Living With Chronic Pain

How We Position Impacts Pain

Are you standing/sitting/lying down comfortably? Do you get so engrossed in work or a TV show you don’t realize you’re sitting on your foot and it went numb? Is there a proverbial pea under the mattress throwing off alignment, making your pain worse?

Becoming more aware of how you sit, stand, lie and walk can significantly alter pain. For a week I was experiencing horrible pain in my left leg, particularly at the knee. To the point that attempting to weight bear after sitting or sleeping was difficult. Without a history of trauma I couldn’t imagine what was causing it. My left leg has been the hardest hit with all my past herniations and surgeries so I was quick to believe it was just a progression of multiple underlying chronic back issues. At my wits end I finally scheduled an epidural. The night before, I realized my sweet 16 pound dog, who usually slept at the end of the bed between my legs had started lying more and more on my leg, causing it to bend and rotate outward to accommodate his weight! Once I stopped letting him do this, the pain resolved.

The same for my tinier dog, weighing only 11 pounds. She likes to curl up on my stomach, but even that amount of weight compresses my abdomen and puts too much pressure on my back. Pushed to the side often enough she has finally learned to get comfortable beside me, not on me. 

Pain alters our posture and gait. That in turn changes the impact on our muscles and ligaments which then changes how we feel. So many patients limp or drag a leg/ foot when hurting. Back pain? We often twist and torque in ways we believe will help to take the pressure off of the painful area. Instead we are just making it worse, by adding other sites to the pain list. My number one tip to patient- makes conscious effort to sit, stand and walk normally. That, all by itself, can provide incredible relief.

Use a cane or walker?

Add a cane or walker and the disruption in symmetry, balance and posture changes again. Not to ignore the pressure they cause on our neck, shoulders, arms, wrists and hands. 

At least a walker is used with both hands. So that pressure is usually equally. But the awkward humping of the spine and pressure on the hands and arms to support our body weight can be overwhelming. That’s why some prefer an upright one that allows users to stand straight while looking forward not down at the ground.

Every time a cane is used for support it alters the distribution of weight to not just the legs but the upper extremities as well. Hold it in your right hand? Then this hand is stressed every time you move. I’m always impressed with the discomfort that mounts in the hand, wrist and ultimately the entire arm and neck when I use a cane for any extended period of time.

Like to cross your legs?

Something as harmless as crossing your leg or sitting cross legged on the floor can cause pain or numbness in an extremity by putting pressure on the peroneal nerve behind the knee, which supplies sensation to the lower extremity. Maintaining this potion for hours can even lead to a perineal palsy resulting in a foot drop- where you can’t lift the front part if your foot and toes. The good news? If you feel any numbness or tingling set in, move!

It can also lead to poor posture causing the pelvis to rotate and tilt. This changes the symmetry of our muscles forcing them to compensate which can lead to lower back, hip, leg pain and stiffness. 

The same is true if you like to tuck one leg under the other. Anything that throws off our normal alignment stresses muscles asymmetrically and can lead to pain.

Sit all day?

We’ve discussed in numerous posts how sitting can cause and exacerbate pain.

* Muscles get used to inactivity. The less we use an area the more they resist getting used. Remember the example of splinting a finger? If I kept it immobilized for a month it would freeze and be incredibly painful to move in the future. Muscles are the same way. Sitting all day allows the legs to weaken and causing pain when finally moved at the end of the day. Get up every hour. Even if it’s just to stretch and walk in place.

* Sitting at a computer screen leads to all sorts of issues in the neck, arms and back. Make sure your work station is ergonomically set up, and you maintain proper posture. Try not to rotate onto one side or the other. This puts greater pressure on that area causing it to work harder, often leading to spasms.

* Position the head and neck so you’re looking straight at the screen. Remember the neck already supports the equivalent of a 10-12 pound bowling. For every inch the neck is flexed, the load on your muscles double. By the time your chin is on your chest they’re supporting 60 pounds of extra weight! The same is true when you use your phone. Have chronic neck pain? This could be the cause.

Good posture while you sleep?

We spends hours in bed at night. How we are positioned for that time can have a significant impact on our pain. Good posture isn’t just for sitting or standing.

* Side sleepers are the most common. Don’t let the chin drop onto your chest. Use pillows to keep your head and neck aligned and maintain the necks natural curvature.

* Put a pillow between your knees to keep your hips and spine aligned. Switch sides to prevent one area from being stressed more than the other. Put your arm on a pillow to keep the shoulder aligned with the chest and not dropping and stressing the shoulder.

* On your back put a pillow under your knees to maintain the spine’s natural curvature and take pressure off the lower back. Under your head, use a pillow that keeps the head and neck aligned so your chin isn’t looking at the ceiling or your chest. Rest your arms on another pillow or part of the blanket in order to keep them from sagging below your chest and pulling on the shoulders.

* Sleeping on your stomach disturbs normal spinal alignment, by dropping the torso into the mattress and causing the back to arch. It increases neck pain because you have to rotate your head to one side. This twists the neck, forcing it out of its neutral position.

Check out my past posts on how pillows, sheets, blankets and mattresses can affect sleep as well.

How about that heavy bag?

We all need to carry items during the day. The question is how much is really necessary, and how is it positioned?

* Large purses and briefcases force one side to work harder than the other when standing and walking, whether it’s carried by hand or on one shoulder. Wearing a backpack type bag allows pressure to be evenly distributed, when positioned properly. Not into those? Use a crossbody strap to better distribute the weight. 

* Throwing any item on to the shoulder puts pressure on the thumb, causing irreparable damage to a finger not meant to carry any weight, only guide. Place it on to the shoulder instead.

Simple changes in how you sit, stand and walk can make a significant difference in your pain. For most it’s just habit, for others it’s a way to combat pain. Whatever the reason, stop. Think about your go-to positions and decide if they’re the best options. Pushing ourselves to sit, stand, walk and lie normally can make all the difference in how we get through the day and night.

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