Most people are aware of positions that are bad for their body. Sitting hunched over with a laptop or looking down at the phone comes to mind. However people don’t typically think of: (1) sitting on low, soft, deep couches or (2) lying down with the head propped up excessively as positions that could contribute to pain. These are common positions people are in everyday and both involve flexion of the spine. In the clinic I find that being in these specific positions for extended periods often accompany ‘flare-ups’ of back or neck pain.
So does this mean that flexed positions of the spine are bad? No, absolutely not – flexion is a normal movement of the spine that occurs everyday whether it’s putting on socks and shoes, reaching down to pick something up, or looking down. There are also sports like rowing or biking that involve flexion movements.
Position 1: Sitting on low, soft, deep couches for extended periods
Position 2: Lying down with the head propped up excessively for extended periods
The more important thing to consider with this is whether the joints are centrated, and secondly, whether it’s a dynamic movement or a static hold. ‘Centration’ means that the joints (where two bones connect) have maximally congruent contact. In other words, the muscles are balanced on both sides and the agonist and antagonist co-contract with movement in order to maintain that maximal congruent contact. With the example of spinal flexion, this would present itself like a uniform curve (as shown in the picture below). A non-uniform curve would mean that the joints are not centrated and would produce increased pressure/strain on passive structures like ligaments, cartilage, and discs. If non-centrated joint positions were to be repeated over and over again, whether with dynamic movements or with static holds, this would likely cause injury and/or pain over time. This is applicable not only to the spine with spinal flexion but with any joint and movement in the body.
This person is bending over into flexion and shows a uniform spinal curve (equal curve throughout), which is a sign of a joint-centrated movement.
This person is bending over into flexion but showing a non-uniform spinal curve (more curved at the mid back and less curved in the low back).
The second thing to consider is the effect of joint centration on static positions, like the two common flexed positions mentioned above. In principle a static position in joint centration would be fine. Getting into those positions every now and then while taking breaks to stand and move would likely not be a problem. However, if these static positions were held for extended periods of time on a consistent basis — hours multiplied by days and weeks — no matter how centrated the joints may be, the effects of gravity, fatigue of the muscles, and lack of lubrication and movement in the joints would contribute to increased strain in the tissues over time (“tissue creep”). That’s why in order to minimize risk of injury and pain, the best thing for the body would be to sit with the joints centrated in a more upright, straight sitting posture.
Instead of sitting on a low/soft/deep couch try a normal chair with back support and padding under your glutes, keeping your glutes all the way to the back of the chair (or a higher/firmer/less deep couch!). If you want to read lying down, try lying with a pillow under your head with the neck not in excessive flexion, so the forehead should be angled slightly higher than the chin horizontally. If lying on your side, try a pillow between your knees and a folded pillow under your head.
Training these joint-centrated positions continuously would be ideal as this would be the best way to prevent injury from happening in the first place. DNS (Dynamic Neuromuscular Stabilization) provides a great platform to train this. It starts with trunk stabilization on the back with the spine horizontal and progressing to more upright and dynamic movements. In this way the brain could start to automatically and subconsciously control it.
Links:
“How should I be sitting (or standing)” - BLOG post describing ideal sitting position
“Sleeping position and pillow type” - BLOG post describing neutral sidelying and supine position
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