Back Clinic Posture Team. Posture is the position in which an individual holds their body upright against gravity while standing, sitting, or lying down. A proper posture visually reflects an individual’s health, ensuring the joints and muscles, as well as other structures of the body, are working properly. Throughout a collection of articles, Dr. Alex Jimenez identifies the most common effects of improper posture as he specifies the recommended actions an individual should take to improve their stance as well as enhance their overall health and wellness. Sitting or standing incorrectly can happen unconsciously, but recognizing the issue and correcting it can ultimately help many individuals develop healthier lifestyles. For more information, please feel free to contact us at (915) 850-0900 or text to call Dr. Jimenez personally at (915) 850-0900.
For individuals trying to achieve healthy posture, could using posture awareness training be effective in treatment and prevention?
Posture Awareness
Spinal curves help support the body’s weight, movement, and balance. Five areas include the neck, upper back, lower back, sacrum, and coccyx. The bottom of the spine or sacrum rests between the two hip bones that comprise the pelvis. Because of this location, the movements made with the pelvis significantly affect the spine. (Ibrahim Alkatout, et al., 2021) When the pelvis moves, the spine moves.
Posture-related back pain and associated symptoms are often caused by a weakened strength and flexibility ratio between the opposing muscle groups that hold the body upright.
Achieving healthy posture requires technique and consistent practice for maintaining a healthy pelvis and low back curve. (DeokJu Kim, et al., 2015)
Finding the low back curve and exploring how it responds when moving the pelvis is important to effective posture awareness training.
Kim, D., Cho, M., Park, Y., & Yang, Y. (2015). Effect of an exercise program for posture correction on musculoskeletal pain. Journal of physical therapy science, 27(6), 1791–1794. doi.org/10.1589/jpts.27.1791
Alkatout, I., Wedel, T., Pape, J., Possover, M., & Dhanawat, J. (2021). Review: Pelvic nerves - from anatomy and physiology to clinical applications. Translational neuroscience, 12(1), 362–378. doi.org/10.1515/tnsci-2020-0184
Żurawski, A. Ł., Kiebzak, W. P., Kowalski, I. M., Śliwiński, G., & Śliwiński, Z. (2020). Evaluation of the association between postural control and sagittal curvature of the spine. PloS one, 15(10), e0241228. doi.org/10.1371/journal.pone.0241228
Zemková, E., & Zapletalová, L. (2021). Back Problems: Pros and Cons of Core Strengthening Exercises as a Part of Athlete Training. International journal of environmental research and public health, 18(10), 5400. doi.org/10.3390/ijerph18105400
Individuals that sit at a desk/workstation for hours for work or school, or drive for a living, could be fostering a long-term condition known as forward head posture. Can understanding the signs and symptoms help to prevent the condition?
Forward Head Posture
Neck pain often causes or is caused by misalignment in the area between the shoulders and head. Forward head posture is a common problem that can strain the neck muscles, leading to pain and worsening neck, shoulder, and back posture. (Jung-Ho Kang, et al., 2012) For individuals who are at risk of developing or are already showing signs/symptoms, it’s important to get medical attention to prevent complications, such as chronic neck pain or compressing a nerve. Individuals can continue to do the work that they need to do but may need some postural adjustments and re-training so as not to continue straining the neck while working.
Postural Deviation
The head is in a healthy alignment with the neck when the ears line up with the gravity line.
The gravity line is an imaginary straight line that represents gravity’s downward pull.
It is used in posture assessments as a reference for noting the positions of the body and determining the presence of any postural misalignment or deviation.
A forward head posture occurs when the head begins to position forward of the gravity line when looking at the body from the side.
Forward head posture is a postural deviation because the head varies from the reference line. (Jung-Ho Kang, et al., 2012)
Muscle Imbalances
Forward head posture often results in a strength imbalance between muscles that support and move your neck, shoulders, and head. (Dae-Hyun Kim, et al., 2018)
The muscles in the back of the neck become shortened and overactive as they flex forward, while the muscles in the front become lengthened, weaker, and strained when they relax.
Kyphosis
Kyphosis also known as hunchback is when the shoulders round forward, and the head is also brought forward. (Jung-Ho Kang, et al., 2012) After many hours sitting at a desk, computer, or driving, kyphosis can also cause and/or worsen forward head posture.
This occurs because the upper back area supports the neck and head.
When the upper back moves or changes position, the head and neck follow.
The majority of the head’s weight is in the front, and this contributes to the forward movement.
An individual with kyphosis has to lift their head to see.
Treatment
A chiropractic injury specialist team can develop a personalized treatment plan to relieve pain symptoms, provide postural retraining, realign the spine, and restore mobility and function.
Standing and sitting using a healthy posture, along with exercises to strengthen the neck muscles, can help get the spine in alignment. (Elżbieta Szczygieł, et al., 2019)
Targeted stretching can help if the neck muscles are tight.
At-home stretches may also relieve pain
Risk Factors
Pretty much everyone is at risk of developing a forward head posture. Common risk factors include:
Constantly looking down at a phone and staying in this position for a long time aka text neck.
Desk jobs and computer use can significantly round the shoulders and upper back, leading to a forward head posture. (Jung-Ho Kang, et al., 2012)
Driving for a living causes prolonged back, neck, and shoulder positioning.
Sleeping or reading with a large pillow under the head can contribute to forward head posture.
Doing work that requires dexterity and close-up positions, like a seamstress or technician can cause over-positioning of the neck.
Individuals who regularly carry a significant amount of weight in front of their body may begin to develop kyphosis.
An example is carrying a child or another load in front of the body.
Large breasts can also increase the risk of kyphosis and forward head posture.
Neck Injuries
References
Kang, J. H., Park, R. Y., Lee, S. J., Kim, J. Y., Yoon, S. R., & Jung, K. I. (2012). The effect of the forward head posture on postural balance in long time computer based worker. Annals of rehabilitation medicine, 36(1), 98–104. doi.org/10.5535/arm.2012.36.1.98
Kim, D. H., Kim, C. J., & Son, S. M. (2018). Neck Pain in Adults with Forward Head Posture: Effects of Craniovertebral Angle and Cervical Range of Motion. Osong public health and research perspectives, 9(6), 309–313. doi.org/10.24171/j.phrp.2018.9.6.04
Szczygieł, E., Sieradzki, B., Masłoń, A., Golec, J., Czechowska, D., Węglarz, K., Szczygieł, R., & Golec, E. (2019). Assessing the impact of certain exercises on the spatial head posture. International journal of occupational medicine and environmental health, 32(1), 43–51. doi.org/10.13075/ijomeh.1896.01293
Hansraj K. K. (2014). Assessment of stresses in the cervical spine caused by posture and position of the head. Surgical technology international, 25, 277–279.
Ankylosing spondylitis is an inflammatory arthritis that causes changes in posture that occur over time. Can exercise and maintaining spinal alignment help improve posture problems?
Ankylosing Spondylitis Posture Improvement
Ankylosing spondylitis/AS is an autoimmune arthritis that primarily affects the spine. It can also spread to other joints of the body and affect the internal organs. Back pain problems are a common side effect of the condition and depending on the severity of damage to the spine, it can have a serious impact on posture.
Affects Posture
The condition usually first affects the sacroiliac joints at the bottom of the spine where they attach to the pelvis. As the condition progresses it works its way to the upper spine. The spine consists of 26 vertebrae/bones stacked on top of each other.
Line up the ears, shoulders, hips, knees, and ankles in a straight line.
Squeeze the shoulder blades together and down toward the back pockets.
Relax the arms at the sides.
Look straight ahead.
Tuck the chin back slightly.
Sitting
The natural curves of the spine need support for proper posture when sitting. Try these tips when at a desk or at a table:
Position the height of the chair so the hips and knees are bent at 90-degree angles.
Place the feet flat on the floor or use a footstool based on chair height.
Place a lumbar support pillow or rolled-up towel behind the lower back.
Position the screen monitor at eye level to keep the upper back straight.
Keep the keyboard and mouse close to the body to prevent overreaching which can increase the rounding of the shoulders and upper back.
Lying Down
Ankylosing spondylitis can make lying down uncomfortable. To support the spine while lying down try to:
Sleep on a semi-firm mattress or type like memory foam to conform to the body.
Place a pillow between the knees to maintain a straight spine when lying on the side.
Use a specialized pillow to prevent placing the upper back in a rounded position.
Posture Exercises
For individuals with ankylosing spondylitis stretching and strengthening exercises can help improve body posture. Individuals are recommended to talk to their healthcare provider before beginning an exercise program.
Chin Tucks
Sit up straight.
Squeeze the shoulder blades together.
Rest the arms at your sides.
Look straight ahead, pull the chin back and in until the stretch is felt along the muscles of the neck.
Hold for three to five seconds and relax.
Repeat 10 times.
Corner Stretch
Stand facing a corner.
Raise the arms to shoulder height.
Place one forearm flat against each wall.
Stagger the feet.
Slowly shift weight over the front leg and lean in toward the corner.
Stop once the stretch is felt across the chest.
Hold for 10 to 20 seconds and relax.
Repeat three times.
Scapular Squeezes
Sit up straight with arms resting at the sides.
Squeeze the shoulder blades together like they are holding an object between them.
Hold for three seconds and relax.
Repeat 10 times.
Maintaining spinal alignment will help decrease back pain that occurs with AS.
Targeted exercises can help stretch tight muscles and strengthen the muscles responsible for maintaining spinal alignment.
Maintaining healthy posture when sitting, standing, and sleeping can help prevent deformities in the spine.
Regular physical activity can help combat stiffness and help maintain overall strength.
For an individualized exercise program, see a physical therapist or chiropractor on incorporating posture exercises to help prevent complications from developing.
Arthritis
References
National Institute of Arthritis and Musculoskeletal and Skin Diseases. Ankylosing spondylitis.
De Nunzio, A. M., Iervolino, S., Zincarelli, C., Di Gioia, L., Rengo, G., Multari, V., Peluso, R., Di Minno, M. N., & Pappone, N. (2015). Ankylosing spondylitis and posture control: the role of visual input. BioMed research international, 2015, 948674. doi.org/10.1155/2015/948674
Individuals with fixed sagittal imbalance, a condition where the normal curve of the lower spine is greatly reduced or absent altogether that can cause pain and difficulty balancing. Can chiropractic treatment, physical therapy, and exercise help improve the condition?
Fixed Sagittal Imbalance
The condition is commonly known as flat back syndrome and can be present at birth or can happen as a result of surgery or a medical condition.
Individuals with flat back syndrome position their head and neck too far forward.
A major symptom is difficulty standing for long periods of time.
Symptoms
The spine has two curves. The lumbar spine in the lower back and cervical spine in the neck curve inward. The thoracic spine in the upper back curves outward. The curves are part of the spine’s natural alignment. They help the body balance and maintain the center of gravity.
If these curves begin to disappear the body can have trouble and difficulty standing up straight.
The loss of curvature causes the head and neck to pitch forward, making it hard to walk and do regular normal activities.
A chiropractor and/or physical therapist can recommend exercises and other forms of treatment. (Won-Moon Kim, et al., 2021)
Life-Changing Chiropractic Relief
References
Columbia University Irving Medical Center. Flatback syndrome.
National Health Service. Common posture mistakes and fixes.
Lee, B. H., Hyun, S. J., Kim, K. J., Jahng, T. A., Kim, Y. J., & Kim, H. J. (2018). Clinical and Radiological Outcomes of Posterior Vertebral Column Resection for Severe Spinal Deformities. Journal of Korean Neurosurgical Society, 61(2), 251–257. doi.org/10.3340/jkns.2017.0181
Kim, W. M., Seo, Y. G., Park, Y. J., Cho, H. S., & Lee, C. H. (2021). Effect of Different Exercise Types on the Cross-Sectional Area and Lumbar Lordosis Angle in Patients with Flat Back Syndrome. International journal of environmental research and public health, 18(20), 10923. doi.org/10.3390/ijerph182010923
Can musculoskeletal therapies treat individuals with upper crossed syndrome to relieve pain, improve posture, and strengthen the muscles in the neck, shoulders and chest?
Upper Crossed Syndrome
Upper crossed syndrome is a condition in which the muscles of the shoulders, neck, and chest become weak and tight, and is usually brought on from practicing unhealthy posture. Symptoms typically include:
Neck stiffness and pulling sensations.
Jaw tension and/or tightness
Upper back tension, lack of flexibility, stiffness, and aching soreness.
Neck, shoulder, and upper back pain.
Tension headaches
Rounded shoulders
Hunched spine
Upper Crossed Syndrome and Posture
The condition affects healthy posture by creating imbalanced muscles between the upper back and chest.
The tight short muscles in the upper chest get overly stretched and remain in a semi-contracted state pulling on the back muscles.
This causes the muscles in the upper back, shoulders, and neck to get pulled and weaken.
The result is a hunched back, forward shoulders, and protruded neck.
The specific muscles affected include the trapezius and the levator scapula/side of the neck muscles. (Hospital for Special Surgery. 2023)
Prescription anti-inflammatory medication for pain symptoms – short-term.
Individuals may be advised by the chiropractic therapy team to avoid too much bed rest and to limit or avoid activities that can cause pain or worsen symptoms. (Cedars-Sinai. 2022)
Studies have shown chiropractic spinal manipulation effectively reduces neck, spine, and low back pain symptoms. (Gevers-Montoro C, et al., 2021)
Increasing or decreasing physical activity as recommended by the therapy team.
Using ice or heat packs to relieve pain and increase circulation to promote muscle rehabilitation and healing.
Using topical pain creams or gels.
Over-the-counter nonsteroidal – NSAIDs, like Advil or Motrin and Aleve.
Muscle relaxants to relieve tension short-term.
Enhance Your Lifestyle
References
Hospital for Special Surgery. Move with the purpose to combat upper and lower crossed syndromes.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. Back pain.
Seidi, F., Bayattork, M., Minoonejad, H., Andersen, L. L., & Page, P. (2020). Comprehensive corrective exercise program improves alignment, muscle activation, and movement pattern of men with upper crossed syndrome: a randomized controlled trial. Scientific reports, 10(1), 20688. doi.org/10.1038/s41598-020-77571-4
Bae, W. S., Lee, H. O., Shin, J. W., & Lee, K. C. (2016). The effect of middle and lower trapezius strength exercises and levator scapulae and upper trapezius stretching exercises in upper crossed syndrome. Journal of physical therapy science, 28(5), 1636–1639. doi.org/10.1589/jpts.28.1636
National Institute of Neurological Disorders and Stroke. Back pain.
Cedars-Sinai. Back and neck pain.
Gevers-Montoro, C., Provencher, B., Descarreaux, M., Ortega de Mues, A., & Piché, M. (2021). Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain. Frontiers in pain research (Lausanne, Switzerland), 2, 765921. doi.org/10.3389/fpain.2021.765921
Factors that cause poor unhealthy posture can be caused by the day-to-day effects of gravity on the body, personal, work, or sports injuries, illness, genetics, or a combination of these factors is also common. This leads to neck and back pain that leads to various musculoskeletal health issues. Achieving consistent healthy posture requires technique and practice. Chiropractic treatment with massage and/or physical therapy can restore muscles to optimal mobility and function.
Factors That Cause Unhealthy Posture
Factors that cause posture problems, like back pain, are often caused by issues with the strength and flexibility ratio between the body’s muscle groups that hold the body upright.
Muscle Guarding
After sustaining an injury, muscles can spasm to protect the injured and the surrounding area.
Muscle spasms can help keep injuries stable and protect them from worsening, but they can also limit movements and cause pain symptoms.
Prolonged muscle spasms can lead to weakened/vulnerable muscles creating an imbalance between the muscles guarding against the injury and those still working normally.
This can cause the body posture to shift to compensate.
Muscle Tension
Muscle weakness or tension can develop when holding a prolonged position day after day or when doing daily tasks/chores in a way that places added tension on the body.
When certain muscle groups are weak or tense, posture will be affected.
Aches and pains begin to develop from the awkward positioning and the other muscles that must work overtime.
Unhealthy Habits
Compensation is when the body can still achieve its movement goal but with compromised and unhealthy alignment.
As the body compensates and accommodates muscle spasms, weakness, tension, and/or imbalance begin to present.
When this happens, the body may be forced to use alternate and less efficient patterns of muscle contraction and flexion.
Technology
Using technology or working with several combined devices can slowly shift the body from correct alignment.
Incessant texting can cause text neck to develop, a condition in which the neck is held in too much flexion, or forward bending, for a prolonged time.
Discomfort, trigger points, and pain symptoms will start to develop, which leads to further posture problems.
Stress and Mental Health
Individuals who experience stress regularly and easily are factors that cause posture problems.
Stress can contribute to shallow breathing or overly-contracted muscles, causing the body to shift out of alignment.
Adjusting posture can help counter the stress effects.
Shoes
Footwear affects posture.
Heels extend the body’s weight forward, which can cause hip and spinal misalignment.
Individuals can wear down the outside or inside of their shoes faster because of things like:
Imbalanced kinetic forces will be translated up the ankle, knee, hip, and lower back.
This can lead to pain and discomfort in any of these joints.
Genetics
Sometimes factors that cause unhealthy posture are hereditary.
For example, Scheuermann’s disease – a condition in which adolescent boys develop pronounced kyphosis in their thoracic spines.
It is recommended to work with the individual’s primary/specialist healthcare provider in conjunction with a chiropractic specialist team for treatment and management.
Chiropractic treatment can help individuals achieve and maintain proper posture through various massage therapies to release tightness and relax the muscles, decompression to realign the spine, adjustments to realign the body, and postural training through exercises and stretches to develop healthy postural habits.
Quick Patient Intake
References
In, Tae-Sung et al., “Spinal and Pelvic Alignment of Sitting Posture Associated with Smartphone Use in Adolescents with Low Back Pain.” International Journal of Environmental Research and Public Health vol. 18,16 8369. 7 Aug. 2021, doi:10.3390/ijerph18168369
Korakakis, Vasileios, et al. “Physiotherapist perceptions of optimal sitting and standing posture.” Musculoskeletal Science & Practice vol. 39 (2019): 24-31. doi:10.1016/j.msksp.2018.11.004
Mansfield JT, Bennett M. Scheuermann Disease. [Updated 2022 Aug 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK499966/
Mingels, Sarah, et al. “Is There Support for the Paradigm ‘Spinal Posture as a Trigger for Episodic Headache’? A Comprehensive Review.” Current pain and headache reports vol. 23,3 17. 4 Mar. 2019, doi:10.1007/s11916-019-0756-2
Mork, Paul Jarle, and Rolf H Westgaard. “Back posture and low back muscle activity in female computer workers: a field study.” Clinical biomechanics (Bristol, Avon) vol. 24,2 (2009): 169-75. doi:10.1016/j.clinbiomech.2008.11.001
Pope, Malcolm H et al. “Spine ergonomics.” Annual review of Biomedical Engineering vol. 4 (2002): 49-68. doi:10.1146/annurev.bioeng.4.092101.122107
Shaghayegh Fard, B et al. “Evaluation of forward head posture in sitting and standing positions.” The European Spine Journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 25,11 (2016): 3577-3582. doi:10.1007/s00586-015-4254-x
Tinitali, Sarah, et al. “Sitting Posture During Occupational Driving Causes Low Back Pain; Evidence-Based Position or Dogma? A Systematic Review.” Human Factors vol. 63,1 (2021): 111-123. doi:10.1177/0018720819871730
Wernli, Kevin, et al. “Movement, posture and low back pain. How do they relate? A replicated single-case design in 12 people with persistent, disabling low back pain.” European Journal of Pain (London, England) vol. 24,9 (2020): 1831-1849. doi:10.1002/ejp.1631
Sitting at a desk or standing at a workstation in the same position for hours at a time every day or night can strain the body’s neuromusculoskeletal system. This causes hunching of the shoulders which leads to body tension, headaches, and neck, shoulder, back, leg, and foot pain. Taking regular breaks to move and stretch out provides various benefits that include pain symptom relief, increased circulation, improved posture, increased energy, muscle relaxation, and improve overall health. Here we look at stretches for sitting and standing jobs.
Stretches For Sitting and Standing Jobs
Sitting or standing for too long can affect an individual’s health. The body is made to move and not remain in one position for long periods. Standing and sitting for a prolonged period of time increases the risk for chronic conditions, sleep disorders, digestion issues, weight gain, obesity, heart disease, cancer, and diabetes. To help break the cycle of staying in one position, experts recommend taking movement breaks for one to three minutes every 30 to 45 minutes, or at least once an hour.
Individuals are encouraged to find ways to set up a job/work system where they are not limited to just sitting or standing but have a balance where they can move around, do some desk work, move some more, and so on where the body is regularly engaging all the muscles and not only using a few that often leads to overworked muscles and overcompensating postures that lead to injuries. This can be using a standing desk, taking quick short walks, or doing some stretches. Movement loosens up the body and helps maintain mental focus.
Flexibility Breaks
The following stretches for sitting and standing jobs are recommended to be done as often as possible to develop healthy habits.
Set an alarm for every 45 to 55 minutes and perform the stretches.
Hold each stretch for at least 15-30 seconds.
Avoid exercises or stretches that cause discomfort or pain.
Chest Stretch
Many individuals begin to hunch forward. Therefore, it is essential to stretch the pectoral/chest muscles and shoulders. Individuals with shoulder problems or injuries should avoid this stretch.
Stand with the feet shoulder-width apart.
The stretch can be performed seated in a chair.
Move the arms behind the body and, if possible, interlock the fingers together.
Straighten the arms and gently lift the hands up until you feel a stretch in the chest.
Hold for 10 to 30 seconds.
Repeat 5-10 times.
Individuals can also use a resistance band and hold it overhead.
Individuals can put their forearms on either side of a doorway, and gently press forward until the stretch is felt in the chest.
Upper Back Stretch
The upper back stretch will help get circulation moving in all the muscles between the shoulder blades as well as the traps and the shoulders.
Begin in a seated or standing position.
Stretch the arms straight out.
Place one hand on top of the other.
Reach away with your arms.
Relax and gently bend the head down.
Imagine the arms curving up and over an imaginary sphere.
Hold the stretch for 10 to 30 seconds.
Neck Stretch
Tension in the neck can lead to headaches and upper back pain. Forward head posture is common when working at a desk/workstation, which places extra weight and stress on the neck muscles. The head can weigh up to 11 pounds. Staying aware of posture and regular stretching can provide relief.
Start in a sitting position, with the back straight and the shoulders back.
Reach down and grab the side of the chair with your hand.
Gently pull on the chair, while tilting the head in the opposite direction, feeling the stretch down the side of the neck and shoulder.
Hold for 10 to 30 seconds and repeat on the other side.
Repeat five to 10 times on each side.
Inner Thigh Stretch
Stretching the inner thigh is important for the hips and groin. This stretch helps open the hips and gets rid of tightness and tension in the lower body.
In a seated position, widen the legs, toes outward, and lean forward with the elbows on the thighs.
Keep the back straight and the abs contracted.
Gently press forward while using the elbows to push the thighs out until a stretch is felt in the inner thighs.
Hold for 10 to 30 seconds.
Repeat as many times as necessary to get a thorough stretch.
Regular stretching will help to improve the range of motion and help the muscles move more efficiently. Stretching may also help individuals reach or maintain a healthy weight for improved posture.
Benefits of Stretching
References
Cooley D, Pedersen S. A pilot study of increasing non-purposeful movement breaks at work as a means of reducing prolonged sitting. J Environ Public Health. 2013;2013:128376. doi:10.1155/2013/128376
Daneshmandi H, Choobineh A, Ghaem H, Karimi M. Adverse effects of prolonged sitting behavior on the general health of office workers. J Lifestyle Med. 2017;7(2):69-75. doi:10.15280/jlm.2017.7.2.69
Fathollahnejad, Kiana, et al. “The effect of manual therapy and stabilizing exercises on the forward head and rounded shoulder postures: a six-week intervention with a one-month follow-up study.” BMC Musculoskeletal Disorders vol. 20,1 86. 18 Feb. 2019, doi:10.1186/s12891-019-2438-y
Feldman, Anatol G. “The Relationship Between Postural and Movement Stability.” Advances in experimental medicine and biology vol. 957 (2016): 105-120. doi:10.1007/978-3-319-47313-0_6
Korakakis, Vasileios, et al. “Physiotherapist perceptions of optimal sitting and standing posture.” Musculoskeletal Science & Practice vol. 39 (2019): 24-31. doi:10.1016/j.msksp.2018.11.004
Lurati AR. Health issues and injury risks associated with prolonged sitting and sedentary lifestyles. Workplace Health Saf. 2018;66(6):285-290. doi:10.1177/2165079917737558
Nakphet N, Chaikumarn M, Janwantanakul P. Effect of different types of rest-break interventions on neck and shoulder muscle activity, perceived discomfort and productivity in symptomatic VDU operators: A randomized controlled trial. Int J Occup Saf Ergon. 2014;20(2):339-53. doi:10.1080/10803548.2014.11077048
Sanders, Martha J, and Claudia Michalak Turcotte. “Posture makes perfect.” Today’s FDA: official monthly journal of the Florida Dental Association vol. 25,2 (2013): 62-5.
Shaghayegh Fard, B et al. “Evaluation of forward head posture in sitting and standing positions.” The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 25,11 (2016): 3577-3582. doi:10.1007/s00586-015-4254-x
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