Healthcare and Medicine Reference
In-Depth Information
It is extraordinarily easy, in fact, to fall into a habit of
sitting that allows one or more of the following to
happen:
1. the head to come forward by flexing the lower
cervicals;
2. the upper neck to go into hyperextension;
3. the chest and front of the rib cage to fall;
4. the lumbars to move back and go into flexion;
5. the pelvis to roll back so that the weight goes
onto the posterior aspect of the ischial tuberosities
(i.e. the pelvis tips toward the tailbone).
This necessarily involves a shortening of the SFL, as
well as likely shortening in parts of the DFL. Depending
on the particular pattern of sitting displayed, allowing
the body to come up may involve lengthening tissues
along the trunk portion of the SFL (the fascial planes
associated with the rectus abdominis, for example).
When the tissues in the front pull down, the tissues of
the SBL (the erectors and their fascia) often widen, so it
will also ease the client's passage toward supported
sitting to bring the tissues of the SBL medially, toward
the midline of the back to correct the widening.
It is also often essential to get the client to 'engage'
(create more standing tonus in) the DFL. Specifically, the
psoas muscle needs to be deployed to steady the lumbars
forward to lift the chest, and the deep longus capitis and
longus colli muscles on the anterior of the cervical
bodies must be employed to keep the cervicals back and
counteract the tendency of both the SFL and SBL tissues
to hyperextend the upper cervicals, pushing them
forward.
The next section describes a spinal integration exer-
cise for sitting that is helpful in bringing all these desir-
able ends to happen at once, but further work on
individual components is often also required. Once bal-
anced sitting is achieved, it needs to be practiced assidu-
ously for some days or weeks until both the nervous
system and its minions, the muscles, have adjusted
to the change. After this initial period of conscious
attention, this kind of sitting will be able to be nearly
effortlessly maintained for hours without diminishing
breathing or attention, nor creating structural pain.
Fig. 10.15 Serious spinal damage at 0 miles per hour!
(© BackCare. Reproduced with kind permission, www.backcare.
org.uk)
Integrating the spine in sitting
(The author is grateful to Judith Aston (www.
astonenterprises.com) for having conveyed the basis for
this integration exercise, but notes that he learned
the following sequence from her in 1975. By now it may
not accurately represent her current approach, and,
memory being what it is, additions or omissions have
likely crept in - but she deserves credit for the original
idea.)
Nearly everyone's schooling involved the postural
adjustment to standard issue desks. The author's expe-
rience is echoed by many of his clients: curled into what-
ever desk fell to the alphabetical roll call, our thoracic
spines bent over the desk, and when called upon,
we raised only our heads, putting a hyperextended
neck over the flexed spine, as in Figure 10.15. Desks that
are adjustable to the children, like posturally efficient
Fig. 10.16 Balanced upright
sitting.
full extension, the major body weights of head, chest
and pelvis poised one atop the other over the anterior
ischial tuberosities, more or less on the same coronal
plane as the top of the acetabulum. As we have noted
in their previous respective chapters, the SFL generally
creates trunk flexion (except at the upper neck), the SBL
generally creates extension, and the DFL is capable of
creating either at various levels of the spine. Easy align-
ment in sitting can be created by balancing these three
lines, though at first attempt the balance may not seem
so 'easy' because of the necessity of moving beyond the
neuromuscular and connective tissue habitus.
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