Yoga SOS: Save our seated spines

With more and more people facing life-threatening illnesses stemming from sedentary culture, yoga and movement teachers have a critical role to play

“Sitting is the new smoking” was a sensational headline which rippled through the news last year, but was this over-dramatic? Increasing evidence shows that it is worth examining issues facing our ever-increasing sedentary culture.

Most people, especially movement teachers and bodyworkers who see these issues across a broad spectrum of clients, associate long-term sitting with structural issues and pain. But there is also growing discussion around the correlation between increased sitting and metabolic and chronic, inflammatory conditions; often referred to as ‘diseases of Western civilisation’. A study of 4,811 British public servants was published this year^[1], which followed people who were on average 44 years old, with no incidence of diabetes, heart or circulatory problems at the start. Over the next 13 years, 402 people developed diabetes and it was these circumstances that the researchers investigated.

The issue of sitting was examined, with low long-term health risks for conditions such as type 2 diabetes, heart disease and an early death stemming from sedentary work. It is theorised that this is because higher status jobs involve more sitting and higher socioeconomic position associated with lower risk of chronic disease. On the other hand, excessive sitting and watching TV is most consistently linked with such long-term health risks and, statistically, those who watch more TV hours are more likely to be of lower socioeconomic status, unemployed, have mental health issues, eat unhealthy foods and be exposed to unhealthy food advertising.

Overall though, whether the sitting was at work or home, the most pertinent association with health risk and sitting was not the amount per se, but how balanced a person’s physical activity was with sitting behaviours. Diabetes risk was reduced, for example, in those who had higher levels of physical alongside having to sit down for long hours at work. A large review recently combined data from over one million participants and found that 60-75 minutes of daily physical activity eliminated the harmful effects of sitting; with the measure of death from cardiovascular disease or any other causes^[2].

This makes sense when we consider there is no comfy furniture in the wild; we were designed within nature and much of our function is bound up in those constant shifts where we would have squatted, sat on uncomfortable surfaces and kept adjusted in ways that encouraged circulation, lymphatic motion and metabolism. Our posture (which also determines much of our function and health) also suffers from the static, collapsed constant of modern sitting or lying habits.

Postural damage

It is more commonly the link between back, neck and shoulder pain where sitting sees most obvious correlation with health issues. One study investigating the connection between time spent sitting and incidence of back pain in 201 people^[3] also reviewed the literature, reporting that adults now spend as much as 6–8 hours per day, more than 45–50% of their waking hours, in a seated position. They observed significant associations between time spent sitting with increased severity of lower back pain, with a body of research showing increased intra-discal pressure, stiffness of the lumbar spine, reduced lower back muscle strength and/or decreased metabolic exchange, also leading to excessive body weight.

See more effects of long-term sitting at the general blog on this same topic: Is sitting too comfortably bad for your health? 

Primary curves

Sitting for long periods is simply not what we were designed to do. As bipedals, standing upright on two legs relies on calibrated curves to continually negotiate the downward pull of gravity. We are a collection of curves and spirals; we are most stable and our structure most congruent when our spine can retain its natural ‘S-shape’.

Our primary curves, also referred to as ‘C’ or ‘foetal’ curves are the bony support of the back of the head, the thoracic and sacral spine and the back of the heels: the curves that move outwards (posterior). We have also evolved secondary spinal curves, which are myofascially supported (by muscle and connective tissue), in order to stand upright, the curves that move inwards (anterior): the lower back and neck (lumbar and cervical spine) as well as the backs of the knees and the arches of the feet (fig. right).

We can see this most obviously at the bony site of the sacral primary curve (tailbone), the shape of the back ribs in the thoracic spine, and the back of the skull. In an ‘ideal’ standing posture, these three curves rise above the primary curve of the back of the heels, suspending the weight of the head above the similar weight of the pelvis.  If one secondary curve is affected by shifts in the primaries (or other reasons), it ripples out to all myofascial support.  We are not designed to sit on chairs – or toilets; there’s a whole other issue surrounding ease of defecation and the angle of our sphincters, which effects our whole digestive tract - or slump on the sofa, where there is little resistance to rise up from and we sink down into compression that has no balancing support.

Aligning the pelvis and lumbar

When sitting, ideally we sit up from the ‘heels’ of the spine as we would rise up from those in the feet when standing. A heel is a rounded bone we can rock on and for optimal expression upwards of the spinal curves, we need to sit just to the front of the sitting bones, as we do the heels in the foot. Slumping back as in fig.above, we are actually sitting onto our tailbone and dragging it under, encouraging habitual posterior pelvic tilt, where the pelvis rolls back, and lumbar flexion or flattening of the lower back, when we stand.

The sacrum as keystone

The sacrum needs a 30-degree angle for its supportive keystone design in the lower back primary curve. If flat (vertical), the top of the femur gets moved back as the pelvis shunts forwards (fig.above). This upsets our most efficient stacking up from gravity; ears above shoulders, above hips, above the head of the thighbone (greater trochanter), above the ankle.

Visceral support

Part of this S-shape spine design is to help support our pelvic and digestive organs, which unlike our four-legged friends, are vertically stacked. A healthy lumbar curve means that these viscera are happily weighted against the lower back, rather than directed straight down (fig.left) towards the pelvic floor, which must then contract and tense to support them and can weaken in the process. This also sends ripples of stress through the pelvic and digestive organs, creating fascial tightness, reproductive and digestive conditions, as well as lower back issues.

Sacroiliac issues

The hip joints and the sitting bones are directly underneath the sacroiliac (SI) joint, where the sacrum (the base of the spine) fuses with the pelvis. This is the root of many lower back issues for many; collapsing backwards into the pelvis strains this connection and can cause inflammation and instability. Especially if we tend to habitually sit cross-legged in the same direction, off-centre tendencies of the pelvis can create micro-tears in the SI joint ligaments. These can also become overstretched from injury, surgery, accidents, pregnancy or emotional holding in protective patterns. Sitting for long periods in the same position will exacerbate all of this.

The computer crunch

While we might perceive sitting as an inert and relaxing position, because we are resting our legs, it is actually as dynamic a position as standing for the spine and torso. It is rare for a human with natural movement to stand still for any period of time equally on both legs, and this is the same for sitting equally on both sitting bones. To do so is tiring, and so we tend to collapse into the lower back after a while.

It is not unusual for the majority of a modern day to be spent hunched over a keyboard (the left example above), if this is not with conscious, supported upright posture (the right-hand side example), it can quickly descend into a hunch that can contribute to a collapsed standing posture, where we lift up from the ground ‘up the back and down the front’ rather than the more open, grounding and supportive ‘up the front and down the back’.

We can see here that the head can be progressively pushed forward of the spine and so place strain on the neck, partly from the forward angle and partly because the head becomes ‘heavier’ to hold up as further away from the centre of gravity. The pelvis will shift forward or back to counter this weight, adding to lower back issues.

While paying attention to sitting posture and consciously lifting up through the front spine is definitely important, getting up and moving around is even more beneficial. When we do this, we move and hydrate tissues, support circulation and raise our metabolism. 

You can read more about posture and its affects on health in Charlotte’s book Yoga Therapy for Digestive Health 

Conscious chair sequence

A seated yoga practice on a chair can help inform how we bring awareness to sitting and also create the movement in the spine and pelvis that can become limited from chair-sitting.

1. Sit forwards
   Sitting to the front of the seat with heels under the knees and feet grounded helps us sit up from the sitting bones. Here posture is naturally aligned with ears above shoulders, shoulders above hips; with natural curves in place. The uplift that comes through the back of the skull – as if it were ‘floating’ above the tailbone – is the optimum upright seated position, where we retain space at the base of the skull and can still self-soothe in the whole body via the vagus nerve that starts here, before moving down around all organs. Here the brainstem also stays awake; when we collapse down, we can become more mentally ‘dull’; hence the “sit up straight” school command had some validity to keep up concentration!

2. Make space through the spine

Creating space between the discs of the spine allows us to twist without compression. Regularly turning around the axis of the spine helps to counter the tension in torso fascia that contributes to back pain and digestive issues. Taking one hand to the back of the chair seat and the other to the outside of the front thigh provides some purchase to open the collarbones and drop the shoulders.

3. Find the lumbar curve 

Pelvic tilts here help remind us where the lower back can ideally sit. Inhaling, we can arch the back to open the front body and chest. Exhaling we then curl in to open the back body and consciously move into the pattern of ‘collapse’ to free that tension. Move between the two pelvic positions to create awareness of sitting bones on the chair and where the balance of a happy lower back curve lies.

 4. Release spinal tension

Rest and relieve a tight, bound-up back in a chair version of Balasana (child pose), opening legs wider and dropping torso down, either head below knees or just elbows to thighs if any dizziness or unease comes from the lower head position. Breathe fully here to allow the nervous system to calm.

Meditation posture

When most people come to seated meditation positions directly on the ground, their postural habits that come from chair sitting mean they will collapse into their pelvis with full uplift (fig. above top). Here they may also lift the chin and compress the base of the skull – a common source of neck and shoulder pain – through habitually looking up at a screen and also the illusion of ‘sitting up’ (fig. above bottom). When working, moving the eyes rather than the head to look down and/or forward can help to avoid this.

1. Provide support

2.Blocks and/or blankets
One (or usually two) yoga blocks or folded blankets under the sitting bones allows upward engagement – the feeling of lifting the abdominal contents out of the pelvis with natural lengthening between the ribs and the pelvis. This may be cross-legged if knees and hips allow.

3.Vary leg position
Many people are more comfortable with legs bent back in Virasana (Hero Pose) with support (block/s, blanket/s, a meditation cushion or bolster).

4.Meditation stool
A dedicated meditation stool will raise the hips higher.

Releasing samskaras

All of these positions nurture the natural S-shape spine that create the expanded inner landscape that meditation invites.

Because collapsed posture can become a set state, especially for those sitting for hours on chairs, when we create more length in the ventral body this way and begin contracting overstretched muscles in the back body that have been habitually over-stretched, this can feel strong at the beginning and even sore after practicing. People even feel quite tired from sitting up onto a block as the muscles are not used to holding this configuration.

Through inviting new, more conscious body patterns for habitual sitting within the context of yoga or movement classes, we are promoting the expansion of awareness to how people sit at work or on the sofa. It is common for people to go through ‘growing pains’ during this reconfiguration; releasing samskaras, held habits, can be an uncomfortable and challenging process. Ultimately, however, this deeper listening and responding to the body leads to greater freedom of movement.

These issues and more are explored within Charlotte’s Further Trainings for Yoga Teachers, see more information here.

^[1] (British J Sports Med. 2017;51(10) https://pubmed.ncbi.nlm.nih.gov/27153869/

^[2] (Lancet.2016;388(10051),1302–1310) https://pubmed.ncbi.nlm.nih.gov/27475271/

^[3] (PLoS One. 2015;10(3),e0121159) https://pubmed.ncbi.nlm.nih.gov/25806808/