This article originally appeared in the August 2005 Harvard Women ’s Health Watch and is provided courtesy of Harvard Health Publications.

Posture and back health

Paying attention to posture can help you look and feel better.

Most of us get back pain at some point in our lives. It may be due to a sports-related injury, an accident, or a congenital condition such as scoliosis. But most of the time, upper or lower back pain develops during the course of day-to-day life. Repetitive activities at work or home, such as sitting at a computer or lifting and carrying, may produce tension and muscle tightness that result in a backache. Fortunately, there’s a lot we can do to prevent this sort of problem. General physical fitness and a healthy weight are important. But one surprisingly simple strategy can go a long way: Paying attention to your posture.

Good posture not only protects you against back pain, it also improves your overall health and appearance. Poor posture, on the other hand, promotes back pain and can affect the position and function of your abdominal organs, inhibit breathing and oxygen intake, and cause headaches. It may also affect mood.

The basics of posture
Posture is the way you hold your body while standing, sitting, or performing tasks like lifting, bending, pulling, or reaching. If your posture is good, the bones of the spine — the vertebrae — are correctly aligned (see illustration).

The back has three natural curves: a slight forward curve in the neck (cervical curve), a slight backward curve in the upper back (thoracic curve) and a slight forward curve in the low back (lumbar curve). When these curves are in proper alignment, the spine, shoulders, hips, knees, and ankles are in balance, and body weight is evenly distributed. The payoff is less stress and strain on muscles, joints, and ligaments, and a reduced risk for back, neck, and shoulder pain. Some of the classic signs of poor posture are a potbelly, rounded shoulders, and a jutted-out neck and chin (known as a forward head position).

Assess your posture
There are several ways you can check your posture to see whether you need a more thorough evaluation from a physical therapist. The American Physical Therapy Association suggests several techniques. Start by standing with your back to the wall and your heels about three inches from the wall. Place one hand flat against the back of your neck, with the back of the hand against the wall. Place your other hand against your lower back, palm facing the wall. If you can easily move your hands forward and backward more than an inch or two, you may need to adjust your posture to restore the spine’s normal curves.

Now stand in front of a full-length mirror. Hold your head straight with your ears level. Are your shoulders even? Are the spaces between your arms and sides equal? Are your hips level? Both kneecaps should point straight ahead, and your knees should be relaxed. (Locking the knees can hyperextend and injure them, causing low back pain.) Your ankles should also be straight; if they roll in, your weight will fall on the inside of your feet, causing foot and ankle pain and poor alignment that can affect the knees, hips, and back.

Help yourself to good posture
You can improve your posture by practicing some imagery and a few easy exercises.

  Imagery. Think of a straight line passing through your body from ceiling to floor (your ears, shoulders, hips, knees, and ankles should be even and line up vertically). Now imagine that a strong cord attached to your breastbone is pulling your chest and rib cage upward, making you taller. Try to hold your pelvis level — don’t allow the lower back to sway. Think of stretching your head toward the ceiling, increasing the space between your rib cage and pelvis. Picture yourself as a ballerina or ice skater rather than a soldier at attention.

  Chin tuck. Sit comfortably in a chair with your feet flat on the floor. Keep your shoulders relaxed and down. Hold your head upright. Pull your chin in toward your neck; hold that position for a count of five; and then relax. Repeat 10 times. To help guide your head, you can gently apply pressure to your chin with two fingers.

  Shoulder blade squeeze. Sit up straight in a chair with your hands resting on your thighs. Keep your shoulders down and your chin level. Slowly draw your shoulders back and squeeze your shoulder blades together. Hold for a count of five; relax. Repeat three or four times.

  Abdominal pull-in. Stand or sit. Inhale; then exhale slowly to a count of five, pulling your lower abdominal muscles up and in, as if moving your belly button toward your backbone. Relax and breathe normally. Repeat a few times.

  Upper-body stretch. Stand facing a corner with your arms raised, hand flat against the walls, elbows at shoulder height. Place one foot ahead of the other. Bending your forward knee, exhale as you lean your body toward the corner. Keep your back straight and your chest and head up. You should feel a nice stretch across your chest. Hold this position for 20–30 seconds. Relax.

  Arm-across-chest stretch. Raise your right arm to shoulder level in front of you and bend the arm at the elbow, keeping the forearm parallel to the floor. Grasp the right elbow with your left hand and gently pull it across your chest so that you feel a stretch in the upper arm and shoulder on the right side. Hold for 20 seconds; relax both arms. Repeat to the other side. Repeat three times on each side.

Practice these imagery and posture exercises throughout the day. You might try to find a good trigger to help you remember, such as doing one or more of them when you get up from your desk to move around, or right before scheduled breaks and lunch. Soon it will become a habit.

Posture while sitting	A hunched-over position reverses some of the spine’s natural curves. To realign them, sit upright as far back in your chair as possible, keep your feet flat on the floor, and your chin parallel to the floor. Relax your shoulders, and be aware of the curve in your lower back. You can use a rolled towel to help maintain the normal lumbar curve.
Posture while standing	Slouching with head forward and upper back rounded disrupts the alignment of the spine’s natural curves. So does standing in an exaggerated military-style, shoulders-back posture. Either of these postures can cause fatigue and muscle strain.

More tips for maintaining good posture
Many simple lifestyle choices can help improve your posture and reduce back pain.

  Be mindful of your posture throughout the day, and realign yourself regularly.

  To prevent muscle fatigue, avoid staying in one position for a long time. Shift positions, or get up to move around every 30 minutes to an hour.

  When standing for long periods (whether teaching a class, ironing, or washing dishes), try resting one foot on a low ledge, stool, or box.

  Hold reading material at eye level.

  Sleep on a firm, comfortable mattress. To maintain the normal curves in your spine, try putting a small pillow under your neck and a rolled sheet or towel at your lower back.

  Exercise regularly to promote strong abdominal and back muscles. Walking briskly with your head held high and stomach muscles pulled in for 20–30 minutes a day is a good start. For more back and stomach strengthening exercises, visit www.health.harvard.edu/womenextra.

  If you prefer slow, gentle, physical activity, try t’ai chi or aquatic exercises to improve your posture, strength, and balance.

  Maintain a healthy body weight.

  Wear comfortable shoes that offer good support.

  If you have any concerns about your posture, consider a session with a physical therapist trained to evaluate posture. Bodies vary: Some women may benefit from muscle stretching; others, from strengthening exercise.