We all know that our posture is poor! Most of us are sitting in a slumped over position while we work, while we are texting on our phones, eating our food, watching Netflix, doing homework, basically throughout the majority of the day! And we wonder why we have back pain, headaches, and tightness in our neck and shoulders. But not only does our poor posture lead to rather insignificant pains, it can take us down a path towards more serious injuries. Let me explain how. Posture is a HUGE deal my friends.
Let’s start off with different types of posture so we can then delve into the implications.
Types of Posture
There is not necessarily a “perfect” posture, but there is such a thing as a balanced or neutral spine. The first type of posture variation is called Lordosis.
Lordosis
A lordosis is an excessive inward curvature beyond a normal range. Both the lumbar spine and cervical spine naturally have a lordotic curve (a “C” shape), but having an increased curve in these segments can lead to an abnormality which can also be referred to as swayback in which not only is there an increased lordotic curve, there is then an increased kyphotic curve in the thoracic spine as a compensation. This type of posture can occur from extreme extension movements seen in dance, cheerleading, gymnastics, and pole vaulting or high jump. Typically, swayback will come with ligamentous laxity (looseness) which then creates instability in those joints. This can occur from other conditions such as pregnancy, obesity, cerebral palsy and muscular dystrophy.
Kyphosis
A kyphosis is an excessive forward curvature of the spine resulting in a “rounding” of the back. The thoracic spine has a natural kyphotic curve to it. When this curve becomes excessive, it then requires the cervical spine to deviate into a forward head posture (we will get to this!). Kyphosis can occur from consistent slouching or rounding of the back (sound familiar?), developmental abnormality acquired congenitally, or from a severe structural deformity. One thing to note about this type of postural abnormality is the effect on the lungs. With a drastic abnormality in the thoracic spine, the lungs are directly in front of the thoracic column and will be most likely impacted!

Flat Back
A flat back variation of posture will be displayed with a decrease in curvature throughout the spine, making the spine appear “flat” or straight. Usually this is seen in the thoracic and lumbar segments of the spine. With this straightness that occurs, usually the hips must compensate and will naturally rotate posteriorly to adjust. The posterior hip rotation then changes the entire lower body mechanics. Most often, flat back is developed from constant sitting, however, this type of abnormality can be developed as a result of injury. Which then leads to more injury. Fun right?!

Scoliosis
The last type of postural variation is scoliosis. This abnormality involves a lateral curvature to the spine and can occur in any segment. Scoliosis can be considered functional or structural. Functional scoliosis occurs when the spine is compensating to maintain correct head positioning. This occurs with some type of muscle imbalance, muscle guarding due to injury, or a leg length discrepancy. Typical conditions in which a functional scoliosis is seen is in muscular dystrophy, cerebral palsy, or other birth defects to the vertebrae. Structural scoliosis is caused by a defect or congenital bony deformation. Some scoliosis cases can be classified by both functional and structural. The main concern with any type of postural variation, but in particular, scoliosis variations, is the long term health of the spine and the curvatures getting worse. This then can compromise the integrity of the spinal cord and/or nerve roots.

Next we need to look at the shoulders and scapula, as they play a large role in posture. (This is my favorite!)





The shoulders, neck, and scapulae are large components to posture that ultimately lead to the most pain, especially when exercise is involved. The first thing we need to look at are the shoulders.





Rounded Shoulders
A rounded shoulder posture is soooooooo common now-a-days. It can be a compensation from another posture variation, but it usually goes hand in hand with the wonderful slouched position we are all in. Sometimes, this posture can also be related to mental health and body acceptance. If depression or anxiety is a factor, individuals tend to stand with less attention creating a slouch. Or if a woman is well endowed in the chest, subconsciously she may resort to a rounded posture to remove attention. When the shoulders are rounded forward, the scapulae are next to follow. The scapulae will protract or slide forward/around the thoracic cage. When this occurs, the muscles that are responsible for keeping the scapulas retracted or back (I.e. the rhomboids, latissimus dorsi, serratus anterior, middle and lower trapezius) will be placed in a lengthened position and therefore lose strength from not being active. This may also bring about a scapular winging position in which the scapula are rotated off of the thoracic cage and protrude posteriorly. Along with this, rounded shoulder posture will cause the pectoralis major and pectoralis minor to be in a shortened position and create tightness. Lastly, in order for us to see being in a rounded shoulder posture, we have to extend the neck to make our head level. That brings me to the next postural variation.
Forward Head
Forward head posture is exactly what it sounds like, bringing the head forward and extended. Forward head posture is also called “Text Neck”. This creates a shortening of the posterior neck musculature and therefore an extreme tightness. This combined with “holding our stress” in the neck and shoulders creates a very uncomfortable section of the body. The head itself weighs approximately 13 lbs. When a forward head posture is developed, the displacement of the weight of the head moves anteriorly creating an increase in muscle activity posteriorly in the neck and shoulders. So not only are the neck muscles shortened and tight, they are needing to work harder to support the weight of the head. These muscles are the levator scapulae, upper trapezius, scalenes, and the suboccipial muscles.
What do all of the postural variations mean?

When it is all put together, you get: Upper Crossed Syndrome and Lower Crossed Syndrome





Upper Crossed Syndrome
These are the complexities created with the slouched posture. Rounded shoulders and forward head creates a tightness in the upper trapezius and levator scapulae (tight posterior neck) and a weakness in the neck flexors. Along with this, there is the cross of tightness in the pectorals and weakness in the rhomboids, latissimus dorsi, serratus anterior, and lower trapezius. In combination with these imbalances, the anterior portion of the shoulder has a lot less space for the tendons to fit properly and the angle of pull on the muscles then changes as well. These all become a problem when going to perform overhead movements. Whether that is lifting a barbell overhead, spiking a volleyball, swinging a golf club, lifting your baby up in the air, or jackhammering cement. How can it be expected to perform these movements well and pain free with the entire upper body alignment unbalanced?
Possible Injuries as a Result of Upper Crossed Syndrome




Shoulder impingement


Rotator Cuff Tear


Chronic Migraines and Headaches


Thoracic Outlet Syndrome


Biceps Tendinitis


Trigger Points


Lower Crossed Syndrome
These are the complexities created with a postural variation involving the lumbar or thoracic spine. This causes tight erector spinae muscles that run along either side of the spine and weak abdominal muscles. This syndrome also leads to the imbalance of weak glute muscles and tight hip flexors. Again, these imbalances become a factor when trying to perform movements such as squats, lunges, kicking a soccer ball, running, jumping, swinging. In actuality, upper crossed syndrome factors can contribute to lower crossed syndrome imbalances as compensation. If an individual is unable to lift a weight overhead properly, the lumbar spine and hips will compensate to help and create the possibility of further injury.
Possible Injuries as a Result of Lower Crossed Syndrome



Disc herniation


Spondylolisthesis (sliding or slippage of the vertebrae)


Nerve root impingement


Hip impingement


Poor patellar tracking and patellar dislocation


Ok, so my posture sucks. What do I do for it?
First off, give me a call! I would love the opportunity to help you create better posture and eliminate the risk of future injury. Posture dysfunction is literally my favorite to correct (only those in the healthcare field get excited about these things!) Second, understand that having good posture is a lot more than just “sitting up straight”. It is re-educating the body of what correct posture feels like. It is re-teaching the weak muscles to activate properly again. It is stretching the tight muscles. Correcting posture takes WORK. But, by putting in the WORK, you are reducing injury risk, reducing pain, and re-aligning the body naturally so you don’t have to think about “sitting up straight”. Third, here are some great exercises to get you started on your path to better posture!
But wait… can’t I just wear a posture correction brace?
Sure, you definitely can. But, it will not help long term. The brace will put you in a better posture, but the problems will still exist. You have to strengthen the weak muscles, stretch the tight muscles, and teach the body. A brace cannot do that.
What about Kinesio tape?
Sure, you can wear Kinesio tape to help correct posture. But, it will not help long term. The tape may remind you to sit up straight, but again, it is not correcting the problems.
So if you want to CORRECT your posture for real, here is a good starting point. Head to my website to find a series of exercises that can help!