Managing Your Posture in PT School

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.

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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.

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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.

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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.

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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!

DPT School Nutrition: 4 Ways to Eat Healthy

Name: Janki Patel, Class of 2020
Hometown: Fremont, CA
Undergrad: University of California, Davis
Fun Fact: I hiked a 14er (Mount Democrat) for the first time…three days after moving from the Bay Area’s sea level.
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If you are currently enrolled in physical therapy (PT) school, or attended in your past, you can probably identify with the struggle of eating healthy, stress eating, and forgetting exercise. With one exam after another, I’ve found myself eating one snack after another. And by snack, I mean chocolate-covered espresso beans, chocolate-covered almonds, and chocolate-covered pretzels. Anytime anyone mentions “free food,” my ears perk up, eyes widen, and I suddenly feel as if I’ve been starving for centuries, instantly questioning “Where?! When?!” And, when I do finally find the time and energy to go grocery shopping, I think to myself, “I’m going to get a ton of vegetables, fruits, and healthy foods only.” Yet, I end up walking out with a handful of unhealthy items, which I justify by all the vegetables and fruits I just filled my cart with (it’s all about balance, right?!). Days later, I find myself eating all those unhealthy items first though, while the vegetables and fruits start going bad. And with more stress, I seek out the fatty, carbohydrate-heavy, sugar-loaded foods for comfort and relief. When I talk to classmates, I find many are in the same boat. It’s almost as if we could use a class about how to consistently eat healthy while in PT school…or maybe just a blog post!

We already learned that nutritious foods are better fuel sources for our brains and bodies, leading to improved energy, clearer minds, and overall better productivity. Ensuring proper nutrition takes self-discipline and motivation. Once you make it part of your everyday though, you won’t even have to think twice about it. Just like driving a car or riding a bike or remembering the direction of roll and glide for the convex-on-concave rule of arthrokinematics. It’s simply a matter of training the brain, or neuroplasticity, if you will.

1. Mindfulness

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Photo Credit: Mindfulness Words

 

Take the time to really listen to your body and thoughts in the present moment. When you find yourself reaching for a snack, ask yourself if you’re truly hungry. Is your stomach really rumbling? When was the last time you ate? If the answer is “no” and “just a half hour ago,” then try opting for a drink of water or a piece of gum to chew instead. If you start deeply craving food, ask yourself where that craving is stemming from. What’s really causing it? Hunger? Or, stress and anxiety? If it’s stress or anxiety, then first acknowledge that the true cause of your feeling is stress or anxiety. But, don’t let that acknowledgement stress you out more. Take a minute to close your eyes and take a few deep breaths, rather than running to the cafeteria or kitchen. Try to then relieve the craving by simply changing your position (sitting up straighter, getting up and taking a quick walk, or stretching) or environment. I find that every time I study on the dining room table, I end up grabbing a snack shortly after I start, or I sit with one to begin with so I don’t have to get up later. With the kitchen so close by, there’s little time between my thought and action. Choose a study spot away from food sources so that you’re given more time to think twice about any craving that occurs and prevent yourself from fulfilling it.

Find more activities to relieve cravings in the moment as well, whether it’s having quick play time with your pet, reading a short article (PT in Motion has great ones!), or talking to a family member or friend for a few minutes. Essentially, we want to train the brain to think “this is my cue to grab water, take a walk, or talk to someone” instead of “this is my cue to eat” whenever it receives the signal of a craving or desire to eat that really stems from stress or anxiety rather than hunger.

2. Commit to a List

Photo Credit: Grocery List

 

This is one of my biggest challenges. I always have a few items in mind that I need to get from the grocery store, but the rest of the items in my cart end up being in-the-moment purchases. Make a solid grocery list beforehand and commit to sticking with it by grabbing only the items you need. One way to do this is to first find healthy recipes and then creating a grocery list from the ingredients. For example, I’m subscribed to New York Times Cooking, which sends me daily emails of recipes. I choose and bookmark a few healthy ones every day so that by the end of the week, I have a list of ingredients for my weekend grocery shopping trip (as well as recipes to cook for next week then!). You can go paper-and-pen style or use an app on your phone to keep track of your list.

Another way is to commit to a 5-5-5 rule. Include 5 vegetables, 5 fruits, and 5 protein items on your list every time you make a trip to the grocery store (or any other area, such as fiber or a specific vitamin, that you may not get enough of). Depending on when your next trip will be though, you may have to increase these numbers. Think of your grocery list as being a grading rubric for a class assignment or a list of topics on an exam. Just as you would ensure to cover all required items for your clinical skills check or anatomy exam, and not a single more item than you have to, commit to ensuring you cover all the items on your list, and not more, for groceries as well.

3. Avoid Justifying Unhealthy Items for Costing Less

Photo Credit: Money Fork

I know we’re all “balling on a budget,” but try to not let that be a reason you start compromising healthy foods for less nutritious ones. Order that avocado for the extra 50 cents. Don’t order that whipped cream on the frappachino simply because it comes at the same price without it. If you’re like me and are easily lured by sale items at the grocery store (who doesn’t like buy one, get one free items?!), try to take more time to practice the previous points of being mindful and committing to a list. It’s easy to fall into marketing schemes since sales make “sense” that we would be saving money. However, it does not make “sense” to feed our brains and bodies with foods that have little to no nutritious value.

This goes for restaurants as well, especially if you don’t cook at home or buy groceries often. Think back to the 5-5-5 rule when ordering still: did you have vegetables, fruits, or protein today? Create and commit to a list and find items on the menu that incorporate this “grocery list.” We’re actually lucky that our bodies already give us a grocery list of items they need for optimal functioning: proteins, carbohydrates, fats, vitamins, minerals, water, etc. Seek the specifics your body truly needs on the menu, just as you would seek keywords in multiple choice options on an exam question to know it’s the correct answer.

4. And Of Course, Don’t Forget to Exercise!

Photo Credit: Time for Fitness

 

This last point is more of a reminder to exercise regularly. The benefits of exercise are endless. Schedule it into your calendar as if it were a mandatory class. Additionally, any time you start to feel your energy levels plunge, try exercising rather than reaching for energy bars or sugary foods for a boost, even if it’s simply 10 minutes. If you’re in class and a craving or energy lull hits, try seated calf raises under your desk, flexing and extending your toes in your shoes, or flexing and extending your fingers and hands (set a frequency too!). Again, it’s about creating a healthy response when your brain gets these signals.

We know exercise can cause physiological changes in more than just our muscles, specifically in our metabolic pathways. Keep moving regularly and solidifying healthy eating habits and it’ll soon feel like you never had a struggle with healthy eating, stress eating, or forgetting exercise. You won’t even have to think twice about it. Just like driving a car or riding a bike or remembering the direction of roll and glide for the convex-on-concave rule of arthrokinematics. It’s simply a matter of training the brain, or neuroplasticity, if you will…these are my foods for thought. Happy nutritious eating!