Back Clinic Posture Team. Posture is the position in which an individual holds their body upright against gravity while standing, sitting, or lying down. A proper posture visually reflects an individual’s health, ensuring the joints and muscles, as well as other structures of the body, are working properly. Throughout a collection of articles, Dr. Alex Jimenez identifies the most common effects of improper posture as he specifies the recommended actions an individual should take to improve their stance as well as enhance their overall health and wellness. Sitting or standing incorrectly can happen unconsciously, but recognizing the issue and correcting it can ultimately help many individuals develop healthier lifestyles. For more information, please feel free to contact us at (915) 850-0900 or text to call Dr. Jimenez personally at (915) 850-0900.
Many individuals attribute to some degree, their neck or back pain to unhealthy posture. Can knowing the causes and underlying factors help guide lifestyle adjustments and seeking medical rehabilitative treatment?
Unhealthy Posture Causes
Numerous factors can cause individuals to practice unhealthy postures regularly.
Unhealthy posture can also be brought on by an injury, illness, or genetics.
A combination of these factors is also common.
Practicing healthy posture is a form of exercise where the muscles support the skeleton in stable and efficient alignment that is present in stillness and movement.
Injury and Muscle Guarding
After an injury, muscles can spasm to protect the body and help stabilize injuries and protect against further injury.
However, movements become limited and can lead to pain symptoms.
Prolonged muscle spasms lead to weakened muscles over time.
The imbalance between muscles guarding the injury and those still operating normally can lead to posture problems.
Musculoskeletal treatment with massage, chiropractic, and physical therapy can help restore optimal functioning.
Muscle Tension and Weakness
If certain muscle groups become weak or tense, posture can be affected, and pain symptoms can develop.
Muscle weakness or tension can develop when individuals hold a prolonged position day after day or when performing routine tasks and chores in a way that places tension on the muscles or uses them in an unbalanced way.
Postural retraining and physical therapy adjustments can help strengthen the muscles and relieve pain symptoms.
Daily Habits
As individuals find ways to accommodate muscle spasms, weakness, tension, and/or imbalances, the mind and body can forget and abandon healthy posture.
The body then begins compensating using alternate, awkward, and counterproductive muscle contractions and stretching that compromise body and spinal alignment.
Use of Technology
Technology – whether sitting at a desk/workstation, using a tablet or cell phone, or working with several devices can gradually shift the body out of alignment. (Parisa Nejati, et al., 2015)
Individuals constantly looking down at their phone may develop a text neck, a condition in which the neck is held in flexion or forward tilting too long, which can lead to pain.
Mental Attitude and Stress
Individuals under stress or are experiencing stressful situations can begin to have posture problems. (Shwetha Nair et al., 2015)
Stress can contribute to over-contracting muscles, which can cause muscle tension, shallow breathing, posture problems, and pain symptoms.
Being aware of body position and correcting and adjusting posture can help to counteract stress. (Shwetha Nair et al., 2015)
Wearing down the outside or inside of the shoes faster from things like weight-bearing habits will imbalance kinetic forces that translate up the ankle, knee, hip, and lower back leading to pain symptoms in any or all of these joints.
Heredity and Genetics
Sometimes the cause is hereditary.
For example, Scheuermann’s disease is a condition in which adolescent males develop a pronounced kyphosis curve in the thoracic spine. (Nemours. KidsHealth. 2022)
Consult Injury Medical Chiropractic and Functional Medicine Clinic for an evaluation, and let us help you by developing a personalized treatment and rehabilitation program.
The Path To Healing
References
Czaprowski, D., Stoliński, Ł., Tyrakowski, M., Kozinoga, M., & Kotwicki, T. (2018). Non-structural misalignments of body posture in the sagittal plane. Scoliosis and spinal disorders, 13, 6. doi.org/10.1186/s13013-018-0151-5
Nejati, P., Lotfian, S., Moezy, A., & Nejati, M. (2015). The study of correlation between forward head posture and neck pain in Iranian office workers. International journal of occupational medicine and environmental health, 28(2), 295–303. doi.org/10.13075/ijomeh.1896.00352
Nair, S., Sagar, M., Sollers, J., 3rd, Consedine, N., & Broadbent, E. (2015). Do slumped and upright postures affect stress responses? A randomized trial. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 34(6), 632–641. doi.org/10.1037/hea0000146
Silva, A. M., de Siqueira, G. R., & da Silva, G. A. (2013). Implications of high-heeled shoes on body posture of adolescents. Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo, 31(2), 265–271. doi.org/10.1590/s0103-05822013000200020
For older individuals experiencing posture problems, slumping, slouching, and upper back pain, could adding rib cage exercises help bring relief and prevent the condition from worsening?
Improved Posture
It’s common to associate a collapsed upper back posture with age, but other factors can also contribute to the problems. (Justyna Drzał-Grabiec, et al., 2013) The rib cage and the pelvis are important to body structure and comprise much of the core. If these bone structures become misaligned due to unhealthy posture, the muscles that attach to them become tight, weak, or both, and the surrounding muscles have to compensate, causing a worsening of the condition and further injury.
Unhealthy postures can be caused by a rib cage that compresses down onto the pelvic bone.
As the upper back slumps or compresses, height can begin to decrease.
Posture awareness exercises can help lift the rib cage off the pelvic bone.
Rib Cage Exercises
This exercise can be done sitting or standing. A daily routine can help improve posture and relieve back problems and pain.
The sitting version helps keep the focus on doing the exercise right.
The standing version challenges body awareness, allowing the individual to feel how the rib cage and upper back movements affect pelvic and lower back posture.
To begin, it is recommended to start in a sitting position.
Once the basics are learned, then certainly progress to standing.
Exercise
Position the pelvis so it is in a slight forward tilt.
This forward tilt will exaggerate the low back curve slightly while tightening the lower back muscles in a good way.
Establishing and maintaining this curve in the sitting position should feel natural.
Inhale and exaggerate the upward lift of the rib cage.
Inhaling causes the spine and ribs to extend slightly.
Exhale and allow the rib cage and upper back to return to their natural position.
Repeat up to 10 times once or twice a day.
For this exercise, use breathing to develop the rib cage’s lift and carriage incrementally.
Don’t max out on the spinal extension.
Instead, focus on how breathing/inhaling supports the movement of the ribs and upper back and develops the muscles from there.
Try to lift the rib cage equally on both sides as the body allows.
With practice, individuals will realize the healthy posture changes and increased distance between the ribs and pelvis.
Guidance and Variation
Perform the exercise with the back against a wall for upper back guidance.
Another variation of the pelvis and rib cage posture training exercise is to raise the arms.
This will create a different posture awareness training perspective.
Focus on rib cage movement when the arms are raised.
Does lifting the arms make the exercise easier, harder, or different?
To enhance posture improvement, stretch the pectoral muscles.
Yoga
Individuals looking for more ways to strengthen healthy posture should consider yoga.
A study published in the International Journal of Yoga suggests that a great way to activate the core may be to include a variety of yoga postures into the routine. (Mrithunjay Rathore et al., 2017) The ab muscles attach to various places on the rib cage and play a role in posture, alignment, and balance. The researchers identified two muscles, the external obliques, and the transverse abdominal, as key to a healthily aligned posture.
Core Strength
References
Drzał-Grabiec, J., Snela, S., Rykała, J., Podgórska, J., & Banaś, A. (2013). Changes in the body posture of women occurring with age. BMC geriatrics, 13, 108. doi.org/10.1186/1471-2318-13-108
Rathore, M., Trivedi, S., Abraham, J., & Sinha, M. B. (2017). Anatomical Correlation of Core Muscle Activation in Different Yogic Postures. International journal of yoga, 10(2), 59–66. doi.org/10.4103/0973-6131.205515
Papegaaij, S., Taube, W., Baudry, S., Otten, E., & Hortobágyi, T. (2014). Aging causes a reorganization of cortical and spinal control of posture. Frontiers in aging neuroscience, 6, 28. doi.org/10.3389/fnagi.2014.00028
For individuals trying to achieve healthy posture, could using posture awareness training be effective in treatment and prevention?
Posture Awareness
Spinal curves help support the body’s weight, movement, and balance. Five areas include the neck, upper back, lower back, sacrum, and coccyx. The bottom of the spine or sacrum rests between the two hip bones that comprise the pelvis. Because of this location, the movements made with the pelvis significantly affect the spine. (Ibrahim Alkatout, et al., 2021) When the pelvis moves, the spine moves.
Posture-related back pain and associated symptoms are often caused by a weakened strength and flexibility ratio between the opposing muscle groups that hold the body upright.
Achieving healthy posture requires technique and consistent practice for maintaining a healthy pelvis and low back curve. (DeokJu Kim, et al., 2015)
Finding the low back curve and exploring how it responds when moving the pelvis is important to effective posture awareness training.
Kim, D., Cho, M., Park, Y., & Yang, Y. (2015). Effect of an exercise program for posture correction on musculoskeletal pain. Journal of physical therapy science, 27(6), 1791–1794. doi.org/10.1589/jpts.27.1791
Alkatout, I., Wedel, T., Pape, J., Possover, M., & Dhanawat, J. (2021). Review: Pelvic nerves - from anatomy and physiology to clinical applications. Translational neuroscience, 12(1), 362–378. doi.org/10.1515/tnsci-2020-0184
Żurawski, A. Ł., Kiebzak, W. P., Kowalski, I. M., Śliwiński, G., & Śliwiński, Z. (2020). Evaluation of the association between postural control and sagittal curvature of the spine. PloS one, 15(10), e0241228. doi.org/10.1371/journal.pone.0241228
Zemková, E., & Zapletalová, L. (2021). Back Problems: Pros and Cons of Core Strengthening Exercises as a Part of Athlete Training. International journal of environmental research and public health, 18(10), 5400. doi.org/10.3390/ijerph18105400
Individuals that sit at a desk/workstation for hours for work or school, or drive for a living, could be fostering a long-term condition known as forward head posture. Can understanding the signs and symptoms help to prevent the condition?
Forward Head Posture
Neck pain often causes or is caused by misalignment in the area between the shoulders and head. Forward head posture is a common problem that can strain the neck muscles, leading to pain and worsening neck, shoulder, and back posture. (Jung-Ho Kang, et al., 2012) For individuals who are at risk of developing or are already showing signs/symptoms, it’s important to get medical attention to prevent complications, such as chronic neck pain or compressing a nerve. Individuals can continue to do the work that they need to do but may need some postural adjustments and re-training so as not to continue straining the neck while working.
Postural Deviation
The head is in a healthy alignment with the neck when the ears line up with the gravity line.
The gravity line is an imaginary straight line that represents gravity’s downward pull.
It is used in posture assessments as a reference for noting the positions of the body and determining the presence of any postural misalignment or deviation.
A forward head posture occurs when the head begins to position forward of the gravity line when looking at the body from the side.
Forward head posture is a postural deviation because the head varies from the reference line. (Jung-Ho Kang, et al., 2012)
Muscle Imbalances
Forward head posture often results in a strength imbalance between muscles that support and move your neck, shoulders, and head. (Dae-Hyun Kim, et al., 2018)
The muscles in the back of the neck become shortened and overactive as they flex forward, while the muscles in the front become lengthened, weaker, and strained when they relax.
Kyphosis
Kyphosis also known as hunchback is when the shoulders round forward, and the head is also brought forward. (Jung-Ho Kang, et al., 2012) After many hours sitting at a desk, computer, or driving, kyphosis can also cause and/or worsen forward head posture.
This occurs because the upper back area supports the neck and head.
When the upper back moves or changes position, the head and neck follow.
The majority of the head’s weight is in the front, and this contributes to the forward movement.
An individual with kyphosis has to lift their head to see.
Treatment
A chiropractic injury specialist team can develop a personalized treatment plan to relieve pain symptoms, provide postural retraining, realign the spine, and restore mobility and function.
Standing and sitting using a healthy posture, along with exercises to strengthen the neck muscles, can help get the spine in alignment. (Elżbieta Szczygieł, et al., 2019)
Targeted stretching can help if the neck muscles are tight.
At-home stretches may also relieve pain
Risk Factors
Pretty much everyone is at risk of developing a forward head posture. Common risk factors include:
Constantly looking down at a phone and staying in this position for a long time aka text neck.
Desk jobs and computer use can significantly round the shoulders and upper back, leading to a forward head posture. (Jung-Ho Kang, et al., 2012)
Driving for a living causes prolonged back, neck, and shoulder positioning.
Sleeping or reading with a large pillow under the head can contribute to forward head posture.
Doing work that requires dexterity and close-up positions, like a seamstress or technician can cause over-positioning of the neck.
Individuals who regularly carry a significant amount of weight in front of their body may begin to develop kyphosis.
An example is carrying a child or another load in front of the body.
Large breasts can also increase the risk of kyphosis and forward head posture.
Neck Injuries
References
Kang, J. H., Park, R. Y., Lee, S. J., Kim, J. Y., Yoon, S. R., & Jung, K. I. (2012). The effect of the forward head posture on postural balance in long time computer based worker. Annals of rehabilitation medicine, 36(1), 98–104. doi.org/10.5535/arm.2012.36.1.98
Kim, D. H., Kim, C. J., & Son, S. M. (2018). Neck Pain in Adults with Forward Head Posture: Effects of Craniovertebral Angle and Cervical Range of Motion. Osong public health and research perspectives, 9(6), 309–313. doi.org/10.24171/j.phrp.2018.9.6.04
Szczygieł, E., Sieradzki, B., Masłoń, A., Golec, J., Czechowska, D., Węglarz, K., Szczygieł, R., & Golec, E. (2019). Assessing the impact of certain exercises on the spatial head posture. International journal of occupational medicine and environmental health, 32(1), 43–51. doi.org/10.13075/ijomeh.1896.01293
Hansraj K. K. (2014). Assessment of stresses in the cervical spine caused by posture and position of the head. Surgical technology international, 25, 277–279.
Ankylosing spondylitis is an inflammatory arthritis that causes changes in posture that occur over time. Can exercise and maintaining spinal alignment help improve posture problems?
Ankylosing Spondylitis Posture Improvement
Ankylosing spondylitis/AS is an autoimmune arthritis that primarily affects the spine. It can also spread to other joints of the body and affect the internal organs. Back pain problems are a common side effect of the condition and depending on the severity of damage to the spine, it can have a serious impact on posture.
Affects Posture
The condition usually first affects the sacroiliac joints at the bottom of the spine where they attach to the pelvis. As the condition progresses it works its way to the upper spine. The spine consists of 26 vertebrae/bones stacked on top of each other.
Line up the ears, shoulders, hips, knees, and ankles in a straight line.
Squeeze the shoulder blades together and down toward the back pockets.
Relax the arms at the sides.
Look straight ahead.
Tuck the chin back slightly.
Sitting
The natural curves of the spine need support for proper posture when sitting. Try these tips when at a desk or at a table:
Position the height of the chair so the hips and knees are bent at 90-degree angles.
Place the feet flat on the floor or use a footstool based on chair height.
Place a lumbar support pillow or rolled-up towel behind the lower back.
Position the screen monitor at eye level to keep the upper back straight.
Keep the keyboard and mouse close to the body to prevent overreaching which can increase the rounding of the shoulders and upper back.
Lying Down
Ankylosing spondylitis can make lying down uncomfortable. To support the spine while lying down try to:
Sleep on a semi-firm mattress or type like memory foam to conform to the body.
Place a pillow between the knees to maintain a straight spine when lying on the side.
Use a specialized pillow to prevent placing the upper back in a rounded position.
Posture Exercises
For individuals with ankylosing spondylitis stretching and strengthening exercises can help improve body posture. Individuals are recommended to talk to their healthcare provider before beginning an exercise program.
Chin Tucks
Sit up straight.
Squeeze the shoulder blades together.
Rest the arms at your sides.
Look straight ahead, pull the chin back and in until the stretch is felt along the muscles of the neck.
Hold for three to five seconds and relax.
Repeat 10 times.
Corner Stretch
Stand facing a corner.
Raise the arms to shoulder height.
Place one forearm flat against each wall.
Stagger the feet.
Slowly shift weight over the front leg and lean in toward the corner.
Stop once the stretch is felt across the chest.
Hold for 10 to 20 seconds and relax.
Repeat three times.
Scapular Squeezes
Sit up straight with arms resting at the sides.
Squeeze the shoulder blades together like they are holding an object between them.
Hold for three seconds and relax.
Repeat 10 times.
Maintaining spinal alignment will help decrease back pain that occurs with AS.
Targeted exercises can help stretch tight muscles and strengthen the muscles responsible for maintaining spinal alignment.
Maintaining healthy posture when sitting, standing, and sleeping can help prevent deformities in the spine.
Regular physical activity can help combat stiffness and help maintain overall strength.
For an individualized exercise program, see a physical therapist or chiropractor on incorporating posture exercises to help prevent complications from developing.
Arthritis
References
National Institute of Arthritis and Musculoskeletal and Skin Diseases. Ankylosing spondylitis.
De Nunzio, A. M., Iervolino, S., Zincarelli, C., Di Gioia, L., Rengo, G., Multari, V., Peluso, R., Di Minno, M. N., & Pappone, N. (2015). Ankylosing spondylitis and posture control: the role of visual input. BioMed research international, 2015, 948674. doi.org/10.1155/2015/948674
Individuals with fixed sagittal imbalance, a condition where the normal curve of the lower spine is greatly reduced or absent altogether that can cause pain and difficulty balancing. Can chiropractic treatment, physical therapy, and exercise help improve the condition?
Fixed Sagittal Imbalance
The condition is commonly known as flat back syndrome and can be present at birth or can happen as a result of surgery or a medical condition.
Individuals with flat back syndrome position their head and neck too far forward.
A major symptom is difficulty standing for long periods of time.
Symptoms
The spine has two curves. The lumbar spine in the lower back and cervical spine in the neck curve inward. The thoracic spine in the upper back curves outward. The curves are part of the spine’s natural alignment. They help the body balance and maintain the center of gravity.
If these curves begin to disappear the body can have trouble and difficulty standing up straight.
The loss of curvature causes the head and neck to pitch forward, making it hard to walk and do regular normal activities.
A chiropractor and/or physical therapist can recommend exercises and other forms of treatment. (Won-Moon Kim, et al., 2021)
Life-Changing Chiropractic Relief
References
Columbia University Irving Medical Center. Flatback syndrome.
National Health Service. Common posture mistakes and fixes.
Lee, B. H., Hyun, S. J., Kim, K. J., Jahng, T. A., Kim, Y. J., & Kim, H. J. (2018). Clinical and Radiological Outcomes of Posterior Vertebral Column Resection for Severe Spinal Deformities. Journal of Korean Neurosurgical Society, 61(2), 251–257. doi.org/10.3340/jkns.2017.0181
Kim, W. M., Seo, Y. G., Park, Y. J., Cho, H. S., & Lee, C. H. (2021). Effect of Different Exercise Types on the Cross-Sectional Area and Lumbar Lordosis Angle in Patients with Flat Back Syndrome. International journal of environmental research and public health, 18(20), 10923. doi.org/10.3390/ijerph182010923
Can musculoskeletal therapies treat individuals with upper crossed syndrome to relieve pain, improve posture, and strengthen the muscles in the neck, shoulders and chest?
Upper Crossed Syndrome
Upper crossed syndrome is a condition in which the muscles of the shoulders, neck, and chest become weak and tight, and is usually brought on from practicing unhealthy posture. Symptoms typically include:
Neck stiffness and pulling sensations.
Jaw tension and/or tightness
Upper back tension, lack of flexibility, stiffness, and aching soreness.
Neck, shoulder, and upper back pain.
Tension headaches
Rounded shoulders
Hunched spine
Upper Crossed Syndrome and Posture
The condition affects healthy posture by creating imbalanced muscles between the upper back and chest.
The tight short muscles in the upper chest get overly stretched and remain in a semi-contracted state pulling on the back muscles.
This causes the muscles in the upper back, shoulders, and neck to get pulled and weaken.
The result is a hunched back, forward shoulders, and protruded neck.
The specific muscles affected include the trapezius and the levator scapula/side of the neck muscles. (Hospital for Special Surgery. 2023)
Prescription anti-inflammatory medication for pain symptoms – short-term.
Individuals may be advised by the chiropractic therapy team to avoid too much bed rest and to limit or avoid activities that can cause pain or worsen symptoms. (Cedars-Sinai. 2022)
Studies have shown chiropractic spinal manipulation effectively reduces neck, spine, and low back pain symptoms. (Gevers-Montoro C, et al., 2021)
Increasing or decreasing physical activity as recommended by the therapy team.
Using ice or heat packs to relieve pain and increase circulation to promote muscle rehabilitation and healing.
Using topical pain creams or gels.
Over-the-counter nonsteroidal – NSAIDs, like Advil or Motrin and Aleve.
Muscle relaxants to relieve tension short-term.
Enhance Your Lifestyle
References
Hospital for Special Surgery. Move with the purpose to combat upper and lower crossed syndromes.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. Back pain.
Seidi, F., Bayattork, M., Minoonejad, H., Andersen, L. L., & Page, P. (2020). Comprehensive corrective exercise program improves alignment, muscle activation, and movement pattern of men with upper crossed syndrome: a randomized controlled trial. Scientific reports, 10(1), 20688. doi.org/10.1038/s41598-020-77571-4
Bae, W. S., Lee, H. O., Shin, J. W., & Lee, K. C. (2016). The effect of middle and lower trapezius strength exercises and levator scapulae and upper trapezius stretching exercises in upper crossed syndrome. Journal of physical therapy science, 28(5), 1636–1639. doi.org/10.1589/jpts.28.1636
National Institute of Neurological Disorders and Stroke. Back pain.
Cedars-Sinai. Back and neck pain.
Gevers-Montoro, C., Provencher, B., Descarreaux, M., Ortega de Mues, A., & Piché, M. (2021). Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain. Frontiers in pain research (Lausanne, Switzerland), 2, 765921. doi.org/10.3389/fpain.2021.765921
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