What is ideal posture and how to improve it?

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Introduction:

This section is dedicated to looking at posture and how to improve it. As with anything else, it is easy to aggravate one’s physical problems and to injure the muscles and tendons attached to the skeleton without even knowing it.

If you have spinal problems and are receiving treatment, you may be doing certain things unknowingly to aggravate and prolong your condition.

Why Do We Have a Bad Posture?

Our culture and society tells us many conflicting things about posture and exercise, some of which is very useful and some of which is misguided and harmful. Coupled with this, it is also not very easy to maintain perfect posture in modern living, which such emphasis on sitting down, especially in awkward environments.

We are often ignorant of what we should exactly be doing, and if we do know, we do not value doing the correct thing enough or are too impatient to do things correctly. We also may not have the bodily awareness to tell exactly what our posture is like at any given moment in time, save for those at the pinnacle of martial arts for example. One does not tend to notice that which is habitual.

It is funny that we live in a society that is so sick that people can’t even be bothered or are too weak to physically support their own upper bodies, but slouch and sprawl themselves onto chairs and sofas for a large number of hours in a day, contorting our bodies and using the lower back as a chair to slouch onto and prop your upper body up against.

What is Correct Posture? Why is it Important?

The spine is meant to be straight at all times, with a nice arch/curve in the lower part of the back. The neck is designed to be straight and in line with the spine. That’s the bottom line. Of course, the spine and back are meant to be very flexible, and can move in all manner of different directions, but the idea is that if you do, it is only for short periods and without much force involved. You don’t have to read the rest of this section! It’s that simple! However, if you want to know how to apply this to exercising and daily routines, please read on.

If you are sitting and curve your spine (ie slouch) then you are putting 2-4 times more pressure on your one side of your vertebrae of your spine and neck. In short, whenever you are sitting down or standing up or exercising, you should have a straight back at all times. Because of the increased loads that you put on your skeleton and muscles during exercise or stretching, it is even more important than when resting to have a straight back.

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Most tension goes to the lower back, and this can result in problems with the legs, for example the knees, the achilles tendons, the hamstrings etc. If we experience problems in the lower body, we go to a physiotherapist to treat these injuries when the root of the problem is our back! Approximately 30 -50% of adults have lower back problems. Unfortunately most of us don’t make the connection. It is not rocket science.

Below is an example of a person standing correctly on the left and a person dropping their hips forwards on the right (with the resulting over-curvature in the spine).

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Excessive dropping of the hips can be a result of ‘overcompensating’ to maintain an arch/curve in the back as a result of trying to correct a slouch. This is illustrated in the picture below. The first person is slouching. The second person is sitting with a correct posture. The third person is engaging in such ‘forced posture’ or overcorrection.

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Stomach Exercises:

The stomach muscles are very important for supporting your lower back. The abdominal muscles and back muscles work synergistically. It is important to have strong abdominal muscles as well as strong back muscles.

Don’t focus on one at the expensive of the other. Unfortunately, the normal ‘crunch’ exercise is very bad for your lower back. From this moment on, never do them again! Or do so at your own risk. The number one rule applies when exercising your stomach – always keep the back straight and maintain the natural curve in the lower spine.

Back Exercises:

To exercise the back muscles, there are a number of exercises you can do. The upper back is exercised by doing a seated row, with a straight back of course, or by pulling dumbells towards you whilst lying on your stomach on a weights bench (very similar exercise as seated row, but does not involve the legs). A third alternative is to stand with a shoulder width stance, knees slightly bend, with your back straight and horizontal, and to hold a barbell or set of dumbells (very light to start with) and lift towards your sides and lower. Repeat. Increase the weight once you reach 10 repetitions comfortably for your next session. It is best to avoid using ‘weights machines’ where you are strapped onto a machine in a sitting position and push a bar backwards with your back. These machines can put unnecessary strain on the lower back if one’s alignment is not perfect (which invariably it is during a certain part of the overall movement). They are not necessary so there is no point bothering with such machines.

To train the lower back, you can focus on two exercises.

service-icon-2For the first lower back exercise, lie on your back on an exercise mat. Bring your feet close to your bottom, with your heels about 6 inches from your bottom. Keep the feet close together. The idea is to use your feet and shoulders as the point of contact with the floor and to lift your pelvis into the air, until the thigh and spine are in line, and then lower. To achieve this anchoring position you must be on an exercise mat or other mat and gripping it with both hands (straight arms). Do as many repetitions as possible or until you feel any discomfort. Ideally you should do as many of these repetitions as you do for the stomach exercise. When you are highly proficient at this, you could try to increase the resistance slightly by wearing a light weight belt. Or just stick to your own body weight and keep increasing the number of repetitions and sets.

The second back exercise is more advanced and is not recommended for beginners or for those with a weak back.

service-icon-2For this second lower back exercise, lie on your stomach on the floor, keep your neck in line with your spine (ie look down) and bring your arms in front of your so your palms are facing down and in front of your face. Keep your legs straight. Simultaneously lift your legs and your chest off the floor keeping the lower abdomen and pelvis on the floor. And then lower. Repeat (repetitions) as many times as possible or until you feel any discomfort.

Stretching:

When it comes to stretching, it is a general guideline to not stretch until it hurts but to breathe deeply and remain relaxed. Achieving the maximum burn humanly possible is an ‘all or nothing’ approach that is unhelpful and destructive! This is often when muscle or tendon damage occurs.

Cardiovascular Exercise Tips:

As a general rule, one should warm up before one’s exercise session. Do your stretches, then do your exercises, do a slight cool down exercise, and then complete your stretching.

It is best to have a day ‘off’ in between your exercise days, i.e. exercise on alternate days. If you have been doing weights on any particular day, it is generally best to do a cardiovascular session afterwards to eliminate most of the lactic acid build up from your muscles.

Some theories say that the best cardiovascular exercise is between 130-150bpm for 20 somethings. Maintaining a very high heart rate above this for long periods of time (e.g. 200bpm) is not providing you with any health benefits. Formulae for calculating your maximum and optimum heart rate for cardiovascular exercise are listed below.

Maximum Recommended Heart Rate = 220 minus your age.

Aerobic Heart Rate (aerobic rate at 70% of your maximum capacity) = 180 minus your age. If you are suffering from illness or are on medication, subtract at least another 10bpm.

Minimum Aerobic Heart Rate = Your Aerobic Heart Rate above minus 10bpm. Try to keep your heart rate in between the aerobic heart rate and minimum aerobic heart rate during the core part of your aerobic work out.

Warm up and cool down Heart Rate should be roughly 100bpm plus or minus 5bpm depending on your age. A warm up or cool down should ideally be 10-15 minutes.

Orthopaedic Soles:

Some physiotherapists/osteopaths/orthopaedic surgeons recommend in soles/orthopaedic soles if you are bow legged or have knee problems etc. As much as these correct the angle of the foot given whatever got you into that situation in the short term, they encourage the spinal problem to stay where it is. It is better to treat the spine, relax all the muscles up in the lower back, and to ween yourself off insoles, and you wear them less and less whilst the posture problem sorts itself out. It’s like putting a plaster on a leaking pipe, not sealing it up properly.

We look at some daily situations of back abuse below.

Lifting Heavy Objects:

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The worst thing you can do to your back is to lean forwards, bending your back and then turn to lift something. Try never to do this! Always keep a straight back when lifting/using force and if something is to the side of you, turn to face it first, then lift, then rotate your entire body in the desired direction using your LEGS! That’s what your legs are for. People tend to use the back to do most of the work as they can’t be bothered to move the rest of the body.

Carrying Bags:

Never go around with a conference bag/trendy one arm DJ bags slung over one shoulder, particularly if it is very heavy. If you do you will be carrying a load and twisting your spine, which is a definite no no. Wear a rucksack instead. There are many cheap or expensive and trendy looking rucksacks around, depending on your inclination. One should aim to distribute the weight evenly, so you can carry as heavy items as you want without causing spinal problems. If you are carrying heavy shopping bags, try to carry an equal weight in each arm, so that the spine is straight. You can pack each bag in the supermarket so that it is roughly the same weight as the next.

Carrying Wallet:

Carrying a huge, bulky, heavy wallet in one pocket of your trousers or jeans is not only uncomfortable and annoying, but is bad for your posture and may subtly affect the way you stand or walk. It is particularly bad if carried in one’s back pocket when sitting down – and you are more likely to get pick pocketed!

Household Sofas Encourage Bad Posture and Over-Reaching:

When you are slouching on a really bad sofa and stretch forward to reach the remote because you are too lazy to get off your backside and sit up/stand up properly (putting the force through your legs as you stand up), you are hugely increasing the risk of slipping a disk. Don’t do this!

When you get up from a sofa, try to keep your back straight and use your legs to take the force, don’t lean forward and take half of the force through your lower back. If you are aware, you can feel how bad this feels on your lower back.

It may be possible to support your back more with enough cushions behind you, but even then, most sofas sit very low, and the pelvis is often below the knees in height, which is not conducive to a great posture.

Baths:

As much as everyone likes to have a nice, long, hot bath, the act of having a bath is probably the worst thing you can do to your neck! The heat is great for your neck and back. But unless you have an extremely long bath tub, where you can rest your head in line with the spine, you are tilting your head forwards at an extreme angle and holding it there for up to an hour. This is not good at all! Avoid baths unless you can have a straight neck! Take nice, hot showers instead Sleeping Posture:

There are so many bad ways to sleep that are bad for your back and neck. If you think about how long are you in a sleeping position, it is no wonder that people develop stiff backs or necks. Our bodies are often used to sleeping in certain positions and we feel uncomfortable when we sleep in a slightly different position.

Remember that although we may prefer to sleep in our usual position, this does not mean it is a posturally correct or healthy posture, and in most cases, it means we are reinforcing a pattern of years of twisting and contorting our skeleton. Many people confuse the concepts of luxury and health, as luxury somehow means being ‘more looked after’ or cosseted. If a mattress or pillow is more luxurious, it may often result in encouraging a lazy posture, which comes more naturally to our conditioned bodies.

So let us examine a healthy sleeping posture. You want to try to keep your spine and neck in alignment the whole time you are in bed. There are in other words two skeletally healthy sleeping postures. Your ability to achieve these is largely dependent on you adopting the correct body position, the performance and suitability of your mattress and the height and nature of the pillow(s) you are using.

With regards to posture, then the two recommended sleeping positions are:

On your back, with your neck in line with your spine, looking upwards. In other words you should be looking straight forwards.

Do not use too thick a pillow so your neck is bent forwards. The pillow should be just the right height to allow your neck to be straight and in line with your spine. You can always raise the height of a pillow by putting a towel or folded vest or t-shirt inside the pillow case (on the underside). Or buy a slightly thicker pillow. Some orthopaedic pillows will have a raised height around the neck to provide more support to the base of your neck. However, those pillows designed for sleeping on your side may not be suitable as the base is too thick/raised and they will exert too much pressure on your neck and may result in your neck/throat being raised up and your head tilted back.

Do not turn your head to the left or right when you sleep on your back with your cheek and side of your face resting on the pillow behind your head. If you spent half of your day with your head turned to one side, it would be extremely uncomfortable. Whilst the neck joint is designed to move, the neck is not intended to rest or remain in the turned position for long periods of time, but seconds at a time. The more severe/pronounced the turn, the more pressure you put on your neck vertebrae. Some pillows have a natural hollow for the head and provide more lateral support, so the body does not have to try so hard to keep the head in the same position. If your pillow is not laterally supportive then you could perhaps consider using a pillow to place on top of the pillow your head is on, but propped up against the side of your head (by your ear), to give your head some support. Your mattress and bed should not ideally sag so your bottom and hips sink too low, meaning your whole back is curved the wrong way – similar to slouching on a sofa.

On your side, with your torso, shoulders and hips perpendicular (i.e. at 90 degrees) to the bed. The lower leg (in direct contact with the bed) should ideally be straight out and extended, with the upper leg bent with the knee out to the side, preferably supported on some pillows (if necessary, depending on your mattress), and with a high orthopaedic neck pillow under your head so your head isn’t tilted to one shoulder or the other). The head should be facing forwards and be perpendicular to your shoulders, and not turned to one side (into the pillow or looking up at an angle at the ceiling). The pillow should support the neck (which is higher up than the side of your head), and should be the correct height. A low pillow can always be raised up to the perfect height as mentioned above with a t-shirt or small towel. There is nothing you can do with a pillow that is too high. The upper thigh should ideally be parallel to the bed, as should the side of your face.

If your head is in not tilted to the left or right shoulder and you have the perfect height pillow, it is possible to tuck in your chin too much (in a similar way to looking down or tilting your head forwards when you are standing up). This again will prevent your neck being straight and in line with the spine and may result in neck ache long term. Try to have a positive posture and look straight away from your body. The more you dip your head and tuck in your chin, the more likely the rest of the back is to follow suit and curve also. It is common for tall people or those who are shy or with low self-esteem to habitually look down or tilt their head forwards/down in this way. Some pillows may rub against your nose if you have your head in the correct position, encouraging you to bring your head in more towards the body to avoid the nose rubbing which can be irritating. If this is the case, you may want to consider changing the pillow or sleeping with your head on one side of the pillow so your face is on the edge of the pillow with nothing rubbing up against your face, but still getting enough support from the pillow so your head is at the correct height.

A variation of this posture is to have both legs semi-extended and together, with a cushion between your knees. If you don’t have the cushion between your knees, after a few nights you may find that you develop pains on the contact areas on your knees that will stop you sleeping. The above posture is preferred however. With the knees together posture, in order to provide enough balancing support, the tendency is to bend your knees more, which can result in bending the knees more in front of you, then curving the whole spine (in a slouching sofa style), which is clearly not good for your back. It may also end up in the foetus position, which is posturally and psychologically unhealthy!

If you don’t use a pillow under your upper knee, then the tendency is for the upper thigh to taper down towards the mattress, with the knee and shin/calf and foot on the mattress. This tends to exert a pressure/stretch on the gluteal muscles on your upper buttock and to pull on the hips on one side, which usually results in some twisting and your hips not being perpendicular to the mattress anymore. The torso and shoulders tend to compensate by tilting towards the bed more (maybe 45 degrees or more) and it results in your neck getting twisted slightly. If not, then you will put a constant torsional twist on your spine during your time in bed. Both of the above are incorrect or lazy ways of sleeping on your side. They are bad for your neck.

Some people are unsure what to do with their arms/hands when sleeping on their sides. It doesn’t really matter too much. You may have the lower arm extended out to the side in some fashion with the upper elbow resting on your side and the forearm resting on the mattress or on your lower arm. There are pros and cons with each position, as too much pressure on the lower arm from your upper arm may be uncomfortable result in frequent changing of position, and may reduce circulation in your lower arm. In addition, you may be tempted to hug your lower shoulder or similar, resulting in a slight pull on the upper shoulder and tilting the shoulders towards the mattress more, which can result in similar problems to the above scenario. You may find using some kind of pillow or cushion in front of you may be helpful for supporting some of the weight of your upper arm. Any number of pillow configurations is possible, and it is likely you will have more the worse quality/suitability your mattress is.

Sitting at your Desk:

service-icon-2You may find that if you have your chair too low to the ground, then the body will naturally tend to slouch. This is cured by raising the chair up and you fill find keeping an upright posture very easy indeed. If you tend to keep your feet underneath you rather than directly below the knees with your feet on the floor, this may cause tension in the body as well as encourage a bad seating position. In addition, it may be helpful to have the base of the seet either flat or slightly sloping forwards to help you keep a straight back. A seat base the slopes backwards, where your pelvis is lower than your knees, is conducive to slouching and it is very hard to maintain a proper posture in this position.

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Driving:

Getting out of the car: Remember what we said about bending and twisting? You have to rotate yourself so you are facing the door opening and then get out. If you twist and get out, your back will not like it!

The risk with most driving seats if that if you are too tall you have to tilt the seat right back, and then you are slouching excessively as there is no lumbar support. Ideally the knees should be below the level of the pelvis, not above it! However, this is not normally possible in saloon cars (particularly sports saloon cars) or sports cars, but usually only in , trucks or MPVs with very high roofs.

Hatchbacks may have enough headroom to have an upright posture, but it is unlikely that the seat can be raised enough to allow the hips be in line or higher than the knees. Of course, this may well be possible in most cars if you are short. If you are tall, this is much more difficult. Please bear in mind that many car seats have a life of 3-6 years depending on usage and after this they tend to sag, especially at the base, as the padding and springs are mechanically worn. A good upholsterer can cheaply modify your car seat by taking the plastic back off the seat and inserting additional foam padding into the seat lumbar area, for example, to improve the lumbar support of your car seat. Or by removing all the relevant padding and springs and replacing them with new units. The correct seat parts can be purchased from your car dealer, or an independent official parts supplier, including foam inserts and the base unit including springs, depending on specification. These can be fitted by the upholsterer of your choice to keep costs down. The more expensive alternative is to buy a new car or physically change the entire driving seat.

Whether we like it or not, driving is bad for your back, no matter how expensive or inexpensive a car you drive. The art of going around a corner results in some tightening of the muscles around the lower back and rib cage. Modern cars are able to go around corners faster and faster, and in addition, modern lifestyles and impatience means that often we drive around corners or roundabouts faster than we perhaps should.

  1. Dural fibrosis,
  2. Arachnoidal adhesions,
  3. Muscle & fascial fibrosis
  4. Mechanical instability resulting from the partial removal of bony and ligamentous structures required for surgical exposure and decompression
  5. Presence of neuropathy.