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FM Patients: Shed an Unnecessary Source of Fatigue and Pain

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By Nancy McCullough, OTR, CHT

(Registered Occupational Therapist, Certified Hand Therapist

Living in Boise, Idaho)

Regardless of our desire to please our mothers, why is it so hard to sit up straight? And do we really feel better when we do? How long do we stay that way before slumping back into our “normal” position? For most of us, having good posture and sitting up straight is such an effort that our attempts to comply with mother’s suggestion are met with failure, so we resign ourselves to the fact that we do have poor posture. We don’t work on it because it’s too much trouble and unimportant. The bottom line is that 99% of the population doesn’t know how to improve posture or keep it that way.

Let me share a trade secret with you. As a hand therapist, I treat individuals who complain of hand pain, elbow pain, shoulder pain, headaches, stiffness in their hands, wrists, elbows, shoulders, necks; feel weak in their ability to pinch, grip, lift, drive; have numbness and tingling in their hands and arms. These people often lose time from work, lose their jobs, have trouble with simple things at home or can’t lift their babies because of their pain and weakness. The financial and emotional impacts can be extreme.

Coworkers or family members don’t understand what these people are experiencing, nor do many of their physicians (similar to people with back pain who are ridiculed because their symptoms are not believed).

These people may undergo surgery on their wrists or elbows in an attempt to relieve their pain, but too frequently the results are disappointing. People with the symptoms I described above share a common thread: The pain, stiffness and sensory changes are influenced by the cumulative effect of repetitive activity performed with poor posture. My treatment for these people with chronic pain is somewhat like a recipe in that you need to include all of the ingredients; posture, stretches, some strengthening and worksite modification, in order for the cake to rise.

Imagine that, a hand therapist talking about posture. But more than that, a therapist who follows her own advice, and what a difference it has made for me and my patients (even my mother has taken my advice and says she notices that she is standing up straighter naturally).

I don’t have Fibromyalgia, but many of my patients have been told by someone in their medical past that they do; despite this diagnosis, these people improve to a point where they have control of their symptoms when they are strict with their regimen of stretches, certain strengthening exercises, postural compliance, cardiovascular exercise, adequate rest, stress reduction, little to no alcohol consumption, and a balanced diet. These are the ingredients of a healthy lifestyle.

Keep in mind that if all of this was so easy, everybody would look as polished as a U.S. Senator. It takes dedication, but not necessarily a lot of work, to make a difference.

Rene Caillet, an internationally known orthopedic surgeon whose work is studied by physicians, chiropractors, rehabilitation therapists and others, points out that for every inch forward the head rests away from the vertical axis of the weightbearing spine, the muscular effort to hold the head in that position increases threefold.

To understand this concept more personally, stand comfortably against a wall (not in a military style) with heels and mid-back touching the wall. Have someone measure the distance between the back of your head and the wall. Multiply that result by 12 pounds (the average weight of a head) and you have an idea of essentially how much weight your neck, back and shoulder girdle muscles must hold to keep your head within the vertical and horizontal axes of the world. This is excessive, unnecessary work for your muscles! (not to mention a great way to accelerate the degenerative process of the joints between the vertebrae). The end result of this effort is pain and fatigue.

If you can improve your posture by bringing your ears in alignment with your shoulders and your shoulders in alignment with your hip joints, it takes minimal muscular effort to keep your head up because the weight of the head is balanced between the forces of gravity which want to pull the head, neck, back, etc. in a domino fashion either forward or backward. In essence, you can shed 30 pounds of weight from your neck, back and shoulder girdle muscles if you can improve your alignment.

Much easier said than done. Ideally, you should meet with your favorite physical therapist for development of a personalized treatment program for postural training which should include stretches for cervical, shoulder girdle and back muscles, strengthening of the muscles which promote “scapular posterior depression” (the military brace position), and begin regular usage of a lumbar (low back) support which is crucial! Using a lumbar support is something you can get started with as soon as you are done reading this article.

Good posture begins with the lumbar curve. When it is supported in its inward curved position, while you are seated against a straightbacked seat, your shoulders naturally come into alignment with the vertical axis of the weightbearing spine. You will also notice that it takes effort to bring your head forward of the shoulders because it is balanced against the forces of gravity. Take away that lumbar support and the low back curve straightens as the pelvis tilts back, the shoulders and head come forward, and you have lost that senatorial appearance. You are then back to supporting 30 pounds of weight at the upper end of your neck.

If you want to add more work to those muscles, do repetitive work with your elbows out away from your body while you sit without supporting the lumbar curve. The muscles in the back of your neck, between your shoulder blades and your upper and mid back experience chronic tension. The cycle of tension = contraction = reduced blood flow = fatigue = pain is perpetuated. The muscles in front of the neck, chest, shoulders, abdomen and low back shorten and tighten. The sitting posture, in which you spend a major portion of your day, experiences a carryover effect into your standing posture (head and shoulders forward of the vertical axis).

Remember, stretches and strengthening are essential ingredients of this recipe, but if you can start “proprioceptive postural training” by using a lumbar support and a straightbacked chair every time you sit down for a three-week period religiously (in the car, at the dinner table, at the movie theater, at work, while watching TV, and while in church, you can train your joints and muscles to become comfortable with the new posture. Kind of like habit-training. After the three-week period, if you should inadvertently revert back to your old posture, your muscles will automatically alert you to squirm and readjust yourself until you can get your hands on your lumbar support.

Your newly acquired sitting position will translate into your newly acquired standing position because your body will be more aware of the increased muscle tension of the neck, shoulder girdles and back, and you will be uncomfortable with the “old” posture. Over time, your body will try to eliminate old postural habits and remind you to stand straighter (this is when your body starts nagging you instead of your mother having all the fun).

I have to add a warning here. Once your body has “morphed” into this new postural habit pattern, you will discover how many uncomfortable and poorly designed chairs there are in the world. Just keep your lumbar support nearby or improvise if you have to (a purse, a jacket, or your forearm behind you if there is nothing else available). If you come to find that your work chair is unacceptable, petition, nag, beg, plead, or bribe your employer into obtaining a chair which provides an erect seat back so you can use your lumbar support. Tell him Nancy says you will work more efficiently when you are comfortable!

The above article is a reprint from TVFO, Inc. Newsletter; a quarterly newsletter published by the Treasure Valley Fibromyalgia Outreach; an Idaho non-profit organization supporting persons with fibromyalgia. If you would like to learn more about this organization, their mailing address is: TVFO, Inc. P.O. Box 98, Meridian, ID 83680-0098. You may also contact TVFO by telephone at 208-939-2421 or 208-887-2113 for information about Wellness group meetings.

Source: The website of the Arthritis Foundation:

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