Sit Up and Take Notice:
Posture and Pain

by Jamie Chiapetta, P.T.

Developing and maintaining good posture is a process that everyone should be concerned with throughout their lives. The constant effects of gravity on earth create this demand. Many Southside Physical Therapy patients who are treated for neck and back pain never sustained any form of trauma. This leads us to believe that poor posture alone can often be responsible for causing pain, and when trauma is involved, poor posture can prevent healing.

When a person assumes good posture the joints of the neck and back are placed in the neutral position, putting the spine’s joints under the least amount of stress. This allows for healing to occur more easily following trauma such as a car accident or a lifting injury. Excessive stress of the joints – even without trauma, secondary to poor posture – can cause excessive wearing (Osteoarthritis) and may lead to the production of bone spurs. Bone spurs are created when an excessive amount of bone is laid down in the body’s attempt to combat the wearing away process. Unfortunately, sometimes these bone spurs will push on surrounding structures causing pain. Maintaining good posture, therefore, helps protect your joints.

In order to assume good posture one must first know the optimal spine position. When standing and sitting, the head should be aligned directly above the shoulders with the shoulder blades and shoulders held back. The lower back should have a small forward curve and this can be supported while sitting with a “lumbar roll.” In sitting, the hips should be slightly higher than the knees and the feet should be on the floor. The head should be held directly above the shoulders when working at a computer and a small nod of the upper neck, by bringing the chin down toward the chest, is appropriate to visualize the screen. From a side view in standing, the canal of the ear should be aligned with the tip of the shoulder, the hip bone, just in front of the knee, and finally just in front of the ankle bone. The knees should be slightly bent.

A common poor position is the forward head, rounded forward shoulders and increased lower back curvature. This stance prevents 1) the back joints from being in a position of least stress and 2) the vertebrae from aligning themselves over one another correctly. Think of building blocks (24 of them to be exact which is the number of vertebrae in the spine) that are stacked one on top of the other. If the blocks are not aligned well enough, the stack will fall. This of course does not occur with people because muscles and ligaments (soft tissue) are used to resist the effects of gravity. Unfortunately, the soft tissue structures are not usually strong enough to withstand this force and pain then becomes present. Muscles may become tight and sore with a sense of general fatigue. Again, the joints are also placed under more stress allowing for excessive wearing to occur.

Often assuming a position of “good posture” will create discomfort for those who have adopted bad habits. Physical therapy can help people achieve better posture by providing gentle stretching techniques and strengthening exercises that are specific to each person’s postural dysfunction. Education on correct posture for lifting and other activities will also help in preventing pain and obtaining a stronger, healthier spine.

Posture is addressed with every SSPT patient. Posture can often be the underlying cause of pain and the reason pain keeps returning. Even if pain is not yet a factor, one should address posture in order to remain pain-free.

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