Posture

Sit up straight! Stop slouching! Shoulders back!

For many, these commands beckon memories of parents reminding us to correct for a poor posture. A lady recently told me how her mother would frequently have her balance a book on her head to maintain an upright position. Thinking this is “proper” she has maintained that position for 30-40 years up to this point. But what is proper “posture” and “position” for our body? Should we be balancing encyclopedias on our head throughout the day for optimal health?

My sister-in-law was in town last month and happened to be dealing with some back issues. As a former dancer, she seemed to be stuck in a “ballet” position: Very upright, back overly extended and arched, on her toes frequently. (She also had been dealing with ongoing plantar fasciitis, see FOOT BLOG to find out why!). We had a great conversation about where she needs to be at in space so that she does not continue to dance through life with overactive back muscles (and heel pain).

These blogs seem to form based on common themes of conversations I have with patients around the time of writing. Lately, I have found myself having similar discussions about posture in sitting, standing, and walking with patients. People often assume positions and postures from learned motor behavior, trauma, external stimuli, and inherited tone that may be negatively affecting their health and well-being.

It may be helpful to define posture and position before we get in to what is optimal for our human bodies. Posture is often defined as the intentionally or habitually assumed position. Our general posture develops from intentional positions (sports, parent’s verbal commands, and other learned motor behaviors) and habitual (hobbies, work positions, other habitual movements) positions and patterns. Underlying tone from our neurological and respiratory systems will also influence our posture. The World English Dictionary defines Posture as follows:

World English Dictionary

d English Dictionary

Note how much of the word “attitude” arises in the definitions. Attitude of the limbs or body…mental attitude or frame of mind….a false or affected attitude. Your posture reflects your general attitude and conveys a message about your attitude and state of mind to those around you. Others are affected by your posture, consciously and unconsciously. To learn more about this, check out this brilliant TED video by Amy Cuddy on how your body language shapes who you are and how that reflects to those around you: http://www.ted.com/talks/amy_cuddy_your_body_language_shapes_who_you_are

Position as it relates to the human body is a general term for a configuration of the human body. The position of the body parts relative to each other will form the posture of the body. We have various tests to see the body is in an optimal position. Improper position of our body parts often lead to abnormal and excessive stress on tissues and less than ideal movement patterns. Intentional and habitual motor behaviors, as well as underlying systemic tone can lead to improper position of our body, resulting in pain and decreased performance.

As physical therapists, we often focus on figuring out the position of your body to see how it is contributing to your symptoms. We also need to be aware of how the position of the body is contributing to the posture and how the posture may be influencing the position and the resulting symptoms. In the clinic we often give corrective exercises and use manual techniques to positively influence the position of the body to improve body mechanics and resolve your symptoms. We often watch you in different environments (BIKE, SWIM, RUN) to see how that is affecting your body position and symptoms. So what are common posture patterns influencing body position that may be negatively affecting your symptoms and contribute to pain?

Contrary to what is commonly thought, many of us are too upright or extended. A lot of humans are dancing through life stuck in a “ballet” position, that is, too much back muscle tone and activation and too erect. We are continually balancing the encyclopedia on our heads to the detriment of our body’s health. With that said, doing the exact opposite is not always good. Slouching down with your chin at your chest working your way through the next level of Angry Birds does not put your body in an optimal position for proper posture.

So what are the keys for proper posture to position our body for optimal alignment?

Dance through life like no one is watching….less extended! Your dance instructor is not watching anymore, relax your back and neck, get off your toes and feel your heels. In a “proper” standing position, most of the weight should be through our heels. Accomplish this by relaxing your back, allowing your pelvis tuck under which in turn will bring the center of gravity back to your heels.

Maintain more of a natural “rest” position. That position is where your body relaxes to at the end of a long sigh. Exhale fully throughout the day to feel this. Blow up balloons to get a sense of it. Many will have a hard time feeling this fully exhaled “rest” position due to chronic hyperinflation resulting in restricted rib and thorax mobility.

Keep your “ribs down” in sitting and standing positions to help achieve the above two points. This is a cue that works for many in sitting, standing, walking, and running.

Move your arms when you walk. When one of our legs moves forward, there is a momentum force created that needs to be dissipated by the opposite arm swinging and opposite trunk rotating forward. Not allowing proper arm movement on both sides will often result in an increase in back tightness and activation to control the forces created by the leg. This can cause increase in back and neck tension and will pull you back to that overly extended dance position. “The Gait Guys” recently discussed this with running. Check it out at http://thegaitguys.tumblr.com/post/91865899474/spine-pain-and-arm-swing-do-you-truly-get-this

Don’t slouch! (Mom was right about this one) The previous points discussed a lot about decreasing extensor tone to stop being overly erect and upright. As we address this with patients, many feel like they are “slouching”. Their internal perception in space is stuck on being too erect and upright so to find a position that is less than that will result in an altered perception of their body in space. They will feel like they are slouching, when in reality they are in a relaxed, comfortable state allowing their body to be in a more optimal position. But don’t go home and tell your mother your physical therapist told you to slouch! Not the case at all. A typical teenager slouched way forward in a chair with their chin down updating their Facebook status is not optimal.

In Amy Cuddy’s TED talk she concludes that tiny tweaks can lead to big changes. These changes can be both positive and negative. Tiny tweaks consistently over time to make your body too upright and erect can lead to a less than optimal body position resulting in pain or symptoms. A posture like this affects our attitude and other’s perception of our attitude. An overly erect and upright posture, while it can be a mental confidence booster, is often portrayed as being apprehensive and unapproachable. Chronically being stuck in this posture negatively affects our body position and potentially our social and work interactions. Allowing your body to be more in a state of exhalation, that is, less extended, will put your posture in a state that will allow a favorable body position. Those around you will view your attitude as being relaxed and approachable. So feel free to take that encyclopedia off your head, exhale, and dance through life with your ribs down and weight in your heels. Your body will thank you and your social and work interactions may improve from your body’s new attitude.

This post was written by Craig Depperschmidt, DPT, PRC