‘You stand like an overcooked prawn!’ Why bad posture is the key to back pain – and 10 ways to improve yours
‘If I was to draw a straight line across the left shoulder and the right shoulder, there’s about an inch difference. Your spine is twisted – you’re twisting it both directions. Look how that right foot is coming out slightly … You’ll notice that your knees are also coming in, there’s a slight knock knee going on on both sides – that’s because you’re also tilting forwards. So your pelvis is not only twisting, it’s also tilted.”
After five minutes walking on the treadmill in consultant biomechanist Tim King’s clinic, Cione Wellness, the news doesn’t sound brilliant. King works with world-class athletes and, thankfully, helps ordinary people with musculoskeletal and pelvic pain too. I’m here to self-consciously show him how my desk-potato body stands and moves.
We’re dynamic animals; we have to move to eat. The brain keeps recalibrating
Tim King, consultant biomechanist
I want my posture and gait assessed to see what problems I might be storing up, because back and neck pain is a huge, enormously worrying public health issue. Recent data from the Office for National Statistics suggests 62,000 people have left the workforce since 2019 because of it, and that’s just the tip of the iceberg. “We’ve certainly heard from our members that people are being seen more about back and neck problems,” says Ashley James, director of practice and development at the Chartered Society of Physiotherapy. “We know that back pain is the number one reason for years lived with disability in the world.” We all know someone with acute or chronic back pain; our homes are full of muscle pain gels, massage balls, foam rollers and heat packs.
Why? Because of how we live. “The key thing – and Covid has exacerbated it – is lack of movement,” says James. Katy Bowman, movement guru and the author of the forthcoming book Rethink your Position, agrees. “We have a movement problem and a side-effect of the movement problem is the posture problem. We are the ninjas of sitting.”
I’m a black-belt sitter, by turns slumped, crouched like a cathedral gargoyle or contorted into a human pretzel. I sit whenever I can, including brushing my teeth or cooking; I just really like sitting, OK? I don’t have serious back problems – yet – but my shoulders are tight, my left buttock regularly aches and I get a niggling sciatic pain down the outside of the same leg. I’m desperate to stop things getting worse. Do I need to address the way I stand, sit and move?
Back in King’s consulting room, he scribbles on a diagram to show me what’s going on. My pelvis twists when I move, meaning one leg ends up “falsely shorter” and the other “falsely longer”. The “longer” leg hitches up to keep me moving, overworking all the muscles under my glute: that’s where the sciatic pain is coming from. He theorises it’s due to a minor childhood fall (probably the time I came a cropper on the ice at Doncaster Dome). The result? I have deep “lordosis” (an arch in the lower back) and mild “kyphosis” (rounding in the upper back). I feel fine because my moderately hypermobile – lax – joints have compensated. I wasn’t aware of any of this. That’s because, King says, the brain adjusts to tell you your posture is normal and keep you moving. “We’re dynamic animals; we have to move to eat. It keeps recalibrating, normalising the new position.”
Carrying a bit of weight on your back is good: you’re going to get stronger. Load is good for the spine
Ashley James, Chartered Society of Physiotherapy
It’s worth challenging your brain with empirical evidence. “Our mind is not really helpful in terms of alignment, so walls are great. See how your body sits relative to a vertical line or wall,” Bowman suggests. If you’re in alignment, “your backside is against the wall, the middle of your back (where a bra strap or heart-rate monitor would go) is against the wall, and the back of your head would go against the wall. With common sense you can see, oh, my head is in front of my body.” Obviously, I try it: my bum and shoulders are touching the wall, but my head is a good inch and a half off it.
I’m left feeling self-conscious about my knock knees, forward slump and tortoise neck – “like an overcooked prawn”, as my best friend says. I’m almost jealous of the debutantes, with their finishing schools and deportment lessons. The good news is that King doesn’t think I need expert help at the moment: some simple self-help measures should do the trick. So I try to walk more, implementing his recommended stride adjustment to get myself more upright – “an inch further and heel to toe”. It feels weird, but I persist, hoping my brain will adjust. I set an hourly phone alarm and do a quick quad or hamstring stretch or at least stand up. I not only brush my teeth upright now, I balance on one leg, or do a few heel raises. I’ll never have the perfect, elegant carriage of a prima ballerina, but hopefully with a few lifestyle tweaks, I can keep this imperfect, idiosyncratic bag of bones, muscles and ligaments working for as long as I need it.
10 tips to improve your posture
1 Tackle your phone habit
Staring at our phones is so constant and pervasive, there’s an abbreviation for the effect it has on us: FHP or forward head posture. Bowman talks about “counterposes for modern life”: ways to challenge the automatic positions life puts us in. One of her FHP counterposes is “head ramping”. “Without raising your chest, slide your head back towards the wall behind you, while at the same time lifting the top of your head towards the ceiling.” (My pilates teacher explains this movement as “trying to give yourself a slight double chin”.) Do it whenever you remember: reading, walking and, yes, looking at your phone.
2 Move, move, move
As Bowman says: “Movement, like food, is not optional.” King is a fan of yoga, pilates and tai chi; James says: “It’s all about doing something that is sustainable that fits into your life.”
Encourage yourself to move more at home. Bowman suggests putting sticky notes on the top of doorways to create “reaching stations” that remind you to stretch up. “If you aren’t tall enough to reach the top of the door jamb with both arms, do one side at a time.”
3 And keep moving through pain
If you have back pain (and no other symptoms), “movement is absolutely a safe thing to do,” says James. He says that people get terrified about moving after an episode of back pain. “Eventually it gets worse because they’re doing less than they did last month.”
4 Ditch weight worries
We think carrying stuff – handbags stuffed with laptops and water bottles, single shoulder bags or unevenly loaded bags of shopping – causes back and shoulder problems. “That’s pretty much debunked,” says James. “In reality, carrying a bit of weight on your back is good: you’re going to get stronger. Load is good for the spine. We worry about overloading the spine, but strengthening the muscle, the discs, the ligaments around the spine – load is good for it.”
5 Look after your feet
“The feet are the foundation for the entire body,” says Rebeca Gomez, clinical director of The Foot Clinic. When the heel in particular is out of alignment, “everything else tends to collapse and the leg internally rotates”. To prevent problems, Gomez recommends shoes with laces, Velcro or zips – “something that holds you around the ankle” – and avoiding slip-on and very flat shoes for long periods. They make us grip with our toes, “which means the toes get deformed and misaligned and you can get overload on the ball of the foot”. Any sports shoe – including for walking – needs a thumb’s width at the toe box, which often means a size above your usual.
Our ankles have also become weaker now we wear formal footwear less often, Gomez says, so strengthen them with heel raises. Put a tennis ball between your ankles, keeping your toes close together, then, using a shelf, table or counter for balance, go up quickly on the balls of your feet and come down slowly and gently, without dropping the ball.
Ideally, get your feet checked annually, like your eyesight or your teeth – and not just the aesthetics. “Calluses and corns are a warning sign that, mechanically, something is not correct,” Gomez says.
Simple stretches are a good corrective to sedentary living. I like Bowman’s upper back stretch when I’m working. I put my hands on the back of a chair or the desk, walk backwards to lower my chest until it’s parallel with the floor, then move my hips backwards over my legs.
Gomez also recommends a deep calf stretch. “If your calves are tight, you are ‘heel striking’ (hitting the ground with your heel) at an angle when you walk, which can cause problems.” Put a fairly fat book on the floor in front of something – a table, desk, shelf – that you can hold on to for balance. Place the front of both feet on the edge of the book with your heels on the floor. Tuck in your bottom, then try and lift your big toes off the book and towards the little toes. Hold for 60 seconds.
When you’re stretching, always do it on an outbreath, King adds. “When you breathe out, all the intrinsic muscles relax.” And don’t stretch until you’re pushing into the point of pain. “Stretch for the pain, to the point of the bite. And don’t yank.”
7 Optimise your home office
Without an employer’s health and safety department to keep me on the ergonomic straight and narrow, I do a workstation assessment with Workhappy, submitting pictures of me at my desk, leaning forward to peer at my screen, legs crossed, balanced on one buttock.
Ronaldo, my assessor, tells me, unsurprisingly, that he has “quite a few worries with your overall setup”. He likes my chair (pro tip: Corporate Spec sells secondhand office chairs at huge discounts), but gets me to slide the seat cushion part backwards, to make it shorter, bringing my bum back, then to raise the back rest to maximise lumbar support. “You want the natural curvature of your spine to be supported.” He gets the armrests out of the way so I can’t lean on them – which would hunch my shoulders – straightens my screen and keyboard, and tells me I need a foot rest.
To health-check your home-working space, look out for these basics: your head should be upright with your ears above shoulders, back slightly reclined and supported, elbows bent at 90 degrees with forearms level with the desk, and feet supported so the backs of the thighs are parallel to the floor. You’ll need to get someone else to take a picture or check for you.
8 Strengthen your pelvic floor
We know we need a strong core, but might not realise that includes our pelvic floor. “The pelvic floor is like a mini-trampoline holding up your bladder, bowels and all your visceral organs; keeping it toned and healthy is of paramount importance,” says King. Kegel exercises are good, he adds, but don’t overdo them or you can cramp up. “People get caught up and do it for too long: do 10 kegels, then leave it for an hour or two.” If you’ve never done kegels before, one suggestion is to pretend you’re trying to stop the flow of urine while you’re peeing, then relax. Don’t do it while you’re actually peeing, and don’t hold your breath, pull in your stomach, squeeze your legs together or clench your buttocks when you’re contracting. Kegels can be easier lying down at first. King also recommends a reverse (or “eccentric”) situp: start seated and then slowly lean slightly backwards from the waist on an outbreath to just beyond your seated posture, and hold for five to 10 seconds.
“Poor posture is about breathing” says King. The linea alba – a band of connective tissue that runs down the front of your abdomen – is linked to your parasympathetic and sympathetic nervous system. “So stress, anxiety is going to put you into this curled position [as the linea alba tightens]. The best way of releasing the linea alba without physical intervention from someone like me is to breathe.” Obviously, we’re all doing that anyway, but you need to do it properly. “You have to breathe so the tummy comes out; if your chest moves, you’re doing it wrong.” Incorporate a few minutes into your daily routine. “Go and sit on a park bench for five minutes and breathe deeply into the diaphragm.”
10 Switch things up
The biggest problem for most of us isn’t bad posture, but failing to change postures. At work, “every hour, go to the toilet even if you don’t need to, wash your face, get your body moving,” suggests King.
“Don’t take your entertainment sitting down,” Bowman urges. “We tend to unwind with our mind to the detriment of our physical body. They both need unwinding and we can do it at the same time.” You don’t have to watch TV less, she says, just differently. “Take your favourite pillow or a folded blanket down on to the floor, start sitting cross-legged, then open your legs wide and push-pull to the right then the left. You’re going to be toggling tight joints.” As James puts it, “your best posture is your next posture”.