Written by Margarita Gurevich senior physiotherapist
Is there a one size fits all for ‘perfect posture’? You might recall being told by your parents, when you were a child, not to slouch, to sit up straight, to hold your head up as you walk. While these reminders are good, there is much more involved when it comes to postural correction. The main thing to remember is that no two individuals are the same, hence it’s logical that there won’t be a ‘generic’ perfect posture.
Our posture has a great impact on our physical and emotional health. It affects not only our appearance, walking style, balance and sports performance, but also respiratory and digestive functions and other health parameters.
As physiotherapists we deal with postural issues on a daily basis. Interestingly, when people think of the term ‘postural correction’, many believe that the areas which need to be focused on are the neck, shoulders, and back. Yet when we assess a patient’s posture, we thoroughly examine not only the neck position, spinal curvature and shoulder height, but also the patient’s leg position (e.g. bow knees) and the arch position of the feet (e.g. flat feet). The reason is that if there are issues in the joints of the lower half of the body (e.g.in the hips/knees/ankles) this can have a bearing on the person’s upper body posture.
Some common issues which are often identified during the postural assessment are:
excessive kyphosis – increased curvature of the thoracic spine (upper back)
insufficient lordosis – reduced curvature of the lumbar spine (lower back)
excessive neck protraction – forward head posture
winging of the scapulae (shoulder blades)
downward rotation of the scapulae
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It’s really important for the assessment to be functional. For example, when a patient comes in with lower back pain, we assume that incorrect posture is the main factor causing pain, or at the least a big contributing factor. If this hypothesis is correct then the person’s pain should start to decrease once we correct his/her posture. This is why the assessment mentioned above is so important. Having done the assessment it becomes obvious what needs to be done in order to help that particular individual attain and maintain the right posture. If there is in fact a significant postural component to the person’s pain, then it will start to decrease fairly quickly once the posture is corrected.
‘So why is there no one ‘perfect” posture?
Once again it is because all people are unique. In fact, you can take two people who both have upper back pain, for example, give them the same postural exercises, but while one person will start feeling better in the corrected posture, the other one might start to feel worse. Let’s focus on this point in a bit more detail.
A common postural exercise which is often prescribed by some physios is to take the shoulder blades down and back, hold for a few seconds, then relax. Yet will this exercise always be helpful?
Two common postural issues listed above were ‘winging’ and ‘downward rotation’ of the shoulder blades. One special test which many physios use is the ‘single arm wall push up’ test. During this test, the patient places one hand on the wall and performs ‘the single arm wall push up’. As the person does this, two movements indicate what is happening to their shoulder blade on that side.
Often the shoulder blade will go out to the side and rotate up. This would be caused by weakness of the muscles between and below the shoulder blades, primarily the rhomboids and lower trapezius muscles.
On the contrary, sometimes the shoulder blade will go out to the side and rotate downwardly rather than up. This would be caused by weakness of the muscles between and above the shoulder blades, primarily the serratus anterior and levator scapula muscles.