Posture - Standing, Sitting, Lying

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Poor Posture creates extra stress on the spine.

Good Posture Habits

Proper Posture Prevents Back Pain

Poor posture (sitting, standing, or lying down) makes the back more vulnerable to injuries and back pain; weak or shortened muscles contribute to poor posture. Fatigue also contributes to poor posture and back pain.

Poor Posture and Back Pain:

When the spine is not in proper alignment the muscles, ligament and joints all are under extra stress. Muscle strain is the most common cause of back pain due to poor posture.


Discs can also suffer from poor posture. When the spine is in proper alignment, the cushioning, shock absorbing discs that are in between the vertebrae are not overly stressed and not as subject to injury.

Lower back pain is the most common back pain caused by poor posture, as the lower back supports most of the weight of the body. However, poor posture can also cause upper back pain, especially in those who slouch. Neck pain is also common.

Strong Muscles for Proper Posture:

Muscles support the spine. A weakness in any of the muscles that support the spine makes it difficult to maintain proper posture. Poor posture is a common cause of back pain due to muscle strain, especially lower back pain.

The back muscles, ligaments & discs are under extra stress when the spine is not in proper alignment. Strong muscles help keep the spine in proper alignment and prevent back pain. Strong muscles also prevent the spine from extending beyond its normal range of motion, which is essential to protecting the ligaments and disks from injury.

Flexible Muscles for Proper Posture:

Tight, shortened muscles in the back or buttocks can throw the spine out of alignment and cause back pain. Stretching the back muscles is important for good posture, but other muscles, such as shortened hamstrings (muscles in back of thigh), can also affect spinal alignment.

What is Good Posture?

Many people remember being told 'Stand up straight' or 'Don't slouch' when they were children. Like 'eat your vegetables', this is still good advice.

The spine, however, is not actually straight. The healthy spine curves inward at the neck, outward at the chest, and inward at the lower back. These two curves balance each other to ensure that the pull of gravity is evenly distributed. If the curves of the spine are increased or decreased the muscles, ligament and joints have to work harder to support the weight of the head and body. This leads to fatigue, strain and back pain.

When standing, the center of the head, the shoulders, center of the body, knees and feet should line up vertically.


Common posture errors of the lower back that cause lower back pain:
Swayback - an increase in the natural inward curve of the lower back.
Flattened back - a decrease in the natural inward curve of the lower back.

Common posture error of the upper back that cause upper back pain:
Rounded or hunched shoulders - an increase in the natural outward curve of the upper back.

Common posture error that causes neck back pain:
Head Forward - ears in front of the shoulders, caused by a bent over position or hunching the shoulders.

The Lower Back Posture Errors:

The positioning of the pelvis controls the curve of the lower back. The pelvis should be in a neutral position. If the pelvis tilts forward, sway back results (the natural inward curve of the lower back is increased). If the pelvis tilts backward, flattened back results (a decrease in the natural inward curve of the lower back). Control of the pelvis is key in keeping the lower spine in proper alignment and preventing lower back pain.

Like the spine, the pelvis is supported by muscles of the back, and abdomen and buttocks and strengthening these muscles helps maintain good posture and prevent back pain.

SWAY BACK - A Common Posture Error of the Lower Back:

When the pelvis tilts forward the lower back arches excessively - sway back. Sway back places extra stress on the ligaments of the spine and leads to back pain. Sway back is more common in a standing position than in a sitting position. Wearing high heels also causes the pelvis to tilt forward and contributes to sway back.

Shortened muscles can also cause swayback. Stretching these muscles and maintaining the pelvis and spine in a neutral position can restore good posture and relieve back pain. Not only can shortened back muscles cause sway back and back pain, but shortened hamstrings (muscles at back of thighs) can contribute to sway back and back pain.

Test for sway back: There should be a slight inward curve to the lower back. To see if your back curves excessively (sway back), stand with your back against a wall, place your feet about 6 inches from the wall. Make sure you head and buttocks are against the wall. If your posture in correct, you will have no more than two inches between the small of your back and the wall. If it is over than this, you have sway back.

*If you have more than 2 inches between the wall and your neck, the muscles in the back of the neck and back need stretching. Don't be impatient. Lengthening the muscles through stretching exercises must be done gradually to avoid overstretching injuries. Overstretching muscles in the neck and back can result in intense neck and back pain and stiffness.

Sleeping on your stomach shortens the muscles in your back and encourages sway back. Sleeping on your side with the knees bent helps counteract a sway back and can relieve back pain.

The pelvic tilt exercise (see back exercises) is especially good for a sway back and can relieve lower back pain. The 'cat' is also beneficial. See Back Exercises page.

FLATTENED BACK - A Common Posture Error of the Lower Back:

There should be a slight forward curve to the lower back. Flat back is more likely to be a problem when sitting than when standing. If the pelvis is tilted too far backward, the lower back loses its natural curve, muscles and ligaments are stretched, causing lower back pain.

Upper Back Posture Error:

ROUNDED SHOULDERS is a Posture Error of the Upper Back:

If your shoulders are rounded you need to stretch the chest muscles and strengthen your upper back muscles. Rounded shoulders are usually the result of slouching. When slouching, the natural forward curve of the neck is also exaggerated, which can result in neck pain as well as upper back pain. It is more common to slouch when sitting. Slouching is often caused by fatigue, especially when sitting in front of a computer.

Slouching also compresses your diaphragm, when leads to shallow breathing. Proper posture allows proper breathing and sufficient oxygen intake. Getting enough oxygen helps to relax muscles and prevents stress from building up in the muscles, especially the muscles of the neck and back. Tense muscles area common cause back pain and neck pain.

Other Posture Error:

HEAD FORWARD- A Common Posture Error:

The back of ears should be in line with shoulders, chin parallel to floor. Being in a bent over position or slouching causes the head to be too far forward.

When standing or sitting in an upright position the weight of your head (about 15 pounds) is supported by your entire spine, which acts as a pillar for your head.

Poor posture habits such as leaning forward puts the burden of supporting the head on the muscles in the neck. This causes muscle strain and pain in the neck and can even cause headaches.

Once the neck muscles are strained, leaning your head over for even very short periods of times can cause neck pain. Proper posture allows strained neck and back muscles to heal more quickly.

The head is heavy and the muscles of the neck take the entire load when your head is forward, creating neck pain.


Many people spend much of their workday sitting. Proper posture while sitting is vital for preventing back pain.

Even when maintaining good posture, sitting for prolonged periods of times can tire the back muscles. Take frequent breaks from sitting; take a short walk every half hour to hour, as the human body was not designed to stay in one position for long periods of time.

Also, the discs are under more pressure when sitting than while standing. Having a chair that reclines slightly shifts you weight onto the backrest of the chair; this allows your back muscles to relax, and takes some of the pressure off of the discs.

Adjustable Chairs With Good Back Support Prevent Agonizing Back Pain.

The pelvis should be in a neutral position. Certain chairs cause the pelvis to tilt backward, decreasing the curve of the lower back (flattened back), which places extra stress on the lower back and causes back pain. If you don't have access to a chair with a good back support, place a small pillow in the small of the back to correct the curve.

Some people try too hard to sit up straight and actually end up tilting their pelvis forward and arching their back. This increase in the curve of the lower back (sway back) also strains the lower back and causes back pain.

When sitting in a chair, the feet should be supported. If the seat is too high for the feet to reach the floor, use a platform to rest your feet on. The knees should be level with or slightly higher than the hips.

Besides lower back pain, neck pain is common when good posture is not maintained while sitting. Make sure your computer monitor isn't too high of low. You shouldn't have to tilt your head up or lean forward to see the screen. We often extend our neck to look at a computer screen, sometimes because it is too far away, sometimes out of habit. Looking upward or looking downward or sideways (which is common practice when viewing a document upon a desk) puts excessive strain on the neck and upper back and causes neck and back pain.

The arms should hang at your sides. If your computer keyboard is too high or too far away the arms have to be kept raised or extended, resulting in tense shoulder and upper back muscles and back pain.

The top of the computer screen should be just below eye level. When reading, place the material on an angle; don't place the reading material flat on a desk or your lap. Leaning your head over for prolonged periods of time is brutal on your neck muscles.


Lying on side with knees bent - pillow between knees for support:

Sleeping on your stomach increases the curve of the lower back, leads to shortening of the muscles in your lower back and encourages sway back. Sleeping on your side with the knees bent helps counteract a sway back and relieves back pain.

If you absolutely must sleep on your stomach, place a pillow under your hips to help support the lower back. However, sleeping on the stomach also can strain the neck and is not advisable.

Lying on back with knees bent - pillow under knees for support:

Lying on the back with straight legs can cause low back pain.

Proper support for the back while lying down is vital in preventing back pain. Back pain not only can result from a saggy mattress, but hours of watching TV while tying on a saggy couch.

Mattresses and Back Pain

A good mattress will conform to the spine's natural curves and keep the spine in proper alignment.

When lying on a saggy mattress, the spine is thrown out of alignment. For people suffering from lower back pain, a saggy mattress that causes the lower back to sink into the mattress and can irritate the spinal joints, resulting in more lower back pain upon awakening.

It the mattress is too firm there will be gaps between the inward curves of the body and the mattress that leave parts of the back unsupported, stressing the back and causing and back pain.

The solution is to get a relatively firm mattress with enough cushioning for comfort. (There must be enough cushioning to distribute the weight of the body and eliminate pressure points) If you already own a bed that is overly firm, you can just get a good quality foam topper for your bed.


Whether Standing, Sitting or Lying - Change Positions Frequently for Back Pain Prevention and Back Pain Relief. Holding any position for too long can also tire out the back muscles and cause back strain and back pain. Holding a position in which the spine is out of alignment makes the back even more vulnerable to back pain. Changing positions frequently will avoid using the same muscle group for too long.

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