Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

Aside from the importance that good posture has in making a good presentation of one's personality, good posture is one of the most important factors upon which good health depends. The design of the body helps to compensate for some of the stress we normally place on the body. The various stressful weights and movements that we impose on the body would cause it to become deformed in youth were it not for the design of the body, the balanced pull on joints and bones by the various movements and the proper alignment in good posture. We can thank the Divine Designer for these marvelous features of the human body. Disfigurements of the body resulting from poor posture are caused by inattention to certain details such as bands that are too tight, desks that do not fit the growing young body, straining or twisting during too long application to intense study, chilled extremities resulting in imbalanced circulation, and certain other factors.

An erect posture places the least strain upon the supporting muscular and ligamentous structures of the body, maintaining them in a proper alignment. Poor posture tends to increase the lordotic curve of the low back and the upper dorsal curve, causing swayback and humpback respectively. Further, the head should not be carried in a far forward position, but should rest easily above the shoulders. With poor posture the chest capacity is diminished and the internal organs droop toward the pelvis. Reduced circulation to the internal organs and lungs along with congestion and restriction of movement is another result of poor posture. One look through a fluoroscope would convince anyone of the desirability of good posture as the organs are compressed and bent over on each other. The head should be held high, the shoulders back and down. Do not tighten the shoulders or sit in a strain with them held high. Nor should the chin be projected forward or retracted backward in the "military position." Generally, all joints and especially the knees should be kept in a natural position, rather than hyperextending or flexing them. The ankles should be kept straight, even if the person has the sensation that he is walking on the sides of his feet.

The back should be trained to remain flat by a simple exercise. Stand against the wall with the heels about 6 inches from the wall. Forcefully flatten the curve of the low back against the wall, and walk away from the wall trying to maintain this position. When one sits in a chair, the back should not be arched so that the hips project backward, but the hips should be tucked under in such a way as to flatten the curve in the low back. Do not feel that this tucking under of the hips and "sitting on the spine" represents poor posture; it is the best position for the spine. One should not sit for long periods on the tip end of the spine, as it can result in "painful coccyx." One hour on a hard seat without moving may result in several months of nursing a sore tailbone. Even with the hips tucked under, the head should be held erect and the shoulders should be back and down. Any forward position of the body such as in writing should be held with the hips being used as a hinge, the body itself being kept straight. One should not slump while sitting.

The position of the body during sleep is important. A firm bed should be used and weak springs should be replaced or reinforced with a plywood board between the springs and mattress. To sleep on one side or the other, but not on the same side all the time, represents the best posture in bed. Sleeping on the back causes many people to snore, as the soft palate relaxes completely and falls down against the glottis, cutting off the air. In some sensitive individuals this may result in a condition called "sleep apnea," in which one sleeps poorly at night but has sleepiness in the daytime. To avoid the problem, one can simply sleep on one side or the other, or on the abdomen. Sleeping face down, however, often reduces the respiratory excursion and causes the person to exchange oxygen less well.

Few persons understand the desirability of warming up before engaging in strong exercise. To warm up helps the joints to distribute the stresses evenly, to allow the large muscle groups to move symmetrically and to avoid overstretching muscles or ligaments on one side of the joint or the other. One should always avoid jerky motions involving the back or extremities before warming up. Twisting, walking rapidly, or running should all be avoided before an adequate warm-up. To warm up, simply begin slowly and carefully any exercise such as walking.

Just as important as warm-up is the period of cooling down after heavy exercise. One should not immediately sit or lie after heavy exercise as doing so puts a heavy strain on the heart. Most heart attacks and fatal arrhythmias associated with exercise come at the end of the exercise period with a sudden cessation of activity.

Learn to lift things in the line of gravity, squatting straight down with a straight back and using the thighs and legs for the lifting. High heels strain the lower back and are a frequent cause of nagging pain. Heels that are higher than one inch should be worn no more than 4 hours per week.

Of course, the most important aid in maintaining good posture is that of good firm muscles - made firm by much outdoor exercise. Walking and gardening are by far the most favorable exercises for developing good posture. In addition, one can sit in a chair in the proper position as described above, hug one knee to the chest, while raising the other leg to the level of the chair seat, keeping the knee straight and toes pointed upward. Hold for a few seconds and alternate knees.

Another exercise is to maintain the same posture in the chair, grasp the chair seat with both hands and pull as if trying to push through the chair bottom. Hold the position from a few seconds up to 1 minute. These simple exercises will strengthen the muscles and help correct the posture. If a strong effort is made to maintain good posture, a great reward will be experienced from these simple measures.‍

Good Posture Summary

• Good posture, head high, shoulders back and down. Avoid tightening shoulders, holding chin either projected forward or retracted backward in "military position." Avoid hyper-extending knees or turning the ankles in or out. Flatten back, keep chest up, and abdomen in.
• Stand against a wall, heels about 6 inches from the wall. Flatten back against the wall. Try to maintain this position after leaving the wall.
• Do not sit in a chair with back arched and the lowest part of the hips touching the back of the chair. Sit with shoulders straight and tall, but scoot down in the chair in such a way as to flatten out the curve in the low back. Keep head up and shoulders back and down. Any forward position as in writing should be held by using the hips as a hinge, keeping the body straight. Do not slump while sitting.
• Sleep on a firm bed. Weak springs should be replaced or reinforced by placing a plywood board between the springs and mattress.
• Learn to lift in the line of gravity. Squat down with a straight back and lift with the legs.
• High heels strain the lower back and are frequently the cause of nagging pain. Heels over 1 inch should be worn no more than 4 hours per week.
• Avoid sudden, jerky motions involving the back while "warming up." Never attempt movement while off balance or while in a twisting or turning position.
• Warming up before strong exercise is essential. It helps the joints to distribute weight evenly. It helps the large muscle groups to move symmetrically, avoiding pulled muscles or ligaments.
• Get daily out-of-doors exercise in walking or working in the garden. Walking, in all cases possible, is the best remedy for physical illness. This exercise will bring all organs of the body into use. There is no exercise that can take the place of walking.

For strengthening, use the following exercises:

• Contract muscles of the abdomen and buttocks while standing with head in an erect position. Hold for 5 minutes.
• Grasp chair seat with both hands and pull as if trying to push one's seat through the chair bottom. Hold up to 1 minute.
• Sit in chair. Hug one knee to chest. Raise other leg to the level of the chair seat, keeping knee straightened and toes pointed up. Hold for a few seconds and alternate.
• Winging. While lying on the floor face down, raise the arms and legs off the floor above the back, and hold the hand and shoulders off the floor, causing the entire body to be supported just on the abdomen. Hold several seconds and build up time to 2 minutes.
• Bridging. Lie on floor on back. Arch back and support body weight on the heels and shoulders, keeping the head off the floor. Maintain this position for several seconds, building up gradually to 2 minutes.
• Do not sit with your legs in a W position - with one foot on either side. It produces an abnormal force on the hips, a femoral anteversion, and can contribute to malfunction of the legs and a pigeon-toe gait. Children especially should be trained to sit with their legs out in front of them or folded in front of them "Indian style."