage employers and employees to find ways to avoid sitting during the day. The AMA adopted this policy because too much sitting has been linked to several diseases (high blood pressure, high blood sugar and Diabetes) and some cancers (breast, colon and endometrial).

Sitting has also been linked to reduced productivity at work, increased weight struggles including obesity and it also negatively affects a person’s mood. The bottom line is sitting is not good for you when done for extended time frames. And when I say not good for you, I mean all areas of your physical and mental life. 

It was with these factors in mind that I have been telling my patients, “ there is no good way to sit.”  I would then go on and cite the references (studies) I have read that have shown how ergonomics don’t work. I would refer to the recent studies comparing the negative effects of sitting to smoking. 

But just recently I started noticing that although it is true I should not encourage people to sit, and it is true I should educate people why sitting is so harmful, what is also true is that each individual has an “ideal” sitting posture that is unique to them, and my duty is to help them find their very own best sitting posture.

The reason I describe it this way is because the “ideal” posture recommended by a lot of experts does not take into account the health of the individual’s spine. The unique characteristics of the individual should determine the “ideal” posture, not the general idea of a “proper position.” 

Of course ergonomic training has in it brilliant suggestions and considerations. I am certainly not claiming to know more than those that created the programs, they have intrinsic value. I will describe my starting point and briefly tell why. But let me stress again that the “ideal” way is not the same way for everyone. It is important you find the posture/position that is most appropriate for you. And fortunately the way to determine this posture is 3 fold:

1.The ideal sitting posture for you is one that helps you to sit comfortably while you are sitting.

2.The ideal sitting posture allows you to get out of sitting position comfortably. In other words, if you feel great while sitting but find it difficult to get out of the sitting posture or if you find that you have more pain once you are out of the chair, immediately after sitting, then the sitting posture you chose was NOT helpful.

3.The ideal sitting posture is one that lasts 30-45 minutes maximum. It is important to change positions and stand after 30 minutes should be the goal.

I am a huge fan of changing positions, so although I think it is reasonable to hold a particular position for longer durations, what I think is more important is to get up and move every so often. And if you are not able to get up from sitting, like when we are driving, then it’s important to change the position by using a roll, reclining the seat, straightening the seat, leaning to the left then to the right; there are a lot of movements you can do to avoid any one position too long. But in the end getting out to walk around is the best choice!

In regards to the act of sitting, I advise people to start by scooting their bottoms to the back of the chair and to physically sit back against the chair. This is a good starting point to learn what “sitting tall” feels like. For some people this is enough. Others will need a lumbar roll to support their backs. Still others will find sitting reclined to be the best position and for people like me I find half sitting/half standing to be the most comfortable. I am not a fan of people trying to sit unsupported. Mainly because it is not likely they will be able to sustain the posture and a lot of people will slouch and this will likely be counter productive. 

Remember that if you are trying something new it is not always “comfortable.” Comfort is not the same thing as pain. So if you have pain when you sit, your body is asking you to move. It is not asking you to move and then simply return to the exact position you were in when it started hurting, but to actually move to an entirely new position. Muscles that are not used to activites can be “sore” but that can be avoided but holding positions for short durations and making sure you are sitting against the back of the chair fully. 

Sitting slouched is not recommended in most cases because the slouched position puts the discs in a position of failure. When we slouch the vertebrae are angled forward and this causes a shearing moment that can lead to breakdown in the disc. I am convinced that one of the most harmful things to the integrity of the discs in our back is sedentary lifestyles and specifically slouched sitting. That being said, if you have severe stenosis, often sitting slouch is the only way you can sit so as I said earlier it is more important to find your “own” ideal posture. 

Remember, find the position that feels the best to you, not only while sitting but also immediately after getting up from sitting. And make sure you are getting out of the chair every half hour or so to change the position and help to minimize the harmful effects sitting has on the rest of the body. 

If you need specific help then it is of course OK to seek help but a friendly suggestion to those seeking advice, make sure the individual is teaching you about “your individual best posture” not the “ideal posture” that is more general in nature.

If you would like my assessment or suggestions please contact my office at 518-306-6894.

This past week I read an article recommending when to use ice versus when to use heat. I would like to give my thoughts and hopefully clarify what I have found works best.

For most of my career I recommended using ice for injury and for pain. I did this primarily because I personally liked ice and how it worked for me. I did it also because I was taught like most everyone else out there that ice helped with swelling. I no longer recommend ice the way I did in the past. I now recommend ice to prevent (or at least minimize) swelling initially, but no longer recommend it to reduce swelling. 

Ice can help to delay or limit swelling and inflammation immediately after an injury, surgery or vigorous activity. Ice limits/prevents swelling by constricting blood vessels resulting in a slowing of blood flow. But that does not mean it can reduce swelling once the swelling has been established. This is why I use it immediately after an injury, surgery or vigorous activity. But after a period of time the fact that ice slows blood flow means that it is not helping to move the swelling, it’s not exactly stopping it from leaving the injured area but it certainly is not reducing the amount of swelling. In my opinion, ice is not the most effective way of dealing with swelling.

When you have an injury, the standard recommendation is to use the RICE protocol (Rest Ice Compress and Elevate.) Let’s say you sprained your ankle, the first step is to follow the RICE protocol. 

Rest: (i.e. get off your sprained ankle) 

Ice: (apply ice for 20 minutes then allow the tissue to warm, so you don’t freeze it or get frostbite and then ice again) 

Compress: (use an elastic wrap or other means to compress the area)

Elevate: (above the heart is the MINIMUM elevation...I recommend people lift their foot to the highest level when they sprain their ankle)

I recommend the following: Use ice for the first 24 hours immediately after an injury to limit how much swelling you get, then switch to CHEM: Compress Heat Elevate and Move. (I made up the acronym CHEM.)

Compress: I have found compression to be far more effective at reducing swelling than any other method and it also works quickly. I have had several patients tell me the most effective advice I gave them was using compression to reduce the swelling. I like it so much that I typically say it at least 10 separate times during an evaluation to get the point across and follow up by wrapping my patients before they leave or suggesting where to find compression garments or compression tape that does the job.

Heat: I no longer recommend ice past 24 hours to help with swelling because it slows blood flow and I am trying to increase blood flow to get rid of the swelling. For muscle injuries I mostly recommend heat and IF I recommend ice, I only recommend it immediately after an event. So if one of my tri-athlete patients has an event and they are doing a big training session I don’t mind using ice to limit and/or hopefully prevent swelling immediately after the training or event, but then the next day I suggest heat and of course compression. 

Elevate: I also like to recommend elevation and I teach my patients with lower extremity injuries to elevate their legs as high as they can. I recommend using the back of a couch for example or one of the big exercise balls. This is a perfect time to be compressing the area as well. 

Often patients will tell me they elevate their legs on their recliner. I am sorry to tell you this is not elevation. This is better than putting your feet on the ground, but it is not the same as elevation and it is not effective for reducing swelling. It may help limit swelling and is better than nothing. 

Move: The final thing I recommend is to move. I have a couple slogans I tell my patients: “when in doubt, move about” and “do a little bit a lot.” The two most common mistakes people make when moving are to do too much or to do too little. Finding what is just right sometimes requires trial and error so I recommend doing 10-15 minutes of some type of activity and then stopping to see what effect it has on the body. Then I recommend doing the same thing every hour. This is how you can do “a little bit a lot.” 

It sometimes helps to have someone guide you through the type of movements that are most effective and most efficient, but it is absolutely not necessary to use the “no pain, no gain” philosophy, which applies specifically to building muscle and does NOT apply to joint issues or injured muscles. No purpose is served trying to force yourself to get better, often this slows the process. 

I am sure there are people out there reading this that have heard their whole lives that ice is good for reducing swelling and although I also used to recommend that, I am more inclined to use compression before ice. Compression can be used 24 hours, 7 days a week, whereas ice should be used for 20 minutes and then there should be time to allow the tissue to warm up again before icing again. 

Clearly compression has a bigger impact. Also due to the nature of most people’s lives, taking the time to ice more than a couple times a day is simply not practical, and yet compression is something you can have on and remain active. I often tell people that if you are only icing a couple times a day it is really not having the effects you think it is. The reduction in blood flow is temporary, so doing it once or twice a day is not very effective. Just another reason to use compression.

Compression prevents fluid from accumulating, it assists our blood flow and it can be used all day long. This is the way to go for sure.

Ice is effective when you use it a lot immediately after an injury to immediately after a big training event and ice is also a way to reduce pain. For the people that like how ice reduces the pain by numbing the area, then of course ice is an effective strategy. In this case it is not being used to reduce swelling, but rather for pain relief. If you are reducing pain with ice then you have chosen an effective method. If you are using ice to reduce swelling there are much more effective and efficient ways (i.e. compression).

I decided to write this because although it goes against things we have all learned, I have found the approach to be more effective and more efficient. I am a huge proponent of reducing swelling, and have found that by doing this, my patients are able to move more effectively and progress through rehabilitation faster. It is just not an effective strategy to rely on using ice. Heat is OK and I am not opposed to it, but in truth the most effective means I have found in reducing swelling is to use compression.

To summarize, use ice immediately after injury or very intense exercise and for up to the first 24 hours. Use compression immediately and persistently until the swelling is fully subsided. Use elevation, the higher the better, immediately after and until the swelling is fully subsided. Use heat, especially with muscular disorders after 24 hours. And finally, when in doubt move about, but make sure you start moving by doing a little bit, a lot.

If you have questions or are uncertain about what to do, feel free to contact me and I can guide you through the process. Good luck, and be well. 

Matthew Goodemote can be contacted by calling (518) 306-6894. Goodemote Physical Therapy PLLC is located at 3 Maple Dell in Saratoga Springs.