Sitting and Bending

 

1. Sitting and Bending

Sitting

Why should sitting be avoided? 

Professor Robert describes what happens when a person sits:

"The course of the nerve is thus very special. It successively traverses three very different regions, describes a curve which drags it around the region of the ischial spine, which it straddles like a violin string on its bridge. The seated position was simulated in the cadaver. It is associated with an ascent of the ischio-anal fat, which becomes applied laterally to the falciform process of the sacrotuberal ligament, so that this is elevated and approximated to the nerve trunk. The latter, contained in the aponeurosis of the obturator internus m., has no means of escape, any more than it has in the gluteal region in the ligamentous grip...since the piriformis [muscle] bars any possibility of upward escape." 

Source:http://pudendalhope.org/sites/default/files/PNE_by_Prof_Robert.pdf

It is important to avoid excessive sitting to prevent possible irreversible nerve damage. 

Bending

Bending is also something to avoid. When a person bends, the pudendal nerve may not be able to glide normally if entrapped which may result in a stretch injury to the nerve. The best way to visualize this process, is to take an elastic band and look at it. Then begin to stretch it. As you are stretching the elastic band, you will see that the further you stretch it, you will begin to see cracks begin to appear in the elastic band. As you continue to stretch it, more and more cracks will appear. If you stretch it too far, it will break. Imagine what stretching can do to the pudendal nerve? Fortunately, we have never heard of the pudendal nerve being stretched so far that it has actually been severed.

With pudendal nerve compression, if the nerve is compressed in one particular area, say the ischial spine, when you bend, the whole pudendal nerve does not become stretched, only the area from the ischial spine down out. This can put a tremendous amount of pressure onto an already compromised nerve. There are some things though that can assist us with the need to bend and pick things up. One of the items, is called a reacher/grabber. You can see what it looks like as you go through the images on this page. This is a great little device, that will prevent you from bending.

What can help with this?

Cushions, kneeling chairs, air desks, frontal chairs. We are not a propenent of any particular cushion. The cushion that you choose should be something that takes pressure off of the pudendal nerve. Some use donut cushions, while others use a U shaped cushion. Here is an example of some cushions, kneeling chairs, and frontal chairs that could be of use, when it's absolutely necessary to sit and/or work on your computer.

 

Most people find that the most comfortable cushion is the type with a cut-out at the back, underneath the coccyx. Some people don't find the slanted cushions comfortable, others like them. . It's a good idea to have several cushions, at home, at work, in the car, etc, so that you don't have to carry one around all the time. But if you're going somewhere else, remember to take a cushion with you. You never know when you may need it. You can make your own cushions quite easily by cutting some foam rubber. Most people go for a cushion thickness of 5 cm (2 inches), but some prefer it twice as thick. Some people prefer a soft foam, and some prefer a very firm foam, or even a board. Experiment to find what is most comfortable for you. There are firms that supply foam rubber in different grades, so you can choose what suits you. .

For some people who are embarrassed of carrying a cushion, some manufacturers have even developed cushion covers that look like knapsacks. You can carry it with you on your back and noone will think twice, if they see you sitting on it. It's great for when you need to leave the home and go out in public to a restaurant or somewhere else.

 

 Regular U shaped cushion. It has a cut out in the back of the cushion, so as to not put pressure on the pudendal nerve. You can look for one of these cushions by putting in "U shaped cushion" into Google. Take your time in looking at the different cushions. Some are heavy, firm, soft, etc. Some also have weight limits. See if the company offers a return policy, so that if any particular cushion that you buy can be returned.

 

 This is an Air Desk. This desk is great if you are at home and laying down in your bed. It has adjustable features, so that no matter what your bed size, you can adjust it to make it fit perfectly. It also has a tilting keyboard holder, so that you can adjust the keyboard, to make it fit to your liking. You can also use this as a standing computer stand. It is very versatile, so whether standing or laying down, or relaxing on a recliner, this is a great option.

You may want to shop for a chair or workstation that changes from a standing to a sitting position. These chairs are relatively expensive, but if your job entails that you work on a computer all day, this is a great option to have so that you can still work but not have to sit.  Kneeling chairs allow you to kneel, offering an additional position option, but be careful because kneeling too much can cause problems for your knees.
 

 This is an ingenious type of chair cushion. It has a concave in the middle of the cushion, so that you can keep some of the pressure off of the pudendal nerve. It can be used on any type of chair and is great also, for short stays when you absolutely need to sit.

 

 This is also called a frontal chair. This is a great type of cushion, but is definitely expensive. You can lay down and put a computer under your head and type away! No worries about sitting with this cushion. You can find this and other types of frontal cushions by looking under "physical therapy" "face down" cushion. This is also a great idea for anyone whom has to be at a computer for long periods of time.

 This particular item is called a reacher or a grabber. They can usually be picked up at your local drug store. They are relatively inexpensive and if you need to pick things up off of the floor, this will become an indispensible tool for you.

 

 

Inexpensive and Creative ideas used for seating options

 

 This is a cushion that moms use, for breast feeding. It can also be used as a cushion. They are relatively inexpensive and a great thing to have in other areas of your home or car. Having an extra cushion around could be useful when you think you might not need one.

 

 This is another great idea. This is a neck cushion. I think most people have seen neck cushions and might be useful for those that are embarrassed in bringing a seat cushion with them.

 

 

Pool Noodles! Another great and inexpensive idea. Using inexpensive children's foam swimming noodles, fashion a U-shaped cushion which fits you, your chair, and your car seat. Use a serrated bread knife to cut the noodles, it works very well. If the simple U works for you, use duct tape to hold the U shape. Wrap the tape around one end a couple times, then bring it across the bottom, then wrap around the other end. Put a piece of tape on top of the sticky part which is holding the U ends together. Another option you might try instead of taping to hold the U shape together -- diagonally slice the ends of the noodle to make them wedge-shaped. Then slide these wedged ends into the back of your car seat or office chair.

 

 Roof Rack Cushion

Go to the nearest windsurfing (watersports) store and buy a thick cylindrical pad used to protect boards when those go on the rack on top of the car. These pads usually go around the metal racks and are quite thick (the thicker the better) and approximately one meter long. They cost about $10, and you would need only one. Once you are in the driver's seat, slide the padded cylinder across the seat under your butt.

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