Posture and Aging

        

My patients often ask me what they can do to improve their posture.  As a physical therapist, posture, or the correction of adverse postural adaptations, is one of the things I most frequently work on with people.   Posture is not only the basis for movement but also contributes to our overall health and well-being.  Good posture is essential for proper movement of the extremities, balance, gait, breathing, and emotional health. Poor posture can not only lead to problems with the musculoskeletal system but with cardiopulmonary and peripheral nervous systems as well. Research has shown that individuals with poor posture have higher incidences of depression, lower subjective life-satisfaction scores, and higher rates of chronic pain. Postural adaptations are a normal part of aging, but are effected by a confluence of physiological and environmental influences.  The more we can change or limit these influences, the more control we will have over our own posture and thus our overall health.

As we age, many things contribute to postural adaptations. Degeneration of the spine begins gradually in the third decade of life.  The intervertebral discs, the cushioning structures between each vertebrae, begin to lose some of their water content and also begin to lose height.  The individual bones, called vertebrae, begin to lose minerals which results in less dense, brittle bones. The breakdown of the vertebrae can cause excessive kyphosis, or forward lean of the mid and upper back. Osteoporosis can make this worse. And because this is the foundation for the head and neck, this will cause the head to pitch forward. If this becomes severe it can compromise lung capacity and can contribute to breathing problems and higher risk of pneumonia. It will also limit normal mobility at the shoulders and can lead to bursitis, tendinitis, and arthritis of the shoulders.

Other postural adaptations can be seen in the lower extremities. Decreased sensation and balance will result in a wider base of support and toeing out at the feet. This can lead to inhibition and atrophy of some of the larger core and buttock muscles, further contributing to functional weakness. Shuffling gait, decreased step length, and fear of falling can contribute to a higher risk of falls. Age-related collapsing of the arches of the feet can result in slightly flexed knees and hips, further contributing to a hunched over silhouette. 

Many of the unfavorable postural adaptions described above can be slowed or prevented. Regular stretching of the chest and back muscles can prevent excessive kyphosis. Regular balance exercises can help with fear of falling and gait disorders. Strengthening exercises for the arms, legs, and back muscles will contribute to more upright posture, and regular cardiovascular exercise will contribute to emotional health and help to keep all of your joints healthy. I would encourage anyone serious about addressing their posture to consult their physician or visit a physical therapist to learn how they can begin to make these changes.

Brian O’Neil is a physical therapist with Magill and Gardner Physical Therapy in Scituate, Massachusetts.