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I'll Tell You What is Causing Pain for Almost Everyone in the Western World (chrishugh.blogspot.com)
95 points by twelch on Sept 29, 2010 | hide | past | favorite | 40 comments



I feel posture just aggravates existing muscular problems. Its good to understand the mechanisms that cause and perpetuate these problems.

There's the muscle sheaths that have stiffened by the lack of use of the full range of motion and the constant deposition of collagen, which literally glues the sheath to itself. This tight sheath can impair blood flow to a muscle, especially when the muscle is contracted for a long time. The contracting muscle presses out against a tight sheath. Blood takes the path of least resistance.

That lack of healthy blood flow can cause the sarcomeres, the contractile unit of muscle, to get stuck in their contracted position. This is how a muscle gets tight and actually shorter.

When a muscle gets very stiff, a trigger point can develop. A trigger point is just an area where many sarcomeres are tight. We certainly notice trigger points, but the muscle gradually hardens for a while before a trigger point develops.

The hard muscles are shorter and thicker and this makes manipulating the sheath to break up the collagen much harder. But if the muscle is softened first, it can be done.

Massage is how you soften the muscle and get the sarcomeres in it functioning again. Massage pushes depleted blood out and then new blood is pulled in from the capillaries.

But there's still one other factor and that is the way muscles communicate with each other to accomplish work. When one muscle is engaged, other muscles receive nerve signals to help. And if there is a trigger point in one muscle, other muscles are engaged via the nerves.

When trying to sit for a long time, tight muscles may be pulling you in one direction, requiring other muscles to have to work constantly to keep you upright. This is why maintaining a natural posture can be difficult. It ought to be something you don't have to struggle to do.

So you may have a tense muscles but it may be another muscle that is the root cause. All of the muscles need to considered and massaged in a systematic way.


Bingo!

Excellent point... "Stand-up straight" as advice is simply too simple.

Still, I think your good advice from Trigger Point therapy should be supplemented with some information from the Alexander technique.

You see, original article begin correctly in saying that "bones don't get tired, muscle get tired". If someone could stand or sit without muscular tension, they could avoid getting or aggravating trigger points.

BUT....

It's just that at point of being in distress, people just don't know how to do that. And there really isn't an easy instruction set that will tell most people how to do that because... trigger points and habitual misalignment causes people's sense of their bodily position itself to be distorted. Specifically, when your muscle is habitually shorted, it "feels" to the person like that muscle where it should be. So a person who say is told to "straighten their back" will do by tensing another muscle to fight against their habitually shortened muscle. And so in practice, as you observe, "posture doesn't help".

Still solution to people's misuse of themselves also has include something like a "hands-on retraining" of the body so the muscles and nerve learn together what "upright" actually means.

I'd link to Wikipedia on the Alexander technique but the article has gotten so crufty it's an embarrassment... Still, retraining of "use of the self" is an important compliment to any massage.


I think a lot of the problems are caused by shoes, chairs and toilets. We more fully exercised our range of motion every day before all of these things that made our lives easier and stiffer.


Yes, these things "cause" plenty of problems. But not by themselves - our unconscious adaptation to them is part of the mix as well. The pace of modern life also comes in.


I will make my standing recommendation for "The Trigger Point Therapy Workbook" now: http://www.amazon.com/Trigger-Point-Therapy-Workbook-Self-Tr...


That's the book that got me started on this whole thing. $13 well spent.


I improved my posture automatically as a side effect of improving my nutrition - through some interplay of strength/stamina/tension improvements, positions that were previously difficult became natural.


This would have been about 20x as useful with pictures or videos to illustrate what the author is talking about.


Conditioning Research just posted about posture http://conditioningresearch.blogspot.com/2010/09/posture.htm...

It shows a couple of videos and mentions the Gokhale Method http://www.egwellness.com/gokhale-method and Ageless Spine by Kathleen Porter http://www.agelessspine.com/book.htm also links to previous posts with further discussion like the Asian squat, and images/videos

You might find it useful

[edited to add] These direct links from CR should be more relevant http://conditioningresearch.blogspot.com/2008/11/posture-fun... http://conditioningresearch.blogspot.com/2008/11/posture-age... http://conditioningresearch.blogspot.com/2008/11/esther-gokh...


Just commented on the original article as such.


Yeah, how can you seriously write "look it up on Google Images. It'll help." and not realize that the article could use them?


Muscles Get Tired, Bones Don't.

This is simply incorrect, as are most of the conclusions that follow from it. Basically, many muscles can trade off individual contractile fibers to remain under tension all day without perceived tiredness.

You are not a stack of blocks and you can hurt yourself by pretending that you are. Your body includes tensile as well as compressive structures and the whole thing is tied together with a control system. You are not meant to stand up without reflex muscle contraction! (You also aren't meant to sit or stand in one position for very long, but that's a longer discussion).

I trained as an Alexander Technique Teacher, but for the technically inclined I'd recommend reading Moshe Feldenkrais's Awareness Through Movement as an antidote to this way of thinking. See Understanding Balance by Tristan Roberts for more detailed information about postural reflexes.


The trouble with advice like this:

  Stick your butt out [...] Stick out your chest
  and fill up your lungs. Now tuck in your chin [...]
is that people interpret it to mean they should apply force to correct their habitual posture, which is like trying to bend something rigid back into place: it compounds the problem. Of course it's hard and often painful to do this, so we almost never keep it up (barring some sort of military regimen), which is probably a good thing.

What's really needed are ways to undo the rigidity. No doubt there are a variety of these. The most effective I've found is the Alexander Technique, an early 20th century form of bodywork that remains modestly widespread, i.e. it's not that popular but you can find teachers in most major cities. It's a curious, very gentle and non-invasive practice that is somewhat counterintuitive but in the hands of a good teacher (I tried three, only one of whom was good) delivers lasting results. I recommend it to anyone who likes to explore this kind of thing.


I highly recommend finding an Alexander teacher as well. I took Alexander classes through my university (it is common among musicians) with John Henes - a great Alexander teacher in Evanston, IL if you're in Chicagoland.

One day in class I particularly remember, prof Henes brought a balance board (one of those round boards on a ball) and asked us to balance on it. He then pointed out that the way we naturally tried to balance was to force the board down in reaction to movements. He taught us to instead balance our bodies, and if we were truly balanced, the board would be too when we stood on it.


Yes, the Alexander Technique is by far best known among musicians and actors, so much so that for many years it was thought of as an acting practice. (Of course Alexander himself was an actor and developed his technique while figuring out why he had lost his voice.) I think this is because these professions have a lot to do with how body and consciousness work together, and this is the area in which AT is very practical. To some people that might sound like gobbledygook, but when your profession depends on it you quickly go with what's practical.

The teacher I like best (who's in the San Diego area) told me that her dream was to get more athletes to realize how much they could get out of it.


I've been interested in the Alexander Technique for a while but haven't started yet (and it's quite expensive here in Shanghai). How would you evaluate a good teacher?


I would go for 2 or 3 lessons and get a sense of the chemistry between me and the teacher. I would also try as many different teachers as possible. The difference between a good teacher and an ok one is dramatic, so this is worth exploring. (Who's "good" may vary from student to student, of course.) I've also noticed that some of the teachers tend to be more doctrinaire than others. I avoid the latter, but YMMV.

If you give it a try, I'd be curious to hear your assessment. The Alexander work is one of very few practices I use every day -- "use" isn't the right word; it's integrated into my habits -- and I have reaped rich rewards from it. To pick a simple example, I've gone on many long motorcycle trips over the years. Typically once I'd been riding for a day or two pain management would become an integral part of the trip. The last trip I did I was astonished at not having that problem any more; I'm pretty sure the AT stuff was the reason.


Where is the science? Show me some studies and experiments. This qualitative BS is worse than useless.


A study has shown that slouching may actually be better than sitting up straight.

http://www.timesonline.co.uk/tol/news/uk/health/article65231...


I have bad posture, partly due to a congenital defect in the cervical spine but more generally due to sitting behind a keyboard all day. I have had a variety of issues with back pain over the years, and forcing myself to sit or stand in proper posture is both do-able and extremely uncomfortable. I do work out and try to stretch, this helps some. Massage helps not at all for me, only has made things worse, I've tried several types of massage with different practitioners.

A huge point of change for me was due to this post: http://news.ycombinator.com/item?id=1269951. To sum it up, tension - and the resulting psychogenic pain - was the major, possibly the sole cause for my pain. Not posture, not lack of exercise or some defect in the spine. At least, since just reading part of this book and all of its predecessor, my pain has gone from constant/unmanagable to a minor annoyance. There is some real empirical evidence behind Sarno's research.


For those interested, there's a book on this topic that is excellent and provides 8 postures improvements (complete with pictures) that will help keep pain away. http://www.amazon.com/Steps-Pain-Free-Back-Solutions-Shoulde... - there's also an Authors@Google talk by the author on Youtube (http://www.youtube.com/watch?v=-yYJ4hEYudE) if you want a taste before buying the book.


A third option is leaning back in your chair. I find that I never get tired of sitting in this position.


Yeah, but you have to curve your neck forward, which seems to cause it to bear the weight of your head on a curved portion of the spine rather than a stacked one.


How old are you? I'm curious because I used to be like that. Now, my back hurts if I am anything but sitting upright or laying flat.


After several years, my chair has gotten tired of me sitting in this position, and it's no longer usable when I want to sit up and get a closer view of the screen. One of many reasons I'm planning on throwing it away when I move out.


This article is not specific enough. I highly recommend finding an Alexander Technique instructor in your area. http://en.wikipedia.org/wiki/Alexander_technique

A good book I've read on the Alexander Technique is How You Stand, How You Move, How You Live by Missy Vineyard. http://www.amazon.com/How-You-Stand-Move-Live/dp/1600940064


Doctor here. Best things you can do are, in order: work out 4 to 5 times a week, eat real food (not to much, mostly plants), and get a standing desk. If you like massage, have at it. Brazilians, well, I don't know. The only Brazilian I know well is an art dealer who advocates Coca Cola as tanning lotion and has a 30' snake skin on the wall.


A trick my mom taught me to find a neutral posture: Stand normally. Stick your arms straight out at your sides, palms facing straight up. Bring your arms down slowly, letting them rotate naturally.


Taking up lifting as a hobby, especially squatting, has done wonders for my posture (although it is by no means perfect)


Yes, I am also quite free of back pains since taking up weight lifting. I do get sore occasionally, but that usually does not hurt.


"The Masai, most Brazilians, gymnasts (but only when they're actually doing exercises) and anyone who carries rocks on their heads for a living, have an upright posture."

Somebody would give a shot at explaining why (most) Brazilians were singled-out in this example?


I think when you're BSing, you're allowed to make any claim you want.


Apparently we carry rocks on our heads for a living?


All that capoeira and streetfighting too. Must be hard to do with a pile of rocks on your head.


Gymnasts typically have a sway back posture, which has some real structural problems that often cause serious issues later in life. This is NOT an upright posture, it is an exaggeration just as a severe slouch is an exaggeration in the other direction.


Somebody would give a shot at explaining why (most) Brazilians were singled-out in this example?

Most people who don't live in a sedentary society probably still have good posture and maintain their natural skeletal alignment. I don't know if this applies to all of Brazil.


Contrary to the stereotype, Brazil is significantly industrialized. The average Brazilian is as sedentary as the average American/German/Japanese.


This excellent book explains many of the same ideas.

http://www.amazon.com/Steps-Pain-Free-Back-Solutions-Shoulde...


what about aeron chairs? They "suspend" me in a good position, whereas other chairs cause soreness if I sit for long periods of time.

What I've noticed from years of "sitting jobs", is that you need to keep the hips, lower back firing/moving. Exercise balls helps a lot. I love siting on exercise balls, as they keep the hips, lower back engage. While sitting on my ball and working, I can rotate my hips in any direction, keeping my muscles stretched/firing. Even those "sitting discs" work well: http://www.amazon.com/FitBALL-Seating-Disc-12-Green/dp/B0011...


I thought this article would be about internet explorer 6.




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