Is bad posture a serious health issue?
A lot of people ask me about how to correct their posture, young and old, men and women, it seems that neck hump, hunchback, and forward head problems are becoming more common.
The medical term for this postural problem is hyperkyphosis. Hyper means in excess. Kyphosis is the name we give to the curvature of the thoracic spine. It is normal to have this curvature. The problem is when this angle is greater than 40 degrees.
Here are some questions that people ask:
“Is bad posture a sign of a serious disease?”
“My doctor told me I have a fat pad on my upper back, can I remove that with diet?”
“Can bad posture lead to back pain?”
“Is bad posture caused by large breasts and will breast reduction improve my posture?”
“Can bad posture affect my lung capacity, digestion or heart function?”
“Are posture correctors any good?”
“Does exercise really correct a bad posture?”
Bad posture means the person has the head protruded forward, and the shoulders rotated inwards in front of the chest.
First, let me explain to you the various types of hyperkyphosis. There is a lot of confusion, even among medical professionals about what can be treated by exercise or not. Not all posture problems can be fixed with exercises. Hyperkyphosis can be fixed or flexible. If it is fixed, there is no exercise that will correct it, only surgery.
Buffalo hump or Dowager’s hump is not the same thing as hyperkyphosis. Buffalo hump is a fat pad in the upper back region. Sometimes the person doesn’t even know they have it. This fat pad is a sign of a hormonal problem, most likely excess cortisol production or when taking medications containing steroids, like prednisone. This fat pad accumulates in this region and does not cause any pain. It is just an aesthetic problem. If the person wants to get rid of this, first they need to check their hormones. This type of fat does not go away with diet and the only way to remove it is by liposuction or surgical removal.
There is another type of postural deformity that does not get better with exercises, this is caused by fatigue, depression, exhaustion or low self-esteem. The person assumes a body habitus that expresses their emotions and feelings. They need psychotherapy more than exercise. Although, exercises are also good for improving mood and self-esteem.
The other type of hyperkyphosis that does not respond well to exercises is when it is caused by vertebral fractures, most common in osteoporosis. The vertebrae breaks and the spine starts getting deformed with the head protruding forward. To treat these postural problems there are some treatments with injections of cement in the vertebras or surgical straightening with screws and rods. We only recommend surgery when the hyperkyphosis is affecting the internal organs like lungs or there is too much pain that does not get better with strong painkillers.
There are some diseases that affect the spine and also cause hyperkyphosis, such as Scheuermann's Disease that starts in childhood, Ankylosing Spondylitis which is a type of arthritis, Marfan’s syndrome, Ehlers Danlos Syndrome, and neuromuscular diseases. There is also hyperkyphosis that runs in families. It is a hereditary trait. If a person has both parents with hyperkyphosis, that increases their chance of having this deformity, and this is not a disease, it is just the way they are built. They are perfectly normal.
Now, there is a type of hyperkyphosis that is flexible. There is no other explanation for the deformity, except for a bad posture, this is the type of problem that resolves with exercises.
How do you know what kind of kyphosis a person has? Is it a fixed deformity that does not get better with exercise? Or is it a flexible postural problem?
Well, the doctor can order an X-ray of the spine and ask the radiologist to measure the Cobb Angle. This is the angle that we measure from the top of the 4th thoracic vertebra to the bottom of the 9th thoracic vertebrae. The patient has to take the X-ray standing up and trying the best upright posture possible. If this angle is bigger than 40 degrees, then there is kyphosis in excess, or “hyperkyphosis”.
Another simple way to find out, without taking an X-ray is by measuring the occiput-to-wall distance. You stand straight looking ahead. Do not turn your nose up. The nose should point ahead. Then if the occiput, which is the back of your head cannot touch the wall, we measure the distance in centimetres. A person that can touch the occipital bone on the wall has flexible kyphosis, which means that they may look like a hunchback, but when you ask them to straight up, they are able to achieve perfect alignment. In this case, it shows that it is a flexible deformity with only muscle imbalance, and that is what we tackle with exercises!
Another simple way to find out is the block method. You ask the person to lie down on the floor, with the nose pointing to the ceiling. If the head cannot touch the floor, you add some books under the head and measure the height in centimetres. It is the same idea of the occiput-to-wall test, but with the person lying down.
Once we make the diagnosis of flexible hyperkyphosis, it is time to work out on that posture. Even if the person has fixed hyperkyphosis they can do these exercises to avoid worsening of their deformity.
The first thing is to pay attention to the height of your pillow and the firmness of your mattress. If you are a back sleeper and your pillow is too high, then you are constantly pushing your head forward, you need a lower pillow. If your mattress is too soft, your pelvis is heavier than your chest, and your tendency is to sink at the pelvis and curving your chest. You need a firm mattress.
Second, it is important to pay attention to the workstation if you spend too many hours in front of a computer, doing manual work, doing crafts or just browsing your cellphone. Be mindful and take breaks. It is important that you change positions and do some exercises during your breaks.
And do not waste your money buying braces or spinal supports to correct your posture. They are not a good substitute for exercise. These passive modalities just enable your body to be lazier and weaker. So forget about them. The only exception is for children and adolescents who have spinal diseases and they need a special type of braces, like a Milwaukee brace that is specially designed to prevent the spinal diseases from getting worse.
If the person has upper back pain it is important they see their doctor. It can be one of the serious conditions that I mentioned above, or it could just be myofascial pain syndrome, and the muscles are so weak and overstretched that they have trigger points.
Enlarged breasts may lead to bad posture and round shoulders, but it would be very rare that the kyphosis cannot be corrected with postural exercises. If you measure the Cobb angle and it is bigger than 40 degrees then it might be the person also has other health problems like osteoporosis with vertebral fractures.
And what about the lungs, digestion, and heart? Yes, the internal organs can be affected in severe cases of hyperkyphosis, especially when it is fixed. When the person starts having symptoms of organ compression it is time to think about surgical correction.
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