What is Posture?
Static posture is defined as the position in which we hold our bodies while standing, sitting, or lying down. Good posture is the correct alignment of body parts supported by the right amount of muscle tension against gravity. Without posture and the muscles that control it, we would simply fall to the ground.
Posture can be divided into two categories:
is the position of your body when you are stationary. Examples of static posture are standing and sitting.
is the position of your body as it moves. Examples of dynamic posture are walking, bending, and lifting.
When you learn what healthy static and dynamic postures look and feel like, you can then learn how to help yourself to prevent back pain episodes as well as manage back pain when posture plays a role.
Normal Spinal Curves
The key to good posture is the position of your spine.
Your spine has two normal kyphotic (backward) curves and two normal lordotic curves (forward):
- neck (cervical) curves forward
- mid back (thoracic) curves backward
- low back (lumbar) curves forward
- hips (sacral) curves backward
Correct posture should maintain these curves, but not increase them. Your head should be above your shoulders, and the top of your shoulder should be over the hips. There are several ligaments and muscle groups, that are extremely important in maintaining good posture.
Supporting the Spine
Ligaments help to hold the skeleton together. They do this by connecting bone to bone. Three of the more important ligaments in the spine are the:
- Ligamentum Flavum- connects under the facet joints to create a small curtain over the posterior openings between the vertebrae.
- Anterior Longitudinal Ligament- attaches to the front of each vertebra and runs up and down the spine.
- Posterior Longitudinal Ligament- runs up and down behind the spine and inside the spinal canal.
The postural muscles prevent the forces of gravity from pushing us over and help maintain our posture and balance during movement. The first group of postural muscles are attached to the front of the spine (flexor) and include the abdominal muscles. These muscles allow you to bend forward (flex) and are important in lifting and arching your lower back. The oblique muscles are attached to the sides of the spine and help rotate the spine and maintain proper posture. The other group of muscles are located in your back (extensor) and allow you to stand upright and lift objects. These muscles include the large paired muscles in the lower back, called erector spinae, which help hold up the spine, and gluteal muscles. All of these muscles work together to stabilize your spine.
Muscle Strength and Flexibility
Muscle strength and flexibility are essential to maintaining the neutral spine position.
- Neck muscles can be strained from poor posture, such as looking down at a computer, desk or workbench for extended periods of time or day after day, holding a smartphone between the ear and shoulder, or even reading in bed. When an over-curvature of the neck occurs, a person appears to have a forward head posture.
- Muscles in the middle back can become inflamed or strained by improper sitting (forward leaning or slumping) at a desk, improper body mechanics when lifting, or carrying a heavy backpack, bag or purse. When this area of the spine curves outward too much, it is called problematic kyphosis. With this, a person appears to have a “humped” back.
- Weak abdominal muscles can cause hip flexor muscles to tighten causing an increase in the curve of the low back. When the natural inward curve of this area is overextended it is called lordosis. This is sometimes referred to as “swayback”.
- Chronic stress can also lead to muscle weakness and back pain. Stress causes back muscles to tighten in a fight or flight response, depriving muscles of energy needed to support the spine.
So, what happens when postural muscles are weak, injured or inflamed? When certain structures in the spine (e.g., facet joints) become injured or inflamed, the postural muscles can spasm, causing back pain and noticeable limitations in movement. An episode of back pain can be a vicious cycle, especially if it lasts for more than two weeks. It can then lead to muscle weakness, because when muscles hurt we tend to avoid using them or even moving as much as we normally do. This can lead to muscle wasting and even more weakening, which in turn causes more back pain because the muscles of the back are less equipped to support the spine. And it goes round and round.
Assessing Your Standing Posture
Postural assessing can be done by yourself, or another person such as a friend, family member or medical professional. When doing this, you should always position yourself in front of a mirror so that you can identify the areas that are good and others that may need some help. Also, if someone else is helping you with this, they may be able to point out things that you do not see as abnormal. A medical professional typically will complete this assessment with you facing away from them. In this position, they can observe the different curvatures when standing and bending over. This is the process:
- Stand in front of a mirror with snug-fitting (not loose) clothing on. With one mirror you will need to change positions to see your frontal and side views. Two or more mirrors are great for this. Like the ones, you find in fitting rooms.
- Look at how your head is positioned. Anteriorly (front view) The head should be centered between the shoulders. Laterally (side view)The chin should be fairly centered over the top of your chest, in a level position. It should not be pushed forward or tilted backward. The middle of the ear should be in line with the middle of the shoulder, the middle of the elbow, hip, knee and ankle bone.
- Your neck should appear straight (anteriorly) with a slightly forward curve(laterally). Chin pointing down or lack of neck curvature can indicate a problem. A flat neck with no curvature is called a “military” neck. This might look very proper, but it isn’t good for your back. By flattening the neck, you are actually straining the muscles and ligaments in your upper back.
- The shoulder should be level (anteriorly) in a straight line with the torso of your body(laterally). They should not be rounded forward or slumped over. By doing so, you are putting stress on the upper and middle back.
- Your waistline and hips should be level(anteriorly). This represents the position of the pelvis. The lower back should have a slight inward curve and the abdomen should be “tucked in”(laterally). This relates to something called a pelvic tilt. The pelvis can tilt towards the front, back, or either side of the body.
Anterior pelvic tilt– Lower part of pelvis tips backward and upper part tilts forward.
Posterior pelvic tilt– Upper part of pelvis tips forward and lower part tips backward.
Lateral pelvic tilt– hips tilting toward either right or left and is associated with scoliosis or people who have legs of different length. You can simulate this by bending one knee and watching the opposite hip change height.
- Knees should be relatively straight(anteriorly) but not entirely locked(laterally).
- Feet should be flat on the floor(laterally) and spaced approximately the same width as your shoulders(anteriorly).
Another way to check your posture and to establish a healthy standing posture is to place your back against a wall. Make sure your heels are approximately two inches from the wall (to allow room for your buttocks). Now do a pelvic tilt. In order to accomplish this, push the small of your back (lower back where it curves inward) toward the wall by tilting your pelvis. Finally, make sure that your knees are slightly bent and never in a locked position. This is also a good exercise to practice in order to strengthen your abdominal muscles and to recognize what good posture feels like when in a standing position. A recent study examined the stress exerted on the lower back while standing. They determined that prolonged standing caused the subject patients to make more frequent body shifts and activate back and abdominal muscles to provide relief. The patients reported more pain and perceived exertion at the end of prolonged standing.
Assessing Your Sitting Posture
You know just as well as anyone, that we tend to sit differently when we are in different settings or doing different things. You are not likely to sit at a desk at work like you do at home on your sofa and you might assume a more formal posture when at an awards banquet than you would if you were grabbing a bit at a local pub with close friends. An interesting study looked at this topic. The researchers examined high school students and the association between home posture habits and the prevalence of lower back pain. They concluded that nearly 50% of the study subjects experienced lower back pain that was directly associated with their home posture habits.
So, to start off this exercise, pick a place where you normally spend time sitting for longer periods of time and sit as you normally would. Now, let’s begin.
- Your back should be straight, with your lower back touching the back of the seat (chair, sofa, etc.)
- Shoulders should be level, straight (not rounded forward) and in a relaxed position.
- Head and neck should be straight and centered between the shoulders, with your chin level with the floor.
- Weight should be distributed evenly between both hips
- Knees should be bent at a ninety-degree angle with the top of them at or slightly above the level of your hips.
- Do not cross your legs.
- Your feet should be flat on the floor.
- Check for natural spinal curvatures in all areas of the back. If necessary, you can support your lower back with a cushion or roll.
Assessing Your Sleeping/Laying Posture
No matter what position you sleep in, your pillow should be under the head, but not the shoulders, and should be a thickness that allows your head to be in a normal position (not leaning backward or pushed forward). These are the other things you need to be aware of:
- Find a position that is comfortable for you that allows your back to maintain the normal curves.
- You should try not sleep on your stomach, particularly with your arms up under your head. This position affects all natural curves in the spine and can make your lower back and neck very sore.
- If you sleep on your side, try not to curl up in a ball. By drawing your knees toward your chest, you arch the back outward and eliminate the natural curvature.
- When sleeping on your back, place a pillow or roll under your knees to reduce strain on your lower back.
- Buy a firmer mattress with a box spring. If your mattress tends to sag or feels soft in certain areas, you can place a board under it to “firm” it up.
- If you tend to have lower back pain when you wake up in the morning, try sleeping with a lumbar support while on your back or place a pillow between your knees while on your side.
Thing You Can do to Improve Your Posture
Be aware of your posture:
Do a quick assessment of your posture during everyday activities, like watching television, cooking dinner, or working at a desk or on a computer.
Change positions and stretch:
When situations require you to be in one location or position for extended periods of time, you can benefit from frequent breaks, changes in position, and gentle stretching. This can be done while standing. You can place a small step stool by you and alternate each foot up and down on the step. This will alleviate some of the strain on your lower back. If you have to sit at a desk or in a vehicle for employment, get up and out. Take frequent breaks when possible and stretch your legs, back, etc. By moving around, you can reduce the stress exerted on different parts of the back and increase circulation. If you can’t get up and walk around, you can do some simple stretching exercises while seated.
Any kind of exercise is good and can improve your general health, but certain types of exercises can be especially helpful for improving your posture. They include:
- Tai chi
- other classes that focus on body awareness.
It is also a good idea to do exercises that can strengthen your core (muscles around your back, abdomen, and pelvis), provide gentle stretching, teach balance and proper body alignment and reduce tension/stress.
Maintain a healthy weight:
Extra weight can weaken your abdominal muscles, cause problems for your pelvis and spine, and contribute to low back pain. All of these can hurt your posture.
Wear comfortable, lower-heeled shoes
(when possible): High heels and unstable shoes can change your posture, your balance and force you to walk differently. This puts additional stress on the muscles and ligaments that help you attain proper posture. A study published in the Podiatry Review journal stated that high heels alter the alignment of the feet, legs, and back, and can have long-term effects on posture and health.
Adjust your work area:
Make sure work surfaces are at a comfortable height for you. This is the case whether you are doing something for work or pleasure. Be aware of your posture when you are sitting in front of a computer, making dinner, eating a meal or enjoying a favorite hobby.
If you have chronic neck or back pain and want to consider stress as a possible cause you may want to read “Healing Back Pain” by John Sarno, M.D or “Back Pain Remedies for Dummies” and “Win the Battle Against Back Pain” by Dr. Sinel. You can also contact Michael Sinel, M.D. directly at michaelsinel.net.
Michael Sinel, M.D.
Board Certified Physical Medicine and Rehabilitation Physician
Assistant Clinical Professor, UCLA Department of Medicine
Dr. Sinel is an expert in spinal disorders, stress-related back pain, and mind/body medicine. He also has obtained certifications as a yoga therapist and mindfulness-based stress reduction instructor. Dr. Sinel is a proponent of using alternative methods to help patients overcome the pain and loss of mobility from spinal disorders and chronic pain syndromes.
Dr. Sinel has authored two widely read books: “Back Pain Remedies for Dummies” and “Win the Battle Against Back Pain.”
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