7 very common posture issues, and how to correct them

This is meant to be a non-technical post, as it is a prelude to a couple new manuals of mine. (More at the bottom.) If you want more nuance on these types of things, feel free to look around the site. 

1) Forward head posture

Forward head postureIn a forward head posture the head is out too far in front of the shoulders. Ideally, the ears and shoulders would be in the same line, 


Good head : neck posture

But here the ears are well out in front of the shoulders: 

Forward head posture comparison with lines

Possible associated issues

Headaches & the Neck

Because the muscles which tilt the head back are working so much more than the muscles which tilt the head down -think chin up versus chin down- headaches can arise in the back of the neck (where many muscles are working too much) as well as neck pain.  

2) Low shoulder(s)

low right shoulder

Jeremy Back

In this issue the shoulders are hanging too low. For a frame of reference, looking from the front we want the shoulder to be roughly a tad above the collarbone:

Neal shoulder line good

In a low shoulder, the shoulder often hangs a bit below the collarbone. The collarbone is slanted down rather than up:

Neal Low Shoulder Line

Neal Shoulders Close Up Both Lines

Both shoulders in this case:

Jeremy Shoulder Close Up with Lines

Often, you can really just eyeball this.

Jeremy Back downward rotation lines 1

Possible associated issues

Neck discomfort

Because the shoulders are pulling down on the neck, the neck can become overstretched. This is where people often feel that “stiffness” on the side of their neck. Because they feel tight, they’ll often do a stretch like this:

Neck stretch

However, that stretch is actually feeding into the issue. As we’ve gone over, this part of the neck is actually already being stretched too much. The last thing we want to do is stretch it more.

Shoulder pain / issues bringing arms up

Because the shoulders are hanging so low, it’s common to have trouble lifting the arms up. Think of the shoulders as having to start from behind. Rather than beginning at the starting line, where they should be:

Neal shoulder line good

They’re beginning from behind the starting line:

Neal Low Shoulder Line

What happens when you have to do more work than you should? You get annoyed. What happens when you have to do this all the time? You get pissed off. Think of the shoulders as progressively getting pissier.

 

3) Rounded upper back / Hunchback (kyphosis)

Mikhail Right Side

Rather than the upper back being fairly straight, it is excessive rounded over.

Mikhail Right Side C and T Spine Outline

Possible associated issues

Shoulders

When the upper back is rounded the shoulders don’t have as much room to move as they would like. Try this: stand up nice and tall and lift your arms up.

Nice and Tall Starting Position for Arms

Arm Raise from Nice and Tall Starting Position

Now, round your shoulders like a hunchback and try to lift your arms again:

Hunchback starting arm raise position

Arm Raise from hunchback position

1) You can’t lift your arms as high and 2) The hunchback version does not feel comfortable. What happens when you do this over a long period of time? Those shoulders go from, “I could use a little more room here, but it’s not too bad” to “OH MY GOD WE CAN’T BREATHE!”

Neck

A hunchback posture goes hand in hand with our forward head posture above. When the upper back rounds, the head moves forward. When the upper back is straight(er), the neck tends to be straight(er).

Neck and upper back GIF FULl

It’s very hard to correct one without focus on the other.

4) Lower back into extension (~lordosis)

Swayback posture more lordosis lumbar extension line

The lower back is either in extension, per above, or it’s getting pushed that direction.

Swayback posture side center of mass pushed forward arrow

Possible associated issues

Lower back pain

Whether the lower back is already in too much extension (lordosis), or it’s heading that direction, the consequence is often the same: The lower back gets pissed off from always doing the same motion.

5) Extended hips

Tony Hip Extension

There are a couple ways to think about this. The hips are getting pushed too far forward, the feet and knees are behind the hips, the center of the body is getting pushed forward.

Tony Hip Extension with lines

Swayback right side lines center of mass forward

Possible associated issues

Hip

Because the top portion of the thigh is traveling much further forward than the rest of the thigh, the top portion can become irritated. Think pain in the front of your hip / groin area, which can consist of aching, clicking, pinching or catching sensations. This is because the head of the femur is being pushed into the joint capsule, amongst other things. The body doesn’t like when things jam against each other when they shouldn’t.

Lower back

This coincides with our comments on the lower back. The two segments are located so close together, it’s hard for one not to be affected by the other. When the hips are getting pushed forward, the lower back is getting pushed forward, or vice versa.

Tony Lower back and Hip Extension

You can also think of it in terms of how gravity is acting on your lower back. This is a little tool I learned from Tom Myers. Push down on someone whose hips are in extension and you can see the repercussions:

Standing gravity stress assessment bad posture

Gravity assessment bad posture getting even worse

See how the lower back goes flaring into extension? Where as if those hips are better aligned under the person’s body, the lower back, and the rest of the body, can receive the load better:

Standing gravity stress assessment good posture

Standing gravity stress assessment good posture with arrows

 

6) Turned in knee(s)Jennifer Front (Less quality) internal rotation knees

The knees point inside of the feet. This may manifest in both legs, only one, or both but more pronounced on one side.

Jeremy front knee lines

More pronounced on his left.

 

Possible associated issues

Knee pain

If you’ve ever twisted your knee, you know full well how much the knee does not like to be torqued. Think of this posture as that: Constant torquing of the knee. The knee is constantly being turned one direction on one side, and another direction on the other.

Jeremy Knee Close Up with rotational lines

Ever see someone tear their knee up? Like an ACL or meniscus tear?

ACL injury knee valgus turning in

ACL injury knee valgus turning in with rotational lines

It’s very often the person’s knee gets hit / gives out inwards. The knee likes to hinge. It likes to go forward and backward. It does not like to go side to side or rotate.

Hip pain

Because the femur is part of the knee,

Femur general picture

This posture has implications at the hip. When the knee is always rotating inward, it’s because the upper leg is turning in and the lower leg is turning out. Where does the upper leg start? Way up at the hip. While the hip can deal with rotational forces much better than the knee, too much rotation in one direction can piss it off as well.

7) Feet turned out

Tony Feet turned out

We can think of this as the feet are either turned out, as above:

Tony Feet turned out with lines

Or the feet are turned out relative to the knees. Even if the feet are straight, if the knees are turned inside the feet -such as in the previously mentioned issue- then the feet, relative to the knees, are pointing outward.

Jennifer Front (Less quality) internal rotation knees tibias too

Possible associated issues

Feet

This is that whole over-pronation business you’ve probably heard about before. An imbalance arises at the feet, where the muscles which pull the foot out become dominant over those which pull the foot in.

Supinated foot

Left ankle turning out; but foot turning in (supinated). Right ankle turning in; foot turning out (pronated).

Because these muscles start at the bottom of the foot, the arch, you’ll often see people whose feet turn out with flat feet / no arches.

flat feet pronation

Knee and Hip

This coincides with our comments on the knee and hip; that of excessively turning in. Watch the person’s right leg here. Notice when the knee and hip turn in the right foot has a tendency to cave in as well.

This is that whole kinetic chain / everything’s connected you may have heard about. It’s very hard to correct an issue at one joint without concern over the joints above and below it.

Summarizing

Our list of issues:

  • Forward head posture (cervical extension)
  • Rounded upper back (thoracic flexion)
  • Lower back extension
  • Hip extension
  • Knees turned in (femoral internal rotation)
  • Feet turned out (tibial external rotation / overpronated)

One way we could think about correcting this is we need more of the opposite of the above:

  • Bring our head back (cervical flexion)
  • Straighten our upper back (thoracic extension)
  • Avoidance of the lower back getting pushed forward
  • Hip flexion
  • Turn our knees out (femoral lateral rotation)
  • Turn our feet in (tibial internal rotation)

We want to go from this:

Bad posture side view

To this:

Good posture side view

Within that, having a certain posture isn’t the end all, be all to this. The crucial component of posture or standing or sitting a certain way, is it’s often an indication of how you most often move. If in your resting posture you have a forward head posture, you likely perform quite a few movements with a forward head posture.

Conversely, having a certain posture can make you more likely to move a certain way. If you do something like sit all day with a forward head posture, then you’re more likely to have this positioning when performing certain movements.

Posture matters, but movement is what matters most.

To see some common movement issues, check out 7 very common movement issues.

Resources to help correct the above

I get a lot of questions regarding changing posture. Sometimes it’s because a person really feels their particular posture exacerbates a pain they have, other times it’s merely aesthetics. I have a few manual to help.

One of which, tailored for this post, is 7 Ways To Improve Your Posture And Movement Throughout The Day. This manual contains seven different changes you can make to your daily life. It moves from head to toe, giving a cue to correct each particular issue, and, using a ton of pictures, details some common scenarios to be on the lookout for.

Add to Cart

The next one is 7 Exercises To Improve Your Posture And Movement. Click here for more info, and or click here to see some of the most common movement flaws.

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There is also my sleep manual, which is very much aimed at the above issues. For more details check here.

Add to Cart

The sleep manual is a pdf, whereas the other two are password protected. For those, after purchasing you’ll see a “Complete Purchase” button. Click that and you’ll be redirected to a page with a password and link. Click the link; enter the password; you’re good to go.

You will also receive an email receipt for your purchase, and, just in case, another email containing the aforementioned password and link. (This email may take a minute or two to come through after the receipt.)

Your email is not automatically added to any list or anything like that. You have to voluntarily opt-in in order to be added to my list, so don’t worry about it.

If you need anything, my email is b-reddy@hotmail.com

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Agree? Disagree? It's all welcome. Our only rule is we talk like we would in person.

  1. First off…Phenomenal site you have here. I feel like I have been educated on a different level with your posts. My concern is with my gluteal folds. They have been assymetrical for probably the last 10 years that I can recount. My right gluteal fold is longer and almost extends all the way out to the side of my leg as my left one is only part of the way and has a nice glute “shelf”. I experience lower back pain on my right side only when i am doing a high repetition of squats with minimal weight. Every other exercise that I perform does not give me any lower back pain. I have included a picture to see if you could help me figure out what is going on. From a side profile I can see that my hamstrings on the right side are not as prominent thsn the left one. I have been to OT’s, Massage Therapists, etc and no one is able to tell me why i have them assymetrical. My world would change if you knew the answer. I have included a picture on my site under “gluteal fold assymetry” http://jforquer1.wordpress.com

    Thank you

    • Hey Jessica,

      Thank you for the nice words.

      That right glute of yours doesn’t look like it has as much meat on it. The first thing I do with someone like that is check to see how well they activate their glutes.

      I have the person do this exercise: https://www.youtube.com/watch?v=ttNXh4Zdefk

      And it’s a very strong likelihood you’ll see the smaller / atrophied side not fire as well. It will either fire late on the lift, or it will not fire at all. What we then do is work on gently squeezing that glute, then lifting the entire leg. (Sometimes this will be quite hard.) Bring the leg down, completely relax, and go again. (Lower back / hips never move!)

      That’s where I’d start. (Can be hard to assess yourself on that, just FYI.)

      I write more about this here, although you’ll have to scroll around to find the poignant remarks in the post and comments: http://b-reddy.org/2012/10/08/you-shouldnt-stretch-your-hip-flexors-if-you-have-hip-pain/

      Hope that helps.

  2. Hi there I’m 19 and I’ve had several imbalance issues and I’ve experienced chronic pain over the course of 1 year, I’ve gone EVERYWHERE, chiropractors, physical therapists, and none of them addressed the problem that I had which after doing research myself I was able to diagnose my problem which was posterior pelvic tilt and it had caused some problem on the right lower side of my back..once I found out what was wrong I was finally able to address the symptoms and I can now walk again something I thought wasn’t going to be able to do as the pain was unbearable.. I have a few muscle compensation issues and I used my arms for leverage a lot to pick up things from the ground due to my back being weak and now I’m experiencing shoulder issues and I cannot determine weather it is the right rhomboid or the scapula or if it’s the rotator cuff, I’ve searched everywhere and convinced you’re probably one of the few people that can help me.. Please let me know if there’s anyway you can help me address these muscular imbalances or if there’s a way I can see you personally

      • Hi Brian,
        Extremely late reply I apologize… Going to different appointments each week seeing different “experts” with their conflicting opinions and “treatments/adjustments as well as terrible depression from getting no results, deviated me from the most sane place which is here. As you’ve stated in one of your articles, I too now loathe some of these people as they really do more harm than good. Thank you so greatly for all the information you share here! I’ve made immense progress through reading and applying your articles more than any other resource or place I’ve gone to. Very hard to find a reliable place in the middle of all the garbage shared out there. Like a needle in a haystack really…very much appreciated

        I’m going to start writing out the “current issues” questionnaire you have your clients go over before working with them. I live in Sacramento but I’d still like to see you personally as well if that idea you threw out there is still a possibility. I just bought some of your products including the sleep and footwear guide, maybe I can give beer money as well! 🙂
        Meeting you would be a great honor.. I don’t know who else to seek for help.
        Two years of pain is enough and I’m ready for it to be over.
        Thank you very much for reading this, hope all is well.

        ps. I will respond immediately now!!

      • Hey Angello,

        Thanks for the nice words. Will be happy to take a look at your questionnaire when you send it over. Happy to see if we can work out meeting in person as well. That always makes things smoother.

        Beer money is always appreciated :).

  3. Hi! Fantastic article. Thank you for taking the time to write it up.
    I just had one question. For someone who’s lower back/hips are pushed forward, is this more of an Anterior or Posterior Pelvic Tilt issue? I.e. could it be corrected by strengthening the glutes and hamstrings while stretching the hip flexors and lower back? Or would it be the other way around? Or perhaps a different management strategy? Thanks again 🙂

    • Hey Rory,

      The hips being pushed forward could coincide with an anterior or posterior pelvic tilt. I tend to focus on getting the hips out of being pushed forward, rather than focusing on the pelvic tilt, in this case.

      Article discussing cueing out of forward hips here: http://b-reddy.org/2013/12/09/cueing-people-out-of-hip-extension-while-standing/

      In other words, I’d typically be focusing more on moving a person in a good amount of ways and seeing when they engage in this pattern. Then, during those movements, the focus would be to not let that movement happen. This opposed to strengthening one or two particular muscles. (By not moving in the pattern, the requisite muscles will get strengthened if needed.)

      Tangential to that: When stretching the hip flexors, most will push the hips / lower back excessively forward. They engage in the pattern we’re trying to avoid! http://b-reddy.org/2011/11/07/a-better-quad-stretch/

  4. I have pain in my shoulders and a feeling of weakness when I lift my shoulders above my head, this has gone on for years. On finding your blog and trying the exercises you have posted I have a sense of joy and hope that I can eliviate the problem. Thank you for sharing your knowledge and expertise.