Chiropractic + Wellness

Changing positions and posture. Individuals who have to sit at a desk, workstation, or cubicle for most of the day increase their risk of back pain, contributing to other health issues. GetAmericaStanding.org reports the average adult sits for ten hours or more a day. Prolonged sitting at home and work without movement, physical activity, exercise can lead to issues like:

• Pain
• Irritability
• Cardiovascular problems
• Obesity
• Diabetes

Long periods of inactivity are associated with increased mortality as sedentariness causes the same damage related to smoking and obesity. It can be challenging to find ways to remain active while sitting at work; this is where changing positions and posture, also known as dynamic sitting throughout the day, can help.

Changing Positions and Posture Throughout the Day

Constantly sitting in a chair means the body remains static, causing blood and energy circulation to slow down, stressing the body's muscles. Changing the body's positions regularly along with short periods of activity like standing up, walking around while on the phone, and stretching helps to work out the muscles and keep circulation at optimal levels.

The Importance of Changing Positions and Posture

The body was meant to move and requires movement to stay healthy. Staying in one position for too long can lead to loss of core strength from the abdominal musculature becoming deconditioned. Muscle deconditioning leads to weakness and tightness. The imbalance affects the spinal support system leading to back, hip, and leg pain. Moving around and doing quick mini-workouts can help strengthen the body, increase core strength, improve posture, burn calories and prevent pain and injury.

The Basics

According to a 2018 study, researchers found improvements in cardiometabolic health among individuals that would stand up, sit less, and move more. Ways to adjust the work or home office to make changing positions and posture easier include.

• Sit-stand desks can be raised and lowered throughout the day to change position regularly.
• Treadmill desks are actual treadmills that are fitted with a desk so individuals can work and walk simultaneously.
• A smaller, less expensive option could be under-the-desk bike peddlers.
• Have resistance bands or small weights at the desk to perform exercises throughout the day.
• Ergonomic chairs
• Kneeling chairs
• Leaning stools
• Balance balls
• Wobble chairs
• Saddle chairs

Medical Consultation

These small changes and adjustments can make a big difference when experiencing body pain from too much sedentariness. However, it is crucial to know if other issues are causing the health problem/s. If back or any pain is associated with any of the following, consult a medical professional.

• Trauma from an accident or injury.
• Balance issues.
• Weakness in the legs.
• Infection.
• Fever.
• Unexplained weight loss.
• Overflow urinary incontinence is when the bladder fills up and empties without feeling the need to urinate.
• Severe constipation.

Body Composition

How to Read Blood Pressure Measurements

An individual's blood pressure includes:

Systolic Blood Pressure

• This is the first or top number listed on a blood pressure reading and is the measurement of the pressure that the blood exerts against the walls of the arteries.
• A normal systolic reading should be less than 120 mm Hg.

Diastolic Blood Pressure

• This is the second number that measures the force of the blood against the artery walls when the heart is resting between beats.
• A normal diastolic reading is less than 80 mm Hg.

Pulse

• The pulse is the number of beats per minute the heart is beating.
• A normal adult pulse is between 60 to 100 beats per minute.

When checking blood pressure, a doctor will read out a vital sign in the normal range of 120/80 mmHg or below. Anything above that could be an indication of an underlying health condition.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

"Ergonomics for Prolonged Sitting." The University of California at Los Angeles, Los Angeles, CA. https://www.uclahealth.org/spinecenter/ergonomics-prolonged-sitting

"Workplace sitting is associated with self-reported general health and back/neck pain: a cross-sectional analysis in 44,978 employees." BMC Public Health, London, UK. May 2021. https://pubmed.ncbi.nlm.nih.gov/33957889/

"Active Sitting Guide: 6 Reasons To Really Consider It." The Ergonomics Health Association. (n.d.) https://ergonomicshealth.com/active-sitting-guide/

"Cardiometabolic Impact of Changing Sitting, Standing, and Stepping in the Workplace." Medicine & Science in Sports & Exercise, Indianapolis, IN. March 2018. https://oce.ovid.com/article/00005768-201803000-00015/HTML

"Reducing occupational sitting time and improving worker health: the Take-a-Stand Project, 2011." Preventing Chronic Disease, Atlanta, GA. 2012.

"Office exercise: Add more activity to your day." The Mayo Clinic, Rochester, MN. October 2019. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/office-exercise/art-20047394

"The Tools: Put an End to Your Sedentary Lifestyle." Ergotron, St. Paul, MN. (n.d.). https://www.juststand.org/the-tools/

Back/spine injuries now rank either second or third overall for workplace injury/s. According to the Bureau of Labor Statistics, every year there are over 900,000 cases of back injuries that account for 1 in 4 non-fatal job-related injuries that involve work days missed. 

Backcare & Standing Work

Back injuries can be painful, debilitating, and life-changing. 8 out of 10 people will experience a back/spine injury that can lead to chronic pain and health conditions. We all need to know, especially those of us that work standing up is firsthand knowledge of how important it is learning how to improve spine health and take steps to prevent back injury.

In order to prevent low back disorders means that there needs to be an understanding of the spine when working along with knowledge of back injury risk factors.

Back/Spine Basics

The spine is a flexible structure that consists of 24 bones that move, shift, and contort, called vertebrae. There are:

• 7 in the neck
• 12 in the chest
• 5 in the low back 

These are connected by ligaments and separated by pads of cartilage, called intervertebral discs. These are the shock absorbers that allow the flexible movement of the spine, specifically at the neck and the low back.

When we stand, the spine naturally curves inwards and outwards. The inward curve is called lordosis, and curves towards the front of the body at the lower back and neck area. The outward curve is called kyphosis, and curves towards the back of the body around the chest area. When we bend over the vertebrae of the lower back change position and shift from being in lordosis to kyphosis when completely bent over and then back again when upright. With this information, it is easy to see how much we move around, bend, stretch and reach during a regular day. The lower back gets used the most, which is why low back pain and injury/s and disorders are the most common.

Causes of Low Back/Spine Pain:

• Muscles or ligaments get strained
• Added pressure on the intervertebral discs
• Nerve/s get compressed or entrapped
• Vertebra gets damaged from trauma 

The National Institute of Occupational Safety and Health concluded: “muscle strain is the most common type of work or nonwork back pain” (Bernard, 1997). This is good news for chiropractors and ergonomists because it means that we can find ways to reduce/change the way we work and the effort involved to minimize injury risks.

Keeping the intervertebral discs healthy plays an extremely significant role in preventing back/spine injuries. If these discs get damaged and start to degenerate, flexibility begins to fade away, stiffness and soreness sets in and the ability to absorb the daily pressure/forces that comes with standing, moving and working.

There is not a normal blood supply to the intervertebral discs. Instead, as the discs change shape when we move around, the nutrients that they need are absorbed into the discs as the waste products are pumped out. This is why moving the body and staying active is very important. Because as you move you are literally feeding your spine and expelling the bad stuff.

Intermittently changing postures and positions helps change the force and weight on the discs so that not all one area is taking the brunt of the force. Remember to move around and keep your spine as healthy as possible.

Risk factors

Major risk factors for back injuries include:

• Awkward postures
• Bending
• Twisting 
• Heavy physical tasks
• Lifting
• Forceful movements
• Whole-body vibration aka W.B.V.
• Static or unmoving work postures

These risks can happen separately or could be a combination of them all, and if these risks are taking place at any one time the higher probability of an injury/s. 

Standing Work

When we stand, the pressure on the lower back discs is relatively low. Not that there is pressure but it is much lower than when seated with an unsupported backrest like bleachers for example. Standing up uses 20% more energy than sitting does. When we need to bend down to pick up objects or reach to get overhead objects there is an increase in the forces and pressure on the lower back, and this is when an injury is likely to happen.

Tips to Minimize Injury

Here are some tips to help minimize your risks of back/spine injury when you are doing standing work:

1. Moving around is important to keep the spine healthy. Moving will help improve circulation and reduce muscle fatigue.
2. Taking consistent short breaks will help reduce fatigue, discomfort and work other muscles.
3. Gentle stretching during some of these breaks helps to ease muscle tension and gets circulation pumping.
4. Pay attention to your posture and the way you stand as you work.
5. Lean on a solid support to help reduce fatigue when you are standing with a support that you can put your back up against, lean against sideways, lean forwards against and to hold on to will increase safety.
6. Keep your back strong and try to do exercises that will strengthen the back muscles. Activities, like Yoga, Crossfit, HITT or workouts focused on the spine for flexibility are the way to go.

• Maintain a stable posture with your feet on a firm surface.
• Avoid twisting the lower back around to reach for things.
• Move your feet so that your whole body changes position.
• Minimize bending, but when you have to, bend for objects in front of you and bend at the knees instead of the back. When bending for objects that are to the side of you change your stance so you are facing the object, and then bend down at the knees.
• Don't overreach but if you have to reach up to a high area to get something use a step-ladder.
• Don't reach over objects and move the obstruction or change your position before reaching for whatever it is.

Low Back Pain? Get rid of it with *FOOT ORTHOTICS* El Paso, TX.

NCBI Resources

The one size fits all method just doesn’t cut it. A more focused approach for every individual leads to better results. Patients find that placing their bodies in certain positions and certain physical activities can:

• Activate
• Aggravate
• Deactivate their back pain.

Patients also find the pain being either better or worse. Understanding why sitting, standing, and walking can change the severity of low back pain can be helpful in diagnosis. These are important cues that help to diagnose and treat low back pain. People sit, stand, and walk all day. This is why so much research has been conducted on how these specific positions and activities contribute to low back pain.

Prolonged standing and walking for healthcare workers can cause or aggravate previous health complications and soft tissue injuries and its effects can usually become instantly noticeable. An abundance of individuals often experience swollen or painful feet or legs, bunions or bony bumps that develop on the joint at the base of the big toe, plantar fasciitis, Achilles tendinitis, varicose veins, knee complications, low back pain, neck and shoulder stiffness, poor posture and the effects that follow, restricted blood flow, heightened risk of knee or hip arthritis and, muscle soreness and fatigue.

Through many healthcare jobs, as well as with other types of jobs, standing is frequently a normal component within a healthcare worker’s day but, when the physical layout or work practices of a task require individuals to reach across wide surfaces in uncomfortable positions or repetitively participate in tasks without breaks, individuals may be at a higher risk of developing musculoskeletal injuries or conditions. Additionally, standing can be much worse when the individual has limited space to move around or while working on hard surfaces and/or wearing unsuitable footwear.

Calf pain is common in individuals that are on their feet for long periods. This could be standing, walking, as part of a job or jogging, and running. In most cases, calf soreness and/or pain result from repetitive/overuse strain/injury/tear of the calf muscles. Pain along with stiffness presents with physical activity, exercise, movement. Chiropractic treatment and Active Release can help alleviate and eliminate calf pain.

Calf  Muscles

The calf muscle is in the back of the lower leg, behind the shin bone, and consists of three muscles. The calf muscle supports the body when standing and enables movement of the foot and lower leg. The calf muscles support the body when:

• Walking
• Running
• Jumping
• Standing on the toes.
• Flexing the foot - lifting the toes toward the knee.
• It helps push the body forward and allows jumping, ankle rotation, and flexing of the foot.

Causes, Conditions, and Disorders

The overuse of the calf muscles usually causes calf soreness, discomfort, and pain. Over time, tiny tears develop in the muscles of the lower legs and calves. Repeated use can lead to more severe injury or condition without proper treatment. Conditions include:

Strain

The most common injury is a strain. Strains happen when the muscle fibers are overused and get stretched too far and/or tear. However, the fibers may not tear in that instance, and so the tear could occur at a later time while doing a basic movement like slightly bending or kneeling to tie a shoe. This is when individuals wonder how a tear happened with a simple action. But the tear was already present, just not fully torn.

Cramps

Muscle cramps and muscle spasms in the calves can be excruciating limiting mobility. Calf cramps can happen during the day or at night. They can result from several factors that include:

• Health conditions
• Dehydration
• Medications
• Pregnancy

Tennis leg

Healthcare providers call this strain tennis leg because it happens when the leg extends and the foot flexes. Tennis players are in this position when they serve and push themselves off into motion; however, it can happen in any sport, job, chore that involves the same movement. This type of muscle strain injury affects the gastrocnemius muscle. 

Compartment syndrome

Compartment syndrome happens when pressure builds up inside a muscle. The pressure significantly reduces the flow of blood and oxygen. It can result from trauma like a fracture or strenuous exercise/activity.

Symptoms

Calf muscle issues can cause calf muscle:

• Pain
• Tightness
• Stiffness
• Pain may be sharp or dull
• Pain can start as mild pain and progressively worsen.
• Limited mobility
• Limited range of motion
• Muscle weakness
• A bump, bulge, or lump in the back of the lower leg.
• Tenderness
• Bruising
• General leg cramps are common and are more likely to happen as the body ages. 
• Healthcare professionals estimate around 75% of individuals over 50 have had leg cramps and pain. 

Calf Health

To prevent and avoid problems with the calf muscles, individuals are recommended to:

Maintain a healthy diet and weight

• Individuals that are overweight are more likely to pull or strain a muscle.
• Excess pounds add pressure on the legs placing individuals at a higher risk of an injury.
• If obese or overweight, talk to a healthcare professional about healthy weight.

Stay hydrated

• Drink the proper amount of water and other fluids
• This decreases the chance of causing a cramp.

Stretch and warm-up

• Warmed-up calf muscles are less likely to stretch too far or tear.
• Before engaging in physical activity at work or school, do a few warm-up stretches to increase flexibility.
• When exercising, gradually increase the intensity.

Stay aware of medications.

• Certain medications can cause leg cramps and/or dehydration.
• Talk to a doctor about taking another medication that does not cause these side effects.

Body Composition

Nutrients of Protein

Protein is necessary for all of the body’s physiological functions. Protein and amino acids are the building blocks of the muscle tissue in the body. The body's muscles are a house, protein is the bricks, and the amino acids that form protein are the building blocks of muscle. The body manufactures various amino acids, but nine are essential amino acids - EAA because they are not made in the body. Individuals have to consume EAAs from food sources like:

• Meat
• Beans
• Nuts
• Soy

A diet that consists of mixed amino acids can help maximize muscle protein synthesis. Protein is essential in building muscle because amino acids help repair and maintain muscle tissue. After a strenuous activity or a workout, protein helps the body repair muscles that are slightly torn. To build a healthy body, the body needs to have the right amount of protein. Protein is an essential component of:

• Muscle development
• Bone density
• Muscle mass
• Lean tissue

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Binstead JT, Munjal A, Varacallo M. Anatomy, Bony Pelvis, and Lower Limb, Calf. [Updated 2020 Aug 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. . Accessed 6/4/2021.https://www.ncbi.nlm.nih.gov/books/NBK459362/ (https://www.ncbi.nlm.nih.gov/books/NBK459362/)

Bright JM, Fields KB, Draper R. Ultrasound Diagnosis of Calf Injuries. Sports Health. 2017 Jul-Aug;9(4):352-355. . Accessed
6/4/2021.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5496702/ (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5496702/)

Young G. Leg cramps. BMJ Clinical Evidence. 2015 May 13;2015:1113. . Accessed 6/4/2021.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4429847/ (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4429847/)

Doctor of Chiropractic, Dr. Alexander Jimenez shares some insights about a pain free workday.

#1. Use Healthy Posture & Movement Patterns

Considering all the emphasis on how little or much we should sit or stand at work, there is almost no discussion of technique in standing and sitting. Inferior technique slumpsitting, archsitting, parking weight is used by many people so on, and poorly on joints.

As long as this is actually true, any place is going to stack up badly in the research—we are starting to see it for standing and ’ve seen this for sitting. Sitting has been much maligned as “the new smoking”; and now standing as a replacement is being demonstrated to cause increased hospitalization due to varicose veins, atherosclerosis that is increased, etc. A good starting point is stretchsitting, to start the journey back to a pain free workday. Stretchsitting is simple, safe, comfy, and therapeutic.

Work with flannel, a towel, or a Stretchsit pillow so it contacts you at mid-back, below the shoulder blades.

• Scoot your bottom all the way back in the seat.
• Lean forwards from the hips, like a mini crunch is being done by you, and tip your ribcage forward.
• Push downwards on the armrests/side bars/seat pan of your chair to get a soft stretch in your lower back.
• Keeping the stretch, lean back out of your hips and adhere your mid back on to the Stretchsit pillow/towel.
• Relax completely, letting the Stretchsit pillow and come from the mini crunch /towel keep you in traction that is light.
• Roll each shoulder back and rest your hands close into your own body.
• Angle your chin down slightly, letting the back of your neck be long.

#2. Vary Your Baseline Posture

No matter how good your bearing, your body still needs a variety of places. Sitting and standing are the most practical positions for most occupations (example computer occupations)—I recommend switching between them every 20- 30 minutes. If other positions and motions are practical for doing your job (eg, walking when speaking on the phone), that’s an excellent bonus—the more baseline stances and movements, the better. (one sitting against backrest, one stack sitting, standing in a desk, and walking with telephone)

#3. Supplement With Rest, Exercise, Movement During & Outside The Workday

Use your breaks in the workday along with your time away from work to supplement your special service line spots. Do you need rest? Exertion? Stretching? Strengthening your abdominal muscles?… There are countless tissues and muscles within your body that have needs just like you are served by a diet that is diverse well, a movement regimen that is varied will also.

#4. Use Well – Designed Tools & Furniture

Experiment and learn with what constitutes furniture that is healthy this is an investment in the way you’ll be spending about half your waking life.