What Causes Poor Posture?

Poor Posture

Shaggy Scooby Doo – A Case Study

Many patients cite poor posture as a reason for their back back, neck pain and a multitude of other poor posture symptoms. Good or poor posture results from a mix of genetics, habits and lifestyle. I love this topic so let’s take a look at some examples of famous posture – the causes of poor posture and the poor posture effects. And then I’ll show you how to fix poor posture!

Part 1. Shaggy – the tall, class clown

(Perhaps to distract from his height) Shaggy is a bit of a clown. Habitually, he doesn’t take himself (or his health) very seriously. So, he’s never set foot in a gym (no doubt the one time he did, he injured himself pratting about with the kettlebells and has never been back).  

What is the Cause: Shaggy’s functional anatomy

Along with humour, he distracts from his height by slouching (assisted by his probable hypermobility – we’d have to test him against the Beighton scale to be sure).

To aggravate matters, a lack of strength and conditioning has led to poor upper back (specifically trapezius and erector spinae) muscle bulk, causing Shaggy to hold his head forward. Minimal trapezius, rhomboids and lat dorsi muscle bulk mean his shoulders slope downwards, fall forward and internally rotate (known as protraction). He has to recruit his suboccipital muscles to hold his eyes level with the horizon (a necessity for good balance). 

His slouching and general lack of muscle tone mean Shaggy has no butt (ie his glutes aren’t ‘firing’). Thus, his legs seem floppy when he walks, and he has lost his lumbar lordosis. Under that baggy green shirt, he has no abdominal tone and is probably developing a beer gut. We’ll look more at whether poor posture causing abdominal pain is a thing when we consider Velma and Daphne’s poor posture.

Poor Posture Effects – Shaggy’s symptoms

Episodes of acute neck and shoulder pain from strained weak, poorly conditioned trapezius and levator scapulae muscles (weak muscle fibres being responsible for the majority of musculoskeletal and joint pain!!)

At well over 6 ft, few chairs are built to accommodate Shaggy’s thigh length – they’re all too short in the seat so he sits with his pelvis tilted up and his spine in a banana shape. 

So from his poor posture back pain (from spinal ligament overstretch) accompanied by flare-ups of acute sciatica pain are likely from his mid 30s. His sciatic pain is  predisposed by the combination of low lumbar disc annular fibre strain and constant stretch of his sciatic nerves, exacerbated by weak glute medius muscle tone giving him unopposed internal hip rotation.  

Also caused by his anterior head position and poor posture headache, particularly tension type headache, from both holding his head up with small suboccipital muscles instead of strong trapezius muscle and referred pain from his weak trapezius and levator scapulae muscles are inevitable.

From poor posture frozen shoulder symptoms can develop. Protracted rounded shoulder posture functionally lengthens some rotator cuff muscles and shortens others. All the rotator cuff muscles are weak and poorly conditioned, eventually giving rise to strains in subscapularis meaning that frozen shoulder symptoms such as shoulder pain and stiffness pulling on clothes, brushing hair, and reaching up your back will occur. 

What are the best treatments for Shaggy? 

For acute shoulder pain we recommend ‘trigger point dry needling into the strained levator scapulae muscles, upper trapezius fibres. These points also work for tension headache with the addition of trigger points in the suboccipital muscles. Western medical and traditional Chinese / Japanese acupuncture would also work. 

For chronic, episodic or acute sciatica generated directly from annular fibre strain and referred by the strained glute muscles we recommend dry needling (both trigger point and Western medical) and /or traditional Chinese / Japanese acupuncture. 

For long-term poor posture neck cracking is very tempting for patients. Thus we would also be likely to manipulate his cervical, thoracic and lumbar spine to give him a sense of ‘having’ a back (and therefore ‘owning’ his spinal health). I would also use a variety of other techniques such as articulation, mobilisation and muscle energy technique to Shaggy’s lumbopelvic muscles (including psoas) and his neck muscles to start conditioning them (meaning flushing them through by contracting and relaxing them).

How to prevent poor posture: short, medium, and long-term management

Shaggy urgently needs to strengthen all his big muscle groups focusing on extensor muscles (such as squats and planks plus all their variations) to correct his head position and support his low lumbar discs. 

In the short and medium term Shaggy will massively benefit from some 1-2-1 Pilates or personal training to help him take ownership of his musculoskeletal health. Given his current poor muscle condition and probable joint hypermobility he’s at risk of sports injury unless he’s supervised in the early part of his fitness journey. He also needs to feel that good muscle bulk and cardiovascular health are both achievable and desirable (which will be immediately obvious owing to the reduction in symptoms).

Overcoming poor posture when working from home

When he works at a desk Shaggy needs to be aware of the following

  •     Laptop at eye level (use a laptop support if needed)
  •     Forearms supported by the desk for their entire length to the elbow – so desk depth is very important
  •     Chair height allowing 90 degrees of flexion at both hip and knee 
  •     Don’t rely on chair back support all the time (a good ratio is 30 min off/30 min on)
  •     Standing desk if possible (a good ratio is 30 minutes standing/ 45 minutes sitting)
  •     A wedge-shaped cushion may help Shaggy maintain good lumbar posture when sitting for long periods. 

·      Not sitting up in bed looking at screens (unless he’s cross-legged with a cushion behind his low back to encourage his lumbar spine into a lordosis!)