Healthy Spine, Healthy Life: Correcting Posture Problems

1. What are the most common types of posture problems (kyphosis, lordoisis, forward head, flatback, scoliosis)? What causes these issues?

The most common postural problems that I see as a physical therapist with 25 years of experience are excessive lumbar lordosis and forward head posture. Many times, the two are seen together. 

Lumbar lordosis, also known as swayback, is caused by tightness of the hip flexors and weakness of the core. As a society, we sit too much for work, entertainment, driving, and just living. We sit more now than at any time in recorded history because of our reliance on technology for most occupations and fields. 


As the hip flexors get tighter, the antagonist muscle, the multifidus, gets weaker. As people make an attempt to use their abdominals and multifidus, they actually end up just creating a bigger swayback, or lordosis. 

A forward head is caused by weakness of the core, tightness of the chest, and the muscles in the front, side, and back of the neck. This causes the shoulder blades to go up towards the ears and the head to go forward, causing forward head posture. This is caused by sitting and technology, as already discussed.


The opposite of lumbar lordosis would be a flat-back posture. This can be caused by muscle imbalances as well. Often, this is paired with a posterior pelvic tilt as opposed to an anterior pelvic tilt paired with excessive lumbar lordosis. Hamstrings, abdominals, and glutes are often tight and overactive with a flat lumbar spine. The lumbar paraspinals, hip flexors, and deep core muscles are often inhibited and weak.


Excessive thoracic kyphosis, also known as a rounded upper back or hunchback, can be caused by several factors. Thoracic kyphosis can be related to forward head posture and the amount of time spent sitting as well. Ergonomics at work can play a role too. 


One of the most common causes of excessive thoracic kyphosis is poor posture, particularly from prolonged sitting or using electronic devices with poor ergonomics. As we age, disc height can decrease. This can result in a more rounded upper back. 

Osteoporosis can increase the risk of thoracic kyphosis as well. Some people may be genetically predisposed to developing thoracic kyphosis. Weakness in the muscles of the upper back and shoulders, combined with tightness in the chest muscles, can also contribute. Injuries or trauma to the spine or upper back can lead to excessive thoracic kyphosis. Certain medical conditions, such as Scheuermann's disease, can also be related to this.

Type of Scoliosis

Idiopathic scoliosis is the most common type of scoliosis, and its cause is unknown. It usually develops during childhood or adolescence and affects girls more often than boys. 

Congenital scoliosis is present at birth and is caused by abnormal spinal development in the womb. 

Neuromuscular scoliosis is caused by a medical condition that affects the muscles and nerves, such as muscular dystrophy, cerebral palsy, or a spinal cord injury. 

Degenerative scoliosis is a type of scoliosis that occurs with the degeneration of the spine due to aging or trauma. 

Traumatic scoliosis is caused by a traumatic injury to the spine, such as a fracture or dislocation. 

Functional scoliosis occurs when the spine appears to have a curve, but the curve is not due to a structural abnormality in the spine. Rather, it is caused by poor posture, muscle imbalance, or leg length discrepancy.

2. How do these postures deviate from good posture?

If the lower back is in a swayback position and the head is forward, it can cause you to lose height. The head is like a 15-pound bowling ball and should be sitting on top of the cervical spine, not leaning forward. There should be a slight lordosis in the lower back, in the area in between lordosis and flatback. 

Thoracic kyphosis is normal, but excessive thoracic kyphosis can be related to pain and muscle imbalance. The most common curvatures of scoliosis can be either a right or left curve, usually in the thoracic or lumbar spine. The curves can vary in degree and severity. These curves are in the coronal plane as opposed to the sagittal plane that lumbar lordosis and thoracic kyphosis are in.

3. What are the long-term effects of bad posture?

Most people focus on the pain that comes from poor postures, like headaches and neck pain from forward head posture and sciatic and low back pain from swayback, but I like to dig deeper. The consequences of these poor postures on the organs are frequently overlooked. 

Forward head posture causes increased tension in the lungs and makes it harder to take a full breath. Lordosis tends to create a forward-spilling effect of the abdominals, causing weakness and pressure on the reproductive organs.

4. What are the best ways to improve posture?

I recommend having an evaluation with a licensed physical therapist to learn what type of posture you have and what kind of plan you would need to improve it. 

For forward head and swayback, I teach my patients how to stretch or release the tight muscles pulling them forward, followed by strengthening the weak antagonist muscles. 

My favorite is to have someone lay on a 3-foot foam roller to open their chest and then practice abdominal and pelvic floor strengthening with a neutral spine. This is just one of many exercises, but it addresses both forward head posture and excessive lordosis.

5. How can posture correctors help?

I think posture correctors are good for the early phases of strengthening the postural muscles, but I do not think they are a good long-term solution. You need muscle strength and postural awareness on your own to make postural changes. Postural awareness is the hardest thing to find, and it takes a while. Using a postural corrector in conjunction with postural awareness exercises can be of short-term benefit.

6. How long does it take to correct posture?

The younger you are, the easier it is to improve long-term posture. However, young people today have bad posture sooner than those from my generation. We did not have computers or phones until after college, and my kids have had those things since an early age, contributing to poor posture sooner. Postural strength improvements require several months of awareness of where your shoulder blades and lower back are in space. 

I was 28 when I finally made long-term improvements in my posture. I practiced Pilates after my stretching and release routine, and after about 6 months, I was 2 inches taller with improved posture.

Learn more about posture here. Common Posture Problems and How to Fix 

Check out my new favorite chair to help you sit in good posture all day…  Why You Should Choose the Duorest Ergonomic Chair from Ergospace: Unveiling the Future of Comfort at Work

Call 512-215-4227 if you are in the Austin area and would like to learn more about how we can help you with your posture. 

Claire earned her Doctorate in Physical Therapy from the University of St. Augustine in Austin, TX. She graduated with honors in 2021. Throughout her time here, she became passionate about outpatient orthopedic physical therapy and decided to stay in Austin. Prior to physical therapy school, Claire graduated from Louisiana State University in 2018 with a degree in Kinesiology. She decided to pursue a career in physical therapy early on in college. The science behind human movement and process of diagnosing and treating different injuries was always fascinating to her. Since early 2021, Claire practiced in other outpatient orthopedic clinics before joining CORE.
Dr. Claire Watkins