Posture and Back Pain

Bad posture can put excessive strain on certain portions of the spine. Here are some tips for improving your posture.

Bad posture can put excessive strain on certain portions of the spine. Over time, this may contribute to back problems. Proper posture aligns the head, chest, and pelvis so that they are centered over one another, with the body’s weight centrally balanced.

Certain postures can throw off the body’s natural balance and put undue stress on certain muscles in the back, while leaving others underused. Examples of poor posture include:

  • Stooped shoulders
  • A forward-pitched head
  • Slouching while sitting or an excessive arch in the lower back

The good news is that poor posture can be corrected. Contrary to popular misconceptions, good posture does not require a rigidly straight (“soldier at attention”) back. Instead, good posture embraces the natural alignment that follows the spine’s gentle S-shaped curve.

Evaluating your posture

If you are having neck or back pain, your doctor may evaluate you and refer you to a physical therapist or other professional. But you can begin to evaluate your posture on your own. You can also work with a partner and inspect each other’s posture.

  • From the side: stand before a full-length mirror, naked or in tight clothing and flat shoes; use a hand mirror to see yourself in the long mirror. Assume your normal posture and do the following:
    • Imagine dots at the front of your earlobe and shoulder, at the center of your hip, just behind your kneecap, and just in front of your ankle bone. Connect these dots—they should form a straight vertical line.
    • Notice how your back curves. There should be a mild inward curve behind your neck and lower back. Your upper back should curve slightly outward.
    • Check your chin. It should normally be parallel to the floor but not thrust forward.
    • Sit in a straight, armless chair. You should still be able to draw a straight vertical line from earlobe to hip, and the three natural curves of your back should be visible.
  • From the front: when standing, your hips, shoulders, and knees should be level—one side should not be higher than the other. The spaces between your arms and waist should be the same on each side. Your kneecaps should face straight ahead, your ankles should be straight (not rolling inward), and your head should also be straight.
    • When sitting, your shoulders should be at equal height, knees facing forward, and ankles straight.

Whether you seek professional evaluation or not, there’s a lot you can do on your own to improve poor posture and help maintain good posture, including the steps below. One important element: maintain a healthy weight. Being overweight can cause or worsen poor posture. Regular exercise can help improve posture, weight control, and overall health.

Posture also varies with age. As people get older and lose height because of disc changes, the curve in the lumbar region of the back tends to straighten. This leads to a slight stoop, which is normal. In addition, the curve in the thoracic region tends to become more noticeable and pronounced with age. The following tips will help to improve poor posture.

When you're standing

  • Think about your feet, and evaluate your footwear. Foot pain—and the posture changes it causes—may simply mean that you’re wearing the wrong shoes. It may also mean that you need evaluation by a podiatrist. Avoid high heels and worn-out shoes.
  • Stand with your weight mostly on the balls of the feet, not on your heels.
  • Keep your feet slightly apart, about shoulder width.
  • Let your arms hang naturally along the sides of your body.
  • Avoid locking your knees.
  • Be sure your head is aligned on top of the neck and spine, not jutting forward.
  • Stand straight and tall, with your shoulders upright.
  • If standing for long periods, shift your weight from one foot to the other, or rock from heels to toes.
  • Stand against a wall with your shoulders and buttocks touching it. The back of your head should also touch the wall. If not, your head is pitched too far forward.
  • Practice tightening your abdominal muscles and flattening your stomach. Hold the position for a few seconds, then relax. Repeat occasionally throughout the day.
  • Practice tightening the muscles that pull your shoulder blades together in the middle. Hold the position for a few seconds, then relax. Repeat occasionally throughout the day.
  • When standing for long periods, try to stand evenly balanced on both feet. If you get tired, shift your weight from one foot to another. Occasionally rest one foot on a small stool, if available.
  • Stand against a wall with your shoulders and buttocks touching it. The back of your head should also touch the wall. If not, your head is pitched too far forward.
  • Standing for long periods, even in a correct position, can be tiring and lead to bad posture. It’s a good idea to move around, even if only slightly.

When you're walking

  • Keep your head up and eyes focused straight ahead.
  • Avoid extending your head out in front of the rest of your body.
  • Keep your shoulders, back, aligned with your hips.

When you're sitting


  • Keep your back aligned against the back of your chair. Avoid slouching or leaning forward, especially when fatigued from sitting for long periods.
  • For long-term sitting, such as in an office chair, be sure the chair is ergonomically designed to properly support your back and that it is adjusted specifically for you.
  • Sit firmly back with your shoulders against the chair, your chest lifted, and upper back straight.
  • Put a small lumbar roll against your lower back for additional support. Keep equal weight on your left and right buttocks.
  • Your feet should be flat on the floor, and your thighs even with your hips, or just slightly higher.
  • If the chair is too high for this, use a fat book or small stool as a foot­rest. Take frequent breaks. Consider using an adjustable desk (a sit/stand workstation).
  • Do not remain seated in one place for too long, even in ergonomically “correct” office chairs that have good lumbar support. Get up to walk around and stretch regularly.
  • When sitting on an office chair at a desk, your arms should be flexed at a 75 to 90 degree angle at the elbows. If this is not the case, the office chair should be adjusted accordingly. Lean forward at your hips, bringing your trunk forward, rather than bending at the waist or neck. Don’t look directly down at your work.
  • The ideal office chair includes armrests to support the weight of your arms. This reduces pressure on your back.
  • Avoid low and soft chairs that are difficult to get into and out of.

When you’re driving

  • Position your seat so you can easily reach the wheel, as well as the accelerator and brake. Your knees should be slightly higher than your hips.
  • Change the seat position occasionally, tilting slightly forward or back, if possible.
  • Change the hand position on the steering wheel occasionally. This will minimize stress on the muscles in the upper back and neck.
  • Try a lumbar roll for your lower back.
  • During a long trip, stop every couple of hours to rest and stretch. Practice good sitting posture while driving—don’t slump.
  • Remember the imaginary wire at the top of your head, pulling it upward.

When you’re lying down

  • Make sure your mattress is comfortable—it need not be hard, but it shouldn’t sag.
  • Back pain in the morning may be a sign that your bed or sleeping position is bad.
  • Avoid pillows that are too thin or too fat.
  • Lying on one side with knees bent and a pillow between them helps maintain the natural curves of the spine.

When you’re lifting or carrying

  • Beware of repetitively lifting objects or carrying objects that are too heavy for you.
  • Long-term use of a heavy backpack or shoulder bag can cause posture problems.