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Dr. Cathy A. Kim, MD, APC

How to Sit in a Car | Ep. 13

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How to Sit in a Car | Ep. 13

Watch (or read) Dr. Kim teach young adults how to properly sit while driving in order to preserve mobility and quality of life for as long as possible. Positioning yourself with functional mechanics in mind is important!

Transcription:

Dr. Kim:
Hi everyone, we are back for another learning episode of how to best move in your everyday life so that you can preserve your mobility and quality of life for as long as possible.

So my friend Chris is back. He’s a good sport. He wanted to come back and learn some more. I had some questions about how to sit in a car after what we had gone through, so we’re going to do that at his car. But before we go out to the parking lot and do that, I wanted to go over a little bit about what the body is doing for us when we have no idea.

We’ll have Chris, we’ll have you sit up on this table because it’s tall and then it will have your legs dangling. 

Taking the Body for Granted

I learned long ago that I don’t want patients sitting waiting for me on the exam table, which is the usual location that we have, patients waiting for the provider and it is because I find that their back pain gets worse when they sit up there. 

So this is Chris sitting up here on the exam table and his legs can’t touch the floor. Hang on one second. Let me get the skeleton. 

I explain that here’s the pelvis, hopefully you can see it’s really hard sometimes from 3D to 2D to see, but we are supposed to sit on these sit bones on the pelvis, that’s a technical term, but you’re supposed to sit on those when you sit down. My point to people is that your pelvis is a bowl and that you’re balancing on these two spots on the skeleton right here when you sit down. 

So when you sit down, you’re not made like a two by four with another two by four. In a jointed kind of robotic way or wooden toy way. You’re, you know, you’re made like a doll, like a life sized doll. If we put a life sized doll of Chris up here and he sat like this with the weight of his legs, the weight that it would be in real life, Chris should slide off of this table, right? Like, why doesn’t he slide off the table with his legs hanging as if you’re sitting on some bleachers or a high wall? 

So what I want Chris to do is to, like, feel like right here, his back muscles on each side of his spine, like above his pelvis right here. So right here and feel the texture on them right here and even feel the texture on each side of his spine so that he can see it right up here by his neck and feel the texture. And he’s got to remember that.

OK, got to remember that. All right. So wait right here. So I’m going to get a chair, now we have Chris sitting in a chair. And this is what I encourage all my patients to do when they’re sitting in chairs. Make sure their feet are flat on the floor so that the floor is fully supporting the weight of your legs.

So now in this position, try again to feel the texture, the texture of your muscles in your lower back and the texture of your muscles in your on each side of your neck. So I’m putting all my eggs in one basket here. But usually people will say the texture is softer than when it was when they were hanging with their legs.

Chris:
I would concur. 

Dr. Kim:
You concur. All right. So why is that? My point to people is that the body, without our knowing it at all times, is working to help us accomplish what we want to do. And we completely take it for granted that when we’re standing and we just stand all our weight on one leg and barely put weight on the other leg, all of these muscles are all working all in your hips to keep you on balance when really if you were just a doll also you should fall over.

So you can keep that up for a certain amount of time in your life. But eventually I say to people that gravity spares no one and eventually you will have to pay. And then I try to help people work their way backwards out of the problem. 

OK, so when we go to the car, then it’s with this principle in mind that when you’re sitting in a car and it puts you in a place that’s really not helping you be in a straight line against gravity because of the nature of one size fits all and these bucket seats, et cetera, then it sets you up to get to have cumulative kind of tension and problems later. Then people will say that they can’t drive longer than 30 minutes or 2 hours without suffering a lot when they get out of the car. 

All right, so let’s go to the car and see what we can work out for Chris. 

Into the Real World

So we’re now down here in the car. I’m sorry about the traffic noise, but there’s no way to bring the car to my office. 

So, OK, so you might be wondering why I’m standing here with this rolled towel and this socket wrench. So these are my attempts to bring to life the concepts that I’m trying to teach about. So when we sit in a car with the bucket seat, these cars and couches and all the chairs, they’re all set up for people to tilt their pelvis backward and then have the back of the chair lean back. People will say, Oh, that feels comfortable. 

But what that really is doing is when you tilt your pelvis backwards this is shortening your hamstrings and the connective tissue underneath here. So when it shortens all of that, this is what I told Chris about in his video. This gets all short and then you take your normal stride and then you’re going to pull your butt under more just to be able to equal the stride you’ve always done and then this is how people with a posterior tilted pelvis will often have this “disappearing butt” phenomenon over the years as they lose their butt. 

So the reason the socket wrenches is here is because what’s happening is when you sit in the seat with this posterior pelvis and then leaning back, this leaning backward will give you a little bit of contraction like through here. So you’re going to be contracted. And if your seat is far away, your thigh will be fully extended. And this is a contracted position for your thigh muscles.

How do you kind of remember that?

Well, back in the day when you’re wearing jeans and you take them out of the dryer and there’s no spandex in the jeans back then we put on our jeans like this. Straight on the bed and then you’d have to do all these exercises. And what was the most uncomfortable thing was to squat in your jeans, to stretch them out in the thigh and in the and in the butt. 

So when you’re driving and you tilt back like under and back and then a fully extended leg and drive like this, then you keep retracting your calf while you do the accelerator. So I brought the socket wrench because what you’re doing every time, your glutes are a little contracted and your thigh muscles are all contracted. And on top of that, contracting your calf. So this overtime is a socket wrench phenomenon. I tell people that it is like cranking down how tight you are all through here. So no wonder when people get out of the car, they struggle a lot and feel terrible, especially the longer the drive.

So we’re going to you know, we’re going to position Chris in the car so that before I already went over how to like sit down, get in the car so we won’t go over that. This is just more like how can Chris position himself so that if he is on a long drive for good habit even when it’s not a long drive so that he is not progressively contracting all of his muscles all around his pelvis area to eventually develop sciatica pain or similar problems later. 

Let’s have you go ahead and sit down here and tell you how to get closer. So this presents a problem. So I counsel patients all the time about how to sit. A lot of them will say that their legs are too long or they’re too big for the space they have in the car.

So I haven’t seen Chris in his car yet. So this will present some real time difficulties about how I can try to help him best position himself for driving. OK, so let’s see how you use it. So like I said, so what happens is that these seats, see how it positions him like tilting backwards right here. 

So this already tilts him backwards and then these seats are bucket seats. So the bucket seat is to accommodate one size fits all.

And the headrest on these seats are pitched forward to help support the head and neck, of course, in case of a crash. And so this puts people in this position of leaning backward when you’re driving. 

I brought this rolled towel because you could use a pillow or this towel to try to make up for that distance in the back so that you weren’t pitched as far backward in the seat.

So let’s see if we can get this. For Chris so we can put this and you’re going to put it around your mid back right around here. 

Then you really try to sit the seat up a little bit. Like if you have it reclined, don’t you?  So try to make it . . . So part of the reason you might do that is because this pushes your head forward.  You see what I mean? So let me see if I could put this up for you a little bit like that.

Does that help you so that it doesn’t make your head go forward? You might need a bigger . . . Yeah, you might need a bigger . . . This has quite a tilt!  Is this tilted? Did you tilt that . . .  Does that pump so that it tilts you back versus forward? Can you make it so it’s not tilting as far back?

How does that thing work? Does it? Yeah. Does it look like it’s lifting up? Do you feel like it’s lifting up? Yes, it is. I think it is lifting up. So it’s not as tilted far back. Yes. That’s good. So when you do that, then you might not need this as far forward as you have the seat.  See what I mean?

So. Yeah. Okay. So he’s adjusted it so his seat is not pitching him back as far. Do you see, right? Yes. Is that as far back? And then now, how is that? 

Chris:
Yes, better. 

Dr. Kim:
You still feel like your head is forward? This is very . . .this is really extreme . . . how much they put that forward. Yeah, look at that. Um, maybe can you go back, go back a little bit on your . . .  make your seat recline here for just this part. Yeah. A little bit more there. So when you do that, how’s that?. It’s better, right? Because I want you to be able to relax because there’s no holding yourself in this position.

You want to be able to relax in this position. So what I like about this, is that Chris’s knee is partly bent as opposed to like, being almost completely straight. And then this way, I know that he’s stretching his thigh and that it’s basically got pre-stretch going on. So when he operates the accelerator and cranks down and makes his calf muscle tight, that it’s not making the whole system as tight as it could possibly be. So this is better. And then if you can see, can you move the camera this way?

So what we’ve done is that we have tried to elevate this a little bit so that he is not in a posterior tilt as much as he was . . . he was really aimed backward here.  So he changed it. So it’s less. And then, we can put a little . . . he can get a pillow or I took a rolled hand towel and put that here and made the seat a little more vertical so that he now – his torso . . . because we want this pelvis and his torso to be closer to a right angle and that helps you in the long term for surviving a long car ride.

All right. Very good. So I’d say that’s it for a longer legged person in a smaller car. And we’re going to try what it looks like when a shorter person is in a car and what kind of challenges it presents there. Thank you.

All right. So here we are with Bella and she had the incredible idea to move so you don’t get as much traffic noise. So hats off to Bella for that great idea.  Thinking on your feet!

Bella:
You’re welcome.

OK, so let’s see what kind of position Bella is in when she’s driving. And even though Bella is only 18, you know, we’re just going to set her up for success so that when she’s 58, she can still handle a long drive.

OK, ready? You want to get in the car, and then we’ll see what your usual position is for driving. 

Bella:
I don’t lean all the way back. 

Dr. Kim:
You don’t? So this seat is tilted backwards. So what do you do? 

Bella:
So I like the fact that when it’s tilted back, like this, it feels good on my lower back. 

Dr. Kim:
Yes. 

Bella:
But I never lean all the way back, so.

Dr. Kim:
OK.

Bella:
I’m always driving like this. 

Dr. Kim:
Oh, OK. So that’s good because that’s kind of good for all the muscles in here. But that means that you’re holding on and doing a lot of, like, extra work against gravity. 

And so what we did with Chris which you didn’t see, but my point was saying, when we’re doing stuff like that and you’re holding, you have no idea how much work all these muscles are statically doing for you and we’re taking it for granted. 

So let’s see if we can help you. Maybe this will come in very handy. In my car I found instead of using this rolled hand towel, I started using a really flat pillow. So I went to a store, bought like ten pillows, put them all in my car and tried to find the flattest one or the size that worked the best.

So these are things that you could do. I also suggested that you can always try to carry a jacket with you when you go somewhere where you think that something like that will happen. When it’s maybe not as socially acceptable to bring like a lame looking pillow or a blanket. And so you could try to bring an extra jacket and fold it.Just whatever little bit will get the job done. I’m just trying to give you ideas. 

OK, so that’s great that you do that so she already drives with her with her knee a little bit bent so that her thighs are somewhat stretched. This again, do you see that this tilts her pelvis backwards this way this bucket seat goes and is that seat able to be adjusted? Can you make the bucket part make the back go up or is it already adjusted as high as. Oh, yes.

Bella:
Like this goes forward. 

Dr. Kim:
Oh, it almost makes you go forward. 

Bella:
I guess it moves the whole seat. 

Dr. Kim:
Oh, it doesn’t change the angle. OK, so yeah. So is that comfortable? Do you need to push it back? The way it was? OK, so let’s put this  . . . so I put this right about here.

Bella:
Yeah. 

Dr. Kim:
And then it’s still leaning you back. So can you make your seat go forward? A little bit near the back of your seat? Kind of, yeah. Yes, right about there. So can you tell that, now, that you don’t have to hold yourself up as much as you were doing it before? Like, can you relax in this position? 

Bella:
Yeah, I can relax.

Dr. Kim:
Yeah. Uh huh. And whereas before you were like, you’d hold yourself. Would you hold yourself here? 

Bella:
Normally I put my butt all the way back like this.

Dr. Kim:
All the way back. Yes. Good for you. And then you go like that. OK, so let’s see. Yeah. So still Keep your butt back.

Like that, but see if you can relax like this. That’s good, right?

When you’re leaning back too much in these bucket seats you actually strain your neck . . .  your neck, your chest, your arms, your shoulder. It just puts all of them under constant contraction strain.

OK, wonderful. It wasn’t too much to fix, but just that little bit will make a big difference in the long run. All right. Thank you, Bella!

Dr. Cathy Kim

Dr. Cathy Kim

Dr. Cathy Kim is a Board-Certified Family Medicine physician and Body Function Specialist. She practices in Camarillo, CA and specializes in complex cases.
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