I am often questioned about which seat cushion, pillow or shoe insert is best. There are so many wonderful as well as gimmicky products out there. Often it is difficult to promote one specific product as there are many other variables to consider. Products are typically molded for a person’s height, size, shape and weight in mind. Since we come in all different shapes and sizes, our body types and our structural imbalances will influence how we will “mold” to for example a lumbar support cushion. For one person, the lumbar support will be just perfect; for others, it may be too firm and uncomfortable. Additionally, the furniture in which a person uses influences the effectiveness of the product. A lumbar support or neck system may work well with the chairs we have in our clinic but will not necessarily work with your chair at home. The design of the chair, including the height of the back support or the angle or firmness of the seat cushion will alter the fit or effectiveness. In physical therapy, it is imperative to teach the principles of ideal alignment so that these can be applied to a variety of settings & situations whether that be in your home, car, office or away. Here are some of the principles we emphasize when considering the effectiveness of the external support system:
1. Pelvic neutral: This is the ideal pelvic position while sitting and standing. This term applies to maintaining the pelvis such that it does not tilt too far forward or backwards. To find pelvic neutral position, sit on a chair with your feet planted on the floor. You will be on the boney part of the pelvis called the ischial tuberosities, commonly referred to as “sit bones”. Without moving your shoulders, rock your pelvis back and forth thus feeling increased weight on the front and back portions of your “sit bones”. When you’re on the very front portion of the ischial tuberosities, you will be in “anterior pelvic tilt” which causes excessive lordosis or arching of the lumbar spine. Extreme rolling backwards onto the posterior portion of the ischial tuberosity leads to slouching and a “posterior pelvic tilt” thus hollowing out the natural curve or lordosis of your lumbar spine. In general, the best position to place your pelvis is in the range between the very ends of anterior or posterior pelvic tilt. Back injuries may occur if you are in these end ranges of anterior or posterior tilt and then combine twisting and lifting motions which place increased demands on the muscles, fascia and discs.
2. Maintaining optimal spinal alignment: The spine has several natural curves to it. Both the cervical & lumbar spines have small degrees of natural arching or lordosis. The thoracic spine however has an opposite slight curve called a kyphosis. The goal is to maintain those natural curves in our spine, which allow for optimal nerve and disc health. Whether you are sitting or sleeping, try to attain and maintain ideal spinal alignment. If sleeping on your back, use a softer more pliable pillow to avoid excessive neck flexion. When sleeping on your side, keep your neck and spine from side bending. Side bending causes excessive compression of one side of your body while the opposite side is stretched. Imagine falling asleep for hours in this imbalanced position then waking up and trying to move!
3. Shoe inserts: Just as chairs may differ, as will your shoes. Because of this, you will likely need a variety of shoe inserts to best bring your feet into an ideal alignment. Personally, I have 3 different pair of inserts.
The important take home message is to learn the principles of good body mechanics and ideal spinal alignment when it comes to deciding on what type of support product best works for you. Body type, physical limitations, style of furniture, can all influence which product best meets your needs. Consider items that you can try for a week or so with the option of returning if it does not fit. If you would like guidance on this, please do not hesitate to reach out to us.