sitting form

According to Dr. Tammy Chen’s NY Times column, dental patients are suffering from an “epidemic of cracked teeth” due in part to posture. How can we avoid a similar fate? Image courtesy Engin Akyurt on Unsplash.

I recently came across a New York Times column by Tammy Chen, DDS, a prosthodontist with a practice in Manhattan, describing the “epidemic of cracked teeth” she’s seen in her patients during the COVID pandemic. Dr. Chen names two suspected culprits: the slumped posture many people adopt while working from home with improvised furniture, and excessive anxiety and stress. Both of these culprits lead to jaw clenching and tooth grinding.

This man’s C-spine — an intensely rounded upper back and tucked pelvis — are all too common in people working from home and on laptops. As Dr. Chen pointed out, such postural habits can have deleterious effects on the jaw.

The dangers of a C-spine
While working remotely, people are slumping and hunching at their computers more than ever before. For many unaware of how to sit healthfully, lack of access to office workspaces (and in some cases, ergonomic furniture) has been difficult to adjust to. Anyone plagued by a C-spine — with an intensely tucked pelvis below rounded, hunched shoulders — is doing themself some real damage if they don’t learn new ways of using their body. I’m always calling out the unhealthy stresses this puts on discs, nerves, bones, and ligaments in the back and neck, but the consequences of poor posture don't stop there.

Gaming posture also often tends toward a C-spine, to the detriment of gamers’ long-term spinal health, as well as jaw health.

As Dr. Chen points out, nerves passing through the neck and shoulder lead directly to the temporomandibular joint (TMJ). TMJ dysfunction is a widespread problem in our culture and can lead to pain, clicking, and popping in the jaw. So it stands to reason (and I’ve seen in my decades teaching) that hunched, slumped posture in the upper body, including the neck and shoulders through which nerves pass, has detrimental effects on the jaw.

The temporomandibular joint (TMJ) connects the jaw to the skull. Original image courtesy Wikipedia user Jmarchn under CC BY-SA 3.0.

Healthier posture = healthier teeth
Thankfully, learning new and healthful ways of using the upper body while sitting and sleeping is within all of our reach. When sitting, the alternative to collapsing into a C-spine is to first fix the foundation of the spine, which is the pelvis. When the pelvis is tucked under, it provides a wonky base for the spine to rest on. Like a building with poor foundations, the spine is then distorted as a consequence, rounding out the back to then cantilever forward with the upper body. This obliges the muscles in the neck and shoulders to do overtime supporting the substantial weight of the head, creating tension and compression all the way through to the jaw.

The remedy is to learn to position the pelvis well by stretchsitting or stacksitting — so named because they either allow the spine to stretch out straight (stretchsitting), or for the bones of the spine to stack upright and relaxed (stacksitting). Both enable sustainable shoulder placement, and a well positioned neck and head. Bingo! Their harmonious arrangement of bones and soft tissues gives our nerves the space and pathways they need to function happily.

Our jaws and teeth are among the body parts where anxiety and stress most noticeably take their toll. Image courtesy Nhia Moua on Unsplash.

Anxiety and stress affect the jaw
Jaw clenching and tooth grinding at night while sleeping are typically the result of anxiety and stress, both of which are increasingly common in 2020. This added pressure and friction on the dental surfaces are another factor Dr. Chen suspects in the high number of cracked teeth she’s seen in her practice since June. How can posture help here?

Learning stretchlying brings our students a level of comfort and rest many have never experienced before. Image courtesy Minnie Zhou on Unsplash.

The luxuriously comfortable and relaxed postures we teach for sleep help relieve tension all throughout the body and improve sleep quality. Better, deeper sleep gives us a more stable footing on which to meet the day, even in stressful settings, and can help our mental health considerably. Why not take steps to improve our sleep quality if it can help our health, both mental and dental?

We recommend stretchlying on the back because it supports and gently tractions the body in ways that allow muscles that have been overworking to finally relax, releasing their grip on the back, the neck and, yes, the jaw. It may seem surprising to link healthy posture and dental health, but it actually makes perfect sense that jaw tension and teeth grinding can have positional causes.

If you’d like to revamp your understanding of comfort and perhaps invest in something other than your dentist’s next vacation, try an Online Initial Consultation with one of our online teachers. We also have a new Free Online Workshop all about how you can use posture to relieve stress! We look forward to supporting you (and your pearly whites) in these challenging times.

This is the third post in our multi-part series on floor-sitting. Read Part 1 on floor sitting and Part 2 on squatting!

It’s very common for women in Africa to sit with their legs outstretched. I’ve seen rows of women use this position to spin yarn, engage in idle chatter, sort items, and more. I’ve seen babies massaged by women using this position both in Burkina Faso and in the U.S. by a visiting Indian masseuse who does traditional baby massage in Surat, India. In Samiland I saw this position used to bake bread in a lavoo (a Sami structure very similar to a teepee).

The Sami, who I visited in July 2015 (see my post Sleeping on Birch Branches in Samiland), bake with outstretched legs in their traditional lavoos (teepees). This is my friend Fredrik’s family.

Sitting with legs outstretched is useful when you need an extended flattish lap and your hamstring flexibility allows it. The ground needs to be dry and clean to make this an inviting position. It’s a particularly useful position for childcare. In addition to the aforementioned baby massage, our team member Angela Häkkilä has observed Anatolian women using their outstretched legs as a cradle for babies and toddlers, who are rocked to sleep with a sideways motion of the legs and a gentle lullaby.

 
In this case, the Burkinabé woman at the left is leaning against a wall for extra comfort while carding wool. With her degree of hamstring and gluteus maximus flexibility, she’d be fine without a wall, too!

The problem
Many people don’t have the hamstring and gluteus maximus flexibility to sit on the floor with outstretched legs and not round the spine. Tight hamstrings and gluteal muscles cause the pelvis to tuck under, preventing upright and relaxed stacking. Over time this can lead to a rounded back, degenerated discs, and pain. 

The fix
Place something under the bottom to encourage the pelvis to antevert, and/or consider sitting against a wall, tree trunk, or other surface to counteract the tendency to round the spine. 

With the modification of adding a support under or behind you, you will not only have expanded your repertoire of healthy sitting positions and possible activities, you will also be elongating your hamstrings to better garden, clean, and hip-hinge in general.

Though this Orissa woman would probably be just fine sitting on the ground, her technique of elevating the seat is very helpful for people in modern societies.

 
This Burkinabé massage therapist is testing the temperature of the water she will use to massage a newborn baby. Note her outstretched legs, sitting stool, and seated hip-hinge, all of which support the baby, the action, and the massage therapist to be healthy.

If this way of sitting would be helpful in your life, or if you’d benefit from increased hamstring and gluteus maximus flexibility, we recommend beginning by sitting on a support that will help antevert your pelvis, or with your behind against a wall for support. Since it’s only an issue of muscle flexibility, it’s certainly possible to work up to sitting with your legs outstretched without other support.

The oldest surviving dated Chinese Buddha figure shows surprisingly slumped posture. Note the forward head, absence of a stacked spine, and tucked pelvis. He would not look out of place with a smartphone in his hand!

This surprisingly hunched Chinese Buddha figure is the oldest dated Chinese Buddha figure that has survived into modern times. The inscription on its base dates it to 338 AD, 500 years after Buddhism came to China from India. Compare the Chinese Buddha figure with this Indian Buddha figure from roughly 800-1000 AD…
 

This North Indian Buddha figure from the post-Gupta period (7th - 8th century AD) shows excellent form. He has a well-stacked spine, open shoulders, and an elongated neck.

There is a dramatic difference in posture. The Chinese figure looks like a lot of modern folk, whereas the Indian one looks upright and relaxed. Why the difference?

Since the models these figures were based on, and everything and everyone contemporaneous to them are long dead, the best we can do is to make educated guesses about these characters.

India, compared to China, is a warm country. Much of the Indian population sits on the floor cross-legged to gather, eat, play, socialize, and more. To this day, the default praying position is cross-legged without props.

Devotees attending a puja in a temple in Bhubansewar, Orissa.

China, by contrast, is generally a cold country, being further north. It is not comfortable to sit cross-legged on the floor in a cold country, and accordingly, it is common for Han Chinese people to use furniture. In fact, China has many famous styles of furniture, like Ming and Qing Dynasty furniture, and the oldest sitting implements date to earlier than 1000 BC.

This historical northern Chinese furniture dates back to the Liao Dynasty (907-1125 AD). Though they are weathered, the chairs’ armrests, backrests, and seat shape give clues about posture in this period. Original image is licensed by Wikimedia Commons user smartneddy under CC BY-SA 2.5.

As is true in our culture, when people sit on chairs, stools, and benches, the hip socket (acetabulum) is not subject to the same forces as in a person who sits cross-legged on the floor habitually. In my blog post about cross-legged sitting, I use a common-sense argument about why the shape of the hip sockets of someone who grew up sitting on the floor are different from those of someone who grew up sitting on chairs. By the time we are 16 years old, the hip socket is entirely ossified and not amenable to significant shaping or “editing”. For this reason, most modern people from colder climates cannot sit comfortably on the floor for long periods without props. This is also why, I conjecture, this oldest Chinese Buddha figure shows an awkward and uncomfortable posture as he sits cross-legged without props.

I imagine the model for the Chinese Buddha statue to have been a dedicated seeker, eager to embody every aspect of his chosen spiritual tradition. Some of these borrowed aspects would have worked well, probably bestowing on him benefits in his chosen path and practice. The borrowed posture, however, does not help him. He would do better with a prop. If he used a prop to elevate his ischial tuberosities (sitz bones) and let his pelvis tip forward, he would all of a sudden discover that he could be upright without any tension or effort. His back could rise and fall with his inhalations and exhalations. And he would be spared much degeneration and discomfort. My guess is that he had the skills to work with much of his pain, but maybe not all of it, maybe not all the time, and maybe not into his old age. The mind has amazing capabilities to override pain signals, but when those pain signals can be quite addressed at their root with simple mechanical solutions, this is worth learning how to do. The mind can then be used to try to address more unavoidable pain, both physical and emotional.

This young woman’s posture, with her protruding head, slumped shoulders, and tucked pelvis, shares many similarities with that of the ancient Chinese Buddha figure. Original image courtesy Andrew Le on Unsplash.

With such slumped posture, my experience indicates that the model’s chest and back would be encumbered by the cantilevered weight of the upper body, and not available for easy expansion. Only the belly is readily available for expansion. The person would learn to soften the belly to allow for easier expansion with the breath. In my imaginings, the belly breathing pattern that started out as a hack could easily get mistaken for a desirable practice to emulate. And this misperception continues into modern times.

If there is any truth to this storyline, the posture demonstrated by the oldest Chinese Buddha figure serves as a cautionary tale. It reminds us that practices develop and thrive in a culturally-specific context. When we import a practice from a different context, it behooves us to consider which portions of the practice can be imported whole, which need modification for local conditions and use, and which need to be edited out of our local version of the practice.

Centuries later, in Japan, Buddhist practitioners invented the zafu, the perfect prop for hip sockets of the kind found in cold countries. A zafu enables a modern meditator to be upright and relaxed, just like the Buddha!

Elevating the seat can make a big difference in meditation posture.

Do you engage in practices you find challenging that are easy in the country of their origin? How have you modified an “imported” cultural practice?

Sitting has been much maligned in the last decade. News sources love to dramatize the issue, and you can find many alarming headlines—such as, “Sitting will kill you, even if you exercise” from CNN in 2015. The debate about the various risks of sitting and possible ways to mitigate them is raging, and articles and research range from “sitting is the new smoking” to “sitting isn’t actually bad for you.”

 
Sitting: is it bad for you?

In the last few years, some research has seemed to backtrack or qualify the fears of the past, making a distinction between sitting for work versus sitting in front of the TV; news articles have begun to note the higher risks of sitting for those who are obese or inactive, and the potentially minimal risks of sitting for otherwise healthy adults. Just two years after telling us that sitting will kill us, CNN now claims, “Sitting might not be so bad for you after all.” There are also studies now suggesting that standing presents its own risks and problems including hospitalization due to varicose veins and inreased risk of atherosclerosis. In any case, studies show that after one month, users of standing desks return to sitting. 

People have been spending long hours each day sitting before the rise of ailments like heart disease and diabetes—is sitting really so bad for us? 

So what are we to believe? Do we sit, or stand—or are both harmful? You have to earn your living some way, and if it’s not going to be sitting, it’s going to be standing. All the back-and-forth in the media might have you believe the trendy guideline “the best position is the next position.” To me, this is a rather defeatist take on the human body. I believe all positions are good for you—if done with good posture, and in moderation.

Many famous thinkers can be quoted on the benefits of sitting calmly.

What is overlooked in all the studies and articles on the subject, is our sitting form and our furniture. Beyond one article that explored the benefits of sitting reclined, which is a relaxing but not a very practical posture, the medical literature seldom touches on how people sit, what they sit on, and what difference these can make to health and back pain. 

Bad furniture can contribute to harmful sitting, but even the best-shaped furniture can’t force you into a good posture. Compare the woman on the left, sitting with a tucked pelvis and rounded spine, to the woman on the right who uses the seat shape to her advantage, stacking her spine effortlessly on top of an anteverted pelvis.

In my experience, a person’s posture, what the person is doing while sitting, and what they are sitting on makes a huge health difference, both through correlated factors and through causation. Sitting with poor posture, whether from habit or from bad furniture, has many negative side effects, from causing joint and muscle pain in the back (and as we know, chronic back pain can bring down your mood and keep you from being active), to limiting lung capacity and circulation, which hinders the body’s ability to heal, remove toxins, and circulate oxygen. Even just being able to breath more deeply can have wonderful effects on physical and mental health, boosting energy, digestion, and mood. All these processes are linked, and when one suffers, it is no surprise that other weak spots in a person’s system can take a big hit, even to the extent of increasing the risk of health issues like heart disease or diabetes.

Sitting slouched all day will leave this surgeon tired and in pain, and less able to effectively help others. 

Apart from these direct effects, someone who sits with good form may be more likely to practice other beneficial health habits, like daily exercise and eating a healthy diet; while someone in the habit of sitting in front of the TV, unmoving for hours at a time is likely to harbor other unhealthy habits.

Sitting with good form can allow you to enjoy other activities that enrich your life and help you maintain mental and physical health.

These women in Burkina Faso are both working and relaxed as they sit for several hours spinning cotton. 

This baby naturally sits with good posture, and surely does not find it tiring or uncomfortable in the least. 

So wave goodbye to your anxiety about whether your desk job or your 3-hour seminar are going to give you health woes. Work on your form, maintain healthy habits like daily exercise and limited TV-watching (or other forms of lazy sitting), and take frequent breaks to move around and get your heart rate up a little. Sitting is a natural human activity, and your body is strong enough to handle moderate amounts of any position, when it’s done well.

 
Sometimes, simply by sitting, the soul collects wisdom.
- Zen proverb

Join us in an upcoming Free Workshop (online or in person).  

Find a Foundations Course in your area to get the full training on the Gokhale Method!  

We also offer in person or online Initial Consultations with any of our qualified Gokhale Method teachers.