The Role of Posture in Preventing & Alleviating Back Pain: Tips for Everyday Life
Posture plays an important role in our body, fundamentally, it dictates how the muscles and joints are aligned, dictating where pressure is focussed. Which muscles will bear more strain, which parts of which joints will be transferring the load. All postures will vary this picture, some will accentuate certain areas in inefficient ways, others will reduce net mechanical strain by aligning the body in a more balanced way.
Nowadays you’re likely to come across material online talking about posture not causing back pain, and while any given posture is not explicitly going to cause back pain, acknowledging the reality of posture’s influence on our structure regardless of the presence of an injury is important. Quite often these statements are really to be contrarian or said without opportunity for full follow up. Hopefully by the end of today’s episode you’ll have a better idea of the role of posture in preventing and alleviating lower back pain.
Why Good Posture Matters
Our spine is a supporting strut that runs through our body with 3 large centers of mass stacked on top of one another, the head, the rib cage or shoulder girdle, and the pelvic girdle. The relationship of these centers of mass above one another and then above the ground dictate the efficiency of the posture.
Any movement forwards or backwards, as well as side to side, of one center of mass above the ones below has an impact on the demand on those structures. For example, even if we were to hip hinge forwards with good low back posture and a braced core, we would find that the top two centers of mass would be forwards of the pelvis. This places increased compression through the spine, as well as on the musculature supporting the spine.
It is very easy to appreciate, given the example above, of the reality of increased mechanical strain on not only the lower back, but also on the muscles and other soft tissues involved in the balance of this posture. Balance meaning, the prevention of the body simply falling into a heap.
It is important to recognise in the example here, we are maintaining a good lumbar spine and general posture through the movement of the hip hinge.
If we were to add a second variable, the rounding of the lower back, for example, we now add additional mechanical factors, such as a focus of load through a particular part of the discs, and an elongation of the low back musculature and ligaments, we’ll touch on this more later on.
These are examples during movement, of postural changes through movement, a clear and obvious example of the significant change in force distribution and strain when comparing a baseline good posture, with significant deviation from this. “Bad postures, of course, are unlikely to be quite this significant, but they are often maintained for durations much longer than we would see in an exercise, so a small mechanical load increase, spread over a long period of time, can become problematic.
Still not convinced? We can probably agree your phone or tablet is not very heavy, so for the rest of this article, whilst you read through slowly, hold your device at eye level in front of you. Your arms don’t need to be stretched out in front, but just held up to your face at a reasonable reading distance. See how you feel by the end.
Understanding the Components of Proper Posture
For the sake of simplicity, we’ll look primarily at the standing posture, knowing that with the elimination of the legs, we have the de facto seated posture too. The pelvis should be orientated neutrally, not tilted forwards, and certainly not with a pelvic tilt (bum tucked in). This allows for the force to be transferred through the junction between the lumbar spine and the sacrum, on in through the sacroiliac joints and to the legs and ground.
The lower back, lumbar spine, would have a neutral curve and the muscles surrounding both the hips and the low back in their neutral position.
Moving up to the rib cage and thoracic spine, it would be positioned above the pelvic girdle, again with the thoracic spine in a neutral position, not rounded forwards, or extended flat, the same status quo in the middle back musculature would be observed.
As we transition into the neck, this would also have a smooth backward bending curve, lordosis, with the head directly on top of the shoulders. Putting the muscles of the neck and shoulders at ease.
When orientated in this way, the natural development of the human body is optimally positioned with the muscles, joints and other soft tissues in their most biomechanically efficient, and with the least uneven strain. In other words, the strain of the body’s own weight is distributed optimally through the body on its way to the ground.
A slight modification in the case of sitting, would be that the sitting bones would be the point at which our body interacts with the ground, as opposed to our feet.
The Impact of Poor Posture on Back Pain
Perhaps to appease the “there is no bad posture” crowd, a more appropriate statement here might be, the impact of less efficient postures on back pain, so from now on whenever we write “bad posture” think “less mechanically efficient”.
Let us get this out the way first…
Those with bad posture do not have to have back pain, for example, if you’ve been lucky enough to adopt bad postures over your lifetime your body, the muscles, the ligaments etc will have adapted to this process by strengthening, or stiffening in key areas. Our body is miraculous and this will take place which is part of the argument. This is perhaps what fuels the statement that posture doesn’t matter or is somewhat irrelevant.
The reality is that even though this badly-postured individual has no back pain and has adapted, they are still passing more force through the system than if they were more efficient from a postural point of view. They’re more efficient at handling more mechanical disadvantages, but they are forcing their body to handle “excessive forces”.
As long as their body continued, uninjured, everything appeared to be fine. However the larger problem with bad posture is its impact if you injure your low back.
Posture is a habit, for many subconscious, which means it affects you every single day without realising it, ever present, but somewhat subtle. When you injure your back, the adaptations that have been present in the soft tissues are often interrupted. The continuous blend of ligaments, muscles and other soft tissues has now a break in continuity. There is a weak link and a section of the back that has more movement than the system as a whole is used to. The muscles remain strong elsewhere, exerting their influence on what they thought was a stable anchor point, but this is no more the case.
The area of injury now is a weak link in the biomechanical chain. The daily posture, with all its increased strain, compared to a good posture, starts to exert more force on the injured back that is trying its best to recover. The bad posture gets in the way of the healing process, and the individual suffering is somewhat unaware!
When we look at cases of herniated discs or sciatica. We see the impacts bad posture can have. The lower back disc herniation is a failure of the back parts of the disc to function, they deform, tear ultimately failing to deal with the strain placed on them. This commonly results in sciatica pain as well as back pain. Being in a position that increases mechanical inefficiency through the lumbar spine only makes the healing of this injured disc more difficult. It is bad enough that we cannot isolate and remove the weight of the torso above in the early days of recovery.
Giving the disc a bit of a break from further load and damage would be helpful at first glance. This is not advisable for any length of time for a multitude of reasons even if we could do it due to the swift loss of muscle strength in the region, among other things. That being said, eliminating unnecessary extra load would always be sensible and a help.
If you’re someone with habitual bad posture, who gets a herniated disc, it’s much better you ditch the bad posture right out the gate!
The challenge is often that that habitual bad posture is just that, habitual, and within 5 minutes you’ll be back at it again! No wonder it is a challenge to come back from the back pain caused by a herniated disc if you’re in this camp.
The short answer here is: ignore the people that tell you there’s no bad posture, adopt a good posture and make it a habit!
Common Postural Mistakes and How to Correct Them
You might think that it’s a weird place to start, but the head posture is vital, the head is a big weight on a long stick… are you still holding your phone up? It can really magnify the weight exerted on the entire body when pushed forwards. A simple drill to remind yourself where neutral is for your posture is to stand against a wall with your heels, bum, middle back, and head against the wall. That is “good” upright posture and something to aim for. Now walk away from the wall trying to keep an awareness for that upright.
The second common error people make with their posture is their thorax being rounded, and shoulders pulling forwards, typical slouching or desk based posture. This is easily fixed using the previous drill but also with the “chest pop” this is whereby you imagine that there is a little cord attached to the bottom of your breastbone. Seated or standing, simply imagine someone on a ladder, 8ft above the ground, 8 ft away from you pulled that cord. Your chest would elevate and move forwards slightly. Your shoulders would depress slightly, and shoulderblades draw slightly together. Your rib cage would also move slightly forwards.
It is often the case that people push their heads forwards, but slouch their rib cage backwards, this helps pull both back into alignment, to the center.
The final posture correction is for the seated individual, this is to reinforce the normal position in the lower back when sitting. Using a small rolled up towel, sit with your pelvis touching the back of the seat, place the towel just above here so that it provides a support for the lower back’s natural lordosis, then simply sit up tall with good posture as outlined earlier. You should feel the pressure of the supportive towel holding the lower back supported. If you “relaxed and slumped” you should feel that the pressure on the towel would increase, warning you this is your back moving to a bad position.
Exercises to Improve Posture
When it comes to improving the posture people in need of this generally fall into one of two categories. The first category is the individual with insufficient good muscle strength and movement patterns. In this instance, there is the requirement to work on the muscles of the “posterior chain” this essentially means working all the muscles on the back of the body from the base of your skull to your heels. Focusing in particular on areas like the middle and lower back as well as the core to strengthen these areas is important.
Movements such as a “W-Raise” whereby you retract the shoulder blades to engage the middle back muscles can be done. These can then be enhanced with the use of bands or cables, to strengthen the muscles over time with progressive training strategies. Another great exercise for strengthening the lower section of the back would be the hip hinge movement, whereby you start standing tall with great posture and imagine a hinge at the hip sockets. From there the body hinges forwards. Your torso posture should remain good through this entire movement.
Both of these exercises feature, alongside advice and support, in the Back In Shape Program, so if you are looking to improve your posture properly and follow a program that will get you there, check it out! Visit the Premium page to learn more.
The second category would be the individual who actually is strong, you’re used to working out, and have normal, healthy levels of strength and ability in these areas. Unfortunately through bad practice over the years, posture has left much to be desired. In this case, 90% of the improvement is made by becoming more conscious of your posture and maintaining good posture actively, slowly this will become a habit. The additional 10% will come from some additional stretching to perhaps help balance out a little dominance that might be present in some of the muscles that oppose this “good posture.
Examples here would be the chest and muscles on the front of the neck. You might also find that the lat muscles and the hip flexors could be contributing to some deviation in normal posture as a result of training practices and bad posture over the long term. Stretching these areas in addition to the mental effort mentioned above will make a gradual change. It is assumed you would be continuing the regimen of exercise that put you in this category so additional instruction is likely not required in that department.
Ergonomic Tips for a Posture-Friendly Workspace
One of the challenges for the human body is that we are not designed to be static for extended periods day in and day out, as we mentioned on a recent podcast, the British Heart Foundation recently stated the average working age adult spends 9.5 hours sitting a day. These sorts of repetitive drawn out tasks are not ideal for muscles, are you still holding your phone out in front of you? Probably not, or at least you’ve had to readjust!
With this in mind one of the most effective strategies you can employ to help your posture and your back, as well as a number of other areas, is to move and fidget. During your day, change positions, move around, take breaks, try to take phone calls standing, or where possible adjust how your body is being used, and where the stress is being placed. This single change will help you alleviate the cumulative effects of bad posture by eliminating the likelihood of bad slumping postures creeping into your daily life.
That being said, there are also some more practical steps you can take to help make your workplace a little more ergonomic, whether it’s a home office or “at work”.
Firstly, look to get a standing desk or a sit-to-stand desk, one which is preferably motorized to increase the likelihood of switching position. Quite honestly, the manual ones are cheaper, yes, but the inconvenience of having to winch the thing up and down, instead of just pressing a button makes them perfect candidates for being a fad purchase. Something that gets used for a week and that’s it.
Secondly, perching stools can be a good option for some, allowing you to be a little more dynamic in your semi-standing position, whilst not feeling like you’re on your feet all day. For some these really work, for others they’re a bit of a nuisance, so figure out if they work for you, but these offer a great option to be “fidgety”, thereby keeping the body fluid and decreasing the ease of any bad postures solidifying.
Thirdly, especially when sitting, a kneeling chair can be a great option. For some of the stiffer among you, the hamstrings are a real limiting factor, by using a kneeling chair you’re able to take the hamstrings out of the equation and allow the pelvis to sit in a more neutral position rather than being pulled backwards as is so often the case in the slouched posture. These kneeling chairs make it easier for you to adopt a more efficient posture, and your muscles will work to hold this posture more effectively. The downside here, is that you are unlikely to have a back to the chair and so for long stints in the beginning this can be fatiguing for the muscles of the back.
It goes without saying, for each of these tips, you must make sure that your desk, computer and everything else used is at a reasonable level, it’s no good the equipment you’re using being all over the place meaning you have to tower over your laptop screen or crank your neck back when trying to look at your desktop computer screen.
Conclusion: Make The Time To Develop Better Posture
Ultimately, posture is simply the efficiency of your body’s ability to bear load. There are postures that are more efficient and those which are less so. On the whole, postures that exert more load and strain on the system, including the back, are temporary, short lived activities. Some even make up part of our healthy resistance training practice. Bad posture on the other hand is a pervasive chronic pattern that seeps into the way we hold our body day in, day out, and makes life much more difficult for us when we inevitably get injured. Whether it is the lower back or something else, bad posture is never going to be a good thing for your lower back health.
Excellent. Thank you.