The word posture is derived from the Latin word “positura” and essentially refers to the position or alignment of the body. The typical human posture is erect or upright and the foundation of human posture is the spine. The human spine has four separate curves when viewing it from the side, two inward or lordotic curves and two outward or kyphotic curves that should equally balance each other (refer to figure). Maintenance of good posture promotes better health and fitness and can improve self-confidence. Ideal posture can be challenging to maintain and the “bad posture” that develops actually requires more energy to maintain during routine tasks (e.g. sitting or standing) and can lead to fatigue and pain.
As a physiatrist, or doctor of physical medicine and rehabilitation (PM&R), many patients come to my office due to pain and/or functional impairments that are a result of poor posture, muscle imbalances and faulty movement patterns. Assessment and treatment of poor posture becomes a priority when treating my patients.
Following a thorough medical evaluation, that may include X-rays, severe postural problems or spinal deformities are rarely identified. More commonly, I discover routine postural problems, like forward head and rounded shoulder (FHRS) posture from too much computer work. These common problems are treatable with the appropriate lifestyle changes, daily postural exercises taught by physicians and physical therapists, and ergonomic changes that may require the help of an occupational therapist. I routinely recommend that patients with desk jobs take postural breaks every hour.
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Besides the FHRS posture of desk or computer workers, less common postural problems identified in my practice include scoliosis and kyphosis. Scoliosis refers to a side-to-side curvature of the spine and usually develops during childhood, especially during periods of rapid growth. Genetics or a strong family history of scoliosis may play a role in the development. Kyphosis, or roundback posture refers to an increased curvature of the spine from front to back (refer to image), this most commonly develops in the thoracic spine (midback) during adulthood, has known causes and can become progressively worse with time. Genetic or familial links to kyphosis are less common, with the exception of a childhood form known as Scheuermann’s disease.
Kyphosis is more common in women and often feared because it causes a loss of height and poor posture. Physicians become concerned with severe or worsening forms of kyphosis due to associated health impairments that include pain, neurological problems, digestive problems or even difficulty breathing. Causes of kyphosis include weak muscles, poor daily postures (e.g. excessive sitting in slumped position), poor balance, osteoporosis and spinal degeneration that occurs in the aging spine to varying degrees. The first three causes listed are physical problems that can be addressed through an individualized exercise program. A physician or more commonly a physical therapist can design an exercise program to improve postural awareness, balance and core strength. A promising physical therapy treatment for scoliosis and possibly for kyphosis is Schroth method.
A common medical cause of kyphosis is osteoporosis, which can lead to compression fractures of the spine. These fractures often occur without trauma and are due to brittle bones and will change the shape of the bone and alignment of the spine. This can lead to the onset of kyphosis or worsening of existing kyphosis. Osteoporosis is a preventable medical cause and can be screened for, diagnosed and treated if necessary by your primary care physician or specialist (e.g. endocrinologist, rheumatologist).
