Good posture. It is one of life's Holy Grails it would seem. How many times have you been told you need to "Fix your posture - pull your shoulders back!"? I hear it said many times from parents and children, friends and relatives, even therapists tell people this...but nearly 99% of the time, this is the WRONG ADVICE!!!
So what exactly do you do?
The aims of this article is to:
1. Explain what good posture is
2. Explain why pulling your shoulders back is NOT the right thing to do (not good posture!)
3. Give you some ideas of what to do to have better posture
For a video on a postural myth, click here
I think for most people, we can certainly see "good posture" better than we can describe it. Sometimes things don't "look right", other times it is subtle and still other times people might think it looks good and it isn't (from my point of view).
I can reference lots of definitions that would answer the question"what is good posture?" but I think the most practical definition is the one I go by...it is where your body is most efficient at doing what you ask it to do.
You see, posture isn't a static activity. Even the Buckingham Palace guards have to breathe so movement is occurring all the time. It isn't a tense posture but it isn't "loose" either. It shouldn't be hard work but it does take a little bit of effort (sometimes).
I think good posture is more a thinking activity...but thinking about it only every now and then. People with "good posture" have probably worked at it more than you - or have been shown how to work at it more efficiently than you have! I will show you later what I mean 🙂
Why pulling your shoulders back is NOT the right thing to do
But I wouldn't be The Physio Detective if I didn't ask "why are your shoulders forward?". In fact, all good therapists worth their salt ask questions like "Why?" and "How?".
You see, your shoulders sit on a rib cage and your rib cage is more like a cylinder than a rectangle - it has curved surfaces. On top of this cylinder sits your shoulder blades - and they only sit on there because muscles hold them in place - there is no "true" joint surface like some other joints have. Therefore, your shoulders sit where the sum of the forces of gravity, your soft tissues (muscles and ligaments) and your bones put them.
An example of how this works is for you to hold a pen in between your fingers. Allow it to hang vertically. Now, you should be able to hold the pen still and move your hand and arm up and over the pen without it pointing away from the ground. You can only do this if you hold onto the pen with *just* the right amount of force. Too hard and your pen will tilt as you move your hand. Too soft and you will drop the pen. That is how posture and your shoulders are related!
Therefore, if you have shoulders that are forwards, it is simply reacting to the foundation on which it sits on - your rib cage must be tilted backwards or your muscles are pulling you forwards because you love "Chest Day" at the gym and you skip "Back Day" or whatever reason you have.
Simply pulling your shoulders back against the sum of these forces just adds more forces - which increases tension in your body. The 2 most common reasons I hear about why people "gave up" on their posture correction exercises are:
1. It's too much effort - pulling against forces is tiring - it is no wonder that it is an effort...
2. It hurts too much - adding tension to painful structures like muscles and joints can make them sore - why do it?
In this example, I have asked our willing volunteer Lauren to stand in a classic "sway back" posture and then pull her shoulders back. Please note that her spinal angle doesn't change and pulling your shoulders back can actually make your neck poke out more!
In this example, I have asked Lauren to pull her tummy in, bum in, chest out and shoulders back - I think you will agree that it doesn't look right!
Simply pulling your shoulders back is not likely to be the correct solution
The Lessons Learned About "Shoulders Back"?
1. Your shoulders sit passively on your rib cage - don't force them back or forwards
2. Your shoulders are mainly affected by your rib cage position - maybe look at how your rib cage is sitting
3. Adding more effort is not sustainable or usually effective
4. Simply pulling your shoulders back is not likely to be the correct solution - it doesn't give you good posture!
Some Steps Towards Better (Good) Posture...
Ok, there are LOTS that I do to get this right - explaining it on here would take a whole website's worth of blog posts to explain it all. However, let me hit the highlights...
1. Getting posture perfect is not achievable
It simply is impossible to have "perfect posture"...I can always find *something* that is not "ideal". I don't ever ask my patients to have perfect posture. My patients never ask me to get them back "perfect again" - if they do, I correct them 🙂
I prefer to take the view that posture is a sliding scale and that it is "about right" for the task. Yes there are things that can be better but ultimately, if you can achieve the task you want to with minimal strain to your body, then that's cool. Obviously bending over to pick up a pen off the floor has a LOT more variability and I am less fussy about how you do this than if you were to try to deadlift 150kg! The more load you have, the less room for error you have.
2. Test and Retest
This is one of the greatest learning tools I can give a patient. Nearly all of my patients want me to "check that I am doing it right"...with posture, I ask them to tell me if they have it right. I can't be there to hold your hand all the time so I try to take the time to teach you how to check for yourself. Here's how you do it...
1. Choose a movement or activity that "hurts" or you have stiffness with or decreased movement. e.g. turning your head. You can even choose a resisted exercise like lifting 2kg or having a partner push on you
2. Note the effort it takes to do the movement - is your neck sore? Can you turn as far? How much effort is it to lift 2kg?
3. Correct your posture to what you think is "good posture"
4. Retest steps 1 and 2 - is it easier or less painful? If it is, you are closer to a good posture for that task. If it isn't, then either you haven't got it right or it isn't right for you.
When I am with my patients, I make sure we find what these tasks are so they can test and restest at home and work.
3. Your Performance Will Improve
This is similar to the point above. Some people don't have pain, they just can't progress in their exercises or they can't go longer at something - sometimes your posture can affect this!
Some quick examples of how changing someone's posture has helped
1. Hockey player who was dropped from taking "short corners" because she couldn't push the ball out hard and fast enough for the play - I changed how she set up for the shot. The end result? A stronger push out!
2. Elite level Rugby player constantly getting injured. Had been doing "core" work since schoolboy rugby. Changing how he set himself to do his exercises, weights and even tackling opened his eyes to the power of good posture. He was an open-side flanker (whose main job is to tackle and then get the ball). I told him to set for a tackle and then I pushed him over with one hand. He was horrified. I showed him how to set for a tackle differently and I couldn't budge him - I had at least 30kg and 6 inches in height on this guy!!
3. Lots of patients who have pain turning their head to check for traffic. I check their sitting posture. One minute they can barely turn 30 degrees. Change their posture, they can turn nearly 90 degrees. Obviously for them, they know they are in the right posture when they can turn their head properly!
4. Friends who have trouble lifting a weight, especially something like a deadlift. Setting the feet, ankles, knees, hips, back, shoulders and neck into more efficient positions allow the body to generate more force.
Basically, the more efficient the posture, the more efficient the performance!
4. Some Cues I Ask My Patients To Think About
Here are some trade secrets for you 🙂
1. The breast bone and the pubic bone (in general) should line up vertically one on top of the other
2. Your pelvis should be in neutral - neither tilted in or out
3. Your back and neck should have a gentle lordosis and your thoracic spine (between your shoulder blades) should have a gentle kyphosis (rounded). This is normal. A flat back between your shoulder blades is NOT normal
4. I ask my patients to over-exaggerate the posture they need to be in - really work hard at it...then imagine that they are a puppet pulled into the air as the "grow taller". Once they are there, gently relax so they keep their alignment but decrease the tension in their body. This works really well 🙂
5. Changing posture will feel "wrong" - this is because your body has receptors in it that tell the brain where you are in 3D. Your brain doesn't like listening to all the signals it gets so it has a mechanism to "turn down the volume" of some of the signals it gets. This includes where you are in 3D. So any change turns the volume up and keeps letting you know that you are "not at your usual spot". most people move to "turn the volume down" (feel back to their usual normal) but then nothing changes. Only through consistent repetition will your brain learn what the new "normal" should be. That is why posture is a thinking exercise that should be done every now and then to train the brain where you should be!
A Video Example...
I can go on and on about posture and other topics but this article is nearly 2000 words now!
The take home message is simply
Don't pull the shoulders back - put your rib cage in such a way that your shoulder sit properly
Putting your rib cage in the right position requires lots of things to be checked - joints, muscles, nerves, coordination, bone shape (yes, crooked bones can cause bad posture!). Sometimes the problem is very close to the shoulders, sometimes it is from the feet. Basically it can be because of any joint in the body - I like to check posture from the feet up or the head down - there is no point being "holistic" if you don't practice what you preach!