Sitting for long periods during the day can adversely affect an athlete’s performance in their chosen sport and is quite often a predisposing factor in injury. Yet many therapists do not pay enough attention to the significance of this factor.
Remember that athletes are not just those we see on TV, but also the 30-year-old delivery man who is trying to break the three-hour marathon barrier or the 40-year-old lawyer and amateur triathlete attempting to qualify for her first age-group world championships. These are the athletes who will be forced to sit for long periods every day. Even among professional athletes, you may need to consider the effects of prolonged sitting if for instance they spend a large amount of their time travelling.
In most people, prolonged sitting will cause all or some of the following:
The better the posture one can maintain during the day, the less likely it is that the above areas will become problematic. Sports injury specialists and conditioning coaches need to recognise that the older the athlete and the more time spent seated over the years, the more ingrained these problems will be.
When you screen an athlete or treat a specific injury, it is very important to know what they spend most of their time doing, if you are going to help put in place preventive measures or holistically rehabilitate an injury. Management must be customised according to each athlete’s occupation and sport.
Let’s consider Jack, our delivery man who is trying to break a three-hour marathon time. His training is being increasingly affected by the lumbar spine and posterior thigh discomfort he feels whenever he tries to run more than 15k. Jack agrees that he sits most of the day in quite a poor posture with his knees out to the side (ie hips in external rotation) and a slouched position. On assessment, Jack demonstrates an anteriorly tilted pelvis, anterior femoral head displacement bilaterally, overactive and tight external rotators of the hip and tight hip flexors.
When palpating his spine, the L5/S1 segment is stiff but only mildly uncomfortable, whereas the L4/L5 segment is very mobile and tender. To put these assessment findings into a clinical picture we need to consider what is happening when Jack is running. At the end of the stance phase, the hip goes into extension and internal rotation. But Jack’s tight external rotators and hip flexors mean his range is quite limited. Jack’s body naturally compensates by anteriorly tilting his pelvis, extending his lumbar spine to try and maintain a normal stride length. This increase in pelvic movement will make him less efficient.
The stiffness in the lumbosacral junction leads to an increase in extension at the L4/L5 segment. When Jack begins to fatigue, his stability muscles will provide less segmental control, the shearing at the hypermobile L4/L5 segment will increase and lead to irritation in his lumbar spine and referral to his posterior thigh. I’m sure most of us have seen this presentation, but it is not usually linked back to the way that a client’s occupation affects their running mechanics. Jack’s daily routine and flexibility programme need to be adjusted to combat the hours he spends sitting in the truck.
Now for Denise, our 40-yearold lawyer and triathlete, who spends hours on end, day and night, in front of a computer, as well as hours sitting on a bike – mostly in the hunched ‘aero’ position. Denise has an increased thoracic kyphosis and cervical lordosis (ie, ‘poked chin’ position) and the right humeral head sits forward in the glenoid. She has a limitation in her thoracic spine extension, protracted and winged scapulas (testing indicates poor lower trapezius and serratus anterior control), and weak and tight infraspinatus and teres minor. This will undermine Denise’s efficiency in her swimming stroke, and worse still make her a classic candidate for a subacromial impingement/shoulder tendinitis – the last thing she would want leading up to a qualifying race.
Just like Jack, Denise needs to implement daily flexibility exercises and regular standing to combat the effects of spending so much time in a seated position, and an exercise programme to train postural and shoulder stability muscle groups.
Prolonged sitting has also been linked to acute muscle strains in dynamic sports, in particular hamstring strains. The lumbar spine stiffness associated with sitting leads to altered neural input into the posterior thigh, the theory goes. This can manifest as increased muscle tone of the hamstrings, which will alter the length-tension relationship and increase the risk of strain. In Australian Rules Football it is not uncommon to see players lying prone on their elbows on the sideline to keep their lumbar spines out of flexion as much as possible. Many teams also follow regimes on long flights to combat the effects of prolonged sitting.
The solution starts with education. The athlete must first learn how to put their body into good posture during the day; how to hold their spine in correct position. Many people try to sit up tall by just hinging through the lumbar spine without altering their thoracic spine or shoulder girdle. What they should be doing is finding a neutral lumbar spine position and comfort-correcting their mid- to upper-back position, so they can better activate through their lower trapezius muscles to pull their shoulder blades out of the elevated and protracted position.
However, it is very difficult to hold good posture if your workstation is poorly set up; for example with the keyboard too high or an old chair with a sloping back rest. A workplace assessment should help by modifying the height and placement of office equipment or introducing corrective devices to help the athlete maintain their position.
Jack may need a lumbar roll to get his lumbar spine out of flexion and a block next to the vehicle’s door to prevent his knee and hip from falling into external rotation. Denise may need to raise the height of her monitor to eye level, lower the keyboard height so that her hands are at elbow level, and use a postural brace for her shoulder girdle and upper back while she is relearning to sit correctly. Seating wedges are very useful where chairs are too low and force the user to sit with their knees higher than their hips (putting the lumbar spine back into flexion). The wedge is also very handy to correct bucket seats in cars.