Spine - Posture & Back Pain

What is posture?

• Orientation or alignment of human body, either static or dynamic

• Static posture: body and its segments are distributed in a manner that maintains the body in equilibrium. Standing, sitting, or lying all ex. of static postures w body at rest

• Dynamic posture: body or its segments are moving - walking, running, jumping, throwing, lifting

Main types of posture

• Ideal or optimal

• Kyphotic-lordotic

• Flat back

• Sway back

• Forward head posture

Optimal posture (even load distribution)

• Head stacked over shoulders

• Shoulders over hips

• Hips over knees/ankles

• Normal spinal curves

  • Cervical lordosis (~30-40 deg)

  • Thoracic kyphosis (~20-40 deg)

  • Lumbar lordosis (~40-60 deg)

Kyphotic-lordotic posture

• Increased thoracic kyphosis

  • Facets and VBs in flexion and upslide position

• Increased lumbar lordosis

  • Increased ant gapping and post compression

  • L4/5 shear forces increase

  • Facets in downslide

• “S” shaped curve in spine

Flat back posture

• Decreased or absent lumbar lordosis

• Post pelvic tilt

• Decreased shock absorption

  • Puts more pressure on IV discs

  • Movement restrictions

• Trunk lean forward to compensate posture

Sway back posture

• Pelvis pushed forward in front of body w post tilt

  • Causes excessive lumbar lordosis

• Lumbar flattens and loses lordosis

• Increased thoracic kyphosis

• Torso “hangs” in extension on ligs and other passive tissues

  • Ligamentous creep can occur

Types of sitting posture

• Slouched

  • Post pelvic tilt

  • Decreased lumbar lordosis

  • Increased lumbar flexion

  • Increased IV disc pressure

  • Increased passive tissue strain

• Forward lean sitting

  • Trunk flexion

  • Highest spinal loading

  • Increased disc pressure (~200-275% of standing)

  • Often seen w studying/computer use

• Upright sitting

  • Ant pelvic tilt

  • Maintains lumbar lordosis

  • Decreased disc pressure (vs slouched)

  • Requires more muscle activation

Posture & LBP

• Posture has effects on:

  • Biomechanics

  • Muscle activation

  • Load distribution through skeletal system

    • Especially spine

• Posture and LBP have a multifactorial relationship

  • Not causal

  • Long term bad posture can have effects on body that can cause LBP

• Some research has shown connection w level of pelvic tilt and how it affects LBP

  • While others show no relationship between LBP and posture

• No clear consensus if correlation btwn posture and LBP

• Instead of correcting posture, JOSPT suggests PTs to focus on:

  • Exercise

  • Movement

  • Manual therapy

  • Education

  • Load tolerance