Recognising and correcting poor posture
It may not sound like a very ‘sexy’ topic, conjuring up memories of being reprimanded for slouching and slumping, but good posture is about much more than appearances. Justin Price explains how to manage poor posture in clients.
Posture refers to the position the body assumes during various activities such as sitting, standing, or lying down. Evaluating a client’s static posture is one of the most important assessments a health and fitness professional can perform, as it provides important clues about how a person is likely to move. For example, someone who presents with an excessively-arched lower back when standing may overuse their lower back muscles to perform movements that require spine extension, such as reaching overhead to catch a ball. Static posture assessments can also reveal the environmental stressors a person experiences during daily activities (e.g. rounded shoulders from sitting too much) and where their body could potentially break down during exercise/sports (e.g. overly-pronated feet could lead to a foot/ankle injury or knee/hip injury).
Since many traditional exercises and leisure activities require people to be on their feet, it makes sense to focus on standing posture, looking at what ideal standing posture looks like, how to perform a quick self-assessment of your own or your client’s posture, and some exercises that can be used to help improve musculoskeletal alignment.
Optimal postural alignment
Optimal standing posture
Good standing posture enables the body to effectively deal with the ever-present forces of gravity and ground reaction forces. This minimises potential for injury to both joints and soft tissue structures. When a person is in an optimal standing position, the following anatomical landmarks should all be in vertical alignment when viewed from the side: the tragus of the ear, the acromion of the shoulder, the centre of the hip, Gerdy’s tubercle (located just below the knee) and the tarsal joint of the ankle (located just below the ankle bone) (see Figure 1).
Quick postural self-assessment
To assess your own posture, stand against a wall in bare feet with your feet pointing straight ahead and your heels, buttocks, shoulders and head touching the wall. Pay attention to where the weight is in your feet. If you are standing in good alignment, your bodyweight should be positioned towards the outside of your heels. However, if you feel pressure in the front of your feet and toes, this indicates that your bodyweight is falling forward. Consequently, you will have to push down with your toes to keep balanced. This compensation may cause your knees to bend and/or your calf muscles to tighten and affect the alignment of your feet, ankles and knees.
Next, slide your hand behind your back while standing against the wall to evaluate the space between your lower back and the wall. If you are only able to slide your fingers into the space, you have an acceptable degree of arch in your lower back. However, if there is enough space for you to slide your whole hand or forearm between your back and the wall, then your lower back arches too much (i.e., excessive lumbar lordosis). If your lower back typically arches too much then your pelvis will also shift out of alignment by tipping down at the front (i.e. an anterior pelvic tilt). As a result, many of the muscles that attach to the pelvis and lumbar spine will be adversely affected (i.e. hip flexors, abdominals, hamstrings, adductors, abductors, glutes, spinal erectors). This can lead to movement dysfunction as well as hip, groin, leg and lower back pain.
Lastly, try to decrease the arch in your lower back by tucking your pelvis under (i.e. posterior tilt). Make a note when you do this of whether your shoulders round forward away from the wall. If they do, this indicates that the muscles of your shoulders and upper back (i.e. thoracic erectors, rhomboids, trapezius) may be weak (which is why it is difficult to keep your shoulders back to the wall when you remove the excessive arch in your lower back). This weakness in the upper back and shoulders can lead to shoulder, back, and neck pain and place more stress on the structures of the lumbar spine (as they will have to compensate for the lack of strength in the upper back).
Assessing posture in this simple way can help you and your clients understand how the body compensates for one area of dysfunction by overusing other areas to maintain an upright position against gravity and ground reaction forces. Addressing these imbalances with various corrective exercises can reduce these compensation patterns, thereby decreasing pain and improving function.
Tight calf muscles can lead to poor posture because they can create alignment problems in the feet, ankles and legs. Performing a standing calf stretch can help realign some of the posterior calf muscles (e.g. gastrocnemius) and help shift your body weight back into your heels when standing.
Stand in a split lunge stance (make sure foot is aligned straight front to back) and push the heel of the back foot into the ground. Pull the toes of the back foot up toward the shin to increase the stretch. Hold for 30 seconds each side.
Hip flexor stretch (with activation of gluteus maximus)
The hip flexor muscles run from the lumbar spine across the pelvis and attach to the top of the leg. Stretching these muscles enables the hips to extend (i.e. move forward) under the spine so the lower back does not have to overcompensate by arching excessively to hold the torso upright.
|Straight arm raise|
Kneel with one leg in front of the other. Posteriorly tilt the pelvis (i.e. tuck under) until you feel the glutes of the back leg contract. Keep the torso erect without arching the lower back excessively. Hold for 30 seconds each side.
Straight arm raise
Strengthening the muscles of the upper back can teach the body to recruit the muscles of the thoracic spine to assist with lifting the torso upright. This can prevent the lower back from getting tired and overworked.
Lie on the ground with your knees bent. Raise your arms overhead until they reach the ground. Pull your arms down toward the floor without arching your lower back, shrugging your shoulders, or bending your arms. Hold for 20 seconds and repeat three times.