Introduction [edit | edit source]

Indian-yogi-yogi-madhav-P SxnJhID1s-unsplash (1).jpg

Good posture is about more than standing up straight so you can look your best.

  • It is an important part of your long-term health.
  • Making sure that you hold your body the right way, whether you are moving or still, can prevent pain, injuries, and other health problems.

What is posture?

Posture, which is the relative disposition of the body at any one moment, is a composite of the positions of the different joints of the body at that time. The position of each joint has an effect on the position of the other joints[1]:

  • Correct posture- the position in which minimum stress is applied to each joint
  • Faulty posture- any static position that increases the stress to the joints

Generally, there are two types of posture[2]:

  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.

Posture Assessment[edit | edit source]

Optimal posture

The key to good posture is the position of the spine. The spine has three natural curves - at your neck, mid/upper back, and lower back. Correct posture should maintain these curves, but not increase them. Your head should be above your shoulders, and the top of your shoulder should be over the hips.

  • In an ideal posture, the line of gravity should pass through specific points of the body. This can simply be observed or evaluated using a plumb line to assess the midline of the body.
  • This line should pass through the lobe of the ear, the shoulder joint, the hip joint, though the greater trochanter of the femur, then slightly anterior to the midline of the knee joint and lastly anterior to the lateral malleolus.
  • When viewed from either the front or the back, the vertical line passing through the body's centre of gravity should theoretically bisect the body into two equal halves, with the bodyweight distributed evenly between the two feet.

While assessing posture, symmetry and rotations/tilts should be observed in the anterior, lateral and posterior views. Assess:

  • Head alignment
  • Cervical, thoracic and lumbar curvature
  • Shoulder level symmetry
  • Pelvic symmetry
  • Hip, knee and ankle joints

In sitting:

  • The ears should be aligned with the shoulders and the shoulders aligned with the hips
  • The shoulders should be relaxed and elbows are close to the sides of the body
  • The angle of the elbows, hips and knees is approximately 90 degrees
  • The feet flat on the floor
  • The forearms are parallel to the floor with wrists straight
  • Feet should rest comfortably on a surface

Posture and Health[edit | edit source]


Poor posture can be bad for your health. Slouching (see image at R) or slumping over can

  • Misalign your musculoskeletal system
  • Increase pressure on the spine, making it more prone to injury and degeneration
  • Cause neck, shoulder, and back pain[3][4][5]
  • 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[6]
  • 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[7]:

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

Physiotherapy[edit | edit source]

Education, teach client to:

  • 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[8].
  • 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 .[9]
  • 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[10]. 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.[11].
    • 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[12] .
  • Smoking. Smoking habits were suggested to have a long-term-effect on the posture control system as it increases risk for lumbar disc degeneration[13].

Objectives for Physiotherapy:

  • Obtain functional Joint Range of Motion. This is necessary to achieve optimal static and dynamic posture alignment.
  • Obtain normal Muscle Length. Maintaining proper muscle length can reduce the risk of postural deviations.
  • Obtain Good Muscle Strength. Sufficient muscle strength is needed to pull the body into the correct posture.
  • Obtain Excellent Muscle Endurance. Postural muscles need to be able to work for hours on end. Poor endurance is a major factor in habitual poor posture.
  • Normal Nerve Extensibility. Neural tissue needs enough length to allow for normal posture.
  • Good Spatial Awareness i.e where you are in space. Verbal and visual feedback as well as postural taping can assist in reinforcing proper body orientation.
  • Perfect Posture Habits. The hardest part is the initial change, then reinforcing the correct habit.[14]

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[15]:

  • 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[16].
  • 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[17]. 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.

Final Remarks[edit | edit source]

  • It is important to make sure clients have good dynamic and static posture.
  • Just knowing how to correct posture is not enough to achieve a change in actual habit.
  • Bodies uses learnt motor patterns to perform everyday activities. When we sit, stand, walk or move - our body follows previously learnt motor patterns. If the body has learned to slouch - that's what it will do.
  • Physiotherapists via correcting and improving posture through assessment and treatment techniques can lead to many positive health outcomes for clients.

References[edit | edit source]

  1. Magee DJ. Orthopedic Physical Assessment (6th). St.Louis,Missouri: Elsevier Saunders; 2014.
  2. Levangie P, Norkin CC. Joint structure and function: A comprehensive analysis (4th). F.A. Davis Company. Philadelphia. 2005
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. Medlineplus Good Posture Available from: (last accessed 21.4.2020)
  9. Efficacy of Core Stability in Non-Specific Chronic Low Back Pain.">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. doi: 10.3390/jfmk6020037. PMID: 33922389; PMCID: PMC8167732.
  10. 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.
  11. 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.
  12. 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.
  13. Kiraz M, Demir E. Relationship of lumbar disc degeneration with hemoglobin value and smoking. Neurochirurgie. 2020 Nov 1;66(5):373-7.
  14. Physioworks Posture Correction Available from: (last accessed 21.4.2020)
  15. 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.
  16. 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.
  17. Janicki JA, Alman B. Scoliosis: Review of diagnosis and treatment. Paediatrics & child health. 2007 Nov 1;12(9):771-6.