Women’s Posture - Part 1

Growing up, we all heard, “Stand up straight,” but why is posture so important? Well, forget about the fact that proper posture can help an aching neck and back. Don't even consider the importance of posture in injury prevention and sports performance. And who cares about slowing down or even halting the development of arthritis or osteoporosis? What if you were to tell your female clients you had a secret on how to make them appear more attractive and confident? Do you think they would sit up straight to listen? The secret, of course, is good posture.

Almost everything we do is in front of us. Now with that said, here's a sure recipe for disaster: add a tiny forward lean with a touch of gravity, and you have a condition called slouching (a.k.a. poor posture). This bad habit repeated constantly over a long period of time will result in a poorly aligned body with many muscle imbalances. As a result, undue stress is placed on the bones, joints, ligaments and muscles of your body. Thus, bad posture is not only an aesthetic problem affecting appearance, but it can also give rise to discomfort, pain and/or disability. On the other hand, a well aligned person is able to use gravity to remain upright and move freely rather than constantly fighting it. Bones go where muscles place them (it’s like setting up a tent: you adjust the ropes and not the pole if it is not standing straight.) Unfortunately, many people ignore the powerful role that posture plays on their health.

Although posture is typically viewed as a static condition, it also influences the way we move. Posture can be simply stated as the position from which movement begins and ends. It reflects the arrangement of one body part to the next. Of course, ideal posture is the position of the joints from which the body functions most efficiently. In order to achieve proper posture, though, you must have adequate joint range of motion (i.e., flexibility) as well as a balanced set of postural muscles (i.e., strength). In other words, you must train the body to walk, stand, sit and lie in positions that place the least amount of strain on supporting structures during movement or weight bearing activities. The message should be clear: we must strive for balance in our bodies and pay greater attention to our posture.

Assessment

Here's a game you can play with your female clients in order to evaluate their posture. They may feel silly, but make them do it anyway! Ask them to shake, wiggle and jump up and down for about a minute. Basically, have them pretend they’re dancing while slightly intoxicated. The trick is to have them perform this exercise with their eyes closed. After 30 seconds or so, yell "STOP" and tell your client to remain standing still in a posture that feels natural to her while keeping her eyes closed. This last point is very important. Posture is best evaluated when removing any visual stimuli and then moving/shaking around to distort the senses so that you revert to a natural position. So while your client has her eyes closed, you should thoroughly evaluate her from the front, back and side (refer to the following checklist for the appropriate criteria). Educator Paul Chek states it best when he says, "Postural alignment is the key evaluation method because posture never lies!"

Posture Checklist

View from front and back (check for symmetry):

• Head straight
• Hips and shoulders level
• Hands parallel to each other
• Knees over middle toes
• Feet straight

View from side (check alignment):

• Ankle, knee, hip, shoulder and ear line up
• Chest up, shoulders back, head erect
• Slight bend in knees and elbows (i.e., unlocked)
• Natural arch in lower back

Here are two simple tests you can perform on your female clients to check their postural alignment:

1. Have your client stand with her back about two inches away from a wall. While keeping her feet flat on the floor and hip width apart, she should lean back towards the wall (see Figure 4). If her shoulder blades and buttocks touch the wall simultaneously, then she is in complete alignment. However, if one side of her body touches the wall before the other or her shoulders touch the wall before her butt does, then she has an imbalance.
2. While standing against the wall (make sure her heels, butt, upper back and head are touching the wall), ask you to try to slide her hand between the wall and the small of her back (see Figure 5). If her hand gets caught between her back and the wall, then she has a normal lumbar (lordotic) curvature. If she can barely get her fingers through, then she does not have enough of a curve in her lower back. If her entire hand slides through, she has too much lumbar curvature.

Posture Related Problems for Women

Women tend to experience several posture related problems. Although many people think large breasts are enviable, many problems exist for large breasted women: shoulder and back strain, headaches, sagging, sore shoulders and poor posture. Breasts encourage the shoulders to round forward. The bigger/heavier the breasts, the greater the rounding that occurs. Unfortunately, as the shoulder girdle migrates forward, the head is also pulled forward, resulting in a forward head syndrome and a kyphotic posture. It is this kyphotic or hunchback posture that encourages slouching, especially in taller, well endowed women. It is interesting to note that the current trend of breast augmentation surgery is causing a slew of lower back patients because their back muscles are not strong enough to counter the extra weight of the chest implants. As a result, these women develop poor posture and experience unnecessary pain (as you will read later, it is important to stretch the tight chest muscles and strengthen the weak back muscles in your exercise program to achieve/restore proper balance.) Breasts appear larger with good posture! Read that sentence again. Therefore, your clients should try to improve their posture first before ever considering any kind of surgery!

Another condition common to women is osteoporosis. Due to a reduction in physical activity and subsequent loss of muscle, a decrease in bone mass and fragility occurs, causing skeletal disfigurations. According to Sinaki, kyphotic postural change is the most physically disfiguring and psychologically damaging effect of osteoporosis and can contribute to an increment in vertebral fractures and the risk of falling. Unfortunately, it has been found that many females lose their ability to extend the thoracic spine and develop kyphosis at a relatively young age (starting as early as 22 years old.) This is yet another reason to exercise on a regular basis (particularly weight bearing exercises) and pay close attention to posture.

Since women are designed with wider hips (causing something called a greater Q-angle between the hips and legs when compared to men) to facilitate the child-bearing process. The pelvis will undergo anterior (forward) pelvic tilt if an imbalance exists between the hip flexors and the lower abdominals. This is quite common since the hip flexors (in particular, the psoas muscle) tend to be the tightest muscles in the human body and are much stronger than the often weak lower abdominal muscles. As a result, the pelvis tilts forward, causing a hyperlordotic posture (or too much arch in the lower back) and a distended abdomen. Inevitably, this will eventually lead to lower back problems and may also cause pain to occur in the hip, knees, ankles and feet. Although posture does naturally change during pregnancy, a forward pelvic tilt will not make childbirth easy!

Women make this problem worse by wearing high heeled shoes, which causes further anterior pelvic tilt and will also tighten and excessively shorten the calves. Women who wear heels often tend to lean forward when squatting. This will lead to problems when picking up a heavy object from the ground because the greater you lean forward when squatting or bending, the greater the strain on your lower back. In this situation, the calves must be stretched often (remember to warm up first, though). In addition to the dangers of high heels, it has also been postulated that constrictive clothing such as tight collars, belts, girdles and garters could adversely affect the spine and compress the abdomen, producing a multitude of symptoms. It is far better to activate your deep abdominal wall naturally. Thus, the first step towards obtaining a flat stomach and reducing joint discomfort should be to improve your posture.

Awareness

In order for your female clients to improve their posture, they must first become aware of it and any bad habits they may have developed. So suggest your clients check their posture, no matter if they are sitting, standing or lying down, every 20 to 30 minutes (a watch can be set, if necessary). They could get into the habit of checking and correcting their posture when the phone rings, when receiving or sending email, during commercials or even when they are just talking to someone face to face. For example, it is common to lean on one side or stand with most of your weight on one leg. Your clients can correct this problem by distributing their weight evenly between both legs and standing tall. Simply visualize being pulled up by your head to help straighten out!

Your clients must be patient in their quest for improved posture. To your nervous system, it takes approximately 300 repetitions to form a new skill. However, it takes more than 5,000 repetitions to reformulate a skill. In other words, it takes a long time to break bad habits! Eventually, though, you can transform old posture but only with lots of practice!

Stay tuned for Part 2 of this series, which will show several strengthening and stretching exercises to improve posture and increase flexibility in your female clients. Part 2 will also address the psychological and social aspects of posture.

References:

1. Banfield, M. A. The posture theory, 7th ed. ISBN 0 9589015 8 9
2. Chek, P. Advanced program design correspondence course. C.H.E.K. Institute. 1999.
3. Chek, P. Scientific core conditioning correspondence course. C.H.E.K. Institute. 1998.
4. Chek, P. Your healthy back - chek list. Muscle Media, Inc. April, 1998; 67: 132-41.
5. Clay, J. H. Posture alignment therapy. The Pain & Posture Clinic. http://www.danke.com/Orthodoc/post3.html
6. Clay, J. H. Why do women have more hip problems than men do (including hip replacement surgeries!)? http://www.danke.com/Orthodoc/posture-hips.htm
7. Dayaram, E. The Alexander Technique. Hypersite Publishing Ltd. 1999.
8. De Mond, T. & Love, C. The perfect start: Assessment. SPRI Products, Inc. Buffalo Grove, Il.
9. Franklin, M. E., & Conner-Kerr, T. An analysis of posture and back pain in the first and third trimesters of pregnancy. J Orthop Sports Phys Ther. Sept.,1998; 28(3): 133-8.
10. Givens, D. B. Bowing head posture. Center for Nonverbal Studies. 1999. http://members.aol.com/doder1/posture1.htm
11. Hodrosky, R. M. Pain management: Maintaining good posture. Department of Physical Therapy, The Cleveland Clinic Foundation.
12. Hughes, R. E., Johnson, M. E., O'Driscoll, S. W., & An, K. N. Normative values of agonist-antagonist shoulder strength ratios of adults aged 20-78 years. Arch Phys Med Rehabil. Oct, 1999; 80(10): 1324-6.
13. Jarrett, B. A. Posture Control Orthotics. http://www.pcopco.com/_Posture_Control_Orthotics__Po/_posture_control_orthotics__po.html
14. Jensen, C., Borg, V., Finsen, L., Hansen, K., Juul-Kristensen, B., & Christensen, H. Job demands, muscle activity and musculoskeletal symptoms in relation to work with the computer mouse. Scand J Work Environ Health. Oct, 1998; 24(5): 418-24.
15. Kariqvist, L. K., Bernmark, E., Ekenvall, L., Hagberg, M., Isaksson, A. & Rosto, T. Computer mouse position as a determinant of posture, muscular load and perceived exertion. Scand J Work Environ Health. Feb, 1998; 24(1): 62-73.
16. Kendall, F. P., McCreary, E. K., & Provance, P. G. Muscles testing and function (4th ed.) with posture and pain. Williams & Wilkins. 1993.
17. Kita, I., Sakamoto, M., Ryushi, T., Aihara, Y., & Arita, H. Dynamics of human cardiorespiratory responses to standing on one leg with eyes closed. Eur J Appl Physiol. 1998; 77(1-2): 60-5.
18. Linder, M., & Saltzman, C. L. A history of medical scientists on high heels. Int J Health Serv. 1998; 28(2): 201-25.
19. Luoma, T. C. TC Talks. Muscle Media 2000, Inc. Dec, 1996; 55: 50-4.
20. Peacock, M. No slouch. Women.com Networks. http://www.womenswire.com/image/posture.html
21. Richardson, T. Poise and appearance for African-American women. 1996.
22. Roman, D., Bugajska, J. & Konarska, M. Characteristic of Muscular Load in Computer Data Entry Workers Assessed by EMG and Postural Angles. Int J Occup Saf Ergon. 1996; 2(2): 128-136.
23. Shirazi-Adl, A., & Parnianpour, M. Effect of changes in lordosis on mechanics of the lumbar spine-lumber curvature in lifting. J Spinal Disord. Oct, 1999; 12(5): 436-47.
24. Sinaki, M. Musculoskeletal challenges of osteoporosis. Aging (Milano). June, 1998; 10(3): 249-62.
25. Stanten, M. Develop better posture. Prevention Magazine. 1999. http://www.healthyideas.com/weight/gym/more/980701.gym2.html
26. Treva. If large breasts are your problem. http://www.trevas.com/
27. Zacharkow, D. Sitting posture: The overlooked factor in carpal tunnel syndrome. Zachback International, 1999. http://www.zackback.com/healthy.htm