Essential Checklist for Sitting, Especially with Neck and Back Pain

Sitting is something that human beings have done since the beginning of ages. However, it is really in this Information Age where we are confined to a piece of technology to do our work, and working at a desk is fast becoming an issue all across the country.  The prevalence of spinal (neck and back) pain is on the rise and it is estimated that Americans spend over $50 billions dollars annually on treating back pain; usually for unnecessary surgeries and injections. That is also a big contributing factor to the opioid (pain medication) crisis that we are seeing today.

Maybe you’re someone who likes to spend time sitting while getting your reading and internet browsing done. Maybe you’re a writer who has to spend hours in front of a computer to get your work done.  Or maybe you work in an office/corporate setting and the computer is what connects you to the rest of the world. For those of us who have to sit and work at a computer to chase after your dreams and/or support yourself financially, I want to remind you that sitting is an aspect of work that is never going to go away. So if we can’t get rid of it, then let’s find a way to take control of it. And to do that, we need to adopt the mentality of an athlete. Not just any athlete, one of the greatest athletes of all time, Lebron James. 

Lebron James is one of the greatest basketball players of all time. As of 2020, he is 35 years old and this is his 17th year in the NBA. Aside from the physical gifts and talent that we see on a nightly basis, the longevity and avoidance of major injuries throughout his career are some of his greatest achievements as an athlete. How does he do this? He prioritizes his health and treats his body as an investment. Approximately a $1.5 million dollar investment per year according to his friend and business manager, Maverick Carter. You can’t be great in sports if you’re hurt. 

To most people, it makes sense that athletes need to focus on their training, diet, sleep and routine maintenance care to make the most of their playing career. We get it; playing sports takes a toll on your body. However, even the longest NBA career will be a small number compared to your career that you will have sitting in front of the computer (Vince Carter just set the NBA record when he came back for his 22th NBA season). Most of us are not retiring after 22 years. The key to focus on here is not the $1.5 million but the idea of investment. Protect and take care of your body so that it can continue to work for you, as long as you want it to.

You probably have never thought about it like this but sitting is a movement skill; a skill that we never learned to develop, and to be quite frank, were probably given bad advice along the way. Were you taught at one point that sitting up tall and holding yourself up was "good posture"?  This type of posture forces you to work your muscles way too much and is unrealistic for you to keep throughout the day. Sitting 8+ hours at a desk takes a toll on your body, which often results in low back pain. And in order for you to work and chase after your dreams as long as you want, you need to start taking care of your body.

1. Understand the biomechanics of sitting and change any harmful habits you may have developed over the years.

2. Set active reminders to mentally check your sitting posture and get up throughout the day.

3. Take proactive steps in your life to reverse the stress of sitting throughout the week. Invest in your body!

It's going to feel unnatural at first.  For some of you, it may even be uncomfortable at first.  This is probably because of the years of compensation and your body parts have gotten stiff in this position.  This is where stretching, massage, and the right type of physical therapy can help you. But first, you must go through this checklist to make sure you are not hurting yourself on a daily basis; the most important step in solving any pain is to recognize and remove the aggravating factor. The beauty of the human body is its ability to adapt and change to stimulus. Start prioritizing sitting as a movement skill and your body will change positively for you.  Below is sitting checklist that you need to implement as soon as you can.

Principles of sitting

• Feet supported by floor or foot rest

• Lumbopelvic angle (where your lower back meets your pelvis) supported by chair or support

• Mid-back supported by chair or support

• Elbows supported by arm rest

• Head looking straight ahead 

• Eyes relaxed and looking SLIGHTLY downward (10-15 degrees)

Seat Height

This may vary for each person’s anatomy and pre-existing musculoskeletal conditions/limitations in the hips and back. 

• Ideally, you should be aiming for 90-95 degrees where your hip meets your back.

• The tighter your hamstring and back, the harder it might be to get to 90 degrees.

• However, a chair that is TOO high will cause you to compensate excessively in your lower back musculature.

• A chair that is TOO low, will cause you to round and slouch. 

Seat Depth

• This will depend on if you are sitting fully supported against the chair or sitting slightly forward

• If you are sitting forward, you should ideally have at least 50% of your thigh on the chair.

• If you are sitting fully supported against the chair, your biggest concern is having your feet fully supported on the ground.

  • Also consider the shape of the seat. Avoid chairs that sink you in too far backwards and chairs that are too narrow because the outsides are too build up.

Arm Rest

• This should be positioned so that your arm angle is about 90 degrees.

• Elbows should be directly underneath your shoulders and forearm should have a straight line to your keyboard/mouse. 

Monitor Height/Angle

• Ideally straight in front of you.

  • If you have multiple monitors, I would recommend either having the one you use considerably more straight in front of you OR making a conscious effort initially to turn your entire body/chair slightly to face the monitor each time.

• Distance of monitor

  • Might depend on your vision, but you should be able to see the monitor clearly. Vice versa, it should not be so close to you that forces you to have to turn your head continuously to scan the monitor.

Keyboard/Mouse Placement

• Keyboard and mouse placed so elbows hang just under the shoulders

• Should also be placed so that your wrist is neutral 

  • You should NOT be reaching for your keyboard/mouse.  This will cause you to slouch or rotate through your back/neck

• Supported by arm rests in this position

What type of functions should my chair have?

Essentials:

• Adjustable Seat Height

• Adjustable Seat Depth

• Adjustable Backrest angle

Beneficial:

• Adjustable Lumbar support

• Sloped Seat Pan with Adjustable Tilt

• Adjustable Armrest

• Adjustable Footrest

What type of support to utilize?

Additions to think consider:

• A step stool or stack of papers underneath your feet

• Sitting wedge

• Sacral support

• Lumbar support

• Thoracic support

• Arm rest or pillow underneath your arms

If you’re in NYC and you’d like to learn more about how you can best avoid fundamental errors of sitting, reverse bad posture and reduce your back pain, please reach out! We’d be happy to schedule a time for us to talk.

Young J. Cho, PT, DPT, CFMT
Zero Point One Physical Therapy
(718)521-6265
info@zeropointonept.com