Posture Pain

Gravity is the enemy. Have a look around you and you will see its force. People stooped, heads forward, rounded shoulders and curved backs.

Now think about the tasks that you do every day. You sleep, you sit, you cycle, you drive, you work at a computer, you cook, you clean, you do almost everything in a bent forward position. You may even stand and walk in a slightly forward leaning position.

Is it no wonder then that if you look at people who are in pain or old, that they are stuck there?

Your posture is one of the most important factors in determining not just your physical health, but also how well you feel, how young you look and how well you are able to perform every-day tasks.

Poor posture is related to tension headaches, upper and lower back pain, shoulder pain, hip pain, knee pain, foot pain, myofascial pain, you name it. It is also associated with depression and responsible for the forward stooped appearance that we see in so many elderly people.

With such far reaching consequences, fixing your posture is one of the quickest and easiest ways of not just helping you recover from physical pain, but of avoiding and preventing it in the first place.

What is posture and in particular, what is good posture?

Posture “refers to the relative arrangement of segments of the body” (Norkin & Levangie 1983). Ideal posture may be defined as “that state of muscular and skeletal balance which protects the supporting structures of the body against injury or progressive deformity”. Under such conditions, your “muscles will function most efficiently and the optimum positions are afforded for the thoracic and abdominal organs.” (Posture Comm of Am Academy of Orthopaedic Surgeons 1947.)

Categories of Posture
As mentioned, posture may also be divided into two categories: static and dynamic posture. Static posture refers to the arrangement or alignment of the body parts whilst the body is at rest, whilst dynamic posture refers to this alignment during movement.

Static posture will therefore directly affect dynamic posture or in other words, the starting position for any movement must affect the precise alignment of the parts during that movement. By definition therefore, good static posture is a prerequisite for good dynamic posture as precise maintenance of correct alignment during movement cannot occur, if the body parts are not correctly aligned in the first place.

But why is posture important?
Posture is important because:

1. It determines the amount of stress on the different tissues and systems of the body which directly relates to the development of pain syndromes and injuries, and also,

2. It determines effectiveness and efficiency of movement and therefore the influences the performance levels of all physical tasks.

Essentially, good posture thereby minimises the abnormal or excessive stresses on the body and optimises the performance of all physical tasks.

2 Postural Patterns in Life
You have 2 postural patterns in life.Posture photo

1. A bending, turning inward pattern. Have a look at people who stoop (e.g. image on the left). The head is forward, the chest is depressed, the shoulders  are rounded, the upper back curvature is increased and hips are bent and the person looks old and stooped.

2. A straightening, turning outward and opening up of your body. In contrast with the image on the left, the person on the right is upright. They look tall. Their head is in line with their shoulders, their chest is lifted and their back has a normal S shaped curve.

Typical Faulty Postures and Related Pain Syndromes
If good posture minimizes excessive or abnormal forces, poor posture exacerbates abnormal or excessive stresses leading to many and varied physical conditions. Some of these include:

Head forward posture (ear lobe in front of shoulder)
– Headaches
– Neck pain (due to disc bulges, facet joint irritation)
– Osteoarthritis of the neck
– Vertebral artery signs such as dizziness, blurring of vision and ringing in the ears

Rounded shoulders and increased mid back curve
– Thoracic spine and rib pain
– Upper back muscle strains
– Shoulder pain
– Decreased rib expansion and therefore limited breathing

Flat back posture
– Low back pain with sitting, bending etc.

Increased low back inward curve
– Low back pain with walking, standing etc.

Turning in and Bent Hips
– Hip osteoarthritis
– Buttock pain (Gluteus Medius Tendinopathy; Trochanteric Bursitis)
– Knee pain (Knee cap pain, Knee arthritis)
– Ankle pain (sprains)
– Foot pain (Plantar Fascitis)

What is good posture and how is it assessed?
The standard way for postural alignment to be assessed is by using the plumb line test where the alignment of the body in standing is assessed in relation to a plumb line positioned above the body (Muscle Testing and Function by Kendall and Kendall).

From the side, a plumb line placed just in front of the outside ankle bone should pass through:
– ear lobe
– bodies of the cervical vertebrae
– tip of the shoulder
– divide the chest in half
– bodies of the lumbar vertebrae
– slightly behind the hip joint
– slightly in front of the knee joint
– slightly in front of the outside ankle bone (lateral malleolus)

From the front, the plumb line should divide the body into two symmetrical halves. The head, shoulders and hips should be level, and also the hip, knee and ankle joints should be equidistant from the line of gravity.

A caveat to this, is that Kendall and Kendall in Muscle Testing and Function state that it is normal for a person’s for the dominant side shoulder to be lower and for the dominant side hip to be higher. Consequently, for this to occur, a scoliosis must be present. They state that the reason for this is due to the increased muscle bulk and the asymmetry of limb usage of one side compared to the other.

Can you do anything to improve your posture?
Absolutely! First and foremost, before deciding whether any intervention is necessary let alone whether it is going to be of benefit, an accurate and comprehensive evaluation must be performed. This obviously will involve an assessment of postural alignment, but also it must take in account other factors such as the habitual postures and movements, as well as an assessment of muscle bulk, tightness and strength, joint mobility, balance and coordination.

Posture Pro – A great tool for assessing posture and bodily stress.posture-pro2
At Bodywise Health, our computerized posture assessment tool called Posture Pro not only gives you an accurate, objective measure of your posture, but it also is able to calculate the stresses on your neck, back, shoulders and legs, and whether they are abnormal or not.

It is a great predictor of whether you will suffer from an injury or pain in any of these areas. Reducing, stopping and preventing your pain often then goes hand in hand with correcting your posture.

Correcting your posture may involve more than just sitting and standing up straight
Correcting your posture and the abnormal stresses involved is a simple matter of using “hands on” techniques to loosen specific stiff joints and tight muscles, whilst using precise strengthening exercises to “shorten” lengthened, weak muscles. In effect, your muscles are used like guywires as the exercises effect is to muscle bind you back into better alignment.

Once gained, this new mobility and strength can then be incorporated with better awareness (reinforced with postural taping), to ensure that correct posture becomes a habit which is maintained over time.

Quick tips on improving your static posture
In the meantime, some quick tips for immediately improving your posture include:
1. Stand “tall”, lifting from the top of your head and from the middle of your chest;
2. Sit with a lumbar roll cushion in the small of your back and relax backward;
3. Strengthen the muscles that hold you up against gravity.

Quick tips on improving your dynamic posture
1. Learn to squat on each foot, keeping your knee over your second toe and without holding on;
2. Progress this to stepping down a step keeping your knee over your second toe;
3. Progress this to hopping, running and cycling keeping your knee over your second toe;
4. Run in a slightly bent forward position.

These posture improvement strategies will have the effect of lengthening your spine and stopping your body from “giving way” under the long term ageing effect of gravity.

Correcting your posture in this way is one of the quickest and best ways that you can permanently reduce your pain and improve your health. I hope that this helps.

Until then,

Best wishes,

Michael Hall
Bodywise Health

For more information on how Bodywise Health can help you to improve your posture so that you may prevent chronic neck and back pain, please call Bodywise Health on 1 300 BODYWISE (263 994).

Please note:
• Rebates are available through your private insurance extras cover;

• For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 BODYWISE (263 994).