When I was growing up my mother was always telling my brother and me to “stand up straight.” Like many people, I often wish I had listened to her then and had better posture than I do now. Are the benefits of good posture purely aesthetic? Does having good posture keep you healthier or reduce your risk of injury? Can bad posture be corrected? If, like me, you have been told time and again about the importance of good posture I encourage you to read on for more information about why this is important and what you can do to correct your own posture.
What is good or ideal posture?
While some may argue that a person’s ideal posture is what’s comfortable and is unique to them, there are generally accepted ideal standing and sitting postures. When viewed from the side, your spine should form two S-shaped curves. The combination of forward and back curves allows people to stand up or sit straight.1 It is thought that good posture balances the weight of the body along the spine, requiring a minimum of muscle work to stay upright and balanced.2 When these curves are increased beyond the norm, it takes more muscle work to hold the body up and stay balanced.2
In standing, an imaginary straight line should connect the top of your head, your ear lobe, the tip of your shoulder, your hip and the center of your foot. In sitting, the curve of the lower back should be supported by the chair, the feet flat on the floor, shins straight up and down, with the hips and knees at the same level. If the knees are higher or lower than the hips it will alter the curve of the lower back and change the forces that the back muscles must support.3
What are some common bad postures?
Changes to the curve in one portion of the spine impacts on other parts of the spine and results in increased curves or posture changes elsewhere in an attempt to balance out the body. One common bad posture is a forward head posture accompanied by an increased curve of the thoracic spine (the part of your back where your ribs are attached).4 An increased curve in this part of the back leads to a head forward posture and increased neck curve in an attempt to keep the face in a forward and upright position. People who spend a considerable part of their day using computers, smart phones or driving often have this type of posture.
PHOTO: Head forward posture with increased curves of the thoracic spine and neck.
Another common posture, occurs when the normal curve of the low back is increased. People with this type of posture may notice that their bottoms stick out when they are standing and that they have a large space between their back and the bed when they lie down on their back. While it may be associated with an increase in the forward curve of the mid-back to balance out the spine as shown in image #2 below, it can also cause people to shift their entire torso back, extending their hips and developing a characteristic sway back posture as shown in image #1. It is thought that a combination of muscle weakness and excess muscle length makes it difficult for these individuals to stand with a more ideal posture.3,5 This kind of posture is often seen on those who are obese, pregnant, or have weak abdominal muscles.3
While poor posture can be related to chronic conditions such as arthritis and neurological conditions, among the general population, poor posture is more commonly the result of poor posture habits. Over time, these habits result in some muscles becoming shortened and less flexible and others becoming over-stretched and weak perpetuating poor posture.2 These postural habits can relate to our daily activities and how we set up our work spaces.
In other cases, compression fractures (broken bones) of the spine can result in changes to the curves of the spine. It was once thought that an excessive forward bend of the thoracic spine, often seen among seniors, occurred as a result of this type of fracture. Research has since shown an excessive forward bend in not always the result of a fracture6 and also that the presence of this type of posture increases the person’s risk of a future compression fracture.7,8
Risks of poor posture?
Poor posture can lead to pain in the neck and back, decreased ability to do daily activities and a decreased quality of life.2,6 In addition to the risk of compression fractures as mentioned above, there are other health risks related to poor posture, namely:
Changes to how the muscles of the hip and shoulder work, leading to injury at these joints and a decreased ability to do one’s daily activities.9
Poor lung capacity and function and the risk of death due to breathing problems.6,7
Quick tips to improve your posture
Program an alarm every 20 minutes or so on your phone or computer to remind you to sit up straight when you’re working at your desk. When the alarm rings, check that you are sitting back in your chair with your low back supported and your feet flat on the floor, roll your shoulders back and check that your jaw is parallel to the floor.
Make your workspace more ergonomic so you don’t have to slouch over the keyboard or lean forward to see the screen. Place regularly used items within easy reach.
Avoid sitting for long periods of time. Stand up at your desk or take a short walk around your office as often as you can, ideally every hour.
Associate a task, colour or object with a posture check. For example, every time you open an email, check your posture. Or if you’re driving, a red light could mean stop and check your posture. See the colour blue? Posture check.
Leave the heavy briefcase or purse at home. Carrying a purse or briefcase on the same side will lead you to lean to the side. If you have to carry heavy items to and from work or school, use a backpack and balance the load on both shoulders. Better yet, ask yourself if you really need to carry everything you’ve packed.
See a physiotherapist for help to correct your posture and address the problems that are contributing to poor posture.
Treating poor posture
In the case of poor posture and posture habits that have developed over time, the best approach is to treat the underlying problems: strengthening weak muscles, stretching tight ones, mobilizing stiff joints, developing better posture habits and altering your work spaces to help you sustain better posture through the day.2,7 Where poor posture relates to other conditions, such as compression fractures, it is important to treat the underlying cause and to work on stretching and strengthening exercises and posture correction to help to prevent a further decline in posture.
Workers’ Compensation Board Alberta. Back to Basics: A guide to good back health. 2008. Available at: http://backactive.ca/pdfs/Back_to_Basics_English_Nov_2010.pdf Accessed on September 29, 2016.
Briggs AM, van Dieen JH, Wrigley TV, Greig AM, Phillips B, Lo SK, Bennell KL. Thoracic kyphosis affects spinal loads and trunk muscle force. Physical Therapy 2007; 87(5):595-607
Physiopedia. Classification of low back pain using Shirley Sahrmann’s movement systems impairments, An overview of the concept. Available at http://www.physio-pedia.com/Classification_Of_Low_Back_Pain_Using_Shirley_Sahrmann%E2%80%99s_Movement_System_Impairments,_An_Overview_Of_The_Concept#Standing Accessed on September 30, 2016.
Quek J, Pua YH, Clark RA, Bryant AL. Effects of thoracic kyphosis and forward head posture on cervical range of motion in older adults. Manual Therapy 2013; 18:65-71.
Sahrmann SA. Does postural assessment contribute to patient care? Journal of Orthopaedic & Sports Physical Therapy 2002; 32(8): 376-379.
Kado DM, Huang MH, Barrett-Connor E, Greendale GA. Hyperkyphotic posture an dpoor physical functional ability in older community-dwelling men and women: The Rancho Bernardo study. Journal of Gerontology: Medical Sciences 2005; 60(5):633-637.
Katzman WB, Wanek L, Shepherd JA, Sellmeyer DE. Age-related hyperkyphosis: Its causes, consequences, and management. Journal of Orthopaedic & Sports Physical Therapy 2010; 40(6):352-360.
Huang MH, Barrett-Connor E, Greendale GA, Kado DM. Hyperkyphotic posture and risk of future osteoporotic fractures: The Rancho Bernardo study. Journal of Bone and Mineral Research 2005; 21(3):419-423.
Borstad JD. Resting position variables at the shoulder: Evidence to support a posture-impairment association. Physical Therapy 2006; 86(4):549-557.