Sit Up Straight. Your Back Thanks You.

But back pain is notoriously difficult, and expensive, to remedy.

“The treatments are varied, and we don’t have great science showing what works best for particular patients,” said Brook I. Martin, an instructor of orthopedic surgery at Dartmouth Medical School. “There are questions about the safety and efficacy of a surprising number of therapies, including some types of surgery.”

Those with back pain inevitably end up with higher overall medical costs than those without, studies suggest. Dr. Martin has found that patients with back pain spend about $7,000 annually on health care, while people without back pain spend just $4,000 a year. (Insurers will pay the majority of these costs, but patients often bear some of these expenses in the form of insurance co-payments and deductibles.) These estimates don’t include costs for lost work days or diminished productivity.

Some back problems, of course, can’t be avoided. Over time, spinal vertebrae naturally degenerate and spinal facets become inflamed, causing stress and discomfort.

“The majority of back pain is the result of muscle and ligament strain or weakness, and can often be prevented by developing core strength and proper posture,” said Dr. Daniel Mazanec, associate director of the Center for Spine Health at the Cleveland Clinic.

Maintaining good posture not only helps you look better (there’s a reason inept people are called slouches), it improves muscle tone, makes breathing easier and is one of the best ways to stave off back and neck pain, not to mention the dreaded dowager’s hump of old age.

“Posture is the key,” said Mary Ann Wilmarth, chief of physical therapy at Harvard University Health Services. “If your spine is not balanced, you will inevitably have problems in your back, your neck, your shoulders and even your joints.”

Sitting a little straighter now? Good. Here’s some advice that will help you make it a daily habit and stave off expensive back problems to boot.

THE D.I.Y. APPROACH First, try correcting your slouching habits on your own. Stand up and lift your chin slightly; align your ears over your shoulders and your shoulders over your hips. Place your hands on your hips and pitch forward about two inches.

There should be a slight inward curve in your lower back, an outward curve in your upper back, and another inward curve at your neck. Maintain this posture and sit down.

When you are sitting or driving for long periods of time, place a cushion or rolled-up towel between the curve of your lower spine and the back of your seat. Supporting your lower back will maintain the natural curve of your spine; when the back is supported, the shoulders more naturally fall into place, said Dr. Wilmarth.

Maintaining good posture requires abdominal and back strength. “It’s not enough to just sit up straight if your core muscles are weak,” said Dr. Praveen Mummaneni, a spine surgeon at the University of California, San Francisco. Consider taking a Pilates class, which focuses on developing one’s core — the muscles and connective tissues that hold the spine in place — or hire a physical therapist to create a personalized exercise plan.

A CUBICLE CURE If you sit at a desk all day, ask your human resources department if they have an ergonomics expert on staff (some large companies do) who can assess your work area. An ergonomist can make sure your chair, desk and keyboard are at the optimal height and can adjust your sitting posture.

If no expert is on hand, make adjustments yourself. The center of your computer screen should be at eye level, and the desk height should allow your forearms to rest comfortably at a 90-degree angle. Work with your feet flat on the floor and your back against the chair.

Whether you work in an office or at home, get up and stretch every 30 to 60 minutes. Sitting for long periods puts pressure on discs and fatigues muscles. And most workers spend the majority of their days sitting down. A recent study published in The European Heart Journal found that Americans are sedentary for an average of 8.5 hours a day.

“Stretching helps break bad patterns and allows your muscles to return to neutral,” said Dr. Wilmarth.

Stand up and place your hands on your lower back, as if you were sliding them into your back pockets. Gently push your hips forward and slightly arch your back. Sit back down and circle your shoulders backward, with your chin tucked, about 10 times.

Not likely to remember? Set your phone or computer alarm to remind you to stand up and stretch each hour. An iPhone app called Alarmed has a feature that allows you to create regular reminders throughout the day.

AN EXERCISE PLAN Habits are hard to break. A physical therapist can show you how to align your spine and provide you with exercises to both strengthen your core and loosen up stiff neck, back, arm and leg muscles (tight hamstrings can contribute to back pain).

The American Physical Therapy Association’s Web site (www.moveforwardpt.com) offers a simple tool that lets you search for physical therapists by ZIP code and specialty.

Most insurers cover physical therapy, although some may insist that you get a referral from a physician before they will authorize a visit.

If you decide to go out of network or to bypass your insurer, you’ll pay $150 to $250 for an initial assessment. Follow-up visits will be $50 or so less. Most experts say you can address basic posture issues in just one to three sessions.

A CLASS IN POISE If you want a more systematic, long-term approach to posture change, consider the Alexander technique, a method that teaches you how recognize and release habitual tension that interferes with good posture.

Not all doctors in the United States are familiar with the technique, but recent research suggests that it can help with lower back pain as well as posture. A study published in The British Medical Journal found that lessons in the technique helped patients with chronic back pain. A 2011 study published in Human Movement Science concluded that the Alexander technique increased the responsiveness of muscles and reduced stiffness in patients with lower back pain.

Try one session to see if it’s for you. If so, consider committing to 10 lessons. Individual lessons cost $60 to $125, depending on the teacher’s experience. Insurers will not reimburse you; group lessons may be more affordable. To find a teacher, go to the Web site of the American Society for the Alexander Technique.

Still slouching? A study published in The European Journal of Social Psychology found that subjects who were told to sit up straight with good posture gave themselves higher ratings and had more self-confidence on a given task than those who were told to slouch.

Moral: Sitting pretty yields immediate, not just long-term, benefits.

By Liz Koch

Feeling vibrant within your core ultimately depends upon a healthy, juicy and responsive psoas. The psoas (pronounced so-as) is your core muscle and an integral aspect of a centered and functional body. As a major player in back pain, knee injuries and tight hip sockets, it is often the exhausted psoas that disrupts range of motion, as well as digestion, bladder functioning and sexual pleasure.

WHERE IS THE PSOAS?
Your psoas is located deep within your core, growing out of the spine at approximately the twelfth thoracic vertebra (the area called the solar plexus), and moves through the pelvis, crossing over the ball and socket joints into the inner thighbones at the lesser trochanter. Being the only muscle to connect your spine to your legs, the psoas moves through the core like a pendulum synchronizing the free swinging of the leg when walking.

WHAT DOES THE PSOAS DO?
With a psoas on each side of your spine, this intelligent tissue communicates relationships between right and left, back and front, upper and lower body, and the deep and superficial layers of expression. Located behind the large abdominal muscles, digestive and reproductive organs, arteries and veins at the very skeletal and gravitational core, your psoas creates a muscular shelf upon which your kidneys and adrenals literally ride. When in harmony with diaphragmatic breathing, your psoas gently massages all the abdominal organs, stimulates blood circulation and enhances the rhythmic flow of synovial fluid.

The psoas is complex and mysterious, and though defined as a muscle, it is actually a very sensitive and responsive tissue; a vital part of your survival fear response, also called the flight/fight and freeze reflex. As part of the fear response, it is your psoas that propels you into a full run, kicks your leg in defense or curls you into a protective ball while falling. The psoas responds to the full range of the both sympathetic (survival) and the parasympathetic (thriving) nervous systems and plays an essential role in eliciting full-body orgasmic response. It interfaces the reptilian (old) brain and the cortex (new) brain, which indicates that emotional well-being, consciousness and functional movement all hinge upon cultivating a functional psoas.

HOW TO IDENTIFY AN EXHAUSTED PSOAS
The psoas becomes exhausted when it is overused, misused and abused. Whenever there is a loss of skeletal proprioception, unresolved trauma and defensive muscular development there will be depleted adrenal health and an exhausted psoas. Poor ergonomics and traumatic events can cause compensations that lead to a shortened, dry and exhausted psoas. If your psoas feels constricted, it may be a reflection of the chair you sit on, the shoes you wear, the stress of sports or fitness activities you engage in, and/or the emotional or physical injuries that you’ve sustained but have not yet healed from. Car accidents, falls, abuse and habitual behaviors are often the cause of muscular/skeletal imbalances that invariably demand help from the psoas.

Here are some visual clues to look for in your clients:

• When there are any tips, dips and torques in the pelvis, the psoas is being engaged to try and maintain poor core coherency.
• Overdeveloped muscles pull on the skeletal system causing core disruption and evoking a response from the psoas. For example, powerful quads can pull the pelvic basin forward and down.
• Tight, restrained or locked hip sockets are often a result of sacral Iliac injury or dysfunction and a clear sign that the psoas is compensating for healthy proprioceptive joint response.
• Low back, knee, ankle and toe problems all suggest the psoas is involved. Over time, the delicate psoas tissue dries and shrinks compensating for healthy skeletal balance.

TAKING CARE OF THE PSOAS
As a messenger of the central nervous system the psoas should not be manipulated. Having your psoas directly palpated is not only painful but can be harmful causing bruising, broken arteries and hernias, as well as evoking old trauma without resolution. Manipulating the psoas simply does not address the reason why your psoas is constricted. Although invasive techniques may sometimes achieve temporary relief, they ultimately do not address the messengers’ message.

The best way to sustain or regain a healthy psoas is by listening to its message and resolving dysfunctional patterns and habits. By creating coherency through somatic awareness, you can revitalize the psoas thus gaining a deeper level of core integrity. Working with, not against, the psoas will bring you into direct contact with your deepest fears, but it will also connect you with an instinctive wisdom and deep relaxation within your belly core that increases functional movement and self-expression.

Releasing stress accumulated each day helps keep the psoas invigorated. Take a leisurely walk, enjoy a soothing bath (with Epson salts or sea salts added) and keep your feet supple. Check out the shoes you wear. Are they comfortable and neutral with low heels and bendable soles? Are they wide and long enough for all your toes to move? Choose a desk chair that has a firm or padded flat bottom, and fill in the bucket seat in your car with a flat folded towel or wedge. Sit on top and in front of your sits bones with both feet on the floor and keep your hip sockets slightly higher than your knees.

CONSTRUCTIVE REST POSITION

The constructive rest position (CRP), shown above offers a safe, comfortable position to release both physical and emotional tension in the psoas. It helps to relieve low back, pelvic and hip tension and allows your whole body to gain the core neutrality that is so important before beginning an exercise or activity. Simply rest on your back, knees bent with feet on the floor parallel to each other, the width apart of the front of your hip sockets. Place your heels approximately 16 inches away from your buttocks. Do not push your low back to the floor or tuck your pelvis. Keep your arms below shoulder height, resting them over your ribcage, by your sides or on your belly. Rest in this constructive position 10 to 20 minutes every day. In CRP gravity works for you, releasing tension throughout your psoas and helping to reestablish neuro-biological rhythms that calm and refresh.