Walk down a busy street and you’ll see some atrocious body language and posture.Most people are hunched over, head down, eyebrows furrowed and probably typing away on their cell phones.Anybody who is sitting is almost guaranteed to be hunched over: driving, eating, talking, on the phone, going to the toilet, working at a desk, studying, etc.But the minute you see someone with great posture, WOW. You really take notice because of the confidence they exude. If you’re ever going into an important meeting or stressful situation the 4 best things you can do to display confidence is to:
smile
speak loud and clear
have a solid handshake
stand/ sit up tall
The Spine
The spine is made up of small bones called vertebrae, stacked one on top of the other. The vertebrae are wedge shaped with flexible cartilage in-between to absorb moderate impact, allow flexible movement and protect the spinal cord.
The spinal cord is made up of many nerve fibers that reach every aspect of the body and allows it to function. Each vertebrae has an accompanying left and right pair of spinal nerves that exits from the spine to the body. The cervical spine is special in that there is an extra nerve pair that exit below the base of the skull or occiput and above the 1st cervical vertebrae. The back is comprised of 24 vertebrae (plus the sacrum and coccyx) and their respective spinal nerves:
Cervix: 7 vertebrae + 8 nerve pairs
Thorax: 12 vertebrae + 12 nerve pairs
Lumbar: 5 vertebrae + 5 nerve pairs
Sacrum: 1 unit of 5 fused vertebrae + 5 nerve pairs
Coccyx: 1 unit of 3-4 fused vertebrae
When looking at a person’s back, the spine should be straight and lay in the center of the body. From the side view, the spine has a double wave appearance. The normal curvature of the spine should follow the below:
Abnormal Curves in the Spine
Abnormal curvatures can be due to genetic physical variations, acute injury, bone or cartilage degradation, improper muscle imbalance due to repetitive strain or poor posture, natural aging and change in weight distributions. Let’s look at each more closely:
Genetic physical variations such as scoliosis can vary in severity. Often young girls, prior to puberty, have a slight scoliosis that self-resolves after their growth spurt has completed. There are 2 forms of scoliosis:
Structural – this is often the genetic form that involves unsymmetrical bone formation.
Functional – shows a curved spine when viewing the person from the back, but when they bend forward to touch their toes, the spine straightens out. This type of scoliosis is due to muscle imbalances pulling and pushing the spine out of neutral position. This is commonly seen with sport’s players who constantly practice one-sided movements and strength training.
Acute injury can be mild or very severe regardless of the force of impact. My uncle had hit his head and went 2 days without much attention to it before going to the hospital. He in fact had a slow leak of blood into his brain, which unfortunately took his life.
To be on the safe side, any injury to the spine or head requires a medical doctor to analyze, test neurological function and structural impact:
falling and hitting the head
whip lash
concussions
herniated discs leading to sciatica nerve pain down the side or back on a leg
fractures of the vertebrae
laceration of the spinal cord can cause numbness and loss of function
any injury to the head or spine causing referral pain, loss of sensation or chronic symptoms
injury leading to inability to control bowel movements or urination
Bone or cartilage degradation is often accompanied with age and rheumatic conditions:
Spondylolysis – stress fracture in a vertebrae (often lumbar) that can lead to spondylolisthesis later on in life.
Spondylolisthesis – a single vertebrae (usually in the lumbar region) slips forward over the one below. Most don’t have any symptoms, however those who do may experience low back and buttocks pain, numbness, tingling, sciatica; muscle tightness or weakness in the leg; increased lumbar lordosis; or a limp. Temporary relief can be found with rest and aggravated by standing, walking and other activities.
Osteoarthritis – bone degradation common to the neck and lower spine due to age and loss of cartilage support. When the disc between the vertebrae begin to dry out and shrinks, this stiffens the spine and may cause bone spurs to form and injure the spinal cord.
Osteopenia or osteoporosis – loss of bone density due to age, especially in post-menopausal women. Protecting your bones and increasing your bone density as a child or young adult with high impact activities, healthy mineral consumption and avoiding calcium leaching foods (ie. soda) will help to prevent osteoporosis later on in life.
Improper muscle imbalance due to repetitive strain or poor posture is one of the most common reasons for mild neck and back pain. With proper exercises, stretches, soft tissue work and possible manipulation of bone structure, the body can re-align to a balanced and symptom-free state.
Foot ware is a commonly over-looked culprit of poor posture and back pain. If your feet and not supported properly it can lead to misaligned knees, hips and shoulders. If you notice your hips or shoulders are uneven, this may be a sign that your body is trying to compensate for unbalanced strength.
However, there are some conditions (ie. leg length disparities, structural scoliosis, etc) where you may never gain physical symmetry due to structural imbalances. Proper muscle maintenance and preventative exercises are key to limiting further problems.
Change in weight distribution and aging naturally transfer the weight supported by the spine. Obesity and pregnancy increase anterior weight at the mid-section causing an increase in lumbar lordosis, also called sway back. As we age and constantly hunch forward, this increases the thoracic kyphosis of our spine. These spinal changes are not necessarily bad unless they are causing pain or referral symptoms.
Proper Posture While Standing, Sitting, and Lying Down
Anatomical posture when standing – forward-facing feet, hips, shoulders and head; ears, shoulders, hips, knees and ankles should create a straight line down the body; shoulders down and back; and palms directed anteriorly is considered proper anatomical positioning. In terms of lung capacity for oxygen and carbon dioxide exchange, having an open chest with shoulders down and back are beneficial.
However, when it comes to low back pain, posture has very little effect. A surprising amount of people with proper posture have back pain and those with poor posture have no pain. Read here for the evidence.
Ergonomics – the posture while sitting is where most people spend their time hunched forward, straining their eyes and extending their necks for hours at a time. Getting fitted for a ergonomic work station and taking hourly breaks to get up and walk can help your physical health and mental well-being.
Proper ergonomics includes a supportive chair with both feet planted on the floor and all angles of the body at 90˚ right angles: elbows, hips, knees, ankles. The screen, book or object in focus should be slightly lower than eye level to avoid exhausting stress on the neck. Similarly to the anatomical position, the ears, shoulders and hips should be in line with one another.
Proper ergonomics at work, driving, eating and sitting in general can help to alleviate a hunched posture
Sleep – the way you sleep can be a large contributor to sleep quality as well as pain. For example, if you have low back pain you should avoid sleeping on your stomach due to the excess pressure of a hyper-extended posture on the spine for many hours.
The best postures for sleep is on your side and if you don’t have a breathing condition, on your back. But what about pillows?
PILLOW UNDER THE HEAD – While side lying, you should have a higher pillow under your head to fill the gap between your shoulder and head. While on your back, use a thinner pillow under your head. Your goal is to maintain a neutral spine (ie. when you’re standing with good posture and not perfectly flat).
BODY PILLOWS – You should also utilize extra pillows at your knees to maintain neutral posture. While side lying the width between your knees and elbows are much more narrow than your hips and shoulders, respectively. Placing a pillow between your knees and arms will take pressure off your hip joints and low back. When sleeping on your back, put a pillow under your knees to release low back stress. If you must sleep on your stomach, putting a pillow under your abdomen and hips will decrease the extension of the low back and will help with back pain, but not your stiff neck from the excessive rotation.
DOES MY MATTRESS REALLY MATTER? — I got the down low on the importance of mattresses when Casey and his girlfriend Molly came to live with Jon and I in Uruguay. Casey Sasek is the owner of the Wildcat Mattress store in Nicholasville, Kentucky and he says that the best mattress you could ever sleep on it made of latex.
Common mattresses have springs within them. When the weight of your body presses down on the springs it can inhibit blood flow to those areas of the body and can inadvertently wake you from your deep REM sleep.
Latex mattresses are made from a natural rubber tree. They are thick, flexible and soft enough to conform to your body to allow proper support without limiting blood circulation. This allows for faster injury recovery, longer duration of sleep in one position and more continuous restorative sleep.
Pillow positioning for a healthy spine while sleeping on your side and back
For more information on the importance of sleep, click HERE.
Exercises
An erect stance and strong postural muscles can help build confidence, improve breathing, improve movement patterns and limit repetitive injuries to the body. Not only does healthy posture come from strong back muscles (erector spinae, latissimus dori, trapezius, rhomboids, rear deltoids and core) but also increased flexibility and supportive foot ware.
Neck and shoulder stretches and rolls – Every morning practice half circles with your neck (ie. as if you are drawing a necklace on your chest with your chin) and shoulder rolls both forwards and backwards.
Double chin exercises – lay on your back and try to push the back of your head into the floor. This will create the ‘double chin’ effect and strengthen your anterior neck muscles while giving your posterior ones a rest. You can do this while lying on your stomach, seated or even with a physio band for added tension, but it’s important to keep your back neutral.
Stretching the chest – find a doorway and place one foot in front of the other. Place a single hand and elbow on the door frame with your elbow at a 90˚ angle (avoid doing both arms at the same time as your pectoral muscles are more likely to contract to protect yourself from falling too far forward). Lean your weight forward into the front leg while turning your body slightly away until you feel a stretch in the chest.
Scapular retraction, Y’s and T’s – you can complete these lying on your stomach or standing bent over with a flat back. Raise your arms at a 45˚ angle (“Y’s”) for 10-15 repetitions then at 90˚ angle (“T’s”) for another 10-15 reps. Hold the top position for 5 seconds with your shoulders down, scapula retracted or pulled back and core engaged.
Scapular and upper back “Y” and “T” exercises strengthen postural muscles
Bracing the core – To learn how to engage your core by starting with thedeadbug.
Lower trapezius and latissimus strengthening exercises – will help to pull your shoulders down and away from the ears.
The trapezius muscles create a diamond shape pattern from the base of the neck out to the back of the shoulders and down to the mid-back. The latissimus dorsi muscle are the ‘wings’ of the back, spanning from under the armpits all the way down to your hips.
The lower trapezius and latissimus muscles help to hold the shoulders down and back for healthy posture
Seated or standing rows with bands or cable machine
Recline rows with low bar or rope
Lat pull down machine – various wide grips
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Photo: Dr. Alison Chen
This essay originally appeared on Dr. Alison Chen’s blog.
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