Being reprimanded for slouching or slumping may not be the best conversation starter, but good posture, also referred to as a neutral spine, is about more than just appearance.

This article outlines how exercise professionals can manage poor posture in their clients.

What is Posture?

“Posture is 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.” (ACA, 2019).

In our daily lives we do not, generally, have to think about our posture; our muscles will typically do this for us, meaning we do not have to consciously think about it.

Things to note include (ACA, 2019):

• Several muscle groups, including the hamstrings and large back muscles, are critically important in maintaining good posture.
• While the ligaments help to hold the skeleton together, these postural muscles, when functioning properly, prevent the forces of gravity from pushing us over forward.
• Postural muscles also maintain our posture and balance during movement.

Why is Posture Important?

Evaluating a client’s static posture is one of the most important assessments an (appropriately qualified) exercise professional can perform, as it provides important clues about how a person is likely to move.

For example, someone who presents with an excessively-arched lower back when standing may overuse their lower back muscles to perform movements that require spine extension, such as reaching overhead to catch a ball.

Static posture assessments can also reveal:

• The environmental stressors the client experiences during daily activities, for example rounded shoulders from sitting too much; and
• Where the client’s body could potentially break down during exercise/sports, for example overly-pronated feet could lead to a foot/ankle injury or knee/hip injury.

What about Standing Posture?

Since many traditional exercises and leisure activities require individuals to be on their feet, it makes sense to:

• Focus on standing posture;
• Looking at what ideal standing posture looks like;
• How to perform a quick self-assessment of your own or your client’s posture; and
• Some exercises that can be used to help improve musculoskeletal alignment.

What is Optimal Postural Alignment?

Good standing posture enables the body to effectively deal with the ever present forces of gravity and ground reaction forces. In practical terms, this minimises potential for injury to both joints and soft tissue structures.

When a person is in an optimal standing position, the following anatomical landmarks should all be in vertical alignment when viewed from the side:

• The tragus of the ear;
• The acromion of the shoulder;
• The centre of the hip, Gerdy’s tubercle (located just below the knee); and
• The tarsal joint of the ankle (located just below the ankle bone)

What are the Consequences of Poor Posture?

Poor posture can lead to excessive strain on our postural muscles and may even cause them to relax, when held in certain positions for long periods of time. For example, you can typically see this in people who bend forward at the waist for a prolonged time in the workplace. Their postural muscles are more prone to injury and back pain.

What Factors Contribute to Poor Poor Posture?

Several factors contribute to poor posture, with the most common being (ACA, 2019):

• Stress;
• Obesity;
• Pregnancy;
• Weak postural muscles;
• Abnormally tight muscles; and
• High-heeled shoes.

In addition, decreased flexibility, a poor work environment, incorrect working posture, and unhealthy sitting and standing habits can also contribute to poor body positioning.

What are the Benefits of Good Posture?

The benefits of good posture include (Miller, 2019):

• Prevents postural muscle fatigue;
• Correctly aligns your joints and bones to encourage efficient muscle activity;
• Helps minimise joint stress;
• Avoids passive ligament overload;
• Prevents backache, neckache and muscular pain; and
• Contributes to your enhanced confidence and a good appearance!

How Do I Stand Properly?

According to the American Chiropractic Association (ACA, 2019), this is how you can stand properly:

• Bear your weight primarily on the balls of your feet.
• Keep your knees slightly bent.
• Keep your feet about shoulder-width apart.
• Let your arms hang naturally down the sides of the body.
• Stand straight and tall with your shoulders pulled backward.
• Tuck your stomach in.
• Keep your head level-your earlobes should be in line with your shoulders. Do not push your head forward, backward, or to the side.
• Shift your weight from your toes to your heels, or one foot to the other, if you have to stand for a long time.

Can I Correct my Posture?

Yes is the simple answer.

However, it is important to remember that long-term postural problems will typically take longer to address than short-term ones, as often the joints have adapted to individual’s long-standing poor posture.

The individual’s conscious awareness of their own posture and knowing what posture is correct will help them consciously correct themselves.

With much practice, the correct posture for standing, sitting, and lying down will gradually replace the old posture.

This, in turn, will help the individual move toward a better and healthier body position.

A Quick Postural Self-Assessment

To assess your own posture:

• Stand against a wall in bare feet with your feet pointing straight ahead.
• Your heels, buttocks, shoulders and head touching the wall.
• Pay attention to where the weight is in your feet.
  • If you are standing in good alignment, your body weight should be positioned towards the outside of your heels.However, if you feel pressure in the front of your feet and toes, this indicates that your body weight is falling forward.Consequently, you will have to push down with your toes to keep balanced.This compensation may cause your knees to bend and/or your calf muscles to tighten and affect the alignment of your feet, ankles and knees.
• Next, slide your hand behind your back while standing against the wall to evaluate the space between your lower back and the wall.
  • If you are only able to slide your fingers into the space, you have an acceptable degree of arch in your lower back.However, if there is enough space for you to slide your whole hand or forearm between your back and the wall, then your lower back arches too much (i.e. excessive lumbar lordosis).If your lower back typically arches too much then your pelvis will also shift out of alignment by tipping down at the front (i.e. an anterior pelvic tilt).As a result, many of the muscles that attach to the pelvis and lumbar spine will be adversely affected (i.e. hip flexors, abdominals, hamstrings, adductors, abductors, glutes, spinal erectors).This can lead to movement dysfunction as well as hip, groin, leg and lower back pain.
• Lastly, try to decrease the arch in your lower back by tucking your pelvis under (i.e. posterior tilt).
  • Make a note when you do this of whether your shoulders round forward away from the wall.If they do, this indicates that the muscles of your shoulders and upper back (i.e. thoracic erectors, rhomboids, trapezius) may be weak (which is why it is difficult to keep your shoulders back to the wall when you remove the excessive arch in your lower back).This weakness in the upper back and shoulders can lead to shoulder, back, and neck pain and place more stress on the structures of the lumbar spine (as they will have to compensate for the lack of strength in the upper back).

Assessing posture in this simple way can help you and your clients understand how the body compensates for one area of dysfunction by overusing other areas to maintain an upright position against gravity and ground reaction forces.

Addressing these imbalances with various corrective exercises can reduce these compensation patterns, thereby decreasing pain and improving function.

Who Can Help?

There are a variety of professionals that can aid individuals to improve their posture, and include:

• General practitioners (GP’s) who will likely refer to one of the below.
• Sports medicine physician or sports and exercise medicine (SEM) doctor.
• Physiotherapist.
• Chiropractor.
• Exercise professionals.

What about Pain in the Posture Habit Change Phase?

Standing comfortably with good posture should feel natural and energy efficient. However, bad postural habits can cause a few muscular aches and pains for a few days during the early transition (posture habit change) phase.

Individuals may experience temporary joint or muscle discomfort or fatigue as their joints realign, ligaments stretch and postural muscles start working.

The good news is that if the individual keeps at maintaining a good posture their body will quickly adapt and they will feel more comfortable and strong in their new normal posture.

What Exercises are Available to Help with Posture?

The following (corrective) exercises can help improve standing posture.

• Two tennis balls on upper back:
  • This self-massage technique promotes extension in the thoracic spine by rejuvenating and regenerating the muscles of the upper back.
  • It also helps prepare the muscles of this area to be able to progress to strengthening exercises later in the programme (refer ‘straight arm raise’ below).
  • Lie on the floor on your back with your knees bent.
  • Place a tennis ball on either side of your spine, in line with the bottom of your shoulder blades.
  • Use a large pillow to support your head so you do not feel too much pressure from the tennis balls.
  • Bring your arms across your chest and hug yourself.
  • Find a sore spot and maintain pressure on it until it releases (10 to 15 seconds).
  • Then move the balls to another sore spot by scooting your butt and body down so the balls roll up your spine.
  • Bring the pillow with you each time you scoot.
  • Spend about two to three minutes each day on the entire area.

• Calf stretch:
  • Tight calf muscles can lead to poor posture because they can create alignment problems in the feet, ankles and legs.Performing a standing calf stretch can help realign some of the posterior calf muscles (e.g. gastrocnemius) and help shift your body weight back into your heels when standing.
  • Stand in a split lunge stance (make sure foot is aligned straight front to back) and push the heel of the back foot into the ground.
  • Pull the toes of the back foot up toward the shin to increase the stretch.
  • Hold for 30 seconds each side.

• Hip flexor stretch (with activation of gluteus maximus):
  • The hip flexor muscles run from the lumbar spine across the pelvis and attach to the top of the leg.
  • Stretching these muscles enables the hips to extend (i.e. move forward) under the spine so the lower back does not have to overcompensate by arching excessively to hold the torso upright.
  • Kneel with one leg in front of the other.
  • Posteriorly tilt the pelvis (i.e. tuck under) until you feel the glutes of the back leg contract.
  • Keep the torso erect without arching the lower back excessively.
  • Hold for 30 seconds each side.

• Straight arm raise:
  • Strengthening the muscles of the upper back can teach the body to recruit the muscles of the thoracic spine to assist with lifting the torso upright.
  • This can prevent the lower back from getting tired and overworked.
  • Lie on the ground with your knees bent.
  • Raise your arms overhead until they reach the ground.
  • Pull your arms down toward the floor without arching your lower back, shrugging your shoulders, or bending your arms.
  • Hold for 20 seconds and repeat three times.

Summary

Posture is important, and poor posture can have a negative effect on an individual’s physical health. This article helps individuals to understand in a quick, ‘layman-style’, format what posture is, the consequences of poor posture, how identify poor posture, and exercises to aid the improvement of posture. With the impact that posture can have it is important to seek guidance from an appropriately qualified professional.

Take care of your posture or you will regret it in the future. As I tell myself, think about when you are 90, not 20, 30, 40 or 50!

References

ACA (American Chirpractic Association). (2019) Maintaining Good Posture. Available from World Wide Web: https://acatoday.org/content/posture-power-how-to-correct-your-body-alignment. [Accessed: 01 September, 2019].

Miller, J. (2019) What is Good Standing Posture? Available from World Wide Web: physioworks.com.au/FAQRetreieve.aspx?ID=44664. [Accessed: 01 September, 2019].