Posture is a critical component of the human condition
I have to admit it. I am obsessed with posture. Everywhere I go, I watch how people stand, move and sit. It makes me happy to see good posture but I am more interested in bad posture. How is it bad, why is it bad, what would the x-ray or MRI reveal, what needs to be corrected. Am I judgemental? Yes, but similar to an editor reading a manuscript. The bones are good, the spine needs some tweaking.
Here are three things I know about posture:
- Everyone notices beautiful posture and mostly ignores bad posture.
- More people have bad posture than good.
- Posture and their related health problems are largely preventable.
Assessing posture is a learnable skill, once you know what to look for. On a professional level, posture is graded into five main groups:
- Excellent - Perfect alignment; movement is balanced and fluid.
- Good - Aligned; movement balanced by not as fluid.
- Average - Head is forward, misaligned pelvis; rounded upper back; movement is strong but with little hip motion.
- Poor - Misaligned and imbalanced throughout the spine; weak lower back, buttocks; movement is stilted and more one-sided.
- Very Poor* - Very unbalanced frame; pain evident; movement cautious with overly soft knees; some limping.
Most people in the developed world spend most of their time sitting. This is what American's posture looks like
*The percentage of "very poor" is, in reality, much greater because grading of posture does not take into account those in wheelchairs, or the very sedentary.
AGING HAS A MINIMAL AFFECT ON POSTURE!
Many young people have terrible posture while many of those over 70 have amazing posture. What changes with age is the speed at which our muscles move. We get slower when we get older. Consider this. The fastest horses in the world are at their peak at age 3, while the horses competing at the Olympics are much older. In fact, almost 25% were over 15. They are the "baby boomers" of the equine set. WQhat keeps then in such amazing shape? Balance, agility, strength, and experience.
When assessing posture I look at the overall picture first.
Anterior (from the front)
- Is the head centered between the shoulders?
- At the shoulders level?
- Is the torso squared (non-rotates)?
- Are the hips level?
How would you rate this pretty woman's posture? Not too bad right?
When you put in the plumb lines, things don't look as good.
It is easy to see her uneven shoulders, hips and arm length. I cannot be sure if she has scoliosis without and x-ray. But, scoliosis aside, I see a pinching of the muscles on her right side (shown left here), causing the right shoulder to drop and the right hip to elevate. You can plainly see her head is off to the left. This is her body's way to distribute the weight more evenly.
Lateral (side view)
Here is what I look for:
- The head aligned directly over the body, so the middle of the ear is in line with the middle of the shoulder, the middle of the elbow, hip, knee and ankle bone.
- The neck, upper back, and low back show a nicely curved profile, a gentle "S" shape.
- The pelvis is in a neutral position, not tilting forward or tucking backward - easily seen in the lumbar area. We want a gentle lordosis.
Take a look at this young man, a fairly typical example:
Now let's add a vertical plumb line and here we see how off balance he is.
The only place where he is plumb is at the knee, all other areas are off by up to 3 inches.
Head and Neck
It is especially important to evaluate the neck and head position. We have a new phenomenon in our high-tech world these days called Text Neck. As the name implies, it is the result of using electronic devices. Millennials are the first group of people in history to grow up with mobile phones, iPads, Gameboys, computers, etc. We can not predict the outcome of their spines, or their health when they turn 40.
Her head is clearly not lined up. I suspect she always carries her head this way. It could be a vision issue, but more than likely it is a habit, a bad habit.
Basically, this is the same forward head as the previous man. It is that common! The middle of his ear should line up vertically with the middle of his shoulder. You can see he is in good shape, but his shoulder is rolled forward most probably because of tight chest muscles. We see this in men (and women) who do lift training. As they overwork their arms and chest muscles they forget about their lats (latissimus dorsi) and lower traps (trapezius) muscles. These are needed to balance out the musculature of the upper body.
The neck has 7 vertebrae (bones). Their purpose is to allow movement of the head and neck and to equally distribute the 12 pounds our heads weigh.
For every inch your head is forward, an extra 10 pounds of pressure is loaded onto the neck.
In the above photo, his head is at least 3 inches in front of where it should be (referencing the red line). If you add the weight of his head and the extra forward head carriage, his neck is carrying about 42 pounds of additional and unnecessary load. It is no wonder neck and upper back pain is so prevalent.
Prolonged forward head carriage like this leads to the degeneration of the discs between the vertebra. They become thinner potentially causing irritation and inflammation to the nerves. The excessive front load on the cervical (neck) spine can lead to bulging and herniated discs. In many cases, irreparable damage will ensue.
Irreparable damage. For the most part, completely preventable.
Back Pain Is An Epidemic!
Almost 90% of our population has experienced back pain during their lifetime as reported by healthcare providers to the CDC. At this very moment, close to 35% of us are currently experiencing back pain. This and joint pain is the number one reason for a visit to the doctor, followed by a cough that won't go away.
Most back pain is not caused by trauma resulting from a car crash, or ship and fall. Instead, most back pain is considered insidious - for no known reason. There is a reason though. It is because of bad posture or postural related issues. I believe
Posture is the most underrated health condition today.
For more information about poor posture and health click here.
Most of the patients I see with low back pain fall into two main categories of alignment. They either have an anterior pelvis or a posterior pelvis. Some of the imbalance can be attributed to the pain they are experiencing at that moment, but it is more than likely the imbalance was there before the pain alarm sounded. Poor posture does not happen overnight, it slowly develops over time, even decades, until it reaches a tipping point.
Here is a good picture of pelvic alignment.
An anterior pelvis (or anterior pelvic tilt) creates a "swayback" appearance like this
The stomach dumps forward, while the curve in the low back (hyperlordosis) is exaggerated. Posture such as this puts enormous pressure on the bottom lumbar discs, while the muscles in the low back work overtime. Eventually, the discs thin out and the joint spaces become narrow.
On the other hand, here is an example of posterior pelvis (or a pelvic tuck) creating a "spoon" appearance in the low back, characterized by a flat back and very small gluteal (butt) muscles. This is a more common condition.
Getting Back To The Millennials
Everyone would agree this photo shows bad posture. I would go far to say an overall appraisal of this fellow shows a lazy, weak posture, and maybe a lack of confidence. His posture looks depressed. This photo looks like he is trying to show bad posture.
But wait a minute. Take a look at this next one. Seated, but basically the same posture. And, we see this everywhere.
Everyone Can Improve Their Posture Regardless of Age or Physical Activity Level
Our bodies were meant to be balanced, front to back, side to side, and top to bottom. We need to work with our body not against our body. When we move the muscles, joints, and bones are supposed to work like a symphony - each doing their job and contributing to the overall beauty of the movement.
Assessing your posture is the first step to spinal alignment and perfect posture. While you're at it, take a look at your spouse's posture, your kid's, your parents. Do something about the Text Neck. Here is how you can start improving your posture today.
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