Build Confidence in Your Posture

Walk down a busy street and you’ll see some atrocious body language and posture. Most people are hunched over, head down, eyebrows furrowed, and probably typing away on their cell phones. Anybody who is sitting is almost guaranteed to be hunched over: driving, eating, talking, on the phone, going to the toilet, working at a desk, studying, etc. But the minute you see someone with great posture, wow! You really take notice because of the confidence they exude. If you’re ever going into an important meeting or stressful situation, the four best things you can do to display confidence are to:

• smile;
• speak loud and clear;
• have a solid handshake; and
• stand/sit up tall

The Spine

The spine is made up of small bones called vertebrae, stacked one on top of the other. The vertebrae are wedge-shaped, with flexible cartilage in-between to absorb moderate impact, allow flexible movement, and protect the spinal cord. The spinal cord is made up of many nerve fibres that reach every aspect of the body and allow it to function. Each vertebra has an accompanying left-and-right pair of spinal nerves that exits from the spine to the body. The cervical spine is special in that there is an extra nerve pair that exit below the base of the skull or occiput and above the first cervical vertebra. The back is comprised of 24 vertebrae (plus the sacrum and coccyx) and their respective spinal nerves:

• Cervix: 7 vertebrae + 8 nerve pairs
• Thorax: 12 vertebrae + 12 nerve pairs
• Lumbar: 5 vertebrae + 5 nerve pairs
• Sacrum: 1 unit of 5 fused vertebrae + 5 nerve pairs
• Coccyx: 1 unit of 3-4 fused vertebrae

When looking at a person’s back, the spine should be straight and lay in the center of the body. From the side view, the spine has a double-wave appearance. The normal curvature of the spine should follow the image above right.

Abnormal Curves in the Spine

Abnormal curvatures can be due to genetic physical variations, acute injury, bone or cartilage degradation, improper muscle imbalance due to repetitive strain or poor posture, natural aging, and change in weight distributions. Genetic physical variations such as scoliosis can vary in severity. Often young girls, prior to puberty, have a slight scoliosis that self-resolves after their growth spurt has completed. There are two forms of scoliosis:

• Structural: This is often the genetic form that involves unsymmetrical bone formation.
• Functional: Shows a curved spine when viewing the person from the back, but when they bend forward to touch their toes, the spine straightens out. This type of scoliosis is due to muscle imbalances pulling and pushing the spine out of neutral position. This is commonly seen with sport’s players who constantly practice one-sided movements and strength training.

Acute injury can be mild or very severe regardless of the force of impact. My uncle had hit his head and went two days without much attention to it before going to the hospital. He in fact had a slow leak of blood into his brain, which unfortunately took his life. To be on the safe side, any injury to the spine or head requires a medical doctor to analyze and test neurological function and structural impact:

• falling and hitting the head;
• whiplash;
• concussions;
• herniated discs leading to sciatica nerve pain down the side or back on a leg;
• fractures of the vertebrae;
• laceration of the spinal cord can cause numbness and loss of function;
• any injury to the head or spine causing referral pain, loss of sensation or chronic symptoms;
• injury leading to inability to control bowel movements or urination.

Bone or cartilage degradation is often accompanied with age and rheumatic conditions:

Spondylolysis: Stress fracture in a vertebrae (often lumbar).

Spondylolysthesis: A single vertebra (usually in the lumbar region) slips forward over the one below. Most don’t have any symptoms; however, those who do may experience low-back and buttocks pain, numbness, tingling, sciatica; muscle tightness or weakness in the leg; increased lumbar lordosis; or a limp. Temporary relief can be found with rest, and pain is aggravated by standing, walking, and other activities.

Osteoarthritis: Bone degradation common to the neck and lower spine due to age and loss of cartilage support.

Osteopenia or osteoporosis: Loss of bone density due to age, especially in postmenopausal women.

Improper muscle balance due to repetitive strain or poor posture is one of the most common reasons for mild neck and back pain. With proper exercises, stretches, soft-tissue work, and possible manipulation of bone structure, the body can realign to a balanced and symptom-free state.

Footwear is a commonly overlooked culprit of poor posture and back pain. If your feet and not supported properly, it can lead to misaligned knees, hips, and shoulders. If you notice your hips or shoulders are uneven, this may be a sign that your body is trying to compensate for unbalanced strength. However, there are some conditions (e.g. leg length disparities, structural scoliosis, etc.) where you may never gain physical symmetry due to structural imbalances. Proper muscle maintenance and preventative exercises are key to limiting further problems.

Change in weight distribution and aging naturally transfer the weight supported by the spine. Obesity and pregnancy increase anterior weight at the midsection, causing an increase in lumbar lordosis, also called sway back. As we age and constantly hunch forward, this increases the thoracic kyphosis of our spine. These spinal changes are not necessarily bad, unless they are causing pain or referral symptoms.

Proper Posture While Standing, Sitting, and Lying Down

Anatomical posture when standing—forward-facing feet, hips, shoulders, and head; ears, shoulders, hips, knees, and ankles should create a straight line down the body; shoulders down and back; and palms directed anteriorly—is considered proper anatomical positioning. In terms of lung capacity for oxygen and carbon dioxide exchange, having an open chest with shoulders down and back is beneficial. However, when it comes to low back pain, posture has very little effect. A surprising amount of people with proper posture have back pain, and some with poor posture have no pain.^[1]

Ergonomics: The posture while sitting is where most people spend their time hunched forward, straining their eyes and extending their necks for hours at a time. Getting fitted for an ergonomic work station and taking hourly breaks to get up and walk can help your physical health and mental wellbeing.

Proper ergonomics includes a supportive chair with both feet planted on the floor and all angles of the body at 90˚ right angles: elbows, hips, knees, and ankles. The screen, book, or object in focus should be slightly lower than eye level to avoid exhausting stress on the neck. Similarly to the anatomical position, the ears, shoulders, and hips should be in line with one another.

Sleep: The way you sleep can be a large contributor to sleep quality as well as pain. For example, if you have low back pain, you should avoid sleeping on your stomach due to the excess pressure of a hyperextended posture on the spine for many hours. The best postures for sleep are on your side and, if you don’t have a breathing condition, on your back. While side-lying, you should have a higher pillow under your head to fill the gap between your shoulder and head; while on your back, use a thinner pillow under your head. Your goal is to maintain a neutral spine (i.e. when you’re standing with good posture and not perfectly flat). You should also utilize extra pillows at your knees to maintain neutral posture. While side-lying, the widths between your knees and elbows are much narrower than your hips and shoulders, respectively. Placing a pillow between your knees and arms will take pressure off your hip joints and low back. When sleeping on your back, put a pillow under your knees to release low back stress. If you must sleep on your stomach, putting a pillow under your abdomen and hips will decrease the extension of the low back and will help with back pain, but not your stiff neck from the excessive rotation. Common mattresses have springs within them. When the weight of your body presses down on the springs, it can inhibit blood flow to those areas of the body and can inadvertently wake you from your deep REM sleep. I thus recommend latex mattresses, which are made from a natural rubber tree. They are thick, flexible, and soft enough to conform to your body to allow proper support without limiting blood circulation. This allows for faster injury recovery, longer duration of sleep in one position, and more continuous restorative sleep.^[2]

Exercises

An erect stance and strong postural muscles can help build confidence, improve breathing, improve movement patterns, and limit repetitive injuries to the body. Not only does healthy posture come from strong back muscles (erector spinae, latissimus dori, trapezius, rhomboids, rear deltoids, and core), but also increased flexibility and supportive footwear. Neck and shoulder stretches and rolls: Every morning, practice half circles with your neck (i.e. as if you are drawing a necklace on your chest with your chin) and shoulder rolls, both forwards and backwards.

Double chin exercises: Lay on your back and try to push the back of your head into the floor. This will create the “double chin” effect and strengthen your anterior neck muscles, while giving your posterior ones a rest. You can do this while lying on your stomach, seated, or even with a physio band for added tension, but it’s important to keep your back neutral.

Stretching the chest: Find a doorway and place one foot in front of the other. Place a single hand and elbow on the door frame with your elbow at a 90˚ angle (avoid doing both arms at the same time, as your pectoral muscles are more likely to contract to protect yourself from falling too far forward). Lean your weight forward into the front leg while turning your body slightly away until you feel a stretch in the chest.

Scapular retraction, Ys and Ts: You can complete these lying on your stomach or standing bent over with a flat back. Raise your arms at a 45˚ angle (“Ys”) for 10–15 repetitions, then at a 90˚ angle (“Ts”) for another 10–15 repetitions. Hold the top position for five seconds with your shoulders down, scapula retracted or pulled back, and core engaged. (See image on top of next page.)

Bracing the core: To learn how to engage your core by starting with the deadbug.

Lower trapezius and latissimus strengthening exercises will help to pull your shoulders down and away from the ears.

The trapezius muscles create a diamond-shaped pattern from the base of the neck out to the back of the shoulders and down to the midback. The latissimus dorsi muscle are the “wings” of the back, spanning from under the armpits all the way down to your hips.

• Seated or standing rows with bands or cable machine see https://youtu.be/GZbfZ033f74
• Recline rows with low bar or rope see https://youtu.be/DgNmt7J2-C0
• Lat pull down machine – various wide grips see https://youtu.be/D5BQ4lsGQoQ