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Good Posture Habits

Poor posture (sitting, standing, or lying down or while in motion) leaves the back vulnerable to fatigue, strain, and injuries.

When the spine is not in proper alignment, the back muscles, ligaments, discs, and spinal joints are all under increased and uneven stress.

Muscle strain frequently results. Spinal discs also suffer as a result of poor posture. When the spine is not in proper alignment, the cushioning, shock-absorbing discs between the vertebrae are subject to uneven pressure and wear.

The lower back is especially vulnerable to pain caused by poor posture, as the lower back supports most of the weight of the body. Neck pain is also very common as a result of bad posture habits such as slouching and holding the head too far forward.

What is Good Posture?

The healthy spine curves inward at the neck, slightly outward at the upper back, and inward at the lower back. These three curves (there are actually four curves if you count the sacral curve at the base of the spine, which does not move) balance each other to ensure that the pull of gravity is evenly distributed. The curves in the spine act like springs to help absorb shock (the discs between the vertebrae also help absorb shock).

The natural of curves of the spine are often referred to neutral spine or neutral alignment.

Though the spine itself isn't actually straight, when viewed from the side an imaginary straight line should pass through the ears, shoulders, hips, and the knees and ankles if standing upright.

If the curves of the spine are increased or decreased, the muscles, ligament and joints have to work harder to support the weight of the head and body. This leads to fatigue, strain and back pain.

*Keep spine neutral or keep spine straight or often used interchangeably in exercise instructions - do not try to flatten the natural curves of the back.

neutral spineCheck your curves. To check the curves of the your spine, stand about 3 or 4 inches from a wall with your head, upper back and buttocks against the wall, You should be able to slide your hand behind the small of your back and the wall but the space should not be over two inches. The same goes for the space between the neck and wall. These are general guidelines only. There are slight variations in the spine's natural curves from one person to another.

Note: The curves in the spine becomed more exaggerated with age - partly due to the effects of gravity, partly due to muscle imbalances caused by chronic poor posture habits and lack of exercise. Posture can be improved any age.

The body adapts to to chronic poor posture habits such as slouching by changing its shape - some muscles, tendons, ligaments becoming shortened and others lengthened. This can be corrected through stretching exercises to relengthen shorted muscles and exercises to tone overstretched and lengthened muscles along with learning good posture habits.

Develop Posture Awareness. Bad posture habits can replaced by good posture habits. The first step is to become aware of the position of your body. Start by being aware of the position of your head. The head should sit over the torso, not in front it. The chin should be level with the floor. The chest should be lifted slightly but not pushed out, the shoulders down and back but relaxed. The ears, shoulders, pelvis, should line up (from the side). The pelvis should be in neutral position, tilting the top of the pelvis forward increases the curve in the lower back; tilting the pelvis backward flattens (decreases the curve in the lower back).

NOTE: Keep the shoulder blades back and down but don't overdo it. The shoulders should be relaxed.

Do Posture Checks. Several times a day, take note of your posture. Is your head centered over your torso. Is your chest slightly elevated. Are your shoulders down and relaxed. Is the curve in the lower back being supported while sitting.

Do some simple posture exercises several times a day. Bring your shoulders down and back and squeeze your shoulder blades together - hold for 10 seconds. This will help to strengthen the muscles that keep your shoulder blades down and back. Bring your head back, without tilting your chin up or down, until you feel a gentle stretch in the back of the neck and hold for 10 seconds to stretch the back of your neck.

Proper posture does necessitate rigid posture. If you cant achieve totally correct posture, get as close to neutral alignment as possible without forcing it. Tensing the muscles for long periods can strain the muscles. If unable to get anywhere near neutral posture (possibly due to extreme tightness of muscles affecting spinal alignment), a physical therapist can recommend the exercises most beneficial.

Exercise to Improve Posture. In some cases, being aware of and replacing poor posture habits with good posture habits is all that is needed. In some cases, posture awareness is not enough and exercises are needed (especially if one has had chronic poor posture for years and muscle imbalances have been created (for instance, habitual slouching can cause muscles in the front of chest and shoulder to become shortened and those in the upper back overstretched and weak).

Muscles that support the spine must have enough strength and endurance to keep the spine upright and in neutral alignment. Muscles that affect the alignment of the spine need sufficient flexibility so they do not pull the spine out of alignment, e.g. tight muscles in the front of the hips pull the top of the pelvis forward, which causes excessive arching of the lower back; tight chest muscles and/or muscles in the front of shoulders result in the upper back being overly rounded.

It may take several weeks or more to sufficiently restore flexibility to tight muscles. Dont overdo stretches as over-stretching can actually cause the muscles to tighten and /or cause injury.

Exercises that improve lower back posture include the plank, bridge, hip flexor stretch and the pelvic tilt (see back exercises). Exercises that improve upper back posture and help prevent slouching, include the row, reverse fly, chest stretch, back against wall stretching exercise (see upper back posture exercises). Back against wall also helps stretch the lower back - a good total body posture exercise

Common Posture Errors:

Lower Back Posture

The positioning of the pelvis controls the curve of the lower back. Maintaining neutral position of the pelvis (pelvis neither tilted forward or backward) is key in maintaining the natural curve of the spine.

Muscles of the lower back, abdomen, hips and the buttocks support the pelvis as well as the lower spine. Strengthening and stretching these muscles helps maintain neutral posture and prevent back pain.

SWAY BACK (Excessive Anterior Pelvic Tilt) - Lower Back Posture Error

Sway back, an excessive arch in the lower back, places uneven stress on the spinal discs and joints of the lower spine. Sway back is more common in a standing position than in a sitting position. Wearing high heels also causes the pelvis to tilt forward and contributes to sway back.

Sway back posture is more common in women than in men - but many women with proper posture appear as if they have a larger curve in the lower back because of more "padding" on the buttocks.

Shortened muscles in the lower back and the front of the hip and thigh can contribute to swayback. Sitting for long periods of time tends to shorten the muscles in front of the hips (hip flexors) over time. Tight hip flexors pull the top of the pelvis forward, causing an excessive arch in the lower back. Stretching the hip flexors and strengthening the abdominal muscles with exercises such as the plank help to maintain the pelvis and spine in a neutral position. The plank exercise engages all the layers of the abs, including the deep abdominal muscles. The pelvic tilt exercise is especially good for a sway back and can relieve lower back pain (see back exercises for instructions).

If you have too much of an arch in the lower back, your pelvis is tilted forward. Tuck in your tailbone slightly to bring your pelvis back to a neutral position but don't overdo it.

Test for sway back or flattened back: There should be a slight inward (forward) curve to the lower back. To see if your back curves excessively (sway back), stand with your back against a wall, place your feet about 4- 6 inches from the wall. Make sure your head, shoulder blades, and buttocks are against the wall. If your posture in correct, you generally will have no more than two inches between the small of your back and the wall (you should have at least an inch). If it is over than this, you may have sway back. If there isn't any space at all you have a flattened back.

Sleeping on your stomach causes your pelvis to tilt forward (especially if you sleep on a soft mattress) and your back to arch, which shortens the muscles in your back and encourages sway back. If you absolutely must sleep on your back, place a small pillow under your pelvis. Sleeping on your side with the knees bent helps counteract a sway back and can relieve back pain.

Tip: Place a pillow between the knees (if you sleep on your side) to prevent the spine from the twisting.

FLATTENED BACK - Lower Back Posture Error

There should be a slight forward curve to the lower back. Flat back is more likely to be a problem when sitting than when standing. If the top of the pelvis is tilted too far backward for prolonged periods of time, the lower back loses its natural curve, muscles, ligaments and discs are overly stressed, and lower back pain may result.

Upper Back Posture

SLOUCHING (Rounded Back and Shoulders) - Upper Back Posture Error

Slouching is more common when sitting than while standing. Slouching is common in people whose occupation involves sitting for most of the day. In many people, the bad habit of slouching can easily be corrected simply by moving the body into a proper position. In others, the muscles in the chest and front of the shoulders have become overly tight from chronic slouching, making it difficult to bring the shoulders back and fully straighten the upper back.



Stretching exercises for the chest and the front of the shoulders can gradually lengthen these muscles back to "normal." Strengthening the muscles in the upper back and the back of the shoulders is also helpful (see upper back posture exercises).

Prolonged slouching overstretches (strains) the muscles between the shoulder blades, causing upper back pain. Slouching while sitting often involves simultaneously rounding the lower back, which can result in lower back pain.

If you find yourself slouching, raise your ribs slightly, which will bring your shoulder blades closer together and your shoulders will automatically be drawn back. Lift the chest slightly without jutting it out. There should be a natural inward curve in your lower back. If you find your back arching (the natural inward curve exaggerated) it is probably because you are jutting your chest out and tilting your pelvis forward (the pelvis controls the arch of the lower back). If your pelvis is neutral, you will be sitting on your sit bones.

Slouching (rounding the upper back and shoulders) causes the head, which normally is balanced on top of the spine, to be too far forward. It doesn't take long for the muscles in the back of the neck and upper back to become strained when the burden of supporting the weight of the head is shifted to the muscles in the back of the neck (see Neck Posture below).

Slouching may be caused by fatigue and is common when sitting in front of a computer for long periods of time. Sitting in any position for too long causes overuse of the same muscles; poor posture adds to the problem as it takes more effort to maintain poor posture than neutral posture. Take frequent breaks.

Slouching also compresses your diaphragm, when leads to shallow breathing. Proper posture allows proper breathing and sufficient oxygen intake. Getting enough oxygen helps to relax muscles and prevents stress from building up in the muscles, especially the muscles of the neck and back. Tense muscles are a common cause of back and neck pain.

Neck Posture

HEAD FORWARD - Neck Posture Error

Habitual head forward posture may lead to chronic neck pain as well as upper back and shoulder pain. Restoring proper posture allows strained neck and back muscles to heal.

When standing or sitting, the back of the ears should be in line with shoulders, chin parallel to floor. The weight of your head is supported by your entire spine, which acts as a pillar for your head.

Poor posture habits such as extending the head forward shifts the burden of supporting the head to the muscles in the back of the neck. The further forward the head is forward, the more stress on the muscles in the neck and upper back. This leads to neck pain, upper back pain, and sometimes headaches as tight muscles in the back of the neck pull on the ligaments that attach the back of the neck to the skull.

Looking down with the head forward pulls on and strains the muscles in the back of the neck and upper back. If one is looking straight ahead with head forward (usually while slouching), the natural forward curve of the neck is increased, causing the muscles in the back of the neck to become tight and shortened. Gentle neck stretching exercises help lengthen shortened muscles over time.

Slouching is a common cause of the head being forward too far (see Upper Back Posture above).

To check the curves of the your neck, stand about 4 inches from a wall with your head, upper back and buttocks against the wall. If you have more than 2 inches between the wall and your neck, the muscles in the back of the neck may need stretching - this is provided your head is against the wall. If you cannot touch the back of your head against the wall your upper back is overly rounded (see Upper Back Posture above). This is only a general rule and does not apply in every situation. The shape of the back of the head will affect how far the space is between the neck and the wall when the head and upper back are placed against a wall - the space will be greater in those whose head is elongated.

Don't be impatient. Lengthening the muscles through stretching exercises must be done gradually to avoid injury. Overstretching muscles in the neck can result in increased neck pain and stiffness.

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Proper Posture While Sitting

Many people spend much of their workday sitting. Maintaining proper posture while sitting helps prevent back pain.

The pelvis should be in a neutral position. Some chairs encourage the pelvis to tilt backward, which flattens the inward curve of the lumbar spine and leads to lower back pain. If you don't have access to a chair with a good lower back support, place a small pillow or rolled up towel in the small of the back to provide support. Take care that the support you use does not push your pelvis too far forward.

The hips should be level with or slightly higher than the knees. Sitting on a wedge cushion raises the hips slightly higher than the knees (over a 90 degree angle between body and thighs), which helps keep the pelvis from tilting backward and helps maintain the natural inward curve in the lumbar spine.

The lower back is under more pressure while sitting than while standing. Having an adjustable chair that reclines slightly shifts your weight onto the backrest of the chair; this allows your back muscles to relax and takes some of the pressure off of the discs.  If the chair reclines the knees may be higher than the hips as long as there is at least a 90 degrees angle between the torso and thighs.

Some people try too hard to sit up straight and actually end up tilting their pelvis forward and arching their back - usually the result of jutting out the chest. This increase in the curve of the lower back (sway back) also strains the lower back. The ribs should be lifted slightly but not jutted out.

When sitting in a chair, the feet should be supported. If the seat is too high for the feet to reach the floor, use a platform to rest your feet on. Having the feet on the ground helps encourage the abs to contract slightly.

Even with good posture, sitting for prolonged periods of time is hard on the lower back. Take frequent breaks from sitting; a short walk every twenty minutes or half hour helps to reduce muscle stiffness and rehydrate the spinal discs.

Neck pain is also common when good posture is not maintained while sitting.

When reading, place the material on an angle; don't place the reading material flat on a desk or your lap. Leaning your head over for prolonged periods of time is brutal on your neck muscles.

The top of the computer screen should be just below eye level. Make sure your computer monitor isn't too high of low. You shouldn't have to tilt your head up or lean forward to see the screen. We often extend our neck to look at a computer screen, sometimes because it is too far away, sometimes out of habit. Looking upward or looking downward or sideways (which is common practice when viewing a document upon a desk) for more than a short time also puts excessive strain on the neck. Use a document holder.

Shoulders should be down, back and relaxed. The arms should hang at your sides. If your computer keyboard is too high or too far away the arms have to be kept raised or extended, resulting in tense shoulder and upper back muscles and back pain.

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Proper Posture While Lying Down

Supporting the spine in its natural alignment while sleeping is important to let the back muscles fully relax and to avoid overextending the muscles, ligaments and spinal joints. A supportive and comfortable mattress is important and using a pillow (between the knees for side sleepers, under the knees for back sleepers, or under the hips for stomach sleepers) can also help take stress of the spine.

Lying on side with knees bent - pillow between knees for support: Lying on your side with the knees bent helps counteract a sway back and can relieve back pain. Using a pillow between the knees helps prevent twisting of the spine.

Lying on back with knees bent - pillow under knees for support: Lying on the back with straight legs can cause low back pain. If you prefer to sleep on your back, bend your knees slightly and place a pillow under them for support.

Lying on your stomach - pillow under the hips: Lying on your stomach increases the curve of the lower back, leads to shortening of the muscles in your lower back and encourages sway back. If you absolutely must sleep on your stomach, place a pillow under your hips to help support the lower back. However, sleeping on the stomach also can strain the neck and is generally not advisable.

Neck support: The pillow supports the neck by filling the space between the head and shoulders. The pillow should not force your head upward or allow it to fall downward, but should keep it in a neutral position. The pillow should also feel comfortable. People who "must" sleep on their stomachs only need a very low pillow.

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The Role of the Mattress

A good mattress will conform to the spine's natural curves and keep the spine in proper alignment.

When lying on a saggy or too soft mattress, the spine is thrown out of alignment. An overly soft mattress allows the lower back to sink too far into the mattress, which can irritate the spinal joints and result in lower back pain upon awakening. Back muscles also become strained as they attempt to keep the spine in proper alignment.

If the mattress is too firm there will be gaps between the inward curves of the body and the mattress that leave parts of the back unsupported. Pressure points will be created on the parts on the body that has contact with the mattress, as there is less area to distribute the weight of the body.

The solution is to get a relatively firm mattress with enough cushioning for comfort. (There must be enough cushioning to distribute the weight of the body and eliminate pressure points) If you already own a bed that is overly firm, adding a good quality foam topper may be enough.

A mattress wears out gradually - springs and foam gradually lose their ability to recover height - resulting in a gradual loss of support and comfort. Sleeping on a new mattress may improve sleep and reduce back pain and stiffness.

See mattresses and back pain page for more information.

TIP:

Change Positions Frequently for Back Pain Prevention and Relief.
Holding the neck or back in one position for too long can lead to muscle strain. Holding a position in which the spine is not in neutral alignment makes the back even more vulnerable to back pain. Change positions frequently to avoid using the same muscle group for too long

Keep the spine in proper alignment while standing, sitting and lying down to prevent back pain.