Posture Part II: Strategies for Improvement

On a previous blog post titled Posture: Does it Matter?, we discussed some of the nuances of posture, breaking down “good” and “bad” posture related to both psychosocial and biomechanical/physiology principles, how the dynamic nature of posture might be more aptly named as acture, and what factors could potentially influence a downward spiral into inefficient postural tendencies.

With a more clear idea of what posture is and is not, we can now discuss some practical ways to improve our posture from the inside out as well as the outside in.

Many of us with postural issues require hands on, neuromuscular training facilitated by a professional to help to relearn efficient movement patterns from the ground up. However, there are also regular strategies that all of us can bring into our daily lives to help enhance our postural awareness, comfort, and prevent issues arising from our habitual posturing.

Change Positions, Move Often

We have the wonderful ability to choose what posture is best for us in any given situation. Sometimes being in more of a flexed position will be desirable, sometimes being more upright will be desirable. Consider cycling between three or four shapes throughout the day rather than always trying to find one “correct” position. What works for us in one moment will not be the best choice in another, and what works best for one person will not be the same as what is best for a different individual. When a specific posture is desired for a prolonged period of time, consider what will allow for the greatest sense of comfort, ease, and support. Notice what your ease of movement is when you are turning and reaching for things, trying to find a position where you can have more freedom of motion. Generally speaking, the most efficient posture will be an upright carriage in which the bones of our spine are stacked, so each bone is able to receive support from the bone that is beneath it.

Another strategy is to move more often throughout the day, establishing a system of movement breaks, stretches and short walks throughout the day. By dynamically changing the length, tension, and blood flow into a variety of tissues, it is less likely that any particular area will get sore, tired and overworked, and less likely that habitual postures will become an issue over time. See our Movement Snacks blog for some ideas on how to bring small movement breaks into the rhythm of your daily routine. A regular, well-rounded fitness routine will also help, which might include a blend of activities that promote cardiorespiratory and musculoskeletal health (e.g. aerobics, strength-training, yoga). Additionally, here are some gentle yoga stretches that you could do throughout the work day-

Consider putting up sticky note reminders to move, stretch, walk around, and change positions throughout the day.

Tips for Finding Effortless Sitting Posture

The following description includes some tips for sitting ergonomics to help support an upright carriage. While most people find these strategies to be helpful and comfortable, keep in mind that one size does not fit all.

• Feet flat on the ground

• A chair with some degree of firmness, with hips at least as high as knees.

• Back support behind low to mid back. A partially deflated children’s ball, folded towel or blanket, or any other object that is comfortable can provide this support

• Head on top of rib cage, rather than significantly protruding forward. Vision and size of text on the screen can play into a forward head tendency, so check that you can see the screen well without craning your head forward. 

• It may be helpful for your screen to be directly forward of eye level, rather than higher or lower.

Enhance body awareness

If we are not aware of our body position, we have much less ability to change it. To further enhance your ability to feel and sense your posture and choose efficient options, consider regularly practicing embodied practices such as yoga, qi-gong, tai chi, body scans, and Feldenkrais lessons, which will help improve postural awareness. Becoming familiar with some “landmarks” of our body can be helpful, such as awareness of where on our pelvic bones we are sitting, where on our feet we are standing, where our chest bone, nose, and eyes are oriented towards. Some lessons that may be helpful for posture that most Wellness Station clients will be familiar with are the pelvic clock, easy turning, and shoulder elevators. Here is an example of the pelvic clock lesson to help you bring a better sense of ease and awareness into your sitting posture. 

To become more aware of your standing posture and ability, use a protruding corner in your house or a door frame to feel the back of your body. Stand against the corner or the edge of a door frame with knees slightly bent, feet slightly in front. First, get a general sense of how much of you can make effortless contact with the edge from the back of your pelvis to the back of your head. Then, tuck your pelvis under so your low back makes contact with the edge. Keep your low back in contact with the edge, as you try to bring your mid and upper back in contact with the edge. Roll your upper back up and down the edge a few times, keeping your low back in firm contact. How much of your upper back can easily contact the edge? Bra strap level? Top of shoulder blades? Regularly checking this can give you a sense of your posture and any changes over time that might be occurring in your ease of effortless stacking.

Ask your Wellness Station practitioner to provide you with additional lessons to help enhance your senses with consideration of your individual needs, limitations, and goals.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

References:

1. Image address:

https://centr.org/images/article/Back_exercises-2.jpg

Reversals: What and Why?

Reversibility is the ability to stop, start, and change the direction of a motion at any point in time.

According to Moshe Feldenkrais, the ability to perform reversals is a key indicator of well-organized, refined movement. When performing a movement, consider your ability to turn around and go the other direction, pause, or do something else. When our reversibility is impaired, it indicates a lack of freedom to change our minds or to respond to changing circumstances. This can be evident in certain functional movements: can we sit down in a chair or get on the floor slow and controlled, or is there a plop? When attempting to change the direction of a movement (e.g. pelvic clock circles), are we able to find a flow or is there jerkiness and incoordination? Can we walk backwards? 

Reversibility is not just a movement, but a state of existence.

Our ability to be spontaneous, go with the flow, adapt, maintain presence and freedom of choice. An ability to perform reversals indicates that we are not moving on autopilot, but have a keen sense of what and how we are doing something in the present moment. When we reverse, we are traveling the same territory but from a flipped perspective. In the muscular system, what primarily for a particular muscle or muscles has been a concentric action (muscle shortening under tension) will become an eccentric action (muscle lengthening under tension). As mentioned above, “sit to stand” is a concentric action, and “standing to sitting” is an eccentric action. When we purposefully choose to reverse, it provokes the cognitive process of attentiveness, comparing and contrasting. This is one of the key requirements for learning.

When we use movement to enhance our learning, the quality of our lives can expand.

As we go through life, there may be a gradual tendency towards settling into our habitual patterns, and an associated loss of spontaneity, functional mobility, and options for how we move and engage with ourselves and the world around us. We may not be able to respond as quickly to the demands of the situation, like needing to step back quickly to avoid an oncoming vehicle while crossing the street. Or we may lose the agility required to turn around when we forgot our keys, and instead of taking one step backwards, we may need to take several small steps to turn ourselves around. The person who has difficulty with these reversals is much more vulnerable to falling when they do have to turn around quickly. Practicing reversals helps us learn more about how we move, and can expand our movement repertoire so we have more options available to us. We certainly do not want our only option to be able to plop down into a chair each time, rather than gracefully descending in any way we choose. Reversals are a key requirement for developing and improving balance, agility, neuromuscular control, and eccentric strength. In fact, dynamic balancing is essentially reversals in action.

Practicing reversals

Walking backwards

Walking backwards is a task that may have originally been easy, but perhaps can become impaired over time. If unsteadiness is present, perform this practice next to the kitchen counter or back of the sofa to have something to hold on to as needed.

Simply start by walking forwards slowly, paying attention to how your body moves, how the feet make contact with the ground, etc. Then, reverse it. Walk backwards, comparing and contrasting this experience to walking forwards. 

Check out this article that dives into the health benefits of walking backwards.

Focus on the eccentric

Bring attention to the lowering component of a movement, whether this is in strength training or daily life.

A simple example is to practice standing up from a chair, paying attention to how you do this. Then, try to sit down the same way in reverse, challenging yourself to lower down slowly. Compare and contrast the process of standing and sitting in terms of the mechanics of the movement as well as the sensory experience.

If strength training is part of your routine, pay attention to the lowering movement such as the descent into a squat, the lower of the weight during a bicep curl, or the lowering of your chest towards the ground during a push up. Try to refine the control of the movement, with the ability to slow it down, pause it at any moment, or reverse the movement at any point in time. Also, in a safe manner, practice some reversals quickly, because sometimes that is what life demands!

Yoga Transitions

If yoga is part of your routine, tune in to the transition between two poses.

A simple example is cat and cow, which involves reversing between spinal flexion and extension. Tune in to the exact moment of transition, and explore reversing the movement at different speeds, and at different phases of the motion (e.g. can you do the cat cow in slow motion, and switch between cat and cow through variety of ranges, rather than going all the way into the full expression of cat pose before transitioning into cow?)

This can be applied to any transition in yoga (or life off the mat). Get creative with it- pick any two yoga poses, and explore a variety of transitions between the two shapes.

Explore Your Own

Enhance your sense of spontaneity and exploration by bringing reversals into your daily life.

Perhaps make up a dance move. Practice the move again and again. Then, try reversing the move, as if someone recorded you and played it in rewind. Or, take an everyday task. Reaching for a glass. Can you pause as you reach, and reverse it? Repeat this, reversing the movement at various stages of the reach.

Notice if this brings any greater sense of awareness of your movement and ability to choose different options for how to reach for something. And notice how much more confident you will be crossing a street when an unexpected vehicle requires you to take a very quick step backwards.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

References:

1. http://kinesophics.ca/reversibility/ 

2. https://www.movementandcreativity.com/blog/podcast/2021/2/7/on-reversibility-the-ability-to-stop-start-or-change-direction-at-any-moment 

3. https://www.eatingwell.com/article/8013593/health-benefits-of-walking-backward/

The Importance of Unilateral Exercises

Most movements can be divided into two categories: unilateral or bilateral. Unilateral exercises are asymmetrical, in which one side of the body (e.g. one leg) is performing an action that the other side does not. Bilateral exercises are more symmetrical, in which both sides of the body are doing roughly the same thing. Both types of exercises are important and functional, but unilateral exercises will facilitate certain benefits that cannot be obtained from bilateral exercises alone. Some examples of unilateral exercises are: reverse lunge, single-leg bridge, single-arm overhead press, split squats, and single-leg deadlift. Examples of bilateral exercises include a squat, deadlift, barbell overhead press, push up, and bridge. In real life, we engage in both types of movements extremely often.

But, because life is rarely symmetrical, unilateral exercises tend to be more relevant to daily life.

Standing on one leg to pull your pants on. Reaching for the glass on the top shelf. Walking. Running.

Bilateral and unilateral exercises both serve a crucial role in functional fitness. While more force and power can be created with bilateral exercises, unilateral exercises require greater balance and stability. They can bring awareness to compensations and imbalances between sides of the body that can easily be overlooked during bilateral movements.(1)

For example, if one has weakness in the left leg characterized by a difficulty in distributing and generating forces, maintaining balance, or moving through a functional range of motion under load, a unilateral exercise will make this extremely clear. If one only ever did regular, bilateral squats, the right leg would continue to overwork, perpetuating a compensatory pattern that could contribute to issues down the road. While we should not expect that our two sides should be equal in their ability, it is helpful to be aware of our unique characteristics and engage in movements that will provide a stimulus for positive adaptations to occur. 

It is important to recognize that with most unilateral, “single leg” exercises, both of your legs continue to carry out an important job. Put simple, one is the mover, and one is the stabilizer. Contrary to what might be evident visually, it is the leg that is not moving that actually has the more difficult job. One leg is weight-bearing, and one leg is non weight-bearing (or bearing less weight than the other leg). The leg that is holding our weight is responsible for maintaining our balance and control of the movement, while the other leg is free to move through space. Consider walking. At each moment in time, one leg is holding your weight, foot on the ground, allowing you to move your other leg forward. By becoming more aware of where we are holding our weight, and which leg is free to move, we can refine our coordination, balance, and efficiency of movement. 

Mime Walking Example

Mime walking is a standing movement lesson that almost all Wellness Station clients learn early on. Many of us begin to have difficulty gliding our pelvis to shift our weight, which can be evident from a forward-flexed posture, short step length, and difficulty standing on one leg. This lesson helps to bring about greater elegance and ease to walking by teaching awareness of weight shifting from one leg to the other. The basic idea is to glide the pelvis to one side (e.g. right) so one leg holds your weight while the other leg lightens up, and then repeat on the other side. Once this concept is learned and felt in the body, countless variations and progressions can emerge that will translate into improved function and ease of walking.

Single Leg Stand to Reverse Lunge

To further progress mime walking, we can apply this motion into a single leg stand. We become aware that one leg is holding us up and controlling our movement and stability, while the other leg is free to move through space. Applying this into a single leg stand to reverse lunge flow is a dynamic way to improve balance, strength, and awareness of our differences from side to side. 

If lacking in steadiness and ease, gently hold on to a support surface with a hand (put your hands in the kitchen sink!), or don’t move the non weight-bearing leg through such a large range. 
If more challenge is desired, move in slow motion, increase the range of motion of the non weight-bearing leg, and/or hold a dumbbell.

Sit to Stands and Squats: Unilateral Bias

A basic squat or sit to stand movement can be changed to have a unilateral focus by holding more weight through one leg intentionally. Coming up onto the tip toes of one foot is a way to do this. 

If lacking in steadiness and ease, use a higher chair, and/or don’t come up as high onto the tip toes (keep more of the non weight-bearing foot grounded). Or, hold on to the kitchen sink as you do this motion. 

If more challenge is desired, use a lower chair or squat through a deeper range, move in slow motion especially on the way down, hold a dumbbell at the chest, or even practice hovering the tip toes off the ground. 

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Sources: 1 https://www.self.com/gallery/single-leg-exercises

Osteoarthritis: To Move or Not To Move?

Osteoarthritis (OA), which is also known as degenerative joint disease, involves a wearing down of the flexible cartilage tissue at the ends of the bones that form joints. It is the most common form of arthritis, and it is estimated that over 32.5 million US adults are affected by it!(1) Prevention strategies of arthritis before it occurs is the most effective way to make sure it will not become an issue in your life. These strategies may include improving movement patterns, staying active, keeping your muscles strong and joints flexible, having good nutrition while avoiding processed and pro-inflammatory foods, staying hydrated, maintaining a healthy weight, and ensuring adequate recovery from exercise with enough sleep and gentle movement.

Once a joint has become arthritic, what are some strategies to keep in mind to optimize functioning, improve joint health, and mitigate the impact that this condition could have on quality of life? 

There is plenty of misinformation out there regarding arthritic joints. Even the terms used to describe OA colloquially can impact the public’s perception in a negative way. Degenerative joint disease. Wear and tear arthritis. Bone on bone! These types of descriptions bring scary images to mind, and imply that movement and exercise is actually unhealthy for joints and can contribute to joints wearing out. Certain doctors may tell their patients with OA that they should not do certain things any more- bend, lift, squat, kneel, run.

Too often, adults with arthritic joints begin to fear movement, or the pain that they may associate with movement, and will begin to exhibit compensations in the way they move. They may begin to become more sedentary, limit participation in various activities, and develop a resentful relationship with the involved body part. These changes contribute to a snowball effect, in which case the changes in mindset and behavior lead to further decline in joint function and tissue weakness, which continues the arthritic process, thereby leading to further pain, fear, and avoidance of movement and activity.

On the other hand, some people may overdo vigorous activity, which can increase inflammation and contribute to additional strain on compromised joints. It can be difficult to find the balance between too much and not enough. Lower impact, moderate activity performed on a consistent basis tends to be the sweet spot in which those with arthritis can keep their joints mobile and strong without contributing to flare ups and potential joint injury. 

Movement is absolutely essential for all of us, and especially for those with OA. If the question is move or don’t move an arthritic joint, the answer is to move intelligently and often.

As arthritic joints tend to become hypersensitized to loading, we must load the joints efficiently without strain, and allow the muscles and other tissues around the joint to get stronger. Stronger, smarter muscles will provide shock absorption and support for the joints, which helps attenuate the forces from daily life, movement, and exercise (like having your own built-in knee brace!) Movement has been shown to limit pain and improve joint motion, as well as prevent the risk of a future injury or fall. (2)
Joints that become arthritic tend to be synovial joints, meaning the joints rely on synovial fluid (the lubricating WD-40 of our joints) to move smoothly. In order for the synovial fluid to stay healthy, slippery, and plentiful, we must move the joint! Movement of joints helps to improve synovial quality and distributes the fluid around the joint so we can move without friction. Additionally, movement helps to distribute blood flow (which contains nutrients and oxygen) around the joint tissues, and can help decrease excessive muscular tension which may be associated with a pain pattern. Exercise has even been shown to activate genes that can help to rebuild cartilage!2 Cartilage has a limited potential to rebuild, but it is possible, and the cartilage that we do have can be strengthened just like other tissues. 

If you have OA, it can be very difficult to get your joint moving and begin the process of regaining strength and mobility. When joints have been painful for a long time, central sensitization may have occurred, which involves central nervous system changes in our perception and response to pain. The pain perceiving pathways may now be embedded deep into our brain circuits, including the prefrontal limbic regions, which is associated with our emotional responses. (3) Combined with structural, tissue-level changes, it is no surprise that many with OA fear movement and require guidance from a physical therapist or other health practitioner to get moving again. Fortunately, physical activity has been shown to have a positive effect on central sensitization, as it can help modulate the pain response by decreasing excitability in the motor cortex as well as stimulating the release of endogenous opioids (endorphins and other substances that are our brain’s natural pain relievers). (3) 

At the Wellness Station, we will be able to guide you intelligently and compassionately towards building strength, improving function, and opening up your life to greater possibilities.

Here is one of my favorite, low-impact exercises for building strength and control in the lower body and core. This can be especially helpful for individuals with knee and/or hip arthritis, in which cases standing exercises like squatting may be inefficient and painful. Many people have done the “bridging” exercise. The Feldenkrais-inspired bridge is known as “spine like a chain”. It involves pressing through the feet to begin to lift one vertebrae at a time from the ground, and lowering down in reverse. This can help to strengthen the glutes and thigh muscles, mobilize the spine, and improve awareness of how we utilize the forces from the ground to move our bodies. Check out this video from Paul McAndrew to get a visual and verbal demonstration of the movement: Spine Like a Chain

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

References:

1. https://oaaction.unc.edu/oa-module/oa-prevalence-and-burden/ 

2. https://lonepeakpt.com/blog/living-arthritis-move-more-or-move-less#:~:text=Moving%20is%20essential%20if%20you,helps%20your%20joints%20be%20healthier 

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5074793/ 

My Feldenkrais-Inspired Journey

Almost three years ago, my life changed for the positive when I was introduced to the Wellness Station and the methodology that influences our practice. I had barely heard of the Feldenkrais Method® at this point as a PT student, and certainly had no idea how to implement its principles into my own life or into therapeutic care. This was a pivotal moment in my life in which the end of my academic journey and the start of my career was just around the corner. I knew that I wanted to bring some new ideas into the therapeutic space, as my experience with traditional physical therapy left me searching for deeper meaning. Beginning to blend my learnings of the traditional therapy model with my study and practice of yoga was extremely helpful, but I knew I had much more to learn.

Following an auspicious introduction to the Wellness Station team, I began to open my mind and body to the greater possibilities that are achievable through a Feldenkrais approach. I began to receive mentorship, attended Feldenkrais movement classes, participated in my own body explorations at home, and improved my knowledge through reading various books on the topic. Through this journey, I have achieved personal growth and a refinement in motor skills, which are gifts that keep on giving.

Below I will reflect on some of the key takeaways of my journey that have helped me feel better in my body and motivated me to share these tools with the world. 

Keenly aware of more body parts and connections between

A key part of the Feldenkrais Method is to become more aware of our body in a non-judgmental way. With a background in anatomy as well as yoga, Feldenkrais helped to deepen my self awareness to a greater level of precision. Using the spine as an example, I used to be only generally aware of my spine, more as a series of “chunks”: my low back, mid/upper back, and my neck. Through slow, controlled movements with a keen attentiveness, I have been able to expand my sensorimotor skills to be aware of specific parts of my spine, and how to move and adjust my position to feel more comfortable in these various areas. Key lessons that helped to build this ability have been the pelvic clock, as well as piano keys and spine like a chain. This idea of each vertebrae being like a piano key can allow us to move with the precision of a skilled piano player- flowing up and down the scales with ease, rather than being limited to mashing many keys all at once. These practices allow us to feel “flow” and connections between various body areas, as the spine is our center, our core, the foundation for our head, and the bridge between our upper and lower body. 

Moved away from strain and over-efforting

Many of us have a tendency to put in too much effort, which can contribute to strain and tension. In fact, we all have inefficient movement patterns, which is just part of the human experience. These neuromuscular inefficiencies may present themselves during exercise, daily tasks, occupational duties, and more. For me, this tendency may have related in some part to perfectionism and competitiveness, as well as a reflection of the overall psyche of our society: do more, work hard, no pain no gain. Certainly it manifested into the way I exercised and practiced yoga to some extent. The Feldenkrais Method teaches us to do just enough, and no more. To become aware of unnecessary effort and tension, and find ways to move without our typical patterns of strain. By practicing movement in this way, I became aware of some of my habits that may have been less than helpful. Fitting myself into a tight yoga shape that didn’t feel good, but doing it because I felt like I should be able to. Overtraining because more is always better. Judging and being hard on myself when I felt like I wasn’t achieving something perfectly. My journey with Feldenkrais has not erased all of these habits, but it has done wonders to help me become more aware of them, and has allowed me to be able to make the conscious decision to be more kind to myself and my body. This has actually done wonders for my yoga and other fitness practices. By finding ways to unlock my emergency brake (unnecessary tension), work with my body instead of on my body, as well as a refined sense of awareness and biomechanics, I have been able to find new growth in terms of the physicality of my movement practices. Better ability to move into difficult shapes with ease, strengthen my body in three dimensions, walk and run with a sense of flow, all while respecting the limits of my body in the moment. 

Expansion of therapeutic toolset

One of the most important characteristics of an effective physical therapist is to walk the walk. These practices are part of my life not only for myself but also for my clients. Even though I am not currently a certified Feldenkrais practitioner, my experience with the method greatly influences my therapeutic style to provide clients with a unique approach to therapy. By practicing what I preach, I am able to share an integrative person-centered therapy that can be very helpful for those who are looking for an alternative option. While every person is very different, the tools obtained from mindful awareness practices can be applied to any person. We all have tissues, and our tissues all want attention!

At the Wellness Station, the therapist and client work together as “body detectives”, discovering neuromuscular inefficiencies that may be contributing to pain and movement challenges.

Based on these findings, lessons that are unique to each individual are taught with improved comfort, biomechanical efficiency, and fitness as the outcomes. To learn more about how Feldenkrais can be applied into physical therapy, read our Feldenkrais Method White Paper.  

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team