Improving Posture to Reduce Back Pain

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With the prevalence of back injuries, I feel as though any program should work on strengthening the back in some capacity.

There are specific injuries that affect people of all ages. Spondylolysis is more common in younger kids, disc herniations and ruptures often occur in the 20’s or 30’s, and degenerative discs mostly affect older adults.

There are millions of other injuries, but no one is really safe from back injuries due to their age.

Proper movement patterns and stability are the keys to preventing, and to an extent diminishing the symptoms, from back pain. A lack of these two is also putting the spine at risk.

This is what the spine should look like in neutral alignment. The majority of kids and adults are not meeting these criteria.

Excessive rounding of the thoracic and cervical spine creates a kyphotic posture. Think Quasimodo.

Think kyphotic type posture is becoming especially problematic because of what human lifestyle has become.

Most people are sitting at computers at work compared to physical labor jobs that are becoming scarcer.

The smart phone is also influencing this rounded back alignment. Getting kids to stop looking down at their phone is almost asking too much these days.

When they become glued to the screen, the shoulders and head come forward to create this poor posture.

On the other end of the spectrum excessive arching of the lumbar spine creates a lordotic posture. This is due to anterior tilt.

Anterior tilt is most prominent in athletic population or jobs that require lots of standing. When anterior tilt is present, the glutes and abs are weak, the hip flexors are tight, and the spinal erectors are overworked.

There are some other undesirable postures.

These poor postures increase the risk of pain from kids in elementary school through older adults.

Spinal Stability

This is very important for training the muscles in a neutral spine. Exercises like planks, body saws, side planks, and Paloff presses all challenge the body to maintain neutral spine. The muscles of the torso all stabilize to make this happen.

Many people must be cued out of their poor alignment to get all the benefits of these exercises. If someone has a lordotic posture, they will probably try to maintain that posture in a plank. They should be cued to slightly round the lower back to eliminate this poor alignment. A slight rounding will posteriorly tilt the pelvis to a more neutral position.

Rounding the lumbar spine may not be desirable in all populations and extreme rounding should be avoided. But for those that are too extended at rest, the slight rounding brings them back to a neutral alignment. The opposite goes for those with the “sway back” posture above.

Core Strength

When I say core strength I am including the abs, the spinal muscles, and the glutes. The abs and glutes, most of the time, need strength to promote better posture.

I talked about the abs before but the glutes are a forgotten muscle group. They get shut off in everyday life unless we train to use them.

Exercises including bridges, single leg bridges, side lying leg raises, prone hip raises, etc. are all ways to activate and strengthen the glutes.

Do not forget about this muscle group because a lack of glute strength is associated with back pain, knee pain, and shin pain. There are also some indirect factors of pain in other areas.  

Movement Patterning

Good movement is the foundation of all other aspects of sport and fitness. Training for a stable spine will bring the spine back to neutral and build strength in the corresponding muscles.

Once this is trained, the person needs to move with good alignment. Squatting, lunging, hinging, running, jumping, etc. will all need special attention to maintain neutrality.

Someone with an extension based posture through the spine cannot deadlift with excessive extension. It will only make the problems worse and work against your goals.

On the other hand, someone with a lordotic curve cannot deadlift with rounded shoulders (not that anyone should) without making their back scream. You may see both in a group of people and they need to be trained differently, since they have opposite needs.

The lordotic person needs to move with more extension through the thoracic spine. Really getting them to keep the chest up and shoulder blades pinched will reduce the symptoms in their back and optimize movement.

T Spine extensions on a foam roller would be a good drill to work on mobility in the upper back.

Creating good movement patterns with a stable spine is going to reduce the risk and/or symptoms of injury. People can get all of the massages, chiropractic work, and electro stim they want. Without good movement patterns, they will never get better.

Back pain is not a death sentence. It can be worked with to create good motor patterns. Once the body is moving efficiently, the strength and performance gains can take place.