IMPROVING YOUR POSTURE

Liz MacLeod is a physiotherapist with a pain management programme. She looks at the importance of posture and explains why you need those curves.

I am sure anyone who has a problem with pain, especially back or neck pain, will have been told by their doctor, physiotherapist, chiropractor or other health care professional, that it is important to maintain good posture. Any magazine or programme on TV which has a "healthy back" theme will almost certainly describe "good posture" and mention its role in keeping your back fit and healthy.

Some of you may have been given specific posture exercises. You may have attended classes where the teacher emphasised the principles of good posture. There are sound reasons for applying these principles. They are based on the knowledge we have about the mechanics of the spine and structures that support it (for example, our muscles and ligaments). Let's have a look at some of those posture issues.

NEUTRAL POSITION

The spinal column is not a straight structure but curved to give it an S-shape. The upper curve is described as the cervical curve, the middle the thoracic curve and the lower the lumbar curve. When we stand or sit with the curves in place, the joints, muscles and tendons are in a neutral position. This means they are least stressed. It is a good idea then to adopt the neutral posture as first choice.

Some of you will have been working on improving your posture. You will have developed a good feel for the neutral positions and be using these postures most of the time. It is good to work on improving the postures you use most of the time while standing (for example, in a queue or peeling potatoes) or while sitting (for example, watching TV or eating a meal). The muscles you use are then being strengthened and the small joints in your spine are under less pressure. By improving your postures you reduce the likelihood of stress on ligaments or any of the soft tissues which help to keep your body in good condition. A well-conditioned body is fit, well balanced and much less prone to injury.


Some of the patients who attend the pain management programme have found it difficult to work on improving their posture. Whenever they adopt the neutral posture for any length of time, their pain flares up. This can be for different reasons.

ADAPTIVE SHORTENING

When you have pain, your body adjusts by adopting a posture which feels more comfortable. This may result in you standing with most of your weight on one foot or sitting mostly on one hip. If you have long-standing pain, the adjusted position may have been your preferred posture for years. If this is so, your soft tissues (your muscles, tendons and ligaments, etc.) will have shortened or adapted to your preferred posture. Can you see how this adaptive shortening will hinder you from achieving your neutral posture? Whenever you try to get there the shortened soft tissues are put on a stretch which results in pain.

Sometimes when the neutral position is attempted, pressure is shifted onto a joint which perhaps is degenerate because of arthritis, or a nerve embedded in scar tissue is tweaked. There can be many reasons why the pain is generated from that troublesome area in your neck or back. Whatever the reason it feels sore and to be avoided! The problem with avoiding is that you never give your spine and supporting soft tissues a chance to be in restful postures. It is likely too that, as part of a coping strategy, you are avoiding certain activities, movements and exercises which give rise to pain. The consequences of all this avoidance is a deconditioned body which is more vulnerable. This in turn leads to further strains and imbalance. How can you tackle this problem effectively?

CHANGING YOUR HABITS

You might find it useful to try this approach. We know that neutral standing involves:
• Weight bearing equally on both feet.
• Standing with the ankles, knees, hips and shoulders directly one above the other.
• Holding the head so that a plumb line dropped from the nose passes through the breastbone and big toe joints.
• Shoulders are held back in a relaxed posture.

How close can you get to this before your pain kicks in? You may find, for example, that you can manage neutral standing if you take three-quarters of the weight on your "good" leg. The next question is how long could you hold that posture before you feel you've done enough? Take a note of the time. For some of the patients on our pain management programme it may be only seconds before they are aware of a build up of pain. The time you identify is your baseline for neutral posture. If you build into your day periods of time for practising neutral posture,


using your baseline level, you will gradually be able to add on seconds or minutes. Trying to remember to do it may be a problem! So, build in prompts, for example, every time the adverts come on TV or whenever you make a coffee. On the hour every hour can be useful to start with. You can gradually add in more practice throughout your day until you have changed your posture habits to those which are kinder to your body. You can use the same approach to improve your sitting posture too.

SITTING

Neutral sitting involves:
• Sitting well back in your chair so that your lumbar curve is supported.
• Shoulders back and relaxed.
• Cervical curve in place.
• Knees and ankles at 90 degrees.


If you can improve your basic standing and sitting postures you will improve the condition of your spine and its supportive soft tissues. You will feel better balanced and more in control of movement, which in turn will improve your confidence to move more freely. Patients have reported less discomfort in parts of the body that had been taking more of the strain. This, believe it or not, can include the bowel - less constipated as a result of improved posture!

Remember though, your body needs to move to be healthy. If you don't slump into a C-shape from time to time, you’ll lose the ability to do up shoe laces! So while it is important to work towards those good neutrals, don't neglect the rest of your spinal needs – stretch regularly in all directions and exercise within comfortable limits.

Physio Footnotes © Liz MacLeod. All Rights Reserved.