Name: Joshua Holland

Undergrad: Idaho State University

Hometown: Centennial, Colorado

Fun fact: Before PT school, I worked at a BBQ restaurant in Missoula, MT called Notorious P.I.G.

Last week, I was editing my Biomechanics skills video when I noticed a curly-haired DPT student in my video with fairly poor posture. I was far from excited when I realized that student was me. I knew my posture wasn’t the greatest after years of asymmetrical shoulder position from college pole vaulting and poor lifting mechanics, but I had no idea it was THAT bad! My shoulders were protracted with my head in a significantly forward position. My initial thought was, “man, I am about to be a PT soon…how am I going to teach posture when my own posture is so poor?!”

An average day for PT students involves a heavy dose of lectures, studying, and an even heavier dose of sitting. Often a PT student may be seated in lectures for 8 hours a day. By the end of the day, professors may start to notice students performing many combinations of wiggling, shifting, and slouching, with many students standing up in the back of the class.

The field of physical therapy involves movement for rehabilitation and we often hear, “exercise is good!” However, within school, sometimes we neglect our own movement in order to remain studious. The intention of this blog post is to initiate the thought of posture and provide some quick exercises that DPT students can use throughout their day. As future clinicians, we are role models to many of our patients, so it is important that we recognize our own posture and work to preserve good body mechanics within ourselves in order to have long-lasting careers and fully help our patients.

I couldn’t sleep after seeing my poor posture! So, I set out the next day to find ways to correct and maintain posture and decided to share them with you all. In this blog post, I interviewed Dr. Alice Davis, an expert on the spine, and fellow first year DPT student, Sarah Spivey, a certified pilates instructor since 2007, to provide some tricks on improving posture!

 

Question and Answer Interview with Dr. Alice Davis

Q: Often our posture is poor in class, we tend to slump over to write down our notes, what are some cues we can use in class to correct this?

A: Make sure your feet are flat on the floor and use the back of the chair to support you. You are becoming kinesthetically aware of your body in space as PT students, so try to be aware of the weight on your ischial tuberosities as you sit. Try to make each ischial tuberosity level. The overuse of repetitive poor posture is what creates problems over time, so start to realize your body position while you sit in class.

Q: While we sit in class it feels like we roll our shoulders forward and lean forward to pay closer attention or write on our devices, what are some cues to get those shoulders back with a neutral head?

A: Because you are sitting at computers for most of the days, you tend to have some upper cervical extension and increased flexion in the lower cervical spine. Imagine there is a rope going straight through your head and down to your seat, try to make that rope as straight as possible. A quick exercise you can do in class is move your shoulders up an inch, back an inch, and down an inch, then hold this for ten seconds, and relax. Try to do 10 reps for 10 seconds of this exercise.

Q: For the anatomy nerds out there, what are some of the muscles that are affected by this forward leaning posture/slumped position?

A: The upper cervical spine is extended in this forward posture position. Suboccipitals are a major component in this and often called the headache muscles because it can result in cervicogenic headache. A cervicogenic headache is when the pain begins in the back of the neck first before it goes up to the skull. This can be posture and stress related. Other muscles that play into extensor moment of the upper-cervical spine are the splenius and semispinalis muscles.

Q: Is there any other tips and tricks we can use in the classroom and out of the classroom to help with posture?

A:  

• Foam rollers are great! You can put the foam roller vertically along your spine with the head and sacrum supported. Using your arms, do some snow angels for pectoralis major and minor.
• If you are feeling uncomfortable and wiggly, your body is telling you to move – get up and move around.
• Do something during lunch time. Eating is important, but try not to study if you don’t have to. Give 30 minutes during lunch for your body and mind.
• Breathing is important. Moving the body and getting the diaphragm to move through breathing helps those muscles that support the thorax. Watch your breathing pattern, especially when you are stressed. Try to do some slow inhales and exhales.
• Try a simple nodding of your head, as if you’re saying yes. This lengthens the longus colli and capitis muscles that can help with postural support. You can even do this when you’re driving! Rest your occiput on the headrest and perform a little nod. Try to hold the nod for 10 seconds with 10 repetitions.

 

Here are some techniques and exercises for managing posture in graduate school (or any career environment!) brought to you by our very own DPT first year, Sarah Spivey!

 

Sit on deflated Gertie ball.

This will allow you to sit up on your ischial tuberosities (IT) to encourage a more natural lordotic curve while also eliminating the pressure on the ITs. By sitting on a relatively unstable surface you will also increase the use of your postural stabilizers. Try to incorporate five minutes per hour of sitting.

Another technique is to use the Gertie ball between your lumbar spine and your chair. Find your ideal posture by allowing yourself to slump in your chair. Now, move into a full anterior tilt of your pelvis until you feel pressure in your lower back. Now, ease off until you feel the pressure disappear. Scoot back toward the back of your chair and place the ball at the level of the lumbar spine. The ball will help you maintain your neutral posture during sitting.

Head nods/nose circles on Gertie ball.

Lie in supine on a firm surface. Bend your knees and place your feet at the distance of your ASIS. Allow your sacrum to feel heavy and equally distributed on the floor/mat. Take a few breaths and notice if you have excessive space between your thoracic spine and the floor. If so, on an exhale, allow your t-spine to sink toward the floor. This should limit any rib flare. Place a 1/3 – ½ inflated Gertie ball (or folded towel) under your head. You should feel pressure evenly distributed near your occipital protuberance – this will insure you are lengthening your cervical extensors (especially for those of use with a forward head!). Take a few breaths and allow your head to feel heavy on the ball. Imagine a one-inch line on the ceiling and slowly trace this line down with your nose. Return to your starting position making sure to avoid moving into extension. Repeat this 8-10 times. Now draw slow circles with your nose around your one-inch line. Keep your circles small and controlled. Perform 6-8 in each direction.

Wall sit pelvic curls.

While sitting in class, if you start to feel your low back tighten up, try this stretch! Stand against a wall with your feet about 12 inches in front of the wall and hip distance apart. Try to feel contact of your sacrum, rib cage and the back of your head on the wall. You should have a very small space between your lumbar spine and the wall. As you exhale, draw your abdominals in and curl your pubic bone up toward your nose. You should feel your lumbar spine flatter against the wall. As you inhale, slowly allow your ischial tuberosities to widen until you are back in a neutral position. Repeat 10-12 times.

 Seated neck stretch – sitting on hand.

Feeling tension in your neck during class? Scoot forward so your back is away from the chair and sit tall on your ischial tuberosities. Imagine lengthening your cervical spine and then gently tuck your chin toward your chest. Try not to flex your cervical spine! Now allow one ear to fall toward your shoulder. You should feel a stretch on the opposite side. If you would like to increase your stretch, you can sit on the hand of the side you are stretching. For example, if you are feeling the stretch on the right side, sit on your right hand. This will bring your shoulder down and away from your ear.

 

Overall, I hope  this post helped you become more aware of how important it is that we practice good posture while in school, or with any lifestyle! Do you have favorite exercises or tips to remind you to practice posture? Feel free to share with us in a comment below!