Introduction [edit | edit source]

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Posture is a highly individual and dynamic aspect of human physiology. It is more about how your body adapts and interacts with different situations than a fixed 'correct' or 'incorrect' state. Posture can be simply defined as the way in which we hold our bodies while standing, sitting, or lying down.[1]

A growing body of research suggests that the concept of a 'bad posture' is subjective, and there is no definitive link between specific postural habits and pain.[2] In fact, posture varies greatly among individuals, and what may be considered a 'good posture' for one person may not work or feel comfortable for another.[3]

What is Posture?[edit | edit source]

Posture is the attitude assumed by the body either with support during muscular inactivity, or the coordinated action of many muscles working to maintain stability. It forms an essential basis that is being adapted constantly[4]

Our posture is an active process involving not only our muscles and joints but also our perception, emotions, and the environment we are in. Even seemingly static positions, like sitting or standing, are full of tiny adjustments and movements.[5]

Inactive Posture: Describe postures adopted during resting or sleeping, and they are more suitable for this purpose when all the essential muscular activity required to maintain life is reduced to a minimum.

Active Posture: The integrated action of many muscles is required to maintain active postures, which may be either static or dynamic[4].

  1. Static posture- the body and its segments are aligned and maintained in certain positions. Examples include standing, sitting, lying, and kneeling.
  2. Dynamic posture- the body or its segments are moving—walking, running, jumping, throwing, and lifting.

Understanding 'Good' and 'Bad' Posture[edit | edit source]

Optimal posture

The traditional view of posture insists on a 'correct' or 'incorrect' way to hold one's body, often associated with ideas about aesthetics, fitness, or health. However, current research indicates that this may be an oversimplified view.

Several studies have found no consistent link between posture and musculoskeletal pain[6], questioning the widely held belief that 'bad posture' leads to back or neck pain. This includes research showing no clear correlation between postural deviations and pain among adolescents[7], and studies showing that correcting posture does not necessarily alleviate chronic pain.[8]

The emerging view in physiotherapy and related fields is that rather than striving for an arbitrarily 'ideal' posture, it may be more beneficial to cultivate postural variability - the ability to comfortably change and adapt one's posture to different situations.[9] Indeed, according to some ergonomists, "your next posture is your best posture." Alternating between sitting and standing may practically eliminate lower back pain while easing pressure on the vertebrae and improving blood flow to the legs.

Posture and Health[edit | edit source]


Poor posture can be bad for your health. Maintaining a posture that puts stress on a joint such as prolonged slouching (see image at R) or slumping over can:

  • Increase pressure on the spine, making it more prone to injury and degeneration
  • Cause neck, shoulder, and back pain[10][11][12]
  • Decrease flexibility
  • Affect how well joints move
  • Affect balance and increase risk of falling
  • Make it harder to digest food
  • Induce breathing disorder and affect surrounding structures including the heart and phrenic nerve[13]
  • In women it can lead to imbalance in the core muscle leading to incontinence and/or pelvic organ prolapse

Age-Related Postural Changes

Ageing inevitably affects posture. The main contributing factors for postural instability are[14]:

  • Thoracic hyperkyphosis
  • Loss of lumbar lordosis
  • Decreased plantar arch

Physiotherapy[edit | edit source]

Rather than 'correcting' posture, physiotherapy can play a crucial role in improving postural awareness and promoting postural variability. Physiotherapists can help individuals explore a range of postures and movements, enhancing their ability to adapt to different activities and environments comfortably.

Important advice could include:

  • Be mindful of posture during everyday activities, like watching television, washing dishes, or walking
  • Stay active. Any kind of exercise may help improve your posture, but certain types of exercises can be especially helpful. eg. yoga, tai chi, and other classes that focuses on body awareness. It is also a good idea to do exercises that strengthen your core.
  • Maintain a healthy weight. Extra weight can weaken abdominal muscles, cause problems for pelvis and spine, and contribute to low back pain.
  • Wear comfortable, low-heeled shoes. High heels, for example, can throw off balance and force person to walk differently. This puts more stress on muscles and harms posture.
  • Make sure work surfaces are at a comfortable height for you, whether sitting in front of a computer, making dinner, or eating a meal[15].
  • Ensure to engage your core (example deep abdominal and pelvic floor muscles ) during strenuous activities and breath out as you lift. This helps to stabilise your spine .[16]
  • Remember to maintain a neutral posture as this helps body to function optimally.

And to avoid:

  • Static postures such as prolonged sitting and standing.
    • Prolonged cross-legged sitting can lead to a bent and asymmetrical posture, especially for people with low back pain[17]. Erect sitting for long hours can also cause postural problems. It is recommended to get up from your chair and move around at least every 30 minutes.[18].
    • Prolonged standing, usually at work, can lead to musculoskeletal pain and vascular disorders. Seated breaks are necessary to prevent the risk of causing associated pain or discomfort[19] .
  • Smoking. Smoking habits were suggested to have a long-term-effect on the posture control system as it increases risk for lumbar disc degeneration[20].

Muscle Action in Posture[edit | edit source]

The balanced posture of the body reduces the work done by the muscles in maintaining it in an erect posture. It has been determined (using electromyography) that, in general[21]:

  • The intrinsic muscles of the feet are quiescent, because of the support provided by the ligaments.
  • Soleus is constantly active because gravity tends to pull the body forward over the feet. Gastrocnemius and the deep posterior tibial muscles are less frequently active.
  • Tibialis anterior is less active (unless high heels are being worn).
  • Quadriceps and the Hamstrings are generally not as active[22].
  • Iliopsoas is constantly active.
  • Gluteus maximus is inactive.
  • Gluteus medius and tensor fascia latae are active to counteract lateral postural sway.
  • Erector Spinae is active, counteracting gravity's pull forwards.
  • The abdominal muscles remain quiescent, although the lower fibres of the Internal obliques are active in order to protect the inguinal canal

Examples of Types of Standing Posture[edit | edit source]

Some of the examples of faulty posture can be as follows:

Posture Types.png
  • Lordotic posture- Lordosis refers to the normal inward curvature of the spine. When this curve is exaggerated it is usually referred to as hyperlordosis. The pelvis is usually tilted anteriorly.
  • Sway Back Posture- In this type of posture, there is forward head, hyper-extension of the cervical spine, flexion of the thoracic spine, lumbar spine extension, posterior tilt of the pelvis, hip and knee hyper-extension and ankle slightly plantarflexed.
  • Flat back posture- In this type of posture, there is forward head, extension of the cervical spine, extension of the thoracic spine, loss of lumbar lordosis and posterior pelvic tilt.
  • Forward head posture - Describes the shift of the head forward with the chin poking out. It is caused by increased flexion of the lower cervical spine and upper thoracic spine with increased extension of the upper cervical spine and extension of the occiput on C1.
  • Scoliosis - A deviation of the normal vertical line of the spine, consisting of a lateral curvature and rotation of the vertebrae. Scoliosis is considered when there is at least 10° of spinal angulation on the posterior-anterior radiograph associated with vertebral rotation[23]. This is a 3 dimensional C or S shaped sideways curve of the spine.
  • Kyphosis - An increased convex curve observed in the thoracic or sacral regions of the spine.

Summary[edit | edit source]

In conclusion, posture is not about adhering to an ideal standard but about how our bodies adapt and interact with different situations. The focus should be not to 'correct' posture but to enhance postural awareness, promote postural variability, and foster overall health and well-being.

References[edit | edit source]

  1. Caneiro, J. P., O'Sullivan, P., Burnett, A., Barach, A., O'Neil, D., Tveit, O., & Olafsdottir, K. (2010). The influence of different sitting postures on head/neck posture and muscle activity. Manual Therapy, 15(1), 54-60
  2. Slater D, Korakakis V, O'Sullivan P, Nolan D, O'Sullivan K. “Sit up straight”: time to re-evaluate. journal of orthopaedic & sports physical therapy. 2019 Aug;49(8):562-4.
  3. Barrett, E., O'Keeffe, M., O'Sullivan, K., Lewis, J., & McCreesh, K. (2016). Is thoracic spine posture associated with shoulder pain, range of motion and function? A systematic review. Manual Therapy, 26, 38-46
  4. 4.0 4.1 Gardiner, Mary Dena.  (1973).  The principles of exercise therapy.  London :  Bell
  5. Dunk, N. M., Callaghan, J. P., & McGill, S. M. (2005). Lumbar spine movement patterns during prolonged sitting differentiate low back pain developers from matched asymptomatic controls. Work, 24(2), 181-188.
  6. Dankaerts, W., O'Sullivan, P., Burnett, A., Straker, L., & Davey, P. (2007). Differences in sitting postures are associated with nonspecific chronic low back pain disorders when patients are subclassified. Spine, 32(6), 698-704.
  7. Dolphens, M., Cagnie, B., Coorevits, P., Vanderstraeten, G., Cardon, G., D'hooge, R., & Danneels, L. (2012). Sagittal standing posture and its association with spinal pain: a school-based epidemiological study of 1196 Flemish adolescents before age at peak height velocity. Spine, 37(19), 1657-1666.
  8. Christensen, S. T., & Hartvigsen, J. (2008). Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health. Journal of Manipulative and Physiological Therapeutics, 31(9), 690-714
  9. Burgess-Limerick, R., Plooy, A., Fraser, K., & Hargreaves, M. (2000). The influence of computer monitor height on head and neck posture. International Journal of Industrial Ergonomics, 25(3), 339-345
  10. Kang BR, Her JG, Lee JS, Ko TS, You YY. Effects of the computer desk level on the musculoskeletal discomfort of neck and upper extremities and EMG activities in patients with spinal cord injuries. Occupational therapy international. 2019 Feb 3;2019.
  11. Borhany T, Shahid E, Siddique WA, Ali H. Musculoskeletal problems in frequent computer and internet users. Journal of family medicine and primary care. 2018 Mar;7(2):337.
  12. Daneshmandi H, Choobineh A, Ghaem H, Karimi M. Adverse effects of prolonged sitting behavior on the general health of office workers. Journal of lifestyle medicine. 2017 Jul;7(2):69.
  13. Albarrati A, Zafar H, Alghadir AH, Anwer S. Effect of upright and slouched sitting postures on the respiratory muscle strength in healthy young males. BioMed research international. 2018 Feb 25;2018.
  14. Fernandes VL, Ribeiro DM, Fernandes LC, Menezes RL. Postural changes versus balance control and falls in community-living older adults: a systematic review. Fisioterapia em Movimento. 2018 Jun 7;31.
  15. Medlineplus Good Posture Available from: (last accessed 21.4.2020)
  16. Frizziero A, Pellizzon G, Vittadini F, Bigliardi D, Costantino C. Efficacy of Core Stability in Non-Specific Chronic Low Back Pain. J Funct Morphol Kinesiol. 2021 Apr 22;6(2):37.
  17. Jung KS, Jung JH, In TS. The effects of cross-legged sitting on the trunk and pelvic angles and gluteal pressure in people with and without low back pain. International Journal of Environmental Research and Public Health. 2020 Jul;17(13):4621.
  18. Wongpipit W, Zhang X, Miyashita M, Wong SH. Interrupting Prolonged Sitting Reduces Postprandial Glucose Concentration in Young Men With Central Obesity. J Clin Endocrinol Metab. 2021 Jan 23;106(2):e791-e802. doi: 10.1210/clinem/dgaa834. PMID: 33186451.
  19. Jo H, Lim OB, Ahn YS, Chang SJ, Koh SB. Negative impacts of prolonged standing at work on musculoskeletal symptoms and physical fatigue: The fifth korean working conditions survey. Yonsei medical journal. 2021 Jun 6;62(6):510.
  20. Kiraz M, Demir E. Relationship of lumbar disc degeneration with hemoglobin value and smoking. Neurochirurgie. 2020 Nov 1;66(5):373-7.
  21. Chiba R, Takakusaki K, Ota J, Yozu A, Haga N. Human upright posture control models based on multisensory inputs; in fast and slow dynamics. Neuroscience research. 2016 Mar 1;104:96-104.
  22. Tikkanen O, Haakana P, Pesola AJ, Häkkinen K, Rantalainen T, Havu M, Pullinen T, Finni T. Muscle activity and inactivity periods during normal daily life. PloS one. 2013 Jan 18;8(1):e52228.
  23. Janicki JA, Alman B. Scoliosis: Review of diagnosis and treatment. Paediatrics & child health. 2007 Nov 1;12(9):771-6.