IF I ASKED THIS QUESTION TO 100 PEOPLE, I SUSPECT I WOULD HEAR THINGS LIKE:
Let’s be honest, the answers I listed are what we talk about when we talk about sitting or choosing an office chair. What if I told you that we’ve been missing the mark?
I have spent most of my career as an occupational therapist specializing in wheelchair seating. Can we agree that people who use wheelchairs for daily mobility are the best examples of how to sit well and safely for prolonged periods of time? Interestingly, the principles we use for wheelchair seating have never been applied to able bodied people who sit all day for work!
I’m here to tell you the real secret behind good sitting. And it’s not a single principle but a combination of principles, or “ingredients” that make up the recipe for pain-free long-term sitting.
WHAT ARE THE INGREDIENTS OF PAIN-FREE SITTING?
1 Support the pelvis; not the lumbar
2 Elongation of the spine
3 Protection for the sit bones against high pressure
4 Maintenance of good posture in resting position
1 SUPPORT THE PELVIS, NOT THE LUMBAR
Think of your back as a building. The pelvis is the concrete base, and the rest of your spine is the tower. You can hold up and position all that weight of the spine/tower in good alignment at the base without pain and for long periods of time.
A lumbar support, which has been the industry standard for 30+ years, is like pushing on the 5th floor and expecting to support the base of the building/pelvis and hold the spine/tower in alignment.
Mechanically the whole office seating industry has been misleading the world that a lumbar support will prevent back pain and/or hold your spine in a neutral alignment. The amount of pressure required to support above and below the lumbar support would be painful and could actually cause back pain.
LUMBAR SUPPORTS HAVE NOT BEEN PROVEN TO REDUCE THE INCIDENCE OF BACK PAIN.1
The solution which has been used in the wheelchair seating industry for years is to support the pelvis. Supporting the pelvis does two things to reduce/prevent pain:
Supports the Natural “S” curve of the spine
The pelvis is the key in posture and sitting. The spine will follow the pelvis to an upright “S” curve when the pelvis is supported in neutral. When unsupported, the pelvis tilts backward and the spine falls into a slumped over “C” curve. The backward tilting or pelvic tuck is a huge culprit to back pain and poor posture. As described above, a lumbar support is insufficient to support the pelvis in a neutral position and will ultimately lead to poor posture and pain.
Minimizes disc pressure
When the pelvis is properly supported, a ripple of positive effects will occur in the rest of the body. Starting from the bottom, the lumbar spine moves into extension or more neutral versus flexion and rounded. This motion reduces the lumbar disc pressure and relieves pressure on pain sensitive structures of the spine including the posterior longitudinal ligament.2 Supporting the pelvis also decreases the need for muscle activation to achieve an upright posture, increases disc space, and decreases pain.
2 ELONGATE THE SPINE
You’ll notice that when your pelvis is supported in a neutral position, your posture will be more upright, which takes you away from the surface of the typical back support. This feels fine for a short period, but over time, the postural muscles automatically search for that support.
This leads to tucking the pelvis, resulting in the hunched posture, rounded shoulders and forward head which we know = PAIN. Add to that a tall, wide back which promotes rounding forward and a forward head posture. Over time these postures lead to strain and pain.
When the pelvis is supported, providing support to the upper back is key to elongating the spine and maintaining upright posture over time.
3 ELIMINATE HIGH PRESSURE AREAS: PROTECT THE SIT BONES
What’s the big deal about the seat? We’ve established that the pelvis is the foundation for good support. When the pelvis is held in neutral, the sit bones are positioned directly underneath and are bearing the brunt of downward pressure. This is why supporting the pelvis at the seat surface through materials and contours is critical to alleviate these high pressures and maintain postural alignment and comfort.
Why not mesh?
When sitting for long periods of time on a mesh seat or a hard surface, our sit bones cause high pressure areas that result in discomfort. Most of us tuck our pelvis to relieve the pressure. This promotes a hunched posture with shoulders rolled in and head held forward. So not only is posture compromised, but comfort is also affected in this inefficient posture which may result in or increase pain.
"The conclusion was that the cushion contour had a greater effect on seat pan interface pressure parameters than the sitting posture. A greater uniformity on pressure distribution and a lower peak pressure implied an improvement of the user’s comfort on the seat.3
This is why the seat design is so important!
4 MAINTAIN GOOD POSTURE IN RESTING POSITION
Rest is important in an office chair to take a phone call or just relax during the work day. Typically recline is used as a resting position by opening up the back angle allowing the individual to lean back. But the reclined posture increases backwards rotation of the pelvis which results in that dreaded “C” spine and forward head posture. Recline also causes forward migration of the hips on the seat.
Opening the back angle causes the pelvis to tuck and slide forward in the seat. This results in a slumped “C” curve and forward head.
The seat and back tilt rearward together, maintaining posture and alignment. This prevents sliding forward on the seat surface and avoids the unwanted effects of recline.
- van Duijvenbode IC, Jellema P, van Poppel MN, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database Syst Rev. 2008 Apr 16;2008(2):CD001823. doi: 10.1002/14651858.CD001823.pub3. PMID: 18425875; PMCID: PMC7046130.
- Moldovan, M. (2012). Therapeutic considerations and recovery in low back pain: Williams vs McKenzie. Timisoara Physical Education and Rehabilitation Journal, 5(9), 58-64.
- Li W, Mo R, Yu S, Chu J, Hu Y, Wang L. The effects of the seat cushion contour and the sitting posture on surface pressure distribution and comfort during seated work. Int J Occup Med Environ Health. 2020 Sep 17;33(5):675-689. doi: 10.13075/ijomeh.1896.01582. Epub 2020 Jul 27. PMID: 32716013.
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