Ladies, the way you were taught to sit may be polite but could be contributing to a long list of orthopedic problems that cause hip and knee pain.

The solution: SLAM! It stands for “Sit Like a Man,” a phrase coined by Texas orthopedic surgeon Barbara Bergin, MD, who believes that the approach is key to treating—even better, preventing—painful conditions of the knees and hips that are particularly common in women, especially as they age.

What problems can sitting like a man help prevent? They include…

  • Hip bursitis, caused by inflammation of the tiny fluid-filled bursa near the hips, which serve as cushioning for the hip bones.
  • Patella malalignment, a kneecap “tracking” condition in which the knee has a tendency to slip out of the “knee groove.”
  • Chondromalacia, sometimes called “runner’s knee,” in which the cartilage under the kneecap (the patella) deteriorates.
  • Gluteal tendonitis, an inflammation of the tendons that attach the gluteal muscles on the butt to the thighs.
  • Piriformis syndrome, in which the piriformis muscle in the butt compresses the sciatic nerve.


What’s wrong with sitting like a lady? It exacerbates a natural female anatomical tendency to rotate the femur (thighbone) inward, which pushes the knees inward. “When we sit ‘lady like,’ we further exaggerate that movement,” explains Dr. Bergin. Here’s how…

  • SLAM_Incorrect_1Keeping your knees and thighs together when you sit pulls the tendons that attach the buttocks to the hip across the hip bone. That puts tension on both the piriformis and the gluteal tendon, which can become inflamed—and can also irritate the bursa sac.
  • Crossing your legs is bad in its own way—contorting the tendons along the knee and overstretching the hip tendons, which puts pressure on the sciatic nerve.

In treating her patients for these conditions, Dr. Bergin became frustrated because the known treatments didn’t always work. Standard options included certain strengthening and stretching exercises, cortisone treatments, anti-inflammatory medications, braces and other orthotic aids.

SLAM_Incorrect_2So she added specific exercises to encourage the femur to rotate outward—and found that this helped reduce her patients’ pain. The problem, she surmised, was that women too often rotate their legs inward.

Herself included. “As I started aging, I got hip bursitis, and I started being mindful of my pain and realized that it had to do with the way I was sitting. It was worse when I was shoving my legs inward,” she says.

If you want to try it, the good news is that you don’t need to slouch like a teenage boy with your legs splayed out—aka manspreading—to get the benefits of SLAM. It’s a subtle change, although it may be easier to get in the habit when you’re wearing pants rather than a skirt or dress.


When sitting, let your knees drop slightly apart, with your knees at about the 11:00 and 1:00 positions. Your knees should align with your feet.

SLAM_CorrectIt’s a slight relaxation of your legs. You may notice that when you sit the way you’ve been trained, there’s a little tension in your legs—when you SLAM, it’s a more natural position for your legs. Be especially attentive to using this positioning when you get in and out of your chair, because sitting and standing puts a lot of stress on your kneecaps. When you get up, keep your feet flat on the ground and don’t allow your legs to collapse into a knock-kneed position.

While Dr. Bergin’s approach hasn’t been proven scientifically, she has seen many of her female patients improve from simply sitting differently. “When I have patients start the SLAM program, they start to feel relief in their hips and their knees,” says Dr. Bergin. “Most are getting better.”

She typically combines the SLAM technique with other recommendations. For kneecap-tracking issues and knee pain, Dr. Bergin recommends also doing physical therapy and avoiding stairs, squats, deep-knee bends and lunges. For hip pain, she recommends physical therapy and avoiding activities that are painful, such as squatting, sleeping on the painful side, power walking and getting in and out of chairs quickly.

Her mission is to help women prevent these painful conditions—so they don’t have to see orthopedic experts like her. She understands that it’s not always possible to SLAM, but she encourages women to wear pants when they can and to take every opportunity, when seated, to sit like a man. She’d like moms to pass on the new approach to their daughters, too.

For more healthy ways to sit and stand, see Bottom Line’sThe Good Posture Guide.”


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