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– by Emma Mattison, NASM Certified Personal Trainer, CNC, & SFC
It's not the LOAD that breaks you, it's how you CARRY it. – Lou Holtz
If you're a visual learner, here is this article in video form...
Your posture affects you more than you think...
Headache, heartburn, indigestion, bad mood, body pain, constipation… it's not Pepto-Bismol, IT’S YOUR POSTURE. Here are the top 6 most common bad postures, problems they may be causing, and how to fix them.
I know, that was a long list of possible side-effects... those are just examples of what problems your posture may be causing you. In this article, the 6 most common bad posture I'm going to be covering are :
(click each to jump to section)
The natural curves of our back
Before diving into the bad postures one by one, I do want to step into an explanation of what a normal back looks like. This is a foundation to understanding posture.
A normal back contains 4 curves. Starting at the neck, we have one that's supposed to curve inwards, towards the front of our body, which is called the cervical curve (concave curve).
The second curve is the convex curve of our shoulders and upper back, the thoracic or kyphotic curve. This curve (convex) has a slight push out away from our body.
The third one we see is at the lower back. This one can be called the "lumbar curve" or lordotic curve. Just like the cervical curve, it is supposed to push in towards the front of your body (a concave curve).
Last, but not least, we have the tailbone curve, also known as the "sacral curve." This one, just like the upper back curve (thoracic/kyphotic), is supposed to be convex as well.
So just bear in mind these four curves, because I'm probably going to be mentioning them throughout, considering they tie into posture.
Disclaimer: don't take anything that I say as replacement for medical advice, the information I'm just providing for you comes from research and should be taken for educational purposes only.
6 Most Common Bad Postures
Before I go into the list, I find it very important to give credit to the initiator behind every one of these postures, and how to fix them: Dr. Vladimir Janda. This brilliant Czechoslovakian physiotherapist and researcher discovered the "cross syndromes," based on muscle groups he categorized as either having the tendency to be too tight (flexors) and too weak (extensors). If you get a chance, read about this man – his story is incredible: About Dr. Janda.
1. Upper Cross Syndrome
This is arguably the most common posture issue. This is characterized by kyphosis or a hunchback posture, stooping forward, and sometimes even, neck humps – specifically, a Dowager's hump which is fatty tissue deposition accumulating on the poor positioning of the cervical and kyphotic curves from chronically poor posture... NOT to be confused with a "buffalo hump," which could be caused by other underlying medical conditions (Cleveland Clinic, 2018). Oftentimes, people with kyphosis or upper cross syndrome can be seen hunched forward with their head jutting forward. This is because they're used to staring at something, like a computer at a desk job or their phone.
Remember that I mentioned several things in the intro, such as indigestion and heartburn? Well, there’s one more that I didn't mention... which is incontinence, or the inability to hold urine. These are all things that upper cross syndrome has the potential to lead to, on top of bad mood and headaches. WHAT? Is it really that serious? Let me explain …
When you are hunching forward, or leaning forward, you're basically crushing your stomach and everything in your gut, including your bladder. Moreover, sitting constantly leads to poor functioning of the "local core muscles." One of these muscles is our pelvic floor. We do not exercises our pelvic floor enough – thus, leading to more potential risk for incontinence and even other issues of the anal sphincter control.
So what about heartburn and indigestion? Imagine all the time you slouch on the couch after having dinner, or you hunch forward to continue with your desk job after lunch. This can cause the heartburn you may feel after eating, and can additionally lead to indigestion (Harvard Health Publishing, 2021).
You might be shocked to know that upper cross syndrome may lead to lower oxygen levels too. Why? Because we're crushing our diaphragm as it cannot expand properly to allow for breathing! So we're "paradoxically" breathing, or chest-breathing, which decreases the amount of oxygen we can consume. What do lower oxygen levels mean? BAD MOOD. Not only that, so does pinching of nerves in your cervical spine which can further lead to headaches. Simply imagine the pressure on your neck, as the heavy weight of your bowling-ball head pushes forward too far with poor posture.
Upper cross syndrome is a major issue in our society because most of us typically have a seated desk job, and the lounging activities that we have after work don't help either. On average, as of 2022, Americans spend just over 3.5 hours a day, cumulatively, looking at their phones. Similarly, as of 2022, average television watching for Americans was around 3 hours a day. So take social media off the phone, put it away, and replace the tv time with a stroll in the park with family! Replace the phone breaks at work with a light stretch session at the desk... there are so many ways to work healthier habits into our daily lives.
How To Fix Upper Cross Syndrome?
Here’s a simple solution : strengthen the right muscles and stretch the right muscles.
When you're hunched forward, your chest is chronically tight, as are some of your neck muscles (levator scapulae) and your upper trapezius. Stretching those can significantly help.
Next, strengthen your middle back muscles and local core stabilizers of the spine. This is because most of our posterior chain muscles and core stabilizers are meant as long-term endurance muscles throughout the day. In other words, they're supposed to keep us upright. When we're not really being upright throughout the day, and we're not walking around or living an active life as our body is designed to do, then we're not exercising those posture muscles that are meant for endurance.
Now you can see why it’s really important to include a middle-lower back exercise that includes strength endurance training.
2. Lower Cross Syndrome
Another common one because it's also caused by sitting for prolonged periods of time. It causes excessive hip flexion, which means that your knees are crumpling forward towards your body.
When you're in the seated position, these excessively tight hip flexors can cause our pelvis to rotate anteriorly (tilt forward). This increases the amount of curve that we have in our lower back, which is not good because it puts more stress on our lower back. This is when you might experience lower back pain and hip pain. Simply because these hip flexors are chronically tight.
How To Fix Lower Cross Syndrome?
Solution : strengthen the right muscles and stretch the right muscles. (yes, again)
You have to stretch your lower back, and stretch your hip flexors. Next, strengthen your local core stabilizers, which are your core muscles, your DEEP CORE MUSCLES. The local core stabilizers are going to be key for most of these posture issues.
3. Layered Cross Syndrome
This is a sweet combination of upper cross syndrome and lower cross syndrome. The result? You're going to see someone slouching with a lower body that has an anterior pelvic tilt. As you can expect, this poor person will have the most issues and there's nothing you can do for it …. I'm just kidding!
To correct this posture, all you have to do is fix upper cross syndrome and fix lower cross syndrome. Same rules apply, stretch it and strengthen the right muscle groups.
4. Pronation Distortion Syndrome
Also known as the "pes planus distortion syndrome" (yes I know, ridiculously long name). I just call it, "knock-kneed, with turned out and flat feet" which looks like this :
For these individuals with pronation distortion syndrome, they usually end up with internal hip rotation. You might have realized that all of those bad postures that I mentioned, for example upper cross syndrome, have a cascade effect of posture modulation, and usually start from something wrong with the feet. Posture is almost never just localized into one problem area. If you get something wrong with your feet, it has the potential to effect other key joints in the body, called the "kinetic chain." This is exactly the case with the pronation distortion syndrome.
Flat feet are usually caused by weak intrinsic foot muscles (Sahabuddin et al., 2021). A weak foot with no arches results in tibial rotation inwards, and causes a rotation of the pulls the knees inward. When the knees are caved in, it twists the femur (thigh bone), causing an internal rotation on the hip. This is when you can start to feel aches and pains throughout the rest of your body. Many people with pes planus distortion syndrome, or pronation distortion syndrome, experience issues in their foot and ankle complex, such as achilles tendonitis or plantar fasciitis. Other knee problems, like having cysts in the knee and hip pain, can happen as well.
If you are an athlete, or looking to become an athlete, this posture needs to be corrected because it can lead to an increased risk of knee ligament injuries, such as ACL tears. The amount of torque that your tibia puts on your knees from the rotation can break, pop, or tear the ligaments in the knee, especially the ACL. So it is really important to make sure that you fix this. This posture also puts athletes at a greater risk for ankle sprains due to poor ankle mobility and strength. Something to consider as far as injury prevention goes!
How To Fix Pronation Distortion Syndrome?
Stretch the gastrocnemius (the main muscle of the calf), the adductor complex (inner thigh), and hip flexors.
For strengthening muscles, I would recommend starting with the feet. You’ll want to work on the intrinsic muscles of the feet, such as getting that arch back up to par, and strengthen the gluteal muscles too (Sahabuddin et al., 2021). Gluteal muscles can help with external hip rotation, so that will help you in the long run. Research shows that gluteal exercises combined with strengthened feet arch can compound the effects of fixing that posture (Goo et al., 2016).
5. Flat Back Posture
Flat Back Posture, also referred to as posterior pelvic tilt, is basically the exact opposite of lower cross syndrome – or anterior pelvic tilt. Instead of having the pelvis rotate forward, your pelvis rotates backwards, so now you look more like you have a “C” shape to your back. It won't necessarily look like that; it might look more flat, especially in the mid-low back. However, this posture represents a classic tail tuck, also known as, "butt wink."
People with posterior pelvic tilt, or flat back posture often complain of the sensation of falling forward and chronic lower back pain. So what exactly causes this syndrome? Guess what… It's SITTING.
Surprised? In fact, all these posture issues can be caused by sitting, one way or another. Your poor posture depends on the way you choose to habitually sit. If you sit forward and lean far in your computer, you may find your hip flexors are excessively tight – leading more towards an anterior pelvic tilt. For the couch potatoes, you might enjoy lounging backwards, which creates an arch for the spine backwards – leading more towards a posterior pelvic tilt, or flat back posture.
How To Fix Posterior Pelvic Tilt?
Having flat back posture, or posterior pelvic tilt, usually leads to tightness in the gluteal muscles and abdominals (specifically the actual rectus abdominis). In this case, I'm not talking about the local core stabilizers but the abdominal muscles that people typically try to work on – the "abs." These muscles are going to be tighter because you're constantly hunched forward.
To fix it, you will need to stretch the abdominals in the opposite direction. Don’t forget to stretch your glutes as well. For strengthening though, you're going to want to work on the local core stabilizers, especially the intrinsic and deep muscles of the spine, and a muscle called the quadratus lumborum. This is going to help you stay in that upright posture.
6. Sway Back Posture
This posture is simply complicated for two reasons. First, because there is a lot going on in the kinetic chain as far as issues. Second, it is a posture that is commonly mistaken for lower cross syndrome. People with posterior pelvic tilt syndrome have a big lower back curve, with the curve dipping really far in towards the front of the body. Oftentimes people will lean forwards with their hips, and they'll lean back with their upper back when they're talking. Another common habit is putting one hand on the hip and leaning back, while the hips push forward. Doing so puts a lot of compression on the lower back curve, which can result in lower back pain.
While the hips are forced forward past the line of the shoulders, essentially it is similar to getting punched into the lower back – putting a LOT of pressure on it. Now, remember that your head, that weighs like a bowling ball (somewhere between 10-20 pounds depending on your size), is now pushed backwards, off of the midline. As a result, your center of gravity completely changed. This is a main reason we see the other common issues that tag along with sway back posture: slight kyphosis, slightly rounded shoulders, and hyper-extended knees. These "tag-alongs" are basically the body's response to try to compensate for the shifted hips, and the weight of the head.
How To Fix Sway Back Posture?
You can understand now why I mentioned there is a lot going on in sway back posture... but good news is you CAN fix it. You'll focus on strengthening the hip flexors and local core stabilizers, and you're also going to strengthen the quadratus lumborum, which is a muscle of your back. Strengthening this muscle can help to fix "butt-wink" while doing squats too. Oh, and if you're a beginner with squats, or just want to improve your form, I've got a video here for that too: How To Do Squats Perfectly As A Beginner? Follow These 6 Easy Tips
For stretches, I do recommend stretching the gluteal muscles (primarily the gluteus maximus) and the hamstrings complex.
Interestingly enough, many elite gymnasts present with this posture issue! Research identified weakness of the lumbar multifidus (a local core stabilizer muscle) in elite gymnasts with postural sway (sway-back posture.) (Mahdavie et al., 2017) Another research article identified an increase in fat deposition in the lumbar multifidus AND another important muscle of the back (erector spinae) for individuals with sway-back posture, indicating 2 possible reasons: the fat deposition was from poor functioning and use of these muscles, and/or the fat deposition was the body's response to pain from the compression due to the lack of usage of these muscles (Pezolato et al., 2012).
Conclusion
In a nutshell, the way you sit and the activities of your daily life can lead to bad posture. This can further result in muscle imbalances, and vice versa! A "muscle imbalance" is when your muscles get super tight in certain areas, and weak in other specific locations of your body. Another note to keep in mind is that, while some gym activities are helping to fix your bad posture, some activities could potentially worsen your posture even further. This happens when you're strengthening the muscles of your body that are already systemically tight.
If you're curious what muscular imbalances you may have, I have an app that will be launching soon that walks you through finding your exact muscle imbalances – and then proceeds to organize the exact exercise prescription for your body! It's basically my brain as a personal trainer, turned into an algorithm for my app with interactive videos
😊 So sign up for the email list to be the first to get a 7-day free trail of the app when it launches! Oh, and if you sign up for the email list, you'll get a free gift sent to your email (hint: it's a free interactive assessment to test your balance!)
Other resources to watch :
If you think that might be the case for you, check out this video on the top five worst leg machines you might be using at the gym.
Or, if you're new to exercising you're just getting started, here's a great beginner's guide to the squat.
About the Author
Hi! I'm Emma Mattison. I'm an NASM certified personal trainer, nutrition coach, stretch & flexibility coach, pranayama breathwork guide, holistic nerd, and lover of birds & music! Scientific literature is fun to me, and my goal is to make it understandable and fun for you!
I am driven to share knowledge I find fascinating & transformative with my clients, and the world. Everyone has the power to take their health into their own hands!
My love for fitness and true discovery of health started with helping my best friend – who I can now call my husband! Today, I couldn't do any of this as smoothly and enjoyably as I do now without him! Check out our YouTube, MyZeniverse! He literally edits and films everything. He's editing the next YouTube video next to me right now, as we speak! Check it out, and give it a like if it's helpful! 😊😊
Citations
Sahabuddin FNA, Jamaludin NI, Amir NH, Shaharudin S. The effects of hip- and ankle-focused exercise intervention on dynamic knee valgus: a systematic review. PeerJ. 2021 Jul 5;9:e11731. doi: 10.7717/peerj.11731. PMID: 34268014; PMCID: PMC8265381. https://pubmed.ncbi.nlm.nih.gov/34268014/
Goo YM, Kim TH, Lim JY. The effects of gluteus maximus and abductor hallucis strengthening exercises for four weeks on navicular drop and lower extremity muscle activity during gait with flatfoot. J Phys Ther Sci. 2016 Mar;28(3):911-5. doi: 10.1589/jpts.28.911. Epub 2016 Mar 31. PMID: 27134383; PMCID: PMC4842464. https://pubmed.ncbi.nlm.nih.gov/27134383/
Pezolato A, de Vasconcelos EE, Defino HL, Nogueira-Barbosa MH. Fat infiltration in the lumbar multifidus and erector spinae muscles in subjects with sway-back posture. Eur Spine J. 2012 Nov;21(11):2158-64. doi: 10.1007/s00586-012-2286-z. Epub 2012 Mar 31. PMID: 22465969; PMCID: PMC3481104. https://pubmed.ncbi.nlm.nih.gov/22465969/
Mahdavie E, Rezasoltani A, Simorgh L. THE COMPARISON OF THE LUMBAR MULTIFIDUS MUSCLES FUNCTION BETWEEN GYMNASTIC ATHLETES WITH SWAY-BACK POSTURE AND NORMAL POSTURE. Int J Sports Phys Ther. 2017 Aug;12(4):607-615. PMID: 28900567; PMCID: PMC5534151. https://pubmed.ncbi.nlm.nih.gov/28900567/
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