Thoughts Have the Power to Create or Eliminate Body Tension

By Tami Bulmash republished from: Medium-Body Wisdom

Photo by Jonathan Borba on Unsplash

The mind and body have long been regarded and treated as separate entities, yet this distinction does little to promote holistic health. Understanding the direct relationship between thoughts and body tension can illustrate how the mind and body either work dysfunctionally through separation, or optimally as a unit.

Mental and physical aren’t separate entities

Stress and pain existed long before the coronavirus, though it was highlighted during this isolating era. In the height of the pandemic nearly eight in 10 American adults cited COVID-19 as a significant stressor. Though it may no longer be front page news, the aftermath of COVID still lingers. Its toll on mental health continues to impact children and adults alike. The shift to remote work was appealing at first, but later created a more pervasive sedentary lifestyle. Now the concern has shifted to an emerging pandemic of back pain.

Yet, there is nothing novel about body tension brought forth by stressful thinking. In 2014, the American Institute of Stress reported 77 percent of people regularly experience physical symptoms caused by stress. Moreover, the findings of a 2018 Gallup poll suggest 55 percent of Americans report feeling stressed for a large part of their day. This is compounded by the American Academy of Orthopaedic Surgeons finding one in two Americans have a musculoskeletal condition. Discerning between mental and physical stress is becoming increasingly obscure.

While the mind and body have long been regarded and treated as separate entities, this distinction does little to promote holistic health. Understanding the direct relationship between thoughts and tension can illustrate how the mind and body either work dysfunctionally through separation, or optimally as a unit. What’s more, viewing the body as a whole being — in thought and activity — can promote better habits which eliminate tension.

The link between stress and pain

Dividing the self into parts is common practice in the Western world. Expressions such as “I’m mentally exhausted” vs. “I’m physically exhausted” provoke differing self-reflections. However, the psycho-physical relationship is evident in the tension stimulated by either thought. For example, sitting in front of a computer necessitates both thought and action. Viewing content on a screen lends itself to a reaction from behind the screen. This response can be minimal and inconsequential, or it can be subtle, yet critical.

Repeatedly engaging in certain thinking habits like, “I have to get this done and fast” are often reflected in forms of body tension such as stiff fingers at the keyboard, a clenched jaw after a meeting, or tense neck at the end of the day. These unconscious responses are common and have a pervasive effect.

The prevalence of technology has led to a plethora of occupational ailments, now referred to as technology diseases. These include carpal tunnel syndrome, mouse shoulder, and cervical pain syndrome and occur because of excessive work at the computer — especially keyboard and mouse usage. According to the book, TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics, by Drs. Erik Peper, Richard Harvey and Nancy Faass, 45 million people suffer from tension headaches, carpal tunnel, and back injuries linked to computer use and more than 30 percent of North Americans who work at a computer develop a muscle strain injury every year.

Pushing through mental tasks is reflected in the physical

Dr. Peper, a biofeedback expert and Professor of Holistic Health at San Francisco State University, gives an illustration of the mind-body connection in relation to pain. His example requires the use of a computer mouse while trying to complete difficult mental tasks. He asks me to hold the mouse in my dominant hand and draw with it the last letter of an address. Then continue to go backward with each letter of the street name, making sure the letter height is only one-half of an inch. He tells me to perform the task as quickly as possible. As I’m drawing the address backwards trying to recall the letters and their order, Dr. Peper commands, “Do it quicker, quicker, quicker! Don’t make a mistake! Quicker, quicker, quicker!”

These commands reflect the endless to-do lists that pile up throughout the day and the stress associated with their efficacy and timely completion. While enacting this task, Dr. Peper asks me, “Are you tightening your shoulders? Are you tightening your trunk? Are you raising your shoulders possibly holding all this tension? If you are like most people who do this task, you did all of that and you were totally unaware. We are usually really unaware of our body posture.”

I have spent the past 20 years practicing the Alexander Technique, a method used to improve postural health. At its core the technique is about observation and utilizing psycho-physical awareness to stop repeating harmful habits. Dr. Peper’s words resonate because becoming aware of unconscious responses isn’t easy. Most people are completely unaware of the relationship between mind-body habits and how they contribute to stress-related pain.

Posture affects mood and energy levels

Posture is often thought of as a pose — most notably being associated with “sitting up straight”. Yet the health implications of good posture extend far beyond any held position. The agility and movement which are evident in good posture exemplify the mind-body connection.

It is well-known that feeling depressed has been linked to having less subjective energy. The American Psychiatric Association listed a variety of symptoms connected to depression including feeling sad or having a depressed mood, loss of interest in activities once enjoyed, and loss of energy or increased fatigue. While the treatment of depression hasn’t traditionally considered the role of posture in informing mood, researchers have started exploring this relationship.

A study by Dr. Peper and Dr. I-Mei Lin examined the subjective energy levels of university students and their corresponding expression of depression. Participants who walked in a slouched position reported lower energy levels and higher self-rated depression scores. In contrast, when those participants walked in a pattern of opposite arm and leg skipping, they experienced an increase in energy, allowing a positive mindset to ensue.

As mentioned in the study, the mind-body relationship is a two-way street: mind to body and body to mind. If thoughts are manifested in the way one holds their body, the inverse would also be true. Namely, changing the way one carries their body would also influence their thinking and subsequent mood. If stopping certain habits — such as walking in a slumped posture — could have a positive impact on mood and well-being, perhaps it’s worth exploring the mind-body relationship even further.

Supporting the mind-body connection

One of the best ways to improve the mind-body connection is through awareness. The more present you are in your activities, the more unified the relation becomes. Give yourself a couple of minutes to connect your thoughts with what you are doing at the moment.

Begin With Grounding

If you are sitting down, imagine coloring in the space of your whole body with an imaginary marker. Begin with your feet planted on the floor. Start to outline the footprints of your feet and then color in the bottom and top of each foot. Take your time. Fill in all the space. See if you discover new parts of your feet — like the spaces between your toes. Continue up through your ankles and toward your calves. Pay attention to the entire limb (front and back). Work your way upward through the knee and then the upper leg. See if you can find your sit bones along the way to the torso. Explore new joints — such as the hip joint.

Lengthen Your Body Through Thought

Continue up while circling the front and back of the torso. Extend the awareness of your thoughts through your shoulders. Allow for an exploration of the arms — noting the joints such as the elbows, wrists and fingers. Pay attention to their length and mobility. Come back up through the arms. Extend up through the shoulders again, this time noting the passage through the chest and neck. Observe the length and space within your entire being. Journey up to the head and travel around its circumference. Imagine filling your head space with air. Picture the wholeness of your head from top to bottom and side to side.

This two-minute mind-body meditation allows you to feel the full extent of the space your body takes up. It is a way to awaken the senses and include them in conscious thinking. This helps generate awareness in how to engage the mind-body relationship optimally. The next time you try it, use a visual aid like an anatomy diagram of the whole body. This can also introduce new parts and spaces of the body you may not have thought of before. However, don’t rely on the diagram each time, as it can pull away your attention from the mind-body meditation. Instead, use it as a reference or guide every once in a while.

Learn from other cultures

In Western cultures, it is common practice to divvy up musculoskeletal ailments into an array of categories such as tension headaches, tension neck syndrome, or mechanical back syndrome. For instance, in countries like the U.S., it is normal to seek a specialist for each area of concern — like a neurologist for a migraine, an orthopedist for neck strain, or chiropractors for back pain. In contrast, Eastern lifestyles have historically taken a more holistic approach to treating (and healing) their patients.

An article by Dr. Cecilia Chan, Professor of Social Sciences at the University of Hong Kong, explains how the Eastern philosophies of Buddhism, Taoism and traditional Chinese medicine adopt a holistic approach to the healing of an individual. Rather than diagnose and treat with medication, Chan and her colleagues explore health through the harmony and balance of the body-mind-spirit as a whole.

Because basic biology clearly delineates how the human head is attached to the body, it seems fitting that the entire being be regarded as a unit. By recognizing the relationship between thought stressors and their manifestation in the physical body, awareness is elevated. This, in turn, can prevent mindlessly engaging in harmful patterns that lead to stress and pain. Combating tension is possible through the realization of how thoughts — whether they are emotional or task oriented — directly impact the body as a whole.

This excerpt from Taro Gold’s book, Open Your Mind, Open Your Life: A Book of Eastern Wisdom, cites Mahatma Gandhi’s famous quote which beautifully elucidates the mind-body connection:

Keep your thoughts positive, because your thoughts become your words.

Keep your words positive, because your words become your behavior.

Keep your behavior positive, because your behavior becomes your habits.

Keep your habits positive, because your habits become your values.

Keep your values positive, because your values become your destiny.

Referring to the mind and body as separate entities perpetuates a disconnect in the being as a whole. This is why distinguishing the mental from the physical further exacerbates the notion that the two don’t work together as an indivisible unit. Understanding the relationship between stress and tension begins through the awareness of habits.

There are recurrent thinking habits like “I’ve got to get this done now” and their unconscious counterparts that become visible through posture. The unknown habits are the ones which accrue over time and often appear seemingly out of nowhere — in the form of tension or pain. Modern culture is quick to treat symptoms, such as those related to excessive technology use. However, a holistic approach to addressing the underlying issue would examine how stress and pain work hand in hand. Once the thoughts change, so will the tension.


Biofeedback, posture and breath: Tools for health

Two recent presentations that that provide concepts and pragmatic skills to improve health and well being.  

How changing your breathing and posture can change your life.

In-depth podcast in which Dr. Abby Metcalf, producer of Relationships made easy, interviews Dr. Erik Peper.  He discusses how changing your posture and how you breathe may result in major improvement with issues such as anxiety, depression, ADHD, chronic pain, and even insomnia! In the presentation he explain how this works and shares practical tools to make the changes you want in your life.

How to cope with TechStress

A wide ranging discussing between Dr. Russel Jaffe and Dr Erik that explores the power of biofeedback, self-healing strategies and how to cope with tech-stress.

These concepts are also explored in the book, TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics.  You may find this book useful as we spend so much time working online. The book describes the impacts personal technology on our physical and emotional well-being. More importantly, “Tech Stress” provides all of the basic tools to be able not only to survive in this new world but also thrive in it.

Additiona resources:

Gonzalez, D. (2022). Ways to improve your posture at home.


Reduce Shoulder Tension with Somatic Practices and Electromyography*

Adapted from Peper, E.  & Booiman, A. (2022). Teaching awareness of shoulder tension with somatic practices and EMG. Biofeedback, 50(3), 80-85 https://doi.org/10.5298/1081-5937-50.03.02

I was totally surprised when I felt with my fingers my deltoid tightening, yet I was totally unaware that this muscles had tightened. No wonder that I am stiff and tight in my neck and shoulders at the end of the day. Now I interrupt my sitting and working with many movement and relaxation breaks and feel so much better at the end of the day. –Participant in training workshop

So many of us experience head, neck, shoulder and back problems as we do less physical movement and more static activities such as working at the computer, attending zoom meeting, driving in traffic, or communicating on their cellphone (David et al., 2021; Kumari, et al., 2021; Al-Hadidi et al., 2019). One contributing factor is that when we sit and work especially at the computer, we maintain covert low-level muscle tension. This unaware tension prevents regeneration and results in discomfort and pain at the end of the day (Kett et al., 2021; Sella, 2020; Whatmore & Kohli, 1968). This tension pattern can be reduced through somatic practices of small movement and muscle feedback with electromyography (EMG) so that the person may develop awareness of their covert tensions (Feldenkrais, 2009; Peper et al., 2010).

By experiencing and feeling the covert muscle tension, the person can understand how minimal movement and static positions can increase muscle tension that may cause discomfort. This unaware muscle tension can be monitored with electromyography (EMG) to show that the muscles have contracted of which the person is unaware as illustrated in the following two examples of looking at the screen (Figure 1) and lifting the shoulders during data entry (Figure 2).

Figure 1. Effect of head craning forward to see the screen on neck and shoulder muscle tension and breathing pattern. Reproduced by permission from Peper, Harvey and Faass (2020).

When the person cranes their head forward to see the text on the screen, neck and back muscles tense. The person is unaware that neck and shoulder muscle tension increased, and breathing is irregular and thoracic when the head is forward. When the person sits erect, the muscle tension is lower and breathing is also slower and lower which supports regeneration.

Figure 2. Effect of bringing the hands to the keyboard on shoulder and forearm tension. Reproduced by permission from Peper, Harvey, & Faass (2020).

When the person places their hands on the keyboard as compared to their hands resting on their lap, shoulder muscle and forearm tension often increase. Unknowingly, the participant raises their shoulders and holds that tension and postion as they rest their hands on the keyboard.  

The purpose of the article is to:

  • Emphasize the most people are unaware of holding low-level muscle tensions while working at the computer, texting or other tasks
  • Offer somatic awareness practices and EMG monitoring as ways to demonstrate the covert tension
  • Provide suggestions to reduce covert/dysponetic muscle tension.

Background

Neck, shoulder, back and eye discomfort have increased as many employees work at home. Unlike their office workstation, that may have been ergonomically arranged, at home the workstation is often their laptop placed on the kitchen table, desk, couch, bed or other location. When using a laptop, the person wither needs to lift their hands and arms up to the keyboard, which automatically increases the tension in the shoulders or look down at the keyboard, which increases neck and shoulder tension and causes the person to slouch.  In many cases, the elbows are more abducted in order to type on the keyboard or use the mouse or trackpad. This abduction of elbows or the reaching forward and lifting of the arms occurs commonly if the desktop is too high (e.g, kitchen table as a desk) or if the person is pregnant or has larger waist. Similarly, arm and elbow abduction occur during daily activities such as stirring a pot, holding the steering wheel while driving, mousing at the computer, walking with objects attached to the belt that interfere with the swinging of the arms (e.g., the gun and Taser on the belt of police officer, hammer and other tools on the belt of a construction worker, or a backpack or handbag crossed over the shoulder), as shown in Figure 3a and 3b

Figure 3a, Walking with abducted arms to avoid hitting the hitting the object on the side of the waist.

Figure 3b. Arms forward and abducting while playing video games.

The abduction of the arm  usually occurs without awareness of the resulting shoulder tension, except that at the end of the day the person feels stiffness, discomfort and sometimes pain in the shoulders.

Tactile experience of medial deltoid tension when abducting the arm developed by Wim Gijzen, PT

Part 1. Awareness of arm movement and tension

  1. Stand up and allow your arms to hang relaxed along the side of the trunk.
  2.  Slightly move (abduct) your left arm away from the trunk (about 1 or 2 inches). Let the arm go and relax. Repeat this twice.

In most cases, participants report that they are aware that the arm started to move away from their trunk but unaware of the tension in the upper arm or shoulder (medial deltoid muscle).

Part 2. Feeling the muscle contraction of the unfelt muscle tension during abduction

Figure 4. Standing relaxed with arms hanging down (A), feeling the medial deltoid (B), and moving the hand 1 or 2 inches away from the trunk while feeling the medial and posterior deltoid muscle activity (C).

  1. Stand relaxed and reach over with your right hand to your left shoulder. Place your fingers just over middle and backside of the top part of the upper arm (medial and posterior deltoid). Relax the shoulder and arm.
  2. Allow your right arm to hang down and be relaxed and feel the softness of the deltoid muscle.
  3. Begin to abduct your right arm 1–2 inches away from the side of your body. The same movement as you did in part 1b.
  4. Bring the arm back and relax. Repeat this movement twice.

Participants felt with their fingers the medial and posterior deltoid contracting before the arm even moved away from the body, even though they were unaware of the shoulder tension. In addition, they were surprised that the intent to move caused the muscle to tense.

EMG recording from deltoid muscle

EMG monitoring to demonstrate unaware muscle tension from the deltoid muscle as shown in Figure 5.

Figure 5. Electrode placement on the deltoid muscle.

  1. Place the electrodes over the deltoid as shown in Figure 5.
  2. Stand relaxed and begin to move (abduct) the left arm 1–2 inches away from the trunk as instructed in the previous exercise of the awareness exercise, and then relax.
  3. Stand relaxed and imagine that you are moving (abducting) the left arm 1–2 inches away from the trunk. Feel the elbow starting to move and then relax.

The moment the person begins to abduct—even though there is no visible movement of the arm and the person is unaware of the tension in their shoulder—the EMG recording of the medial and posterior deltoid shows the increased activity. In many cases even imagining and the movement will also increase the EMG activity, as shown in Figure 6.

Figure 6. EMG recording of arm abduction and imagining the initiation of arm abduction

Discussion

Participants were surprised that they didn’t notice the muscle tension in their upper arm and shoulder until they felt it with their fingers or saw it on the EMG recording. Teaching participants to become aware of their muscle tension is a useful strategy to demonstrate that muscle tension occurs without awareness and demonstrate the need to take recuperation/regenerative breaks to relax the muscles. The important concept is that chronic low-level tension may lead to discomfort (Almendras & Peper, (2021). To reduce the risk of discomfort, the person needs interrupt static low-level tension with microbreaks or movement. Do the following practices to experience how experience how low static muscle tension causes discomfort.

The effect of static muscle tension

  1. Sit comfortably on a chair.
  2. Lift the right knee slightly up so that the foot is lifted one inch above the floor and keep holding it up, as illustrated in Figure 7. (For guided instructions see: https://peperperspective.com/2020/07/23/why-do-i-have-neck-and-shoulder-discomfort-at-the-computer/ [Peper, 2020])

Figure 7. Adapted from Peper, Harvey, & Faass, 2020; Peper, 2020Experience the effect of holding static muscle tension while lifting the knee up one or two inches. After a minute or so the person will experience the beginning of discomfort in their hip flexors.

Relax the leg and drop the foot to the floor.

Everyone reports that in less than a minute they became aware of the tension and discomfort. They also tend to hold their breath initially as they held their knee up. The discomfort increases if they continued to hold their knee up. Yet, these are the same muscles that we tighten and relax s during walking and then no discomfort occurs (Almendras & Peper, 2021).

The urge for movement after static muscle tension

  1. Make a fist and hold this for about 2 minutes.
  2. After a minute or so, experience the discomfort in your hand and forearm.
  3. Relax the fist and drop the hand on your lap.

After relaxing the hand, most people will move their fingers without thinking about it. When the person moves, the discomfort fades away. This experience illustrates that when discomfort occurs people need/tend to move. Each contraction is followed by short regeneration period.

These short practices illustrate how discomfort can develop if muscles are held contracted for extended time periods even at a very low level of tension.

Recommendations

  1. Guide participants through sensing the covert muscle tension of the deltoid so that they recognize that muscle contraction occurs without awareness.
  2. Guide the participant through the knee-lifting practice to understand the importance of relaxing muscles episodically.
  3. Encourage microbreaks to relax and regenerate the muscles (Peper, Harvey & Faass, 2020).
    1. Lift your arms up and let them flop down against the side of your body.
    1. Raise your shoulders and let them drop.
    1. Get up and move.
  4. Arrange the ergonomics so that the arms need not abduct.
    1. Place your hands on the steering wheel so that the upper arm can be relaxed while hanging downwards.
    1. Adjust the desk height so that the fingers can be at the keyboard without having to raise the shoulders or abduct the elbows. The keyboard height is usually lower than the height for a dining room table.
    1. Use a split keyboard so that the elbows are beside the trunk and flexed at about 90 degrees.
  5. Feel safe so that the arms and shoulder relax and to avoid triggering a defense reaction and protective posture.
    1. Practice stress reduction techniques, move or wiggle when feeling threatened, scared, or excessively sympathetically activated.
    1. Watch inspirational and uplifting media instead of fear-inducing media such as news.
  6. Take many large breaks (e.g., lunch walks, coffee breaks) and move the shoulders and arms so that the static tension is released.
  7. Interrupt static positions with short different activities (e.g. while working at home, clean the dishes during a break, put clothes in your washing machine, or do some stretches). When you perform different movements, the muscle activated in the previous activity can relax and regenerate.

As one of the participants said after taking many breaks during the day, “There is life after five.” What he meant was that before taking the breaks, he felt perfectly okay; however, after incorporating breaks, he had more energy and felt more alive at the end of the day.

*We thank Wim Gijzen, PT, for teaching the somatic exercise of feeling the deltoid muscle to develop awareness of muscle tension.

See the following blogs to reduce TechStress:

References

Al-Hadidi, F., Bsisu, I., AlRyalat, S. A., Al-Zu’bi, B., Bsisu, R., Hamdan, M., Kanaan, T., Yasin, M., & Samarah, O. (2019). Association between mobile phone use and neck pain in university students: A cross-sectional study using numeric rating scale for evaluation of neck pain. PLoS ONE, 14(5), e0217231. https://doi.org/10.1371/journal.pone.0217231

Almendras, M. & Peper, E. (2021). Reactivate Your Second Heart, Biofeedback, 49(4), 99-102.https://doi.org/10.5298/1081-5937-49.04.07

David, D., Giannini, C., Chiarelli, F., & Mohn, A. (2021). Text Neck Syndrome in Children and Adolescents. International Journal of Environmental Research and Public Health, 18(4), 1565. https://doi.org/10.3390/ijerph18041565

Feldenkrais, M. (2009). Awareness through Movement: Easy-to-Do Health Exercises to Improve Your Posture, Vision, Imagination, and Personal Awareness. New York: Harper One.

Kett, A. R., Milani, T. L., & Sichting, F. (2021). Sitting for too long, moving too little: Regular muscle contractions can reduce muscle stiffness during prolonged periods of chair-sitting. Frontiers in Sports and Active Living3, 760533. https://doi.org/10.3389/fspor.2021.760533

Kumari, S., Kumar, R., & Sharma, D. (2021). Text Neck Syndrome: The Pain of Modern Era. International Journal of Health Sciences and Research11(11), 161–165. https://doi.org/10.52403/ijhsr.20211121

Peper, E. (July 23, 2020). Why do I have neck and shoulder discomfort at the computer? The PeperPerspective. https://peperperspective.com/2020/07/23/why-do-i-have-neck-and-shoulder-discomfort-at-the-computer/

Peper, E., Booiman, A., Tallard, M., & Takebayashi, N. (2010). Surface electromyographic biofeedback to optimize performance in daily life: Improving physical fitness and health at the worksite. Japanese Journal of Biofeedback Research, 37(1), 19–28. https://www.jstage.jst.go.jp/article/jjbf/37/1/37_KJ00006254804/_pdf

Peper, E., Harvey, R., & Faass, N. (2020). TechStress: How technology is hijacking our lives, strategies for coping, and pragmatic ergonomics. North Atlantic Books.

Sella, G.E. (2020). SEMG biofeedback reeducation and rehabilitation: The Sella protocol. Biofeedback, 48 (2): 41–44. https://doi.org/10.5298/1081-5937-48.1.3

Whatmore, G. B., & Kohli, D. R. (1968). Dysponesis: A neurophysiologic factor in functional disorders. Behavioral Science, 13(2), 102–124. https://doi.org/10.1002/bs.3830130203


Reversing Pandemic-Related Increases in Back Pain

Reversing Pandemic-Related Increases in Back Pain

By: Chris Graf

Reproduced by permission from: https://www.paintreatmentdirectory.com/posts/reversing-pandemic-related-increases-in-back-pain

Back pain increased significantly during the pandemic

Google searches for the words “back pain” reached an all-time high in January 2022. In a Harris Poll in September 2021, 56% of respondents said they had chronic pain, up from about 30% before the pandemic. There are probably multiple reasons for the uptick in pain in general and back pain in particular related to COVID, including added stress and ongoing symptoms of long COVID. Poor posture while working at home is another likely contributor.

Back pain and Ergonomics

According to Dr. Erik Peper, co-author of Tech Stress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics, It is likely that poor ergonomics in the home office are partially to blame for the apparent rise in back pain. “With COVID, ergonomics have become a disaster—especially with people who use laptops.” Peper, an internationally known expert in biofeedback and Professor of Holistic Health Studies at San Francisco State University, said that it is “almost impossible” to sit correctly when using a laptop. “In order for the hands to be at the correct level for the keyboard, the head must be tilted down. The more the head tilts forward, the most stress that is placed on the cervical spine,” he said, noting that the arms will no longer be in the proper position if the laptop is placed on a stand to raise it to eye level.

For laptop users, Peper recommends using either an external monitor or external keyboard. When using an external keyboard, a laptop stand can be used to elevate the screen to the proper eye level. University of California at Berkeley recommends other tips for ergonomic laptop positioning. 

When using both laptops and desktops, attention should be focused on proper sitting posture. Ergonomic chairs are only part of the equation when it comes to achieving proper posture.

 “A good chair only gives you the opportunity to sit correctly,” Peper said. The goal is to achieve anterior pelvic tilt by having the seat pan slightly lower in the front that in the back. He recommends using a seat insert or cushion to achieve proper positioning (see figure 1).

Figure 1.  A small pillow or rolled up towel can be placed behind the back at kidney level in order to keep the spine slightly arched (see figure 2).

Figure 2. Sitting Disease: Cause of Back Pain and Much More

According to Peper, people who spend extended periods of time at their computers are at risk  of developing   sitting disease—a  condition of increased sedentary behavior associated with adverse health effects. A  study   that appeared in the American Journal of Preventative Medicine found that prolonged sitting was associated with an increased risk of 34 chronic diseases and conditions including chronic back and musculoskeletal pain. According to the study, “Being seated alters the activation patterns of multiple weight-bearing muscles and, therefore, excessive desk use is associated with adverse back curvature, back pain and upper extremity problems such as carpel tunnel syndrome.”

To Avoid Back Pain, Don’t Slouch!

Sitting for prolonged periods of time can cause back, neck, arm, and leg pain, but slouching is even worse and can damage spinal structures. “Most people slouch at computer, and when you slouch, our spine becomes more like the letter C, our abdomen is compressed, the diaphragm goes up which causes us to shallow breathe in our upper chest,” Peper said. “That impacts our back and digestion and many other things.”

According to Peper, slouching can also impact our mood. “Slouching is the posture associated with depression and low energy. That posture collapse may evoke negative and hopeless emotions. If I sit up and look up, I have less of that. I can have more positive and uplifting thinking.”

 Peper recommends a simple device to help people improve their posture. Called an Upright Go, it attaches to the neck and provides vibrational feedback when slouching occurs. “Every time it starts buzzing, it’s a reminder to stop slouching and to get up, wiggle, and move,” he said. “We have published some studies on it, but I have no investment in the company.”

Peper’s 4 Basic Tips for Avoiding Back Pain and Other Sitting Diseases:

#1 Get Up and Move

“Rule one is to take many breaks—wiggle and move,” he said. “People are unaware that they slightly raise their shoulders and their arm goes slightly forward—in their mousing especially. By the end of the day, they feel stiffness in their shoulders or back. So, you need to take many wiggly breaks. Get up from your chair every 15 minutes.”

Use Stretch Break or one of the other apps that remind people to get up out of their chairs and stretch. 

Walk around while on the phone and wear a headset to improve posture while on the phone. 

For back pain, skip in place or lift the right arm at the same time as the left knee followed by the left arm and right knee–exercises that cause a diagonal stretch along the back.

#2 Just Breathe

  • “Learn to practice lower breathing,” Peper said. “When you sit, you are forced to breath higher in your chest. You want to practice slow diaphragmatic breathing. Breathe deeply and slowly to restore a natural rhythm. Take three deep breaths, inhaling for five seconds, then exhale very slowly for six seconds.” For more instructions on slower diaphragmatic breathing visit Peper’s blog on the subject. 

#3 Take Visual Breaks:

  • Our blinking rate significantly decreases while looking at a screen, which contributes to eye strain. To relax the eyes, look at the far distance. “Looking out into the distance disrupts constant near-focus muscle tension in the eyes,” he said. By looking into the distance, near-focus muscle tension in the eyes is disrupted.
      
  • If you have children, make sure they are taking frequent visual breaks from their screens. According to Peper, there has been a 20 percent increase in myopia (nearsightedness) in young children as a result of COVID-related distance learning. “The eyes are being formed and shaped during childhood, and if you only focus on the screen, that changes the muscle structure of our eyes over time leading to more myopia.”

#4 Pay Attention to Ergonomics

  • “If you are working on a desktop, the top of screen should be at eyebrow level,” Peper said. “Your feet should be on the ground, and the angle of the knees should be about 110 degrees. You should feel support in mid back and low back and be able to sit, lean back, and be comfortable.”
      
  • Peper recommends adjustable sit/stand desks and regularly alternating between sitting and standing.  
     

For more specific guidance on ergonomics for prolonged sitting, UCLA School of Medicine offers detailed guidelines. And don’t forget to check out Dr. Peper’s book  on ergonomics as well as his blog, The Peper Perspective, where you can use the search feature to help you find exactly what you are looking for. 

But in the meantime, Dr. Peper said, “It’s time for you to get up and wiggle!”

Find a Provider Who Can Help with Back Pain

Christine Graf is a freelance writer who lives in Ballston Lake, New York. She is a regular contributor to several publications and has written extensively about health, mental health, and entrepreneurship.    


Hope for insomnia, depression, anxiety, ADHD, exhaustion, and nasal congestion -Breathe light, slow and deep

Anxiety, depression, insomnia, exhaustion, ADHD, allergies, poor performance have all increased (Barendse et al., 2021; London & Landes, 2021; Peper et al, 2022a; Peper et al, 2022b; Vasileiadou et al, 2021). One of the unrecognized contributing factor is dysfunctional mouth breathing (McKeown, 2022). Improve health by learning to breathe in and out through the nose during the day and night. Listen to the inspiring presentation by Patrick McKeown, author of the superb book, The breathing cure-Develop  new habits for a healthier, happier & long life (McKeown, 2022). In this presentation, he describes the science behind these disorders, the rationale for breathing light, slow and deep and offers simple breathing exercises to reduce symptoms and improve performance.

References

Barendse, M., Flannery, J., Cavanagh, C., Aristizabal, M., Becker, S. P., Berger, E., … & Pfeifer, J. (2021). Longitudinal change in adolescent depression and anxiety symptoms from before to during the COVID-19 pandemic: A collaborative of 12 samples from 3 countries. https://doi.org/10.31234/osf.io/hn7us

London, A.S. & Landes, S.D. (2021). Cohort Change in the Prevalence of ADHD Among U.S. Adults: Evidence of a Gender-Specific Historical Period Effect.  Journal of attention disorders, 25(6), 771-782. https://doi.org/10.1177/1087054719855689

McKeown, P. (2022). The breathing cure-Develop  new habits for a healthier, happier & long life.  West Palm Beach, FL: Humanix Books.

Peper, E. (2022). Reduce anxiety. the peperperspective. https://peperperspective.com/2022/03/23/reduce-anxiety/

Peper, E., Harvey, R., Cuellar, Y., & Membrila, C. (2022b). Reduce  anxiety. NeuroRegulation, 9(2), 91–97. https://doi.org/10.15540/nr.9.2.91  

Vasileiadou, S., Ekerljung, L., Bjerg, A., & Goksor, E. (2021). Asthma increased in young adults from 2008–2016 despite stable allergic rhinitis and reduced smoking. PLoS ONE, 16(6): e0253322. https://doi.org/10.1371/journal.pone.0253322    


Freedom of movement with the Alexander Technique

Erik Peper and Elyse Shafarman

After taking Alexander Technique lessons I felt lighter and stood taller and I have learned how to direct myself differently.  I am much more aware of my body, so that while I am working at the computer, I notice when I am slouching and contracting. Even better, I know what to do so that I have no pain at the end of the day. It’s as though I’ve learned to allow my body to move freely.

The Alexander Technique is one of the somatic techniques that optimize health and performance (Murphy, 1993). Many people report that after taking Alexander lessons, many organic and functional disorders disappear. Others report that their music or dance performances improve. The Alexander Technique has been shown to improve back pain, neck pain, knee pain walking gait, and balance (Alexander technique, 2022; Hamel, et al, 2016; MacPherson et al., 2015; Preece, et al., 2016). Benefits are not just  physical. Studying the technique decreases performance anxiety in musicians and reduces depression associated with Parkinson’s disease (Klein, et al, 2014; Stallibrass et al., 2002).

Background

The Alexander Technique was developed in the late 19th century by the Australian actor, Frederick Matthias Alexander (Alexander, 2001).  It is an educational method that teaches students to align, relax and free themselves from limiting tension habits (Alexander, 2001; Alexander technique, 2022).  F.M Alexander developed this technique to resolve his own problem of becoming hoarse and losing his voice when speaking on stage.

Initially he went to doctors for treatment but nothing worked except rest. After resting, his voice was great again; however, it quickly became hoarse when speaking.  He recognized that it must be how he was using himself while speaking that caused the hoarseness.  He understood that “use” was not just a physical pattern, but a mental and emotional way of being. “Use” included beliefs, expectations and feelings. After working on himself, he developed the educational process known as the Alexander Technique that helps people improve the way they move, breathe and react to the situations of life.

The benefits of this approach has been documented in a large randomized controlled trial of one-on-one Alexander Technique lessons which showed that it significantly reduced chronic low back pain and the benefits persisted a year after treatment (Little, et al, 2008).  Back pain as well as shoulder and neck pain often is often related to stress and how we misuse ourselves.  When experiencing discomfort, we quickly tend to blame our physical structure and assume that the back pain is due to identifiable structural pathology identified by X-ray or MRI assessments. However, similar structural pathologies are often present in people who do not experience pain and the MRI findings correlate poorly with the experience of discomfort (Deyo & Weinstein, 2001; Svanbergsson et al., 2017). More likely, the causes and solutions involve how we use ourselves (e.g., how we stand, move, or respond to stress). A functional approach may include teaching awareness of the triggers that precede neck and back tension, skills to prevent the tensing of those muscles not needed for task performance,  resolving psychosocial stress and improving the ergonomic factors that contribute to working in a stressed position (Peper, Harvey & Faass, 2020). Conceptually, how we are use ourselves (thoughts, emotions, and body) affects and transforms our physical structure and then our physical structure constrains how we use ourselves.

Watch the video with Alexander Teacher, Elyse Shafarman, who describes the Alexander Technique and guides you through practices that you can use immediately to optimize your health while sitting and moving.

See also the following posts:

References

Alexander, F.M. (2001). The Use of the Self. London: Orion Publishing. https://www.amazon.com/Use-Self-F-M-Alexander/dp/0752843915

Alexander technique. (2022). National Health Service. Retrieved 19 April, 2022/.  https://www.nhs.uk/conditions/alexander-technique/

Deyo, R.A. & Weinstein, J.N. (2001). Low back pain. N Engl J Med., 344(5),363-70. https://doi.org/10.1056/NEJM200102013440508

Hamel, K.A., Ross, C., Schultz, B., O’Neill, M., & Anderson, D.I. (2016). Older adult Alexander Technique practitioners walk differently than healthy age-matched controls. J Body Mov Ther. 20(4), 751-760. https://doi.org/10.1016/j.jbmt.2016.04.009

Klein, S. D., Bayard, C., & Wolf, U. (2014). The Alexander Technique and musicians: a systematic review of controlled trials. BMC complementary and alternative medicine14, 414. https://doi.org/10.1186/1472-6882-14-414

Little, P.  Lewith, W G., Webley, F.,  Evans, M., …(2008). Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. BMJ, 337:a884. https://doi.org/10.1136/bmj.a884

MacPherson, H., Tilbrook, H., Richmond, S., Woodman, J., Ballard, K., Atkin, K., Bland, M., et al. (2015). Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial. Ann Intern Med, 163(9), 653-62. https://doi.org/10.7326/M15-0667

Murphy, M. (1993). The Future of the Body. New York: Jeremy P. Tarcher/Perigee.

Peper, E., Harvey, R. & Faass, N. (2020). TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books.

Preece, S.J., Jones, R.K., Brown, C.A. et al.  (2016). Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis. BMC Musculoskelet Disord 17372.  https://doi.org/10.1186/s12891-016-1209-2

Stallibrass, C., Sissons, P., & Chalmers. C. (2002). Randomized controlled trial of the Alexander technique for idiopathic Parkinson’s disease. Clin Rehabil, 16(7), 695-708. https://doi.org/10.1191/0269215502cr544oa

Svanbergsson, G., Ingvarsson, T., & Arnardóttir RH. (2017). [MRI for diagnosis of low back pain: Usability, association with symptoms and influence on treatment]. Laeknabladid, 103(1):17-22. Icelandic. https://doi.org/10.17992/lbl.2017.01.116

Tuomilehto, J., Lindström, J., Eriksson, J.G., Valle, T.T., Hämäläinen, H., Ilanne-Parikka, P., Keinänen-Kiukaanniemi, S., Laakso, M., Louheranta, A., Rastas, M., et al. (2001). Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N. Engl. J. Med., 344, 1343–1350. https://doi.org/10.1056/NEJM200105033441801

Uusitupa, Mm, Khan, T.A., Viguiliouk, E., Kahleova, H., Rivellese, A.A., Hermansen, K., Pfeiffer, A., Thanopoulou, A., Salas-Salvadó, J., Schwab, U., & Sievenpiper. J.L. (2019). Prevention of Type 2 Diabetes by Lifestyle Changes: A Systematic Review and Meta-Analysis. Nutrients, 11(11)2611. https://doi.org/10.3390/nu11112611


A breath of fresh air: Breathing and posture to optimize health

Most people breathe 22,000 breaths per day. We tend to breathe more rapidly when stressed, anxious or in pain. While a slower diaphragmatic breathing supports recovery and regeneration. We usually become aware of our dysfunctional breathing when there are problems such as nasal congestion, allergies, asthma, emphysema, or breathlessness during exertion.  Optimal breathing is much more than the absence of symptoms and is influenced by posture. Dysfunctional posture and breathing are cofactors in illness. We often do not realize that posture and breathing affect our thoughts and emotions and that our thoughts and emotions affect our posture and breathing. Watch the video, A breath of fresh air: Breathing and posture to optimize health, that was recorded for the 2022 Virtual Ergonomics Summit.


Support the healing process: Be a gardener not a mechanic

Six years ago, I had a bilateral hernia repair, the surgeon was highly recommended and recognized as an expert in his field. Although the surgery was a mechanical success, the failure of the post-operative care resulted in severe urinary retention, multiple emergency room visits, and ongoing urinary difficulties. Six weeks after the surgery, I was still lugging a Foley catheter with a leg collection bag that drained my bladder. The surgeon had stated I could be back doing physical activities with a week (Peper, 2019).   From my perspective the surgeon was a mechanic and not a gardener. The moment the mechanical structure was fixed in surgery, he had completed his work even if post-surgical complications arose.

Being a mechanic in medicine is an important role. The concept of being a mechanics is not limited to surgery, it can be applied to any treatment strategy when the practitioner focuses narrowly only on the presenting issue. A broken bone > align and put on a cast; hip pain due to the breakdown of cartilage > hip replacement surgery; depression > prescribe antidepressant medication; diabetes > prescribe medications to reduce blood sugar; hypertension > -prescribe anti-hypertensive medication; pain > prescribe opioids, etc. In many cases, healing is much more than mechanical interventions, it often includes post-operative care, exploring factors that may have contributed to disease onset, and retraining such as ongoing physical therapy for hip replacement surgery or teaching stress management, exercise, diet and lifestyle changes for people with diabetes.

Much of healing, especially for the treatment of chronic conditions, needs  much more than a mechanical intervention.  For example, type 2 diabetes, depression, or hypertension are triggered and maintained to a large extent by socio-economics inequalities and stressful lifestyles. Treatment needs to focus on healing and reduce the factors that created or now maintains the illness and support those factors that enhance healing.  This is similar to the role of a gardener.  Once planted, a successful gardener needs to be aware of, and support, all the factors that facilitate the plants growth (enough sunlight at the right time, appropriate watering and fertilizer, soil conditions, etc.). 

These concepts are discussed in the superb article by Gavin Francis, MD and seminal book by Wayne Jonas, MD that describes how medicine needs to change and incorporate an holistic perspective to support and nurture the healing process.

Superb article by Gavin Francis, MD:  ‘We need to respect the process of healing’: a GP on the overlooked art of recovery. (Francis, 2022)

Seminal book by Wayne Jonas, MD: How healing works (Jonas, 2018).

Additional resource to optimize health and healing when needing surgery

References

Gavin, F. (2022). ‘We need to respect the process of healing’: a GP on the overlooked art of recovery. The Guardian. https://www.theguardian.com/world/2022/jan/04/we-need-to-respect-the-process-of-healing-a-gp-on-the-overlooked-art-of-recovery

Jonas, W. (2018). How healing works. New York: Lorena Jones Books

Peper, E. Surviving and preventing medical errors. (2019). Townsend Letter-The Examiner of Alternative Medicine. 429, 63-69. https://www.townsendletter.com/article/429-surviving-and-preventing-medical-errors/


Healing from paralysis-Music (toning) to activate health

Madhu Anziani and Erik Peper

In April 2009, Madhu Anziani, just one month prior to graduation from San Francisco State University with a degree in Jazz/World music performance, fell two stories and broke C5 and C7 vertebras.  He became a quadriplegic (tretraplegia) and could not breathe, talk, move his arms and legs and was incontinent.  He also could not remember anything about the accident because of retrograde amnesia.  Even though he was paralyzed and the medical staff suggested that he focussed on how to live well as a quadriplegic, he transcended his paralysis and the prognosis and is now a well-known vocal looping arts and ceremonial song leader/composer.

His recovery against all odds provides hope that growth and healing is possible when the mind and spirit focus on possibilities and not on limitations.  Alongside physical thereapy he utilized energy healing and toning/sound vibrations to recover mobility.  Toning, the vocalization of an elonggated monotonous vowel sound susteained for a number of minutes tends to vibrate specific areas in the body where the chakras are located (Crowe & Scovel, 1996; Goldman, 2017). Toning compared to mindfulness meditation reduces intrusive thoughts and mind wandering. It also increases body vibration sensations and heart rate variability much more than mindfulness practice (Peper et al, 2019). The body vibrations induced by toning and music could be one of the mechanisms by which recovery can occur at an accelerated rate as it allows the person’s passive awareness and sustained attention to feel the paralyzed body and yet be relaxed in the present without judgement.   

Watch Madhu’s inspirational presentation as part of the Holistic Health Lecture Series by the Institute for Holistic Health Studies, San Francisco State University. In this presentation, he describes the process of recovery and guides the viewer through toning practices to evoke quieting of mind, bliss within the heart, and a healing state of being.

For an additional discussion and guided practice in toning, see the blog, Toning quiets the mind and increases HRV more quickly than mindfulness practice.

Madu Anziani is a sound healer who endured being a tetraplegic (paralysis affecting all four
limbs) and used sound and energy healing to recover mobility. He is a SFSU graduate and most
well-known as a vocal looping artist and ceremonial song leader/composer.

http://www.firstwasthesound.com

http://madhu.bandcamp.co

REFERENCES:

Crowe, B.J. & Scovel, M. (1996). An Overview of Sound Healing Practices: Implications for the Profession of Music Therapy, Music Therapy Perspectives, 14(1), 21-29.

Goldman, J. (2017). The 7 Secrets of Sound Healing. Carlsbad, CA: Hay House Inc.

Peper, E., Pollack, W., Harvey, R., Yoshino, A., Daubenmier, J. & Anziani, M. (2019). Which quiets the mind more quickly and increases HRV: Toning or mindfulness? NeuroRegulation, 6(3), 128-133.