There’s a good chance that you’re sitting down as you read this article.

You may be sitting down in front of your computer at work.

You may be reading this on your daily commute.

Or you may be sitting somewhere in the comfort of your home.

Now, while sitting itself isn’t necessarily a bad thing, the sheer amount of time most of us spend in this position day after day can lead to severe consequences on our health and movement quality.

Studies have shown that the average American spends around eight hours a day in a seated position. Most workers spend the workday glued to their desks. Most students spend the school day sitting in the classroom and their evenings studying at their desks.

We also spend significant amounts of time every day commuting in cars, on buses, trains or planes. It’s not uncommon for people working in big cities to spend up to  commuting to and from work every day.

Many spend most of the day sitting

To add to all this, as technology has developed and become an integral part of our lives, more of our entertainment and leisure activities have become more sedentary and have locked us into a seated position for an even greater amount of time. Some of these include the availability and increased popularity of mobile entertainment on tablets and phones, computer and console gaming, on-demand video like Netflix and more.

What effect can this have on our health?

Too much sitting has been linked to a range of health problems, including heart disease, diabetes and premature death.

One study showed a 15% greater risk of dying within three years for those who sat more than eight hours a day when compared to those who sat for less than four hours a day.

Not only can prolonged sitting shorten our lives, it can also decrease our quality of life by straining our musculoskeletal system and affecting our movement and posture.

Sitting is often viewed as a static position. However, in order to maintain that position, our muscles have to constantly contract. This strain can create adaptations that decrease athletic performance, ability to perform daily activities, create aches and pains, and increase the risk of injury.

Before we look at how you can start to undo the damage caused by prolonged sitting and start to restore function, let’s first examine what sitting does to the body.

What happens to your body when you spend too much time sitting down

Prolong sitting leads to inhibition and shortening of the gluteus maximus and rectus femoris. This combination contributes to much of the low back pain experienced by many people.

Shortened rectus femoris

A shortened rectus femoris will limit hip extension

When short, the rectus femoris limits hip extension and predisposes the pelvis to an anterior tilt during standing. Because of the pull on the ilia of the pelvis, the rectus can also facilitate an anterior rotation of the SI joint during ambulation.

The effect is two-fold. The direct pull of the muscular attachment creates a rotation, while also limiting hip extension, which encourages hypermobility of the SI joint to compensate. This affects the pelvis in both sitting and standing.

Inferiorly, the rectus can create patella-femoral dysfunction via patella alta. When you take someone suffering this through a squat assessment, the person will demonstrate limited knee flexion with increased hip and/or trunk flexion.

Shortened gluteus maximus

Sitting can shorten the gluteus maximus

The gluteus maximus, when short, also contributes to anterior pelvic tilt, but in a slightly different way. The glutes will over-facilitate hip extension, which somewhat ‘locks’ the hip in place. To compensate and stand up correctly, the pelvis again goes into an anterior rotation because as the hip extends, the SI joint anteriorly rotates.

A really interesting thing happens when we take this SI joint and put into a seated position: The glutes now limit hip flexion.

Lumbar pain

In order to try to sit upright, we end up moving into a posterior pelvic tilt. Again, as the hip moves into flexion, the SI joint posteriorly rotates to assist in the movement.

This overstretches the lumbar erectors and can create lumbar pain with sitting. With the joint malpositioned, it is less able to support weight, especially when we take away the shock absorption of the lower extremities. This can lead to compression of the sacral nerves as well as sciatica.

How it expresses itself in the toe touch and squat

Assess using a toe touch (via Gray Cook’s book Movement)

Assessing this in a squat or a forward bend—the toe touch—we see the hips have limited mobility into flexion. In both of these movements, the lumbar spine will hyperflex, usually at the L4/5 or L5/S1 level, in order to compensate for the hypomobility of the hip. This leads to greater anterior compression of the disc and can be the predisposing factor in protrusions and herniations.

How most people sit

An ideal sitting position is where someone is sitting erect with both feet flat on the floor.

Yet people rarely sit like that.

People all sit differently

One of the biggest problems in sitting is people tucking their feet under their chairs, which increases the amount of knee flexion, but also, in order to balance it puts the ankle into plantar flexion.

Sitting in this position for prolonged periods of time can lead to different compensations.

Because of increased knee flexion, the hamstrings shorten, but so will the gastrocnemius since it crosses both the ankle and the knee.

The ankle plantar flexion will further increase the tension and shortening of the gastroc, but can also bring the soleus and possibly the posterior tibialis into play—a short posterior tibialis leads to a “high arch.”

This can contribute to plantar fasciitis or knee pain. It can also lead to low back pain because as the hamstrings shorten, they pull the pelvis into a posterior pelvic tilt when standing.

Again, if we take the person into a squat, there will be limited ankle dorsiflexion, so the heels come up.

The knees will move into hyperflexion, which can stress the anterior cruciate ligament (ACL) as the knee moves anterior to the toes.

There will be minimally limited hip flexion due to the posterior rotation of the pelvis, which will create hyperflexion of the L4-S1 vertebrae. Heavy loads on this are just an injury waiting to happen.

Other common forms of sitting tend to be gender specific.

Gender differences in sitting

How men tend to sit

Men tend to cross one leg over with the ankle resting on the opposite thigh, whereas women cross with the top thigh resting on the bottom one. Each position presents with unique shortenings and, conversely, unique movement patterns.

For men, the crossed leg moves into external rotation and abduction. This can lead to shortening of the lateral structures of the hip and thigh: the hip external rotators, IT band and biceps femoris portion of the hamstring.

During a posture assessment, the hip can present with external rotation, but adduction due to SI compensations. The non-crossed leg may have shortening of the gluteals, as well as tightening of the trunk lateral flexors: the obliques, quadratus lumborum (QL) and possibly the erector spinae creating a hip hike when standing or walking.

Looking at the motion of the hip in this situation, the hip has a tendency to adduct. This seems counter intuitive to the lateral structures being short.

As the IT band shortens, it pulls the SI joint into a lateral tilt. Since the femur has to follow the line of the pelvis, the femur crosses under the body, thus adducting the hip. As the hip adducts, it can greatly affect the balance of runners and walkers alike by changing the striking surface of the foot from the plantar surface to the lateral portion of the foot.

As these people stand, their feet will be too close together, with at least one foot under the midline of the body. The femur may also be predisposed to external rotation, which can be identified by looking at the placement of both the foot and patella.

If only the foot points to the side, it is in tibial external rotation, which is a different issue. During squatting, the affected side will move into adduction and this will also cause that hip to drop. Bending over, the hip will rotate laterally in external rotation to decrease the tension in the biceps femoris in order to increase range of motion.

Women who sit with their legs crossed

Most women who sit with their legs crossed tend to present with a different dysfunction. Here we usually see the same dysfunctions bilaterally—shortening of the hip internal rotators and adductors. This can lead to medial rotation of the pelvis that can be identified by a pigeon-toed stance. Again, see how the foot and knee turn in. When this position is put into a squat, there will be lateral rotation of the hips, which can cause lateral knee or foot pain.

Women also tend to present with sacral torsion due to this sitting posture. The leg that is crossed on top will tend to have shortening of the psoas, which will pull that side of the pelvis superiorly, specifically the ilium.

On the opposite side, the leg crossed under might have tightening of the gluteus maximus from limited hip flexion leading to an inferior rotation of the pelvis. One side goes up while the other side goes down, leading the sacrum to compensate for both, usually via a rotation towards the superior side.

Impact on the thoracic spine

The thoracic spine

Sitting typically decreases thoracic mobility. This can lead to dysfunctions in the rib cage as ribs move in one of four planes. It can also affect scapular stability as the scapulo-thoracic joint becomes hypermobile to try to maintain proper movement.

Or the reverse can happen: The ribs ‘lock’ the scapulae in place, leading to hypermobility of the glenohumeral joint, especially in overhead athletes or throwers.

In overhead athletes, the sternoclavicular (SC) may also become unstable. Both of these conditions can lead to tendonitis of the long head of the biceps tendon or supraspinatus due to the structures trying to maintain the position of the humerus in the glenoid.

However, there can be other regional dysfunctions at the shoulder, too. The latissimus dorsi can create internal rotation of the glenohumeral joint. This may lead to impingement, typically of the biceps, but could also involve the supraspinatus of the rotator cuff.

Shortening of the supraspinatus and/or deltoid leads to the shoulder being abducted while the person is at rest. Lastly, the pectorals can create protraction of the scapulae and glenohumeral joints and, long term, potential medial translations of the SC joints.

Impact on the cervical spine

The cervical spine

The cervical spine tends to have similar postural deviations as do the lumbar and thoracic spines. The cervical spine may laterally flex and rotate in a compensatory manner opposite what the trunk is doing. If the trunk is flexed to the right, the cervical spine flexes to the left. This is to maintain what the body knows to be normal—having the eyes and ears horizontal with where we are looking.

From a lateral view of the spine, the lumbar and cervical spines tend to hyperextend, while the thoracic spine tends to hyperflex. The trunk flexion occurs due to shortening of the rectus abdominis. This can be postural, as limited hip flexion leads to increase rectus activation to try to keep an upright position. However, it can also be a trained response due to rep after rep of crunches.

With this flexion in the thoracic spine, the person would walk around looking down all of the time. To compensate, the cervical spine moves into extension to look straight ahead. This tends to be exacerbated in some runners, most cyclists, and in desk-bound office workers. The increasingly smaller computer and phone screens are also leading to increased forward-head posturing.

How to fix it

As movement professionals and clinicians, how do we get desk jockeys, long-distance drivers and populations who spend a lot of time sitting moving toward better health?

One approach that has worked well is to work on movement in broad brush strokes, starting from the top of the body at the head and neck, or at the bottom with the toes and feet.

Start with the head and neck

People who spend a lot of time sitting often hold the head in a forward position. We start here to facilitate movement in the head and neck.

Help your client train the eyes to move in all directions. Do this slowly, deliberately and with high concentration, like tracking a finger or tracking an object through a maximum range of motion. Try using the cue, ‘Move your eyes as if you’re reading a sentence across a particular passageway.’ This will bring intensity and focus when doing the movement.

Start with the eyes, and then move to the head and the neck. Have the person move the head and neck slowly, not just rotating it from left and right, but also top and bottom, and then through more complicated ranges of motion.

Why is moving slow so important? This allows us to appreciate deficits in range of motion, a lack of control, pain or other dysfunctional patterns.

Move onto the feet

Let’s go to the other end of the body—the toes and the feet. For most people who live in modern society, the toes and feet are locked up. They’re not reflexively stable—they’re stiff.

That’s an important distinction. Stiffness is strength when under a maximal load. A lot of people hear the word ‘stiff’ and associate it with performance.

When it’s not under maximal load or not in a point of performance, however, stiffness is pathological. We need to be able to create stiffness for strength, but if stiffness is the default, it creates an inability to move in a healthy manner.

All of those small joints in the toes and feet need to have mobility. When those small joints don’t have mobility, they’re rigid. They then force compensations up the kinetic chain. This equates to more strain on the ankle and the Achilles tendon, calves and knees.

To start restoring mobility and function in the feet, I like to warm up with small toe articulations and foot movements like ankle rolls.

Do heel circles with the toes planted on the ground, while allowing the heel to circle very slowly through a maximal range of motion in one direction and then the other while keeping the spine tall and long.

Retrain the breath

Another thing that’s important when helping someone who spends a lot of time seated is working on breathing. Breathing is one of the most underrated training avenues.

Breathing is the only vital process we can voluntarily control, and it can have a huge impact on core functionality. When we train how to breathe, we’re re-training the ceiling and the floor of the core, parts of the diaphragm.

The pelvic floor is the diaphragm at the floor of the core and is crucial because everything neighboring or attached to it shares some fascial connection—not only the areas of the lower back and hips, but also the quads through the upper leg, as well as the knees and all the way up into the ribs.

So what is your aim when retraining the breath? It’s to get the breath out of the neck, upper shoulders and chest, and help drive that breath down into the lower abdomen.

Have your client lie down on the ground (image from Mark Cheng’s Prehab-Rehab 101)

If you’re not sure which type of breathing your client is doing—chest or abdomen—have the person lie on the floor. Note which part of the body heaves or creates the most motion when breathing.

For example, if the neck muscles fire a lot during a large breath, most of the energy is focused on creating that deep breath by using the neck, and the person needs to learn to use the abdomen.

Relieving low back pain

Many people who spend a lot of time sitting also suffer from low back pain. When a lot of people with low back pain are treated through different modalities—physical therapy, acupuncture, chiropractic, etc.—often the breathing is not addressed.

Focusing on deep diaphragmatic breathing toward the pelvic floor rather than just under the ribs, can often alleviate back pain and get these people back to functionality and strength.

If your clients are suffering from low back pain, this is definitely something to look at.

Restoring abdominal function

When helping restore function and movement in people who spend a lot of time sitting, you also want to address the abdominals.

As with all muscles, healthy abdominal muscles should not be rigid all the time. The muscle tone should be adaptable. However, with extended periods of sitting, abdominal muscles will weak or stiffen.

To restore normal muscle tone, put a hand on the abdominals, which may be either super sensitive or rigid. This will often either tickle or hurt due to a guarding response from the brain. Sometimes a little bit of manual therapy such as light kneading can help with this by stimulating these muscles to start firing properly again.

Restore movement in different positions

By this point, you’ve started restoring movement and function at both ends of the body—at the head and at the feet. You’ve also started to address the core by restoring normal breathing.

The next step is to help your client move proficiently in a variety of different positions.

Movement is position specific. A person may move well when lying down face down, but may not demonstrate the same proficiency when lying supine. The same goes for other positions like sitting, kneeling, half-kneeling, tall-kneeling and standing.

Therefore, when helping to restore someone’s movement, you need to work in all different kinds of positions to demonstrate proficiency.

Mark Cheng coaching the Sphinx position in his Prehab-Rehab 101 DVD

A crawling position as demonstrated on Mark Cheng’s Prehab-Rehab 101 DVD

Mark Cheng coaching the tall-kneeling position in his Prehab-Rehab 101 DVD

Try starting off working in a supine position. Then move to a seated position. Then go to a kneeling position, a tall-kneeling position, a half-kneeling position and finally, a standing position. Your client will be increasingly challenged in each position.

Another great exercise to use is the Turkish getup. When performing the Turkish getup, have clients work on their breath and eye position in each stage of the movement. Have them rotate the head and neck during the movement to teach them how to keep it mobile. Do the same for the distal joints by having them perform ankle circles. You might also have them press the kettlebell from each position in the movement.

This will help improve their ability to move in different positions, and will start reversing the effects of being ‘locked’ in a seated position.

Constantly check posture

Our posture changes constantly if not checked, and many people are unaware of this.

The nervous system is calibrated to accept a certain point as a reference point—kind of like the zero point on a scale. This reference point can ‘drift’ slowly and a new reference point can then be established.

For example, if someone starts to spend a lot of time sitting slouched in front of the computer, this position can become the ‘new normal’ for the body. The body will then accept this position as the new reference point. This is how poor posture when seated carries over to other positions like standing.

Because of this, don’t assume what the body feels as straight is straight. It might be because that body has set a new ‘zero point.’

Change the environment to be more ergonomic

For some people, it may be possible to modify the work environment to encourage better posture. This can be incredibly helpful as it minimizes the long periods spent in poor posture.

For those of us who work in front of a monitor, the base of that monitor should be at nose level—the eyes are always going to focus on the object of intent.

The head and neck will rotate or flex to create the easiest line of sight. The rest of the body works to achieve that.

When we put the monitor at a height forces us to sit up straighter, it helps us reinforce good posture with less conscious effort.

Standing workspaces are also great, but if the monitor is too low, the person will still end up flexing at the neck and hunching forward to look at screen.

For the average adult, the monitor needs to be about two feet off the desk space if the hands are going to be in a comfortable position for the keyboard. That’s a lot higher than most people currently have it.

Have your clients elevate their monitors using a carton or a stand. It doesn’t really matter as long as they elevate the monitor so the base of the screen is roughly at nose level when standing or sitting tall.

Spend extra time mobilizing the hips

One final point when helping people out of the seated position is spending extra time mobilizing and training the hips. In particular, you want to get them to bend past 90 degrees and then to extend past 180 degrees in an unweighted and a weighted context. At the beginning, assist if needed.

What does flexion facilitation look like? If you’ve looked at Primal Move or other training methods that have a yoga foundation, from the supine position you’re looking at the happy baby exercises.

To try it, simply lie on your back, grab your feet and play in that position. The ability to let go of your feet without your legs shooting back to a half-seated position is very important.

You can facilitate flexion in a lower-stress environment by lying on your back, working the happy baby pose progressions and then start loading this.

In terms of body weight, you might use a cocorinha. Those who play capoeira know a cocorinha is like a seashell, where the body is essentially in a deep squat with a narrow base, trying to use the lowest profile possible while still on flat feet.

If you want to move from the happy baby positions with someone who is very rigid who can’t flex the hips deeply or bring the thighs to the chest, start with a supine shin grab. Have the person grab the shins just below the knees. If the client can get to that, start bringing the thighs closer to the body, and change the hand position to grab the feet to move into the happy baby position.

For a little bit more compression or a little bit more flexion to facilitate that, from the supine position keeping the thighs as close to the chest as possible, wrap the arms around the shins, hug them and roll from this position.

Next, work on extension.

Work on the cobra position, cobra progressions, standing extension and almost into a sun salutation. Here the feet are flat and the arms are overhead in full shoulder flexion, and then reach back.

***

This article was adapted from Steve Middleton’s, The Role of Posture in Movement Dysfunctions and Mark Cheng’s Seated Death & Prehab/Rehab 101 video.

You can visit Steve Middelton’s site at http://assesstreatcondition.webs.com/

You can learn more about Mark Cheng at his website: http://drmarkcheng.com

Here are more resources to help your clients restore function and movement:

Prehab/Rehab 101

Restoring fundamental movement patterns can go a long way in unlocking performance and reducing injury risk. In Prehab/Rehab 101, Mark Cheng teaches five groundwork progressions based on the neurodevelopmental sequence. These progressions will help form a solid foundation for more challenging movements and activities.

Click here to learn more about Prehab/Rehab 101.

Key Functional Exercises You Should Know

In Key Functional Exercises You Should Know, Gray Cook will show you how to use the right exercise to get results for your clients, in less time and with less work. He’ll bring you clarity about the corrective hierarchy.

He’ll show you what he considers the key exercises that stand out in a library of functional exercise options, and will show you when to use each, and how to modify them for your clients.

In the DVD, Gray will explore—

• His three key functional exercises: the chop and lift, the Turkish getup, and the deadlift
• The hierarchy of these exercises: which to work on first for the quickest results
• Gray’s favorite regressions and progressions on each exercise, and when to use each
• The subtle verbal coaching cues he uses to maintain correct alignment and stability through the movements
• What most people do incorrectly on the movements and how to coach and correct them (he coaches these in live demonstrations)
• and much more

You’ll finish knowing how to use these key exercises as functional and corrective tools with your clients, and will never again be stuck using ineffective corrective exercises that don’t actually help your clients improve.

Click here to learn more about Key Functional Exercises You Should Know.

Tap Into the Brains of Some of the World’s Leading Performance Experts

FREE Access to the OTP Vault

Inside the OTP Vault, you’ll find over 20 articles and videos from leading strength coaches, trainers and physical therapists such as Dan John, Gray Cook, Michael Boyle, Stuart McGill and Sue Falsone.

Click here to get FREE access to the On Target Publications vault and receive the latest relevant content to help you and your clients move and perform better.