Ever wondered why you get a stiff achy back standing around in queues or waiting at the photocopier?

Shifting from one foot to the other to get comfortable? Suffering from neck, mid or lower back pain after standing for long periods?

In this post I am going to describe the three main standing postures I see in clinic and some of the problems that these positions can cause. In addition describing ways to correct these positions in order to achieve a neutral standing position (The correct posture!)

In clinic I hear many reports from clients who tell me they have a tilted pelvis, their spine is out of alignment or they just have bad posture. If the spine was out of alignment or the pelvis was tilted or twisted we are talking about a structural skeletal problem. This type of injury requires either a large sudden impact to the pelvis or spine, or it is a long term chronic structural condition with far deeper causes. These are serious conditions and require expert assessment, specific treatment and discussion with orthopaedic specialists as to the treatment plan.

However, in clinic the majority of clients are not suffering with these conditions but are standing in such a way as to cause the pelvis to be tilted forwards or for the spine to be held in a flexed,

extended, rotated or tilted position. This means that we are consciously using, or not using our muscles in many cases and we fall into three main positions.

• The Flat back,
• The Tilted pelvis
• Forward shoulders

Before we get to that it is important to know why the correct standing position is so. It is basically down to anatomy and biomechanics (The way joints move and interact with one another).

The spine is known as being sigmoidal, meaning S shaped. This is because the spine should be curved, we have three natural curves in the spine which are the Lumbar lordosis (Lower back), Thoracic Kyphosis (Mid back) and Cervical kyphosis (Neck). This should not be mistaken for spinal conditions called Lumbar lordosis or Cervical kyphosis. We are referring to the normal and optimal position of the spine in a static position. See image right

The reason we have these three curves is due to the shape and size of the vertebrae, the cervical vertebrae are much smaller than thoracic and lumbar vertebrae. As we move further down the spine the vertebrae increase in size and change shape. Which in turn changes the angle of the spine and forms the natural curves. This is supported by a complex system of muscles which we control!

The flat back…

This is someone who stands tall through the spine. Often they will say to me that they have been told to imagine being pulled up through their head. This causes them to elongate the spine and causes the vertebrae to almost stack on top of one another. Standing in this way often leads to neck and shoulder pain resulting in headaches.

The tilted pelvis…

This is the lazy stance, much more common than the flat back. This is where someone stands with the knees locked back and the hips pushed forwards. This caused the pelvis to sit in a forward tilted position. Over time hip flexors and the quadriceps muscle become tight. This effectively holds the pelvis in this forward position. Standing in this way causes the forward tilting of the pelvis and increases the Lumbar curve of the spine. This then has a knock on effect throughout the spine and leads to a combination of anterior pelvic tilt and a forward shoulder position.

Forward shoulders

This position is seen most when clients are sat down, sitting slumped over a keyboard for 8 hours a day will lead to the shoulders falling forwards.  Over time, this altered sitting position starts to occur when we are standing and this is potentially due to a combination of learned behaviour and muscular restriction. This position can also combine with the tilted pelvis position but is variable from person to person.

Symptoms

It depends on you and your body as an individual as to how your back copes with this stress and where or when you start to feel discomfort. Potentially these positions will cause ankle, knee and hip pain, lower, mid and upper spinal / back pain, shoulder and neck pain potentially leading to headaches.

The main focus for all these scenarios is posture education and advice. Providing manual treatments such as manipulation (cracking the spine), massage, acupuncture and stretching will help to control the symptoms but will not resolve the underlying problem. If posture changes are not implemented it will only be a matter of time before the symptoms return….

Treatment

Here are the two main strength and conditioning exercises required. Doing these exercises will enable you to not only achieve but to be able to maintain the correct position. However it is important to note that doing these exercises will not resolve your back or neck pain. Consistently maintaining optimal posture can.  Once you have practiced these exercises for a week or so, start trying to move your pelvis and control the position of the pelvis and shoulders when you are not stood against the wall and see if you can control the movement more specifically. It is only then that you will be able to adapt or change your posture. This is the key to the whole process.

This exercise is designed to strengthen the muscles in the mid back and needs to be done in order to provide the strength and endurance to be able to hold the shoulders in the correct position when standing.

Try this with a tin of baked beans in each hand. Do 20 – 30 repetitions 2-3 times. Once a day.

This exercise is to help you to control the position of your pelvis. Stand with your back up against a wall and try to flatten the small of your back into the wall. You can use a hand towel in the small of your back to help, try to squash the towel with your back. You should feel your abdominal muscles tighten and your pelvis will tilt backwards. Whilst holding this try to squeeze your shoulder blades together as in the exercise above.

Practice this for 5 -10 minutes once a day

The movements required to achieve a neutral standing position or “good posture” are easy but require specific control, practice, strengthening and perseverance. In many case you will have ‘learnt’ to stand in the wrong position it can take some time to change this habit.

This information is a guide on how to achieve a neutral and optimal position when standing. It is not meant as a diagnostic reference and if you are suffering with symptoms you should seek further medical advice.

As always any feedback or comments are welcome.