I think we all know, at a baseline, that good posture is healthy for our bodies. And yet, right behind gravity and yoga, poor postural habits keep me in business. The interesting thing is that I see a pretty equal number of slouchers and those that take “good” posture too far and cause themselves just as much pain as their slouching counterparts. So what is “good posture”? Let’s dive in.
First, let’s talk about how the spine is meant to work. Just like a car, our skeletons have parts and those parts are meant to fit together in a certain way and move in a certain way. You wouldn’t turn one wheel on your car 30 degrees outward and expect the car to go straight, would you? Or the tire not to wear out, right? Our bodies are machines too – they’re just made of biologic parts, most of which can’t be replaced.
If you look at the spine from the front or the back (see the middle picture above), it should pretty much be a straight line. Any curvature you see in that direction is called a scoliosis. To me, though, the more interesting view of the spine is from the side – what we call a lateral or sagittal view (far left). The lateral view gives you a good idea of how weight should be distributed in the spine between the discs and the facet joints. We’ve all heard of the discs, in part because injuries to the discs are very common. But injuries to the facet joints are just as common, and generally when your doctor tells you that your xray shows arthritis or “wear and tear”, it’s in the facet joints.
In a normal spine, the weight (or load) should be fairly equal between the discs and the facet joints. So back to that xray: if you have arthritis in your facet joints, why do you think that is? Your medical professional might try to pass it off as “age-appropriate wear and tear”, but let’s be better than that. Is it because your father had arthritis in his spine? Nope. It’s because you’ve been leaning on those facet joints for years. Here’s how that happens:
Look at the above picture. It’s a group of seemingly erect, good-looking healthy humans. But I can tell you by looking at this picture who’s going to get arthritis in their spine, and it’s not the woman on the left. I’ve added dots and lines to illustrate a point. The top dot is at the side of the shoulder and the bottom dot is at the side of the hip. In normal, aligned anatomy, the top dot and the bottom dot should be in line with one another. So I added a line for each of them. The woman on the left, who I’ve said is probably not going to get facet joint arthritis, has 2 dots that line up on a vertical axis. The poor two souls on the right, however, both have the same problem: the top dot is behind the bottom dot. What that means is that they have much more weight through the back of the spine – the facet joints – than the front of the spine – the discs. And you would look at the woman second from the right and think “wow, that’s nice posture!” Right? But she’s what I have non-technically termed an “over-corrector”. She’s so intent on standing up straight that she’s thrown her shoulders behind her hips. And that might not cause problems in her teens, but it’s sure going to in her 40’s. And 50’s. And 60’s. You get the point.
I’d like to define the term “swayback”, because this is a term that’s thrown around quite frequently and people don’t really know what it means. Look at the models below:
The figure on the far right is standing in a swayback, meaning his shoulders are behind his hips. Swayback doesn’t mean a big curve in the low back – it means that if you drop a plumbline from the shoulder, it falls behind the hips. Swayback is SUPER common. I correct it constantly. Sometimes it’s from postural over-correction – the throwing the shoulders back approach. Sometimes it’s because a person has a large belly – either from pregnancy or obesity and they’ve had to adjust their center of gravity to keep from falling over. And sometimes, I’ve come to theorize, it comes from psychosocial causes. I’ll give an example: I once treated a male psychotherapist, a pretty tall guy, who had one of the worst swaybacks I’ve ever seen. As we were working on correcting his posture and getting him more upright, he happened to mention that he’s been told he’s intimidating when he stands up straight. Huh! My husband likes to joke that some people don’t like me at first because I have really good posture and they think I’m prissy. Huh! And why is it cool in middle school to slouch? Clearly there are psychosocial factors that contribute to the way we hold ourselves, which I find absolutely fascinating and I’m ill-equiped to treat. All I can tell you is that you stand like that gentleman on the far right and you WILL get facet joint arthritis at a certain point in your life and get to be very good friends with someone like me.
Now that you have that long-winded back-story, we can start to talk about the fun part: CORRECTION. I find that, when correcting the swayback posture, simpler is better. If you try to think about 25 cues at the same time, chances are you’re going to fail. Two cues are generally enough: 1) take a 1″ forward bow and 2) very slightly rise up from the crown of your head.
Now you’re not going to bow as far as these ladies, but the forward bow picture makes the point that the only thing you’re doing is hinging at the hip. For most people, 1″ is plenty. Try it with a nice full-length view of yourself in a mirror. Find the point where you see your shoulder come right over your hip and hold there. Now face forward. You’re going to find that you feel like you’re leaning forward and you want to look at the floor. Don’t worry – that’s just because your brain is not calibrated correctly. Without changing the orientation of your plumbline, get your head looking forward. And there you go – you’ve corrected your swayback.
Habit change is hard. It takes diligence, it takes correcting yourself a hundred times a day. But it’s worth it and it can be done – your brain and your body will re-calibrate if you’re consistent. And it will save you years of pain and time and copays and imaging and worry. So get out there and stand up straight! (But not too straight).
The Movement Mama 