Blog Post written by Dr. Marnie Hansen, DC, a Chiropractic Physician in Salt Lake City, UT
April 18, 2024
"Sit up straight!" Our parents would say.
And for good reason. Good posture is a sign of good health. But getting it doesn't have to be hard, tedious, or boring. And there is so much more to it than just sitting up straight.
A patient once said to me (and I'll never forget!):
"Dr. Marnie, good posture is sexy. We should all work on our posture for this reason."
While there are many more important reasons to work on your posture, let's face it, good posture looks good on. Standing tall exudes a sense of embodiment, self assuredness and self love. There is a good energy to it. We tend to gravitate toward people who hold their heads up high, and want what they have. And in this case.. wanting this is good! Being aware of your posture, and wanting to improve it is the first step in changing it for the better.
Numerous studies, papers and research published discuss how good posture is linked to good health. It can reduce wear and tear on the joints, and prevent sports and performance injury. Good posture can also play a big role in overall health and longevity, as it aids in proper circulation and organ function.
The opposite is true, as well. Bad posture can lead to poor health outcomes. It's no surprise that poor posture over time can increase your risk for neck and back pain, joint pain, inflexibility and organ dysfunction. It can make you look older and decrease your life span, and overall mood and wellness.
According to the NIH:
"Poor posture can also decrease your flexibility, how well your joints move, and your balance. It can impact your ability to do things for yourself and increase your risk for falls. Slumped posture can even make it more difficult to digest the food you eat and breathe comfortably." (1)
You've probably heard the term, "Sitting is the new smoking." What we do on a daily basis adds up! From slouching in front of our computers and phones, to forward head posture in the car. Slumping over on the couch during a good movie or hunching over our dishes, gardens or books. What is one to do in a world set up for poor posture?
Awareness is the First Step
Good news is, is that it's not too late to make improvements to your posture! And becoming aware of your daily habits, and how you got to be where you are, is the first step. Poor posture can take years to develop, the great news is that it doesn't have to take years to improve.
So, what, in fact, causes postural problems?
When we are in a chronic state of forward flexion, like bending over our computers and phones, this over-tightens the muscles at the base of your skull and upper neck, as well as your pecs, as we roll our shoulders forward in back posture. Conversely, this will weaken the deep neck flexors that hold your head up high, and the rhomboids and lats, which keep your shoulders down and back.
This is called Upper Cross Syndrome, or Upper Crossed Syndrome, (2) as the weakness from the deep neck flexors to the lower traps, lats and rhomboids create one half of the X, and the tightness of the suboccipital muscles and pecs create the other.
Lower Cross, or Lower Crossed Syndrome (3), is caused by an imbalance or weakness of the glutes, abs, and related muscles, creating one half of the lower-cross. Conversely, the low back and hip flexor muscles take over to do all the work, causing tightness in the low back muscles, quadratus lumborum, and hip flexors such as the piriformis and psoas muscles.
Becoming aware of how you use your body is essential for postural improvement. Being aware of how the muscles and structures are affected by slouching, helps you self assess what muscles are helpful to stretch and what muscles to strengthen.
For example, after a long day at a computer, it might feel nice to stretch your pecs or do some back bends as you lay back on an exercise ball. Getting up every once in a while from a long plane flight to do squats or forward bends might relieve some back pain. Fixing your posture is possible, and awareness is the doorway to restoring it.
Check Your Posture at Home
Now that you know what Upper and Lower Cross Syndromes are, and are aware of your habits contributing to poor posture... let's do a posture check!
You will need a mirror, preferably full length. Start by looking at your posture from the front and ask yourself these questions:
Is my head and neck tilted to one side or the other?
Is one shoulder higher than the other?
If I put each hand on my hip bones, are they level?
Do my knees bow out or come in to touch each other?
Are my ankles rolled in or out away from center?
Do my feet pronate or supinate (roll in or out?)
If you answered yes to any of these questions, it is likely you have postural stress. Many times this can be corrected with good habits, other times it takes the help of a trained professional with a keen eye for posture and has the physical medicine skills and experience to change it.
Looking at the bag of tools a practitioner has is helpful in determining where to go for postural help. Chiropractors are highly trained in postural biomechanics and spinal movement, and many specialize in postural correction through specific adjustments and exercise. Physical Therapists are highly trained in postural exercise and biomechanics as well, and can also provide an excellent resource for postural relief and strengthening. The Alexander Technique is a well known postural technique, and seeking out massage therapy can help relieve pain that comes from postural stress.
I show my patient's these postural self checks to do at home, along with checking them in-office during routine adjustments. Getting adjusted can go a long way in postural correction, and maintaining it with healthy lifestyle choices molds the postural work long term.
Address Forward Head Posture
Addressing forward head posture is key to correcting upper cross syndrome. This head posture is typically a learned habit over time, or a result of injury. Chronic forward head posture can be a result of slouching at a computer or phone, whiplash, concussion, sports injury, or everyday falls and spills.
So, what is forward head posture?
Think of a straight line running through the top of your head, through your ears, the middle of your shoulders, hips, knees, and ankles (if you are looking at yourself from the side). For every inch your head is naturally forward from this line, it is estimated that you are putting 10-12 pounds of pressure on the structures of your neck (or cervical spine) and structures like the discs, ligaments and muscles.
A normal neck should have a good curve to it. A neck that has been through trauma, injury or chronic postural stress typically shows a reduction in curvature, if not a reversal in curvature when X-rayed.
Why does this matter?
Your spine protects your spinal chord and all of the delicate branches of nerves that run out of it. A healthy curvature allows the spinal cord to run through it with better ease, and breathing room, so to speak. A reduced or reversed curve typically adds tensile stress to the spinal cord, nerves and muscle attachments. I tell my patients to think of a banana, and stretching it to curve in the opposite direction. Puts a lot of stress on the banana, it's outer skin, and everything connected to it, right?
So, what are the biomechanics behind this? How does this happen?
Your head is like a ten-pound bowling ball (give or take), depending on your size of head. When it is in a forward position, it will over engage and tighten the suboccipital muscles (headache muscles, base of the skull), upper traps (shrugging muscles), and pecs (slouching forward). Therefore, the healthy supportive muscles of the neck like the deep neck flexors (that hold your head high) and lower traps (keeps your shoulders down and back) become under engaged or weak.
Your body can alert you in the form of headaches, neck pain, eye pain, shoulder tension or pain, or even nerve issues down the arms or upper back. And your body is very smart! People will come in to my clinic with pain that they think just started out of the blue, when really, if I just look at their posture, I can see it took years to develop, and the symptoms of pain is just a side effect of poor body mechanics.
Forward head posture adds unnecessary pressure of the spine, which can have effects not only on the muscles, but can lead to arthritic issues and joint degeneration, stress to the nervous system, radiculitis and nerve pain due to the spinal stress. Over time that can certainly add up.
Forward head posture is no joke. Addressing it early can save years of neck pain down the road. And likely years of your life. I've added a few posture saving exercise below for you to get started on.
Support Your Spine
I see a lot of neck and back pain in my office, and as the prevalence of desk jobs is on the rise, I see it in younger and younger populations. They all ask me for advice on what they can do at home.
The first question I usually ask, is: What position do you sleep in?
Being a side sleeper can put stress on your neck, shoulders, hips, knees and low back. Stomach sleeping puts and incredible amount of stress on the neck. Most of my chronic neck pain patients are stomach sleepers. Back sleeping can be difficult for some to fall asleep, or increase symptoms of sleep apnea.
So, what position is best?
Back sleeping puts less stress on the spine in general, and is my recommended form of sleeping. For those suffering from sleep apnea, side sleeping helps with keeping the airways open. I tell my patient's if they side sleep, make sure that their pillows are propped up enough to allow a 90 degree angle between their head and shoulders, and put a pillow between your knees to take the stress off the hips and low back.
If it's painful to sleep on your back, perhaps try getting fitted for a proper neck pillow, or try using a bolster under your knees to reduce stress on the low back. I fit my patients for neck pillows in my office, and find the support on the neck can be very relieving for neck pain and headaches.
If you have to sit or drive for your job, I recommend to my patients that they find a low back support. Sometimes I find that rolling up a towel and putting it in the curve of the low back can be much more effective than fancy and expensive devices that don't contour properly to their spine. Other options to consider would be sitting on an exercise ball to keep the core engaged, or try using a sit/stand desk.
Structure and function are interchangeable and always work together. Proper exercise supports the underlying structure of the spine, as proper spinal alignment can reduce the stress on the nerves, muscles and organs that it attaches to and protects... leading to better function! Supporting the structure and function goes a long way with postural health.
Get Professional Help
Get checked! A trained eye can give an objective perspective on exactly what is happening with your posture, and provide a comprehensive treatment plan.
Chiropractic can assist in supporting the spine in proper movement and flexibility. Chiropractors trained in postural correction also work on improving cervical and lumbar curvature to put a little more spring in your step and improve the shock absorption ability of the discs, so to speak. They also work with severe postural problems such as scoliosis and thoracic kyphosis (too much curvature of the thoracic spine) or Dowager's Hump (4).
A proper Chiropractic postural exam includes assessing for Upper and Lower Crossed Syndromes, Forward Head Posture, Thoracic Kyphosis, Lumbar Lordosis and proper Cervical curvature. X-ray examinations are extremely helpful in postural assessment and screening for any arthritic or degenerative changes due to wear and tear of the joints, inflammation or chemical imbalance.
Simple Exercises for Postural Support
I give a few starter exercises to my patients to help in the process of postural correction. These can be done at home or in the office, and the more the better. The body responds well to consistent and frequent input, and as these exercises are easy to do. They do require dedication and sometimes it takes time to see results.
They are safe to do for nearly every body, yet it's always a good rule of thumb to run any kind of health recommendations by your trusted physician. Perform them to your tolerance, and remember some soreness is OK. Listen to your body, and if it the exercise aggravates your condition, either stop, or reduce the frequency or intensity of how you do them. But know, in the beginning, some soreness does happen. (Videos on these exercises to come, for now, here are some brief descriptions):
Wall Angels Stand against a wall, putting your shoulders, heels, head and hips against the wall. Bring your arms up to the wall as if making a 'snow angel' movement. Make sure that your wrists, elbows, shoulders and fingers all stay against the wall (this is hard, and is the goal with this exercise). Now, slowly angel your arms up and down by engaging the muscles between your shoulder blades and keeping your hands, wrists and elbows against the wall. Not easy, huh? It gets easier with practice. Do this once a day, for 30-60 seconds each. Great for Upper Cross Syndrome and Forward Head Posture.
Brueggers Postural Relief Can be done at your desk chair, bench, or anywhere where you can sit with your knees, ankles and hips all at 90 degree angles. (Video coming soon, will help! Youtube this one for now) Find your sit bones and sit right on them. Sit upright, bringing your shoulders down and back, head straight back, giving yourself a 'double chin.' Engage your core and sit like this for 30-60 seconds, several times a day for relief.
Pec Stretches Find a doorway, corner or telephone pole and stretch that pec! Open up the chest and use your body to pivot into the stretch. Voila'! You've relieved your desk posture for a while!
This should provide a good foundational start to your postural journey. By incorporating these tips, you are on your way to sexier posture and a healthier body! Wishing you a happy healthy spine!
Dr. Marnie Hansen is a Chiropractic Physician working in Salt Lake City, UT. She has specialized in the correction of postural issues and musculoskeletal pain for over fifteen years, incorporating soft tissue therapies into her gentle Chiropractic techniques with the goal of achieving faster results for her patients. She sees a broad range of conditions, including neck and back pain, scoliosis, pelvic floor pain, disc herniation, radiculopathy and nerve pain, sports injury, sprains and strains, concussion, headache, and more. "If you feel it, I've seen it," she says.
For more, check out doctormarnie.com
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