Posture

Physioworks's key foundation of treatment has been the recognition and correction of postural faults.

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Understanding Posture
Are you sitting comfortably?
Are you standing correctly?

The understanding that posture has a major role in musculo-skeletal health is starting to filter through to the general population. At Physioworks we have many clients who present to the clinic for treatment - not for pain - but because they recognise that they have a postural fault! This means that the client can quickly work to remove the factors that cause pain (or may do in the future) - such as poor posture.

How does poor posture cause pain? A correct posture means that the key body parts stack vertically on top of each other. This positioning will usually allow the joints to sit in their 'mid-range' or middle position.

This middle position means that the joints are mildly unstable as no ligaments are tightened in this joint alignment. The small, deep, postural muscles that attach closely to the joint have to work to maintain stability and this correct position. But, what it also means, is that the postural muscles have to be strong and controlled enough for the job, and it is in the training of these muscles where the therapists at Physioworks have extensive knowledge and experience.

Living in the 21st Century means that we sit for far longer than ever before in history. We sit to work, to play and then, when we are tired, we slouch on the sofa. This slouching encourages our low back to take exactly the opposite to ideal shape. Our lifestyles also encourage us to be physically passive. Our work involves smaller and smaller movements performed under tension (compare the physicality of the skills required to use a manual typewriter with those for a computer keyboard!)

Sitting is in itself tough on the back but slouching is one of the most constant and damaging strains on our spines in modern life. If we slouch on a regular basis the slouch will feel 'normal' to us but human nature is to interpret that feeling as if it is correct.

The art of correcting posture lies in the co-operation between the therapist and the client. Getting the client to 'buy in' involves education so that they understand the benefits of the exercises. This is because a lot of the movements are extremely small and gentle.

It requires time and work for an efficient, low effort, correct postural habit to form, but the health and fitness benefits reaped will be worthwhile in both the short and long term.

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Sitting Correction

The problem with sitting is that all too often the furniture we sit on actually encourages our low back to take exactly the opposite shape and round into a slouch sitting position. Sitting is already tough on your back but slouching is one of the most constant and damaging strains on our spines in modern life.

If we slouch on a regular basis the slouch will feel normal to us but human nature is to interpret that feeling as if it is correct. We therefore positively reward ourselves for a negative behaviour - and keep on slouching. So to change posture you have to make a change to your shape. The new corrected shape will feel wrong to begin with, and this can be confusing, especially as changing shape can also create 'change' pains.

Correcting the low back and pelvis position is the first thing. This is the foundation of correct posture. Get this area level and the rest of the posture tends to sit correctly on top. The lower limbs are important to be correctly aligned also. Shoulder girdle and head positioning follow.

In sitting the most common postural fault is the 'C'-shaped spine. This is a particular fault amongst computer users, drivers and other sedentary workers.

Don't move! How are you sitting as you read this? If you are at your computer, have you slouched into a 'C'-shape? To recognise this postural type you will find that your low back has lost its correct curve so that it has flattened, or worse, rounded. You will be sitting on the back of your sitting bones (ischial tuberosities). Gravity will have a hold on your shoulders and will drag them forward. Your head will no longer be balanced directly on top of your spine, gravity and the muscles attaching to the neck and shoulder girdle will encourage the head to poke forward.

The lower part of the neck will excessively bend forward at its attachment to the body leading to a 'dowagers hump.' As this would lead to us looking at our feet all the time, we extend our upper necks, lifting the head to place our eyes in such a position that we can see forward.

It is often extremely difficult to tell for yourself what your posture is like - a mirror is a useful 'feedback' tool, as what we feel our posture is, might not be how it actually is.

If you are sitting poorly try this...

1. Sit on the front of the sitting bones, by pushing your low back forward.
   
   
2. Square your shoulders, without elevating them or adding a chest lift by linking chest movement to shoulder movement. Try to keep the lower ribs 'down' as the shoulders retract - stopping the shoulders movement back if the chest starts to lift.
   
   
3. Lift your head so your face is directed at the ceiling. Then 'lengthen the back of your neck' so your face points forward. (This initially corrects the low neck position and then corrects the upper neck).
   
   
4. Keep a relaxed breathing pattern. As you breathe in - make sure the air gently fills the lower lungs - don't fill the upper chest.

Can you adjust your chair to support this shape? If not, can you add a cushion or rolled up towel to your low back to maintain this shape? Remember, when correcting a sitting posture correctly placing the low back position can actually improve the entire sitting posture.

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Standing Posture Correction

Analyse your own posture first.

Kyphotic-lordotic stance or the 'beer bellied man' posture means that the weight of the abdomen drags the pelvis forward and down - increasing the curve of the low back, so the upper back curve has to increase also. The head pokes forward as a consequence.

The flat back posture or the 'tall boy syndrome' means that the pelvis gets tucked under or rotated back (if we use the top of the pelvis as the frame of reference). This flattens the low back curve.

The sway back posture, probably the commonest, means that the pelvis doesn't tip forward or back but rather just shunts forward.

The main postural faults in standing are related to the shape in which we hold our pelvis and low back. The head position is usually forward. Standing correction also requires a mirror and good kinesthetic awareness. Good leg muscle length is an advantage as short muscles pull the pelvis into inappropriate positions or make it difficult to alter the pelvic posture.

Like sitting, working on the pelvic position is the first objective. The ability to feel the position of the pelvis needs to be keener and gentle muscle strength to hold this shape needs to be developed.

Self-correction of posture is very difficult to perform correctly; hands on advice can shorten the learning curve.

A very important component to postural correction is the gentleness required to maintain the new shape. This is because the body likes to perform the least amount of work to do a job and maintaining a correct posture should be a background activity that is effortless. The common 'Tin Soldier' stance taken by the new convert to correct posture indicates that they may be having to use a lot of mindful effort to think of the many factors involved in holding the correct shape - and that effort may be physically interpreted. It requires time for an efficient, low effort, correct postural habit to form.

Give it a go…

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