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Posture: everything you wanted to know & more

Posture is more than just how well you sit or stand – it is a window into the health of your body and tells us how well your muscles, joints and nervous system are working. Dysfunction in the muscles, joints or nerves can be seen as subtle postural changes, such as tightness of a muscle or the position of a joint.

 

What is good posture?

 

There have been various opinions over the years on what ideal posture should look like. We have probably all been told at some time to “pull your shoulders back” or ”tuck in your stomach” but is this actually how we are designed to stand and move? Or is this perhaps doing us more harm than good?

Posture is best understood by looking through the lens of ‘developmental kinesiology’ – the study of the mechanics of human movement during early development.  Observation and analysis of development from the new-born through to early childhood gives key understanding to how we are truly designed to function and therefore what resulting posture should look like.

We all have the same ‘postural’ or movement program stored in the brain. This is the program that takes us from flat on our backs at 3 weeks to standing tall at 3 years. This sequence is not learned – babies are not taught to lift their heads, to turn or to crawl.  It is an inbuilt program that has been honed over millions of years of evolution. As the baby’s brain matures during this developmental period so does the control of its muscles allowing eventually for upright posture.

 

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By assessing this development sequence we can understand what proper function and posture is, and what it isn’t. Good posture follows a few simple guidelines:

 

1. Proper ‘centration’ (alignment)

The joints should be aligned correctly both when static and when moving. This will differ slightly depending on individual body proportions but the same fundamentals hold true for everybody e.g.:

  • Head directly over the shoulders, not poking forwards.
  • Shoulders wide and spread, not hiked.
  • A ‘long’ spine (not excessively straight, curved or slumped).
  • Knees in-line with feet, not collapsing inwards.

However, if the body is functioning poorly (for whatever reason) we will see deviations from these ideals. Deviations follow common patterns in both the developmental period and later in life. The following illustrations show examples of ‘good’ and ‘bad’ postures in a prone position.

Here you can see a ‘good’ postural pattern in both baby and adult. Note the similar pattern in both pictures – neutral position of the low back and head with the shoulders depressed (green arrows).

 

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Here you can see a ‘poor’ postural pattern. Note the similar pattern in both baby and adult – sagging lower back, elevated shoulders and jutting of the chin (red arrows). These postural deviations increase the risk of spine, shoulder and neck injuries.

 

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2. Low muscle tone

There should be good co-ordination and balance between all the muscle groups. Excess ‘tone’ or tightness in a muscle group signifies imbalance.

 

3. Proper Breathing Pattern

A normal breathing pattern is driven by the diaphragm (the muscle that sits under the lungs). With an ‘in’ breath the diaphragm should contract downwards, inflating the lungs. This filling of the lungs pushes the abdominal organs down leading to expansion of the abdomen.  This is called a ‘diaphragmatic’ or an ‘abdominal’ pattern of breathing.

In many patients this pattern of breathing is disturbed.  Instead of the diaphragm expanding the lungs from below, the muscles of the neck and shoulders lift the ribcage up. Breathing in this fashion overloads the muscles and joints of the neck, which can predispose to pain and injury.

 

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Correct breathing pattern (left) vs. poor breathing (pattern right)

 

 

What causes poor posture?

 

Anything that changes the function of the muscles, joints or nervous system will ultimately be reflected in a change in posture. This can be the result of many insults:

1) Poor Movement Habits

The body will attempt to adapt to any prolonged stress that is put on it. Exercise physiologists call this the ‘SAID’ principle or “Specific Adaptation to Imposed Demand”. This is usually thought of as a good thing; you go to the gym, you lift some heavy weights and your body adapts by building stronger bones and muscles.  However, this phenomenon can just as easily have negative effects. If, every time you go to the gym, you only work certain muscle groups or train with poor form you will be setting yourself up for muscle imbalance and injury down the road.

Another prime example is sitting. When you sit, certain muscle groups tend to shorten (eg: the pectoral muscles of the chest, the hip flexors and the hamstrings). If you are in the habit of sitting for extended periods, these muscles will eventually adopt a permanently-shortened condition which will wreak havoc on your movement quality and will predispose to injury.

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2) Non-Optimal Early Development

The quality of development during the first few years has a big impact on structure and movement patterns in later life. As discussed above, brain maturation during development leads to changes in how a baby’s muscles control its body, and these changes in muscle control lead to changes in bone structure, resulting in the typically shaped adult skeleton.  However, if development is compromised, which is estimated to occur in around 20-30% of the population [1], newborn patterns of muscle function and skeletal shape persist into adulthood. Learn more here.

 

 

This can lead to typical structural changes such as:

  • Flat feet
  • Knock knees
  • Forward tilted pelvis
  • Slumped spine

These structural issues lead to poor posture and movement patterns, resulting in more strain on the surrounding joints and increasing the risk of injury.

 

3) Protective patterns:

When a part of the body is damaged by injury or trauma, messages are sent from the site of injury to the brain. The brain analyses these messages and, if sufficiently threatening, they are interpreted as “pain” and defence mechanisms are triggered to prevent or to minimise further damage.   

Part of this reflex defence mechanism includes changing how certain muscles work. Some of the muscles tense and guard whilst others are inhibited (or tuned down). In the short term this works well to protect the area from further damage. However, in some instances, this protective pattern can persist long after the injury has healed. As Janet Travell M.D. White House Physician for John F Kennedy famously said:

 

“After an injury tissues heal, but muscles learn. They readily develop habits of guarding that outlast the injury.”

 

If these patterns do persist, movement will be compromised. A good example of this is after knee or ankle injury. We very often see patients who, despite no longer being in pain, show significant residual deficits and poor movement on the previously injured side. A simple screen to assess lower quarter stability is the single leg balance test. To test this yourself stand on one leg with your arms crossed (not shown); you should be able to hold this position comfortably for 30 seconds eyes open and 10 seconds eyes closed. Make sure to check both sides.

 

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4) Genetics and Structure

Our skeleton is shaped not only by development in the first years of life (as discussed above) but also via our genetics. An interesting illustration of this is in the sport of Olympic weight lifting. Eastern Europeans have long been dominant in the sport and one reason for this, according to Professor Stuart McGill of Waterloo University, is the shape of their hip sockets. Their genetically shallow hip sockets allow them to squat deeply without flexing their spine (which would otherwise predispose them to back injury).

 

 

5) Stress/ Emotional State

Stress elicits a sympathetic (“fright or flight”) response. This leads to a variety of changes in the body including increased tension in certain muscle groups. This pattern of increased tension is similar to that seen in the protective or newborn pattern with, for example, hiking of the shoulders. This is why you will often hear people say that “their stress goes straight to their shoulders”. If this stress persists for some time, the body may adapt and change the pattern of muscles it uses to move.

 

 

Do I have poor posture?

 

To assess someone’s posture requires a range of tests looking at mobility, strength and movement patterns. However, a quick and easy screen of upright posture that can provide valuable information is the ‘Wall Angel’ test.

 

To perform the ‘Wall Angel’ test: 

  • Find a clear wall and stand with your back to it. Your head, mid-back and buttocks should all be touching the wall, your feet can be a comfortable distance (a few inches) away.
  • Next bring your arms up to the 90/90 position (as shown) with the back of your wrists and fingers against the wall.
  • Then, without moving your head or hands, try to also flatten your lower back to the wall.

Scoring: This test can be scored from 0-3, with the results as follows:

 

3 – Perfect!

  • You can comfortably achieve the position as shown.
  • Your eyes are horizontal, not looking up, and your chin is not jutting out. 
  • You can simultaneously flatten your fingers, hands and spine against the wall.
  • If you are in this category well done!  A ‘3’ doesn’t necessarily mean that you don’t have any postural flaws but it does show you have good global movement in most of the right areas (shoulders, chest, spine).  You will likely gain more benefit from focusing on strength and stabilisation training rather than stretching exercises.

 

2 – Pretty good:

  • You can flatten your head against the wall with your eyes horizontal and your chin not jutting out.
  • You can flatten your fingers and can almost flatten your wrists but not quite (<1cm form the wall).
  • You can almost flatten your spine to the wall but not quite.
  • A ‘2’ translates to ‘good enough’ – not perfect, but not worth worrying about too much. Your time would likely be better spent working on other areas.

 

1 – Work needed:

  • You can’t flatten your head against the wall or you can flatten you head but to do so your chin juts out or your eyes are no longer horizontal.
  • You can’t flatten your fingers against the wall or your wrists are still a way off (> 1cm from the wall).
  • You cannot flatten your spine anywhere near the wall.
  • A ‘1’ indicates a dysfunction of upright posture. If you have neck or shoulder pain this is very likely a contributing factor. If you don’t currently have pain you are likely at higher risk for neck, shoulder or low back injury.

 

0 – Pain

  • You experience pain during any phase of the test. 
  • This test should not cause pain, if it does it is not normal. You should have it investigated by a suitable healthcare practitioner.

 

If you are looking for an expert opinion on your posture click here to see how we can help.

 

I had had a stiff neck and shoulders from being hunched over a computer screen all day…. The consultation and testing is thorough and the treatment is relaxed and done with confidence.

Matthew Chambers

 

 

Can I improve my posture?

 

In almost all cases the answer is yes. The extent to which it can be improved will be different for everyone. The best method for improvement will also be individual specific but there are common considerations that will be important for most people:

 

1: Manage Sitting Time

In many cases time spent sitting is the primary factor in postural problems. Even if you exercise for an hour every day, if you’re sitting for long periods, especially in a poor positon, this is a battle you won’t win. For those that work at a desk there may be no getting around having to sit for some period of time but there are variations and alternatives that can help:

  • Change your set up: If you are using a chair change its set up throughout the day; height/ angle of seat pan, angle of back rest etc. This will help you avoid continuously stressing the same areas of the body.
  • Sit-Stand desks: If you work at a desk I would highly recommend an adjustable sit-stand desk. These allow you to move from a sitting to standing work position. More isn’t always better however and standing for too long, particularly if not used to it, can also be harmful. Alternate between sitting and standing, and change standing postures frequently. Anti-fatigue mats can also be useful when standing.
  • Treadmill desks: Allows you to walk whilst working.
  • Swiss Ball/ Balance Disc: This will help you use different muscles as you sit.
  • Squatting – Long before chairs and seats we used to rest in a squat position (in fact many cultures still do). This is a fantastic way to maintain good mobility and strength throughout the whole body.

 

If do you have to sit for work make sure your desk set-up is as back friendly as possible. Click here for infomation on proper chair and desk set up.

 

2: Move more  

Walking is the perfect anedote to sitting. Aim for at least 1 hour of walking per day (but this doesn’t have to be in one go).  When walking remember to:

  1. Walk upright: Think about someone pulling you tall from the crown of your head.
  2. Relax your shoulders.
  3. Swing your arms: This not only gets your spine moving but research also shows that shows that swinging the arms from the shoulders (not the elbows) reduces spine loading up to 10% [3].
  4. Walk briskly, without over striding. Small slow steps results in more spinal load, increasing symptoms in many low back cases [3].

 

3: Targeted Exercises

In most cases targeted exercise is needed to either strengthen weakened postural muscles or lengthen short / tight muscles. Visit our resources section for a more information on targeted postural exercises or download our free ebook:

 

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Three exercises to fix the back your desk broke

Learn which areas of your body are affected most by a long term sedentary lifestyle and 3 easy exercises you can start doing today for less pain, less stiffness and improved health.

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Treatment for poor posture

 

In chronic or stubborn cases, in addition to the strategies outlined above, hands-on treatment may be required. There a number of effective treatment options available including:

 

Manipulation

Changes in posture are often accomapnied with restriction of specific joints. Joint restriction is most commonly seen in the upper neck, mid-back, pelvis and feet. Chiropractic manipulation is a controlled, specific force applied to a restricted spinal or extremity joint. It is often associated with a ‘clicking’ or ‘popping’ noise, similar to what you might hear when a wet glass is lifted from a table – this is simply caused by a release of gas from the joint as movement is restored. Manipulation a very quick and effective approach to restore proper movement to restricted joints to improve posture and reduce pain.

 

Mobilisation

Mobilisation also works to free restricted joints but involves slower movements so is not usually associated with ‘clicking’ or ‘popping’. 

 

Soft tissue work

Changes in posture also effects the muscles and other soft tissues (ligaments, tendons etc), with some muscles prone to tightness and others prone to weakness. A variety of soft tissue technqiues can be employed to address short or tight muscles to improve mobility and posture and to reduce pain. Common soft tissue techniques include ischamic compression, cross friction, active release, graston and pin and stretch.

 

Dry needling

Dry needling is a therapeutic technique using an acupuncture needle to penetrate the skin and stimulate the underlying tissue. It is very effective at treating deep trigger points (knots) in the muscles which may be limiting movement or casuing pain.

 

 

If you are looking for effective treatment for your posture click here to see how we can help.

 
Fabio-Vescovi

Before treatment I had back pain and stiffness. Now I am less stiff and even sleep better. I would certainly recommend treatment to my colleagues as we all sit 7-9 hours a day at the computer.

Fabio Vescovi

 

 

 

References

  1. Meholjic, A. (2010). Can a Motor Development of Risky Infants Be predicted by Testing postural Reflexes According to Vojta Method?. Materia Socio Medica, 22(3), 127-131
  2. Michaud, T. C. (2011). Human locomotion: the conservative management of gait-related disorders. Newton Biomechanics.
  3. McGill, S. (2007). Low back disorders: evidence-based prevention and rehabilitation. Human Kinetics

 

Figures reproduced from:

  • Liebenson. C., Journal of Bodywork and Movement Therapies
  • Kolar, P. (2014). Clinical Rehabilitation. Alena Kobesová
  • McGill, S. (2007). Low back disorders: evidence-based prevention and rehabilitation. Human Kinetics

 


This page was written by Steffen Toates. Steffen is a chiropractor at Dynamic Health Chiropractic in Jersey, Channel Islands. For more information about Steffen click here.