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Low Back Posture

Low back pain is one of the commonest and most troublesome musculoskeletal conditions in the world, responsible for a large amount of pain and suffering as well as expenses. A large proportion of people who have a back pain episode for the first time still have problems with pain and functional limitation one year later. There are a lot of reasons which might explain why someone has a back pain problem and posture can be an influencing factor in initiating or maintaining low back pain. People adopt a variety of postures in a variety of bodily positions, some related to their particular structure and some related to the activity performed.

Skeletal structure and the balance of muscles in the body varies between individuals and in some cases holds the skeletal elements of the spine in less than optimal positions, allowing increased strains to be exerted on the body tissues. With time these excess strains can cause inflammatory or degenerative changes in the discs, joints, ligaments and muscles of the back which can lead to painful symptoms. In the standing position the size of the lumbar curve, the lumbar lordosis, can vary from very flattened to extremely curved although it is difficult to relate this greatly to any particular pain problem.

An increased lumbar lordosis can force the facet joints of the lumbar spine together and may contribute to degenerative changes in these joints, a problem known to be potential source of low back pain. A tightness of particular muscles or ligaments may be natural or may develop after a back pain episode, maintaining the posture of the spine in an unhelpful position over time and keeping the pain going. Sitting is the most troublesome position in which we can develop or suffer from back pain, as the forces through the spine are high and the spine is at or near its end range of flexion.

Physiotherapy assessment and management of low back posture starts with the patient''s history of their pain problems and their medical history and moves on to examining the patient''s posture as a whole in standing. This might include the posture of the hind feet and forefeet, the knees, hips, back, thoracic spine, neck and head. The physio may test the strength and extensibility of structures around the major joint complexes to search out weakness and tightness which can be improved by stretching or strengthening exercises to alter the posture.


Author: Jonathan Blood-Smyth

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