Joey (Host): It's a key part of having a healthy spine, so we're discussing maintaining good posture. Our guest is Dr. Benjamin Streufert, an orthopedic spine surgeon. This is BayCare HealthChat. Thanks so much for joining us. I'm Joey Waller. Hi there, Dr. Streufert. Welcome.

Benjamin Streufert, MD: Glad to be here. Thanks Joey.

Joey (Host): Yes. We appreciate the time. Great to have you aboard doc. So first, and we'll get into some further details in a moment or two, but generally speaking in a nutshell, doctor, why is good posture so important in building a good foundation for your overall body?

Benjamin Streufert, MD: Well, that's an excellent question and one I get a lot in patients that come to see me in clinic. The posture of your back and your spine and how your upper body connects to your lower body is just vitally important in maintaining good mobility and function. So the posture really does serve, as you described, as the foundation for your body.

So as you move about your day, as you bend down to tie your shoes, as you get out of bed in the morning, as you brush your teeth and wash the dishes, leaning over the sink. A stable back posture, really can help prevent injuries that may occur or even slow the progress of degenerative change as it occurs.

Now foundationally, your back posture is supported by your core musculature, your abdominals, the abs that people so often work at with sit-ups, but also the back muscles that help you lean and bend and twist through the lumbar spine. And all of that kind of contributes to a healthy back posture.

Joey (Host): Yeah. So many parts of the body are connected with one affecting another that people aren't aware of. So what are some conditions or injuries that are commonly caused by poor posture?

Benjamin Streufert, MD: Well, poor posture, it’s almost a little bit like looking for the chicken or the egg. Some people are concerned about the way their posture might affect a future injury, while other people might be experiencing a change in their posture based on a current injury. So many patients with what are very common complaints of neck and lower back pain, may have had a muscular strain that affects their posture, causing them to maybe lean forward, which unfortunately, in many cases, puts you out of balance.

You can imagine, as I kind of referred to earlier, leaning over the sink to wash some dishes. Well, that leaning causes an extra strain on your lumbar spine muscles, your lower back muscles to keep you upright. So, if you're experiencing a strain that causes you to lean forward or keep your neck held in a forward tilted position, it can actually exacerbate, or make worse, some of those muscular issues that you might be dealing with. So that's where things, for treatment, like physical therapy or muscular rehabilitation and even medicines to help with some of the muscular conditions, can really help you reestablish that good balanced spinal posture.

And there are certainly other conditions that are more longstanding, like lumbar arthritis or lower back arthritis or stiffening problems of the spine, in the neck, and the lower back that can contribute to kind of a loss of the normal curvature of the back, and if that loss then leads to you being tilted forward, then you have to engage all of those same muscles I just described even harder just to stand up straight and to look ahead and have a forward-looking gaze. So a lot of these things can be either a response or a problem that you currently deal with, but all of it comes together in a pretty complex way to establish a good, solid balanced posture.

Joey (Host): So you just mentioned the one example of leaning over as in doing dishes at the sink. What are some other common causes of poor posture?

Benjamin Streufert, MD: Well, the other causes of poor posture can be affecting the whole situation, not just in the acute phase where, you know, maybe it's a lifting injury that causes a lower back strain, or even a herniated disc that can come from kind of where a lower back injury might cause a worsening of pain.

Those things can kind of contribute to poor posture but also be caused by poor posture in the end. But to answer your question more directly, there can be other conditions. I sort of mentioned some spinal arthritis or degenerative type conditions that happen in older adults, where you can have a leaning forward or even a curvature type problem that can affect your posture sometimes that change occurs earlier in life, in adolescence where a person might develop scoliosis or even a kyphosis type problem. Both are technical ways to describe curvatures in the spine, and sometimes those need to be evaluated before they progress further into adulthood.

Joey (Host): And so, what are some symptoms that bad posture may be hurting your body, whether it's your spine, your back, or elsewhere?

Benjamin Streufert, MD: Certainly, certain spinal injuries can cause poor posture and even be from poor posture. Signs that your body might be responding negatively to poor posture might include a generalized fatigue. It's harder to stand for longer periods. We call that standing intolerance, and sometimes that can come from either weakened back muscles, injured back muscles, sometimes even spinal stenosis where the nerves that travel through the spine can be pinched. And sometimes leaning forward is something we do unconsciously to help relieve some of that pressure.

So if you start to see in yourself or in your loved ones a change in the way that you hold your body, a change in the posture, less ability to stand or painful standing, or a change in the curvature that you might see in either you looking in the mirror or in your loved ones, then that's a sign that the posture might need additional investigation - things like X-rays and clinical exams with spine experts.

Joey (Host): Now, especially for those with back issues, how important is using the right chair and what's your guidance there?

Benjamin Streufert, MD: The exact right answer for that is somewhat hard, in the same way that it's somewhat hard to describe the perfect mattress, whereas some people might prefer that very soft feathery down and other people say, “Well, I wake up with a sore back. I'd rather sleep on the floor or a firm mattress.”

So in the same way, it's a bit tough to describe a one size fits all for a chair, as well. What I would generally counsel my patients and others looking to improve their posture is to have enough support so that you feel less fatigued, so that you need to adjust your position less frequently. You have less discomfort throughout the day.

And probably more important than the right chair for sitting is actually a good variability: changing positions during the day. So oftentimes people who are recovering from a back injury will feel somewhat better when they stand. There's actually biomechanically less pressure on the disc spaces when you are standing versus when you're sitting.

So limiting the amount of sitting you do and increasing the amount of standing you do and changing throughout the day is probably the best advice to deal with those lower back and even neck issues.

Joey (Host): And speaking of which, for those that sit for long periods, like at work or in front of a computer at home for whatever reason, what's your advice, for instance, about using sitting-to-standing desks and varying things up?

Benjamin Streufert, MD: I think the ergonomics are a great target for helping you improve your posture, but also your neck and your lower back symptoms. So I think that's a very good point, Joey. When you're talking about the things you can control in a work environment where you’re coming from COVID, a lot of us were asked to work from home and sometimes that was an uncomfortable desk shoved in the corner.

Well, if possible, having an ability to go from sitting to standing to changing positions throughout the day, perhaps even, could be very valuable. I sometimes tell my patients, “Well, if you're working on a laptop, what about finding a bookshelf so that you could stand in front of that with a laptop on a higher bookshelf to just change the ergonomics and kind of add some variability so that you're sitting and craned over that laptop just a little bit less.”

Joey (Host): Speaking of craned over, some people, as you well know, lean over when walking. So what causes that actually.

Benjamin Streufert, MD: So there's a variety, and actually it's a somewhat complex picture that explains why some people lean over when walking. Probably the most common reason is generalized fatigue in the lower back muscles. So, it could just be, that those muscles need a little bit more training, a little bit more strengthening and healthy exercise, but oftentimes in older years, patients with kind of poor posture or even a leaned over posture again, they have to use those muscles extra hard just to stand up straight. And sometimes even a spinal condition called stenosis, or spinal arthritis can stiffen and straighten the spine and cause that need to lean forward because it's just hard.

Other things can happen where muscles in the legs can become somewhat tighter and that makes it harder to stand up straight. Imagining leaning backward, if you were to ask to do so with some stiff hips and arthritic hips, maybe, could be even more difficult. And sometimes it's in our older years, we like to see where our feet are being placed. A lot of times in older individuals, you might not feel your feet the same way as you did when you were 20. And so, seeing where you're putting your feet and being very cautious so that you would not fall or trip over your shoes is actually part of the reason why people might want to lean forward and look down.

The use of assistive devices can also contribute, but understandably, no one wants to see an older person or a person with restricted mobility have a fall. But leaning on a walker can also be a source where folks feel more comfortable, kind of leaned forward, and that can not only exacerbate some lower back issues but contribute to kind of that leaned over posture.

Joey (Host): All right. A couple of other things. So what are the best treatments for poor posture?

Benjamin Streufert, MD: Well, understanding why the posture is abnormal, I think, is probably the best and quickest and most effective way to get the right treatment. So it's not going to be a one size fits all. Generally in younger years, muscular issues can contribute, sometimes disc herniations can cause an alteration of posture, a lean forward or a lean to the side. And most of the time that can be successfully treated with things like medicines and physical therapy.

If posture comes from kind of more fixed areas where the spine has changed in response to arthritis, or spinal deformity, sometimes surgical treatment is the right answer. But almost always we try to help a patient kind of navigate that process really by finding out the real reason for the problem and then addressing it sequentially so we can help in the most conservative and effective way that we can.

Joey (Host): Understood. How about any simple exercises, especially at home, that promote strong posture?

Benjamin Streufert, MD: There are some great and actually very simple exercises that can help make some progress to combating poor posture. Something as simple as planks where you are in a pushup position, and either you can modify this by dropping to your knees if you're new to the exercise, but essentially, you're doing a pushup but not pushing or going back and forth towards the ground. Even just holding that can work the abdominal muscles and the core without bending through the back, which can sometimes be painful, especially in times of acute injury. In addition to planks, you can modify that, by the way, by doing side planks or even modified versions. You can find plenty of those online, including on YouTube.

But in addition to that, even things like good mornings, where you're working on the back muscles, kind of lifting the arms and legs laying flat on the stomach can be helpful stretching. Including in bed, many of my patients will find that actually getting some good stretches in, where you bring one knee or the other or both up towards the chest can kind of stretch out those lower back muscles, before they get out of bed so that it's a little less painful.

All of those things work on stretching and strengthening the lower back and core muscles, which can help posture tremendously, and also prevent you from having those first few painful steps in the morning or at least making it a little less painful.

Joey (Host): Excellent. And in summary here, doctor, short of exercises like those you just mentioned, how about a mindset, a tip for people to keep in mind, to maintain good posture in general, whether it's sitting up or standing straight, whenever possible?

Benjamin Streufert, MD: That's an excellent point because in the end, a physical thing, like your posture may be unconscious to you. You may go through your day as a person who maybe suffers from poor posture. You may go through your day and find yourself slowly hunching forward and dropping your head and leaning forward.

And I think understanding what that's doing can sort of help you understand maybe how to best treat it. Because a lot of times that lean forward posture will make it even harder for those back muscles, which you're trying to work on, making it harder for those muscles to, kind of keep you upright.

So getting ahead of things where you're thinking about kind of keeping the shoulders back and the nice straight posture, using a cane or a walker as needed if you needed the mobility support. But really kind of keeping that chin up, shoulders back, nice balanced spinal posture can actually make it easier to get through the day. Not harder, but easier because you're keeping yourself balanced and you're not overusing those lower back muscles by the poor posture of leaning forward and becoming out of balance.

Joey (Host): Yeah, when I'm sitting for a while, even during this interview several times, I'll kind of squeeze my shoulders back, and I think a lot of that goes back to starting when I was a kid. My mom, whenever she'd see me slumping, slouching, she'd say, sit up straight. I don't want you to be round shouldered. And it’s stuck with me all these years.

Benjamin Streufert, MD: Yeah, that's too true. And I often recommend, a patient might think, well do what your mom and your dad and your grandma would've said, you know, keep a nice healthy posture, shoulders back, sit up straight, and really a lot of the other tips too, the easy stuff. Sit to stand, some gentle exercise can really go a long way.

But certainly if the posture is really becoming an impediment, you find yourself leaning over, you can always come on in and have an expert kind of take a look at it to really determine what the cause might be and the appropriate treatment.

Joey (Host): Well folks, we trust you are now more familiar with maintaining good posture. Dr. Streufert, valuable information for all of us indeed. Thanks so much again.

Benjamin Streufert, MD: And thank you. I appreciate it.

Joey (Host): Same here. For more information, please visit BayCare.org. If you found this podcast helpful, please do share it on your social media. I'm Joey Waller. Thanks so much again for being part of BayCare HealthChat.