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Is Bad Posture the Cause of Your Back Pain?

Many people recall their mother telling them to straighten up when displaying bad posture. As if a small voice inside of you is telling you this from afar. For me personally, posture is constantly on my mind as it was drilled into my head in Physical Therapy school. I am a rather tall man; 6 foot 4 inches to be exact, and it is easy for me to slouch down, as most everything is too low for me in this world. I remember one of my Physical Therapy professors walked up to me one time just to tell me "straighten up Shawn, you are going to be a Physical Therapist for goodness sakes!"


While in the clinic working with my patients you might say my posture now is excellent; as I have to be a good example right? However, on the weekends and evening my posture might struggle a bit, even though I hate to admit! I would have to say displaying good posture more consistently throughout the day helps my back immensely. Especially when it comes to sitting for long periods of time, lifting heavy things and bending over to work on patients or do yard work on the weekends. Yet I am just one person in this large world and my personal experience may or may not count.


So what is this whole hype on posture anyway when it comes to back pain? Does it really matter when it comes to keeping a healthy back? Well... lets explore this concept for awhile in this blog.


-Lets first talk about what bad posture might do to your back and the influence it can have on certain structures. Our backs are made up of vertebrae bones stacked up on one another and connected via joints called the facet joints. Between each vertebrae there is a disc called the intervertebral disc which provides shock absorption, stability and fluid motion to your spine. You might look at it like a cushion to your back. Our vertebrae's are held together through a huge network of muscles and ligaments that work in coordination to provide proper posture, stability and movement. Another part between the vertebrae is called the intervertebral foramina where the spinal nerve exits from the spinal cord and travels down your leg as in the case of the lower back called the lumbar spine. While the nerves in your neck travel out and down your arms.




There is an optimal position for your back which allows you to lift, carry and stand/sit for long periods of time without much strain to your spine. If this position is not maintained for awhile, certain structures can have undo stress on them. For example when you slouch while sitting then your disc will have more load and compression on it. Slouching puts more load to the front of your spine where your disc is housed. Another example is a swayed spine which places more stress on the facet joint, which is on the back part of your spine. Next we will explore the different types of bad postures and what insight these postures can give into the muscles that are tight and the muscles that are weak.


Slouched Posture: The most common



A slouched posture can happen sitting and standing. When this posture is maintained over a long period of time our hamstrings become tight and our back muscles called paraspinals are weak. When these muscle changes occur it can make it harder to even try and correct this type of posture; especially as we get older and more stiff.


Swayed Posture:



This type of posture can lead to added stress to the facet joints in your lower back. Weakness in the gluteal muscles, tightness in the back extensors and an overall weak core leads to this type of posture.



Scoliosis and Side Leaning:



Some people are born with scoliosis and progresses over time, others acquire it later in life depending on several factors; long periods of poor posturing, lifestyle and type of work they did as examples. Scoliosis can be fixed; meaning it will not improve despite attempts at improving it. The spine itself has undergone permanent changes in structure and alignment. Other scoliosis's can be flexible and will improve and correct with proper treatment. Some people just lean to one side due to tight muscles and weak muscles. In this case one leg might be weak over the other, the pelvis might be out of alignment, or our latissimus, quadratus lumborum and abdomen muscles on one side might be tight. One leg longer than the other can also cause this kind of posturing.


So lets say now you add stress and load to an already poor posture; as such when you lift or carry a heavy object. The force can significantly increase on your lower back when lifting incorrectly. Here is a few example of this:


A 10 pound objects lifted at 10 inches away from the the body = 100 pounds of force on the back.​ A 25 pound object lifted at 10 inches away from the body = 250 pounds of force to the low back, and so on. Bending forward causes a 150% increase in disc pressure. Lifting 20-Kg weight with back straight and knees bent 73% increase. With back bent and knees straight 169% increase.


Here is an example of the effect of the head posture on the lumbar spine: For every inch the head moves forward away from optimal position, it increases the force stressing the spine by 10 pounds. Our head weighs about 12-15 pounds on average. So Imagine holding a bowling ball away from your body for awhile; that would be tough right? Now imagine keeping the bowling ball close to your body; this would be much easier!


However bad posture is not everything when it comes to back pain. People without back pain have bad posture! Yet, most people I see who have back pain have some degree of bad posture. Many other factors need to be assessed besides posture when examining a person with back pain. Posture is just one piece of the puzzle when it comes to treating a patient with back pain. Looking at a persons lifestyle, age, prior injuries, flexibility and strength all factor in to why a person has back pain.


I can say with almost full certainty that when bad posture is present with already injured tissue from trauma or overuse conditions then that bad posture continually stresses the tissue and can lead to delayed healing.


I would like to share with you now some tactics I use in the clinic to help my patients improve their posture:


-Improving posture using imagery: When sitting imagine sticking your bottom out increasing the space between your lower back and chair, pull your shoulders back and tuck your chin in. When standing imagine keeping equal weight between your legs, slightly stick your bottom out and imagine lengthening your spine as if there is a string attached to the top of your head and pulling you straight up. Another example is imagine your are carrying a basket of fruit on top of your head; would you like to carry this basket while in a bad posture position? I know it would be very difficult and painful for me!



-Improving posture through exercise: These are three of my favorite posture retraining exercises that I commonly give to my patients:




QUADRUPED ALTERNATE ARM AND LEG - BIRD DOG


While in a crawling position, brace at your abdominals and then slowly lift a leg and opposite arm upwards. Your hip will move into hip extension on the way up. Lower leg and arm down and then repeat with opposite side. Try and do 10-20 repetitions and each time you lift the arm and leg to reach imagine lengthening your spine.


Maintain a level and stable pelvis and spine the entire time.



Kneeling Hip Flexor Stretch


Start in a half kneeling position with a pad/pillow for knee comfort, squeeze the buttocks of the back leg, lean the body forward as a whole without arching your back, lift the arm on the same side of the back leg, bend slightly away and rotate towards the up arm side and hold this for 30 seconds






PLANK


While lying face down, lift your body up on your elbows and toes. Try and maintain a straight spine. Do not allow your hips or pelvis on either side to drop. Maintain pelvic neutral position the entire time. If you cannot do this on elbows and toes, try elbows and knees. Initially try and hold for 20-30 seconds.


I hope this helps at improving your posture and gaining a better understanding of the spine and the influence of bad posture. I wish you a happy journey at reducing your pain and living a healthier life!


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