Posture is a critical component of the human condition
I have to admit it. I am obsessed with posture. 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, what would an x-ray or MRI reveal, what corrections are needed?
I suppose its like an editor reading a manuscript. The bones are good, the spine needs some tweaking.
Here are three things I know about posture:
1. Everyone notices beautiful posture and everyone ignores bad posture - unless it's really bad.
2. More people have bad posture than good posture.
3. Poor posture and their related health problems are largely preventable.
Check this out. These are before and after pictures and what we see every day.
How Posture Is "Graded"
Assessing posture is a learn-able 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 but 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 back and buttock muscles; 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 a great deal of their day sitting. We know this leads to poor posture. This graph is a representation of what American posture looks like
*The percentage of "very poor" is, in reality, much greater because grading posture does not take into account those in wheelchairs, or the very sedentary.
Aging itself can have minimal affect on posture!
Many young people have terrible posture while many at 70 have amazing posture! Although genetics does play a part, the biggest affect on posture are our daily activities.
The major change with aging has to do with the speed at which our muscles twitch - how rapidly the muscles react to a nerve impulse. The older we get, the slower we move. It is the same in humans as it is with horses (ie. Kentucky Derby racing three year olds).
But did you know that muscle mass and joint flexibility changes at a much lower rate? Of course this is directly proportional to the activity level of the person.
We may be slower, but we can still move and perform to a high standard as we get older.
How your posture is today will definitely affect how it will be in 10 years from now.
When assessing posture I look at the overall picture first. I ask the following questions:
Anterior View (from the front)
- Is the head centered between the shoulders?
- Are the shoulders level?
- Is the torso squared (not rotated)?
- Are the hips level?
How would you rate this pretty woman's posture? Not too bad, right?
When you put in plumb lines, things don't look as good.
It is easy to see her shoulders, hips and arm length are uneven. Its difficult to tell if she has scoliosis without an 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 View (from the side)
- Is 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?
- Are the neck, upper back, and low back nicely curved into a a gentle "S" shape?
- Is the pelvis in a neutral position, not tilting forward or tucking backward? This can easily be 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 we see how his spine is off balance.
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 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 looking down at electronic devices.
Millennials are the first group of people in history to grow up with mobile phones, iPads, video games, computers, etc. We can not predict the outcome of their spines, or their health for that matter, 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 that has turned into a trait.
The middle of his ear should line up with the middle of his shoulder.
Basically, this is the same forward head as the previous man. It is SO common! You can see he is in good shape, but his shoulder is rolled forward.
Probably he has overdeveloped his chest muscles and ignored his back muscles. We see this commonly in people who weight train. It is also very often seen in women with large breasts.
People overwork their arms and chest muscles and forget about their lats (latissimus dorsi) and lower traps (trapezius) muscles. The back muscles must be equally strong to balance out the musculature of the upper body.
A chronically rounded upper back thins out and thus weakens the back muscles. This makes it almost impossible to hold your upper back in correct posture for any longer than a few moments.
The neck has 7 vertebrae (bones). Their purpose is to allow movement of the head and neck and distribute out the weight of the head (which is about 12 pounds) throughout the neck and upper back.
For every 1 inch your head is forward of the plumb line, an extra 10 pounds is loaded to the neck.
In the above photo, you can see 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.
This is a MAJOR CONTRIBUTOR to wide spread neck, shoulder and upper back pain!
Years of carrying your head in this manner leads to degeneration of the discs between the vertebra. They become thinner potentially causing irritation and inflammation to the nerves. Excessive front load in the cervical spine leads to bulging and herniated discs. In many cases, irreparable damage occurs.
This can begin as early as 20 years of age!
PELVIS AND LUMBAR SPINE
Here is a good example of pelvic and lumbar positions.
An anterior pelvis (or anterior pelvic tilt) creates a "swayback" appearance like this - too much curve.
You can see the lumbar spine curve is exaggerated (hyperlordosis). The stomach dumps forward.
This type of hyperlordosis, puts enormous pressure on the bottom lumbar discs, while the muscles in the low back work overtime. Eventually, discs thin and joint spaces become narrow. A frequent cause of anterior pelvis is overly tight hip flexors (psoas).
A posterior pelvis or decrease lumbar curve (hypolordosis). Has the opposite effect.
Posterior pelvis, or pelvic tuck, creates a "spoon" appearance in the low back, characterized by a flat or rounded back and very small gluteal (butt) muscles. Small butt muscles ALWAYS leads to low back pain. It looks like this
Everyone would agree the following photo shows bad posture. This fellow shows a weak and lazy posture, almost as if the spine is caving in on itself. It exudes a lack of self confidence.
But wait a minute. Take a look at this next one. Seated, but basically the same posture.
Unfortunately, this is the way many of us sit for hours every day. Poor seated posture is especially true with Millennials.
Back Pain Is An Epidemic!
Almost 90% of our population has experienced back or neck pain during their lifetime as reported by the CDC. At this very moment, close to 35% of us are currently experiencing pain.
Back and joint pain are the majority of doctor visits, followed by a cough that won't go away.
Most back pain is not caused by a traumatic event like a car crash, or a fall. Instead, most back pain is insidious - for no known reason. Rather it is an accumulation of minor injuries coupled with bad posture or poor postural habits.
Therefore MOST BACK OR NECK PAIN IS COMPLETELY PREVENTABLE!
Poor posture does not happen overnight, it slowly develops over time, even decades, until it reaches a tipping point. The alarm sounds, and in the body expresses the alarm by pain.
Poor posture is the most underrated health condition today.
For more information about poor posture and health click here.
WHAT CAN WE DO?
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. With movement, all muscles, joints, and bones are supposed to work like a symphony - each doing their job and contributing to the overall quality of the motion.
Here is where we start
1. Assess your posture. Have someone take a front and side view of you, like the ones shown above. You will be able to see the issues. While you're at it, do the same for your spouse, kids, your parents.
2. Check out this quick guide to aligning your spine.
3. When working out spend as much time on your back muscles (lats, lower traps, glutes) as you do on your chest and abs.
4. Check out YouTube exercise videos. Particularly for the lats, lower traps, teres muscle, and glutes.
5. Change your habits. Be aware of your posture, try to ALWAYS stand and sit up tall.
6. Make good posture a PRIORITY. You will be glad you did!
Remember, doing something about your posture is much better than doing nothing. It takes time and effort but you will be rewarded by seeing and feeling NEW AND AWESOME POSTURE!