How to fix Flat back posture


Image from FixTheNeck.

What is a Flat back posture?

Flat back posture is a type of posture that is characterised by the lack of natural curves in the spine.

As a result – the alignment of the spine (as viewed from the side) is flatter than normal.

 

Characteristics of Flat back posture:

  • Forward head posture: The head is poked forward.
  • Rounded shoulders: The shoulders are slouched forwards.
  • * Flat thoracic spine: Lack of upper back natural curve (Thoracic Hypokyphosis)
  • * Flat lower back: Lack of lower back natural curve (Lumbar Hypolordosis)
  • Posterior pelvic tilt: The pelvis is rotated backwards.

(* This blog post will cover these main areas to address your Flat back posture.)

 

a) Flat thoracic spine

This is where there is a loss of natural curve (kyphosis) in the upper back.

The thoracic spine is locked into extension.

Cause: This occurs when the thoracic spine attempts to position the shoulders and head (which are generally slouched forwards in most people) into a more up right position.


Muscles responsible:

  • Spinalis thoracis
  • Iliocostalis thoracis
  • Longissimus thoracis
  • Posterior intercostals

 

b) Flat lumbar spine:

This is due to a Posterior pelvic tilt.

What’s that?… It is when the pelvis is rotated backwards.

Cause: Sitting with a slouched posture.

This leads to an imbalance of the forces around the pelvis causing a net force to tilt backwards.


Muscles responsible:

Tight/overactive:

  • Hamstrings
  • Abdominals
  • Gluteal muscles

Weak/inhibited:

  • Lumbar paraspinals
  • Hip flexors

Note: If you would like to know more about the ideal pelvis position, check out this post: The correct pelvis position in sitting.

 

Why is having a Flat back posture a bad thing?

… because curves are sexy! (… in moderation, of course)

Having natural curves in your spine is actually a good thing! It helps with load distribution.

In Flat back posture, the spine has a poor ability to absorb and distribute mechanical stress evenly throughout the body.

As a result, the muscles may have to work harder to help stabilise and move the spine.

 

How to test for it?

a) Flat thoracic spine:

Take a side profile photo: Observe for the presence of a flat segment in the upper back region.

Note: Make sure that you do not confuse the shape of your shoulder blades as a curve in your upper back.

 

b) Posterior pelvic tilt:

In standing, place one finger on your pointy hip bone at the front, and the other on your pointy bone at the back.

If you have a Posterior pelvic tilt, the finger at the front of your hip bone will be noticeably higher in comparison to the finger on the pointy bone at the back.

Exercises for Flat back posture


Image courtesy of Idea go at FreeDigitalPhotos.net


Note: All exercises are to be performed gently and pain-free. If you have any questions, please feel free to contact me on Facebook.


Flat back posture:

1. Flat thoracic spine

a) Releases:

// Thoracic paraspinals

Instructions:

  • Place your body weight on a massage ball in the areas to the sides of the spine and between your shoulder blades.
    • Find all of those tender areas!
  • Roll over the ball in a circular motion.
  • Spend at least 5 minutes to do the whole area.
  • Do NOT place the ball directly on the spine. (… It’ll hurt!)

b) Stretches:

// Stretch into flexion

Instructions:

  • Whilst sitting, interlock your fingers behind your neck.
  • Proceed to gently pull your neck downwards.
  • Focus on bending at the upper back as much as possible.
  • Aim to feel a stretch in your thoracic spine area.
  • Hold for 30 seconds.
  • Take deep breaths in whilst in this position
    • Imagine the air expanding the area between your shoulder blades.

// Stretch with foam roller

 

Instructions:

  • Whilst sitting, place a foam roller on your lap.
  • Bend and round your back whilst your chest is in contact with the foam roller.
  • Focus on bending at the upper back as much as possible.
  • Aim to feel a stretch in your thoracic spine area.
  • Hold for 30 seconds.
  • Take deep breaths in whilst in this position
    • Imagine the air expanding the area between your shoulder blades

c) Joint mobilisation:

// Rotations

Instructions:

  • Get into the 4 point kneel position. (see above)
  • Place one hand behind your head.
  • Proceed to twist your body to the side where the hand is on your head.
  • To isolate the thoracic region:
    • Do not allow your lumbar spine to move:
      • Brace your abdominals.
      • Keep your ribs cage low.
  • Repeat 20 times.
  • Repeat on the other side.

// Translations

Instructions:

  • Whilst keeping your pelvis stationary, slide your upper torso to the side.
  • Try to also lift the shoulder on the side you are sliding to.
  • Aim to feel a stretch on that side of your torso.
  • Alternate both sides.
  • Repeat 15 times.
  • (This is a difficult one. Don’t worry if you can’t get it the first time!)

d) Improve Control

// Standing intersegmental cat/cow

Instructions:

  • Whilst standing, wrap your arms around an exercise ball as much as you can. (see above)
    • Try to get your fingers tips to touch.
  • Starting from the neck: Proceed to round your spine down one vertebra at a time until you reach mid-back.
  • Emphasise the rounding over the areas where your spine is the flattest.
  • From here, reverse your movements back to the beginning.
  • Repeat 20 times.

// Intersegmental cat/cow

Instructions:

  • Get into the 4 point kneel position.
    • Hands in line with shoulder joint. Knees in line with hip joint.
  • Starting from the neck: Proceed to round your spine down one vertebra at a time until you reach mid-back.
  • Emphasise the rounding over the areas where your spine is the flattest.
  • From here, reverse your movements back to the beginning.
  • Repeat 20 times.

e) Regain your natural curve

It may take some practise… but you want to keep a slight natural curve in your upper back at all times.

If you don’t do this, your thoracic spine will likely just go back to being flat again.

 

 


2. Flat lumbar spine

a) Releases

// Hamstrings

Instructions:

  • Place your hamstrings on top of a massage ball.
  • Use your body weight to apply pressure onto your hamstrings.
  • Make sure to cover the whole hamstring muscle on both sides.

// Abdominals

Instructions:

  • Lie on your stomach.
  • Place a massage ball under your abdominal region
  • Gently circulate your body weight on top of the ball.
  • Do not to apply too much pressure. 
    • (Do NOT squash your organs! STOP if it hurts.)
  • Use deep breaths to help relax your muscles.
  • Spend at least 1-2 minutes.

b) Stretches

a) Upper hamstring

Instructions:

  • Whilst standing, place a slightly bent knee in front of you. (see above)
  • Lean forward by hinging at the hips.
  • Remember to keep your back straight!
  • Aim to feel a stretch in the upper portion of your hamstrings.
  • Hold for 60 seconds.
  • Alternate legs.

b) Lower hamstring

Instructions:

  • Whilst standing, place a straight knee in front of you.
  • Lean forward by hinging at the hips.
  • Remember to keep your back straight!
  • Aim to feel a stretch in the mid/lower portion of your hamstrings.
  • Hold for 60 seconds.
  • Alternate legs.

c) Abdominal

Instructions:

  • Lie on your stomach.
  • Place hands on floor directly under shoulders.
  • Straighten your elbows.
  • Arch backwards.
    •  (Note: Be careful if you have lower back issues)
  • Aim to feel a stretch across your abdominal region.
  • Breathe and expand your stomach as you stretch.
  • Hold for 60 seconds.

 

c) Strengthening

// Sitting knee lifts

This is to activate the hip flexor muscles.

Instructions:

  • Sit up right.
  • Whilst keep your back still, bring one knee up towards the roof.
  • Hold for 5 seconds.
  • Alternate on other side.
  • Repeat 30 times.

// Superman

This is to activate the lower back muscles.

Instructions:

  • Lie on your stomach.
  • Stretch out your arms in front of you.
  • Lift your upper body and legs off the floor.
  • Hold for 5-10 seconds.
  • Repeat 30 times.

// Pelvic tilt (4 point kneel)

Instructions:

  • Assume 4 point kneel position. (see above)
  • Tilt your pelvis forward.
    • Your back should start to arch
  • Hold for 10 seconds.
  • Repeat 30 times.

 

// Pelvic tilt (In sitting)

Instructions:

  • Whilst sitting up right, proceed to tilt the pelvis forward.
  • Hold for 10 seconds.
  • Repeat 30 times.

 // Glute strengthening

You will also want to strengthen your gluteal muscles whilst in the correct pelvic position. I’ve written a whole post on this here.

d) Maintain neutral pelvis

If you do not maintain a neutral position of the pelvis throughout the day, then your posterior pelvic tilt will continue to be an issue.

Make sure that you tilt your pelvis forward to a neutral position whilst you are walking, standing, sitting etc.

As your body has had this posture for a long time now, it will try to go back to it as a default settingYou need to resist this!

 

3. Other areas to consider

*** READ THIS ***

If you have a Flat back posture, then you will most likely have:

I have already covered these areas in detailed posts that include EVERYTHING that you will ever need to know. (Click the links above!)

(I’ve only included 2 exercises for each area in this post just to get you started. Don’t miss out on the rest!)

a) Forward head posture:

// Sub-occipital release

Instructions:

  • Place the ball underneath the base of the skull.
  • Gently rotate your head on top of the ball.
  • Continue for 3-5 minutes.
  • Do both sides.

// Chin tucks + nods

Instructions:

  • Gently tuck your chin in.
    • “Make a double chin”
  • Aim to feel a gentle lengthening sensation at the back of your neck.
  • Make sure to keep your eyes and jaw level. Move the head horizontally backwards.
    • Think of the movement like a book sliding back into the shelf.
  • Whilst maintaining this position, nod your chin downwards.
  • Hold for 5 seconds and repeat 30 times.

 

b) Rounded shoulders:

// Chest stretch

Instructions:

  • Place both hands on the door frame.
  • Lunge forward.
  • Do not flare out your ribs.
  • You should feel a stretch in the front part of your shoulder/chest region.
  • Hold for 30 seconds.

// Elbow flares

Instructions:

  • Start position: Place both hands (elbows forward) on the sides of your head.
  • End position: Pull your elbows all the way back.
  • Aim to feel your shoulder blade muscles contract.
  • Hold for 5 seconds.
  • Repeat 20 times.

Say good bye to your Flat back posture!

Feel free to leave me a comment!

I reply to everyone!

About

I am a physiotherapist who has personally experienced the pain as a result of bad posture. I would like to offer you some of the solutions that I and my patients have greatly benefited from.

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48 thoughts on “How to fix Flat back posture

      1. My xray shows my spine is straight not curved is structural change to spine or it is due miss muscle alignment

      2. My xray shows i have flat lumber spine is it permanent or it can reversed to s curve by doung your given excercise ….do every flat back posture patient has flat lumber spine ….is it temporary or permanent

  1. Sir i have flat back from 6 or 7 years which i came to know after reading your blog also my one shoulder is elevated but when i arch backwards standing and gets to normal position my elevated shoulder gets lower for some times and then again gets elevated is this is due to flat lower back ….i have flat lower back and i check it from wall test..in how much time i would restore my curve…also when i am sitting my shoulders are equally positioned sry for my english

  2. This is by far the best site I’ve seen. Excellent information and clear instruction. Thank you!

    I’ve had chronic daily headaches for nine years. A physical therapist recently told me that both upper and lower back are very flat, causing me to want to lean forward and put head forward. I believe this is contributing to the problem.

    The headaches are always accompanied by:

    Very tight back and shoulder muscles
    Scalp is very tight with painful areas, sometimes on raised bumps
    Hot behind eyes
    Tender eyebrow area

    Over the years have tried these things that did nothing:
    Botox to scalp
    Trials of medications from Neurology
    Epidural
    Nerve Block
    Trigger point injections
    10-week chronic pain program
    They wanted to fuse three neck vertebrae but I declined.

    These things are helpful temporarily:
    Massage to back and sub occipital area
    Chiropractic
    Relaxation with mindfulness
    Yoga
    Ice to head and sub occipital area
    Heating pad to back tight muscles
    Lie down for a while
    Lying lengthwise on a foam roller and moving arms is the best relief so far.

    I worked at a computer for 30 years, plus bad posture all my life.

    A physical therapist recently told me that both my upper and lower back are very flat,I really believe this may be a major contributor to problem.

    Do you have any suggestions for me other than the exercises on this page?

    Thank you,

    Anne

    1. Hi there Anne,

      For your headaches, check out this post: Forward head posture correction

      It sounds like your muscles at the base of your skull (ie. sub-occipitals, SCM, semispinalis) may be causing your headaches.

      A lot of the treatments that you mentioned appear to only treat your pain (symptoms), and not so much the reason as to WHY (cause) you have the pain.

      It is common to have a poked neck/forward head posture with a flat back posture. To completely fix your head issues, you will need to address the underlying postural issues as well (ie the flat back).

      Hope this helps!

      Mark

  3. Hi Mark,

    It was just brought to my attention that I have a flat back. I have a anterior pelvic tilt as well. My symptoms include right side neck pain, right side poor scapular recruitment upper trap overactive. I also have left hip pain which comes in goes. Any ideas what I need to focus my energy on. Thank you!

    Josh

  4. Hi Mark,

    Thank you for all the interesting articles.

    Just some background on my history and whether you will be able to provide some insight.

    I have had winged scapula in my left shoulder for many many years (initially started as a pinched nerve.) My injury is to such an extent that I cannot do upper body weight exercises in the gym(I used to train through the pain.) My left bicep gets stiff much quicker than my right and the pinch worsens when I gym. It just doesn’t feel right and I am super conscious of it.

    I have been to physical therapists, Chiropractors, Biokineticists but all they told me was to strengthen my Serratus Anterior, but all this has done is worsen the pain. During my search for the root cause of my problem I was told that I have flat back posture. Do you think that the flat back posture could be the cause to my problems?

    Another thing that was quite interesting was when I went for lynotherapy (fascia release in areas to help re-align the body.) It was found that my left hip was very stiff and once the fascia was realeased my shoulder was much better, but this was only a temporary fix. I am very much conscious of the fact that when I walk my left hip gets more strain than my right. How can that be?

    I suspect that my Winged scapula is either due to my flat back posture or left hip problem? I’m just struggling to find the link between everything.
    It is also worth noting that I sit infront of a PC all day and used to have a rounded shoulder posture in my younger days.

    Your feedback would be much appreciated. Please let me know if you require more information.

    Many thanks
    Arnaud

    1. Hi Arnaud,

      If your issue is mainly poor muscular control of your shoulder blade muscles, check this post: How to fix a winged scapula.

      However- A flat upper back can disrupt the concave/convex relationship between the scapula and thorax. This can lead to winging of the scapula.

      Fascial line connect the whole body (Including a link between hips and shoulders). You might consider checking your pelvis alignment out to delve a bit deeper into your postural issues.

      Mark

  5. Hi Mark- Thank you so much for your article. I have just started to sit on my sit bones and doing your suggested exercises for Flat back.

    I have had my right hip higher then the left, since a small child, (I’m 54) as Im pretty sure that when I had a motorcycle accident at 8 yrs old and fractured my leg and pulled all the ligaments, is were it all began. (No physical therapy after my leg healed)

    So, here Iam at 54 with lots of pain. I have always had low back pain, but it never reached a 10, (1-10 pain scale) until 8 yrs ago when I was at the gym doing adductors on the machine. It felt like I pulled a muscle on the inside of my right leg.

    As the pain got worse, finally got Mri and did physical therapy. Was told I had Spinal stenosis and was treated for that. I have been to 5 different Physical Therapist in 8 yrs for treatment with little success.

    The last Therapist told me I had “Flat Back” I had to stop treating with her because of insurance. It has only occurred to me with in the last two months, that maybe my flat back (Thoracic and Lumbar) is the root of all of my issues.

    Here is what my last MRI, a yr ago said:
    CERVICAL-Cervical spinal cord is normal. There is a levocurvature of cervical spine. Minimal to mild posterior disc bulging.

    THORACIC -Thoracic spinal cord is normal. There is a mild upper thoracic spine kyphosis with Schmol’s nodes which may reflect old Scheurmanns disease. No cord compression. Mild central and mild posterior disc bulging.

    LUMBAR-Severe Spinal Stenosis on my right side and moderate on left.

    I realize that I may not feel the effects of evrything on the MRIs. When I went to see if surgery on my Stenosis was needed, the Dr said that “Even tho my MRI said severe, his physical exam of me says, not so severe. I have had no cortisone shots as well.

    As I work on my posture, my stenosis is getting in the way. I have read so much information, I feel overwhelmed. I would love for a fresh pair of eyes to exam me and start over.

    Also, for the last year, I have been working out at the gym. ( the senior citizens classes) Walking, lifting weights and doing Ab exercises to stabilize my spine from the Stenosis. Stretching everyday. All day, sometimes. My Right lumbar hurts at a 7 or 8 most of the time.

    Any of your thoughts are appreciated.

    Thank you!

    1. Hey Kim,

      With severe spinal stenosis, it is important to make sure that swelling of the nerve and/or any posterior disc bulges in the area are kept to a minimum (relative rest from aggravating activities, cortisone, anti-inflammatories etc). This is to reduce the chance of the nerve getting squashed.

      If your stenosis is due to bony/joint changes, there is not too much we can do to remove it without surgical intervention.

      Your certain posture may also predispose you to placing too much compression stress to your lower back resulting in your right lumbar spine pain. (esp. if your right hip is higher. Check this post out: Lateral pelvic tilt)

      You have also pointed out that any findings of the MRI does not necessarily mean it will manifest as symptoms. And this is very true!

      It sounds like you are doing the right thing and keeping as active as you can… which is exactly what you should be doing.

      Please message me on facebook if you would like more specific help!

      Mark

    2. Hello doctor i am saif from india.i have a low back pain its loss of lumbar lordosis my spine has become flat.i have started doing physiotherapy from last 20 days now i feel less pain.dr how long will it take for my spine to get curve if i do regular exercise.and can i do forward bending in yoga once my pain is gone.or do i have to avoid it for my whole life.

      1. Hi Saif,

        It is fine to do forward bending in yoga once your body is flexible and strong enough to do so without any reproduction of your symptoms.

        Mark

  6. Hi Mark,
    Thank you for your fabulous post on flat backs! I wish I would have had you on my “team” 17 years ago when I sustained a terrible whiplash induced concussion on a horse. I have been to countless physical therapists and doctors of all kinds over the past 17 years. Not a single one mentioned that I have a flat back which hasn’t allowed me to heal properly. I even saw a neurologist at the Mayo Clinic a year ago with negative MRI’s of my head and neck (with the exception of white spots on the brain from chronic migraines/headaches and some minor soft tissue calcification). He just told me I have occipital neuralgia and tried treating it with cervical vertebrae and occipital nerve injections. I even went as far as having nerve ablations done with hardly any improvement. Physical therapists have told me just to strengthen my neck which has always ended in extreme pain. With the recent help of my chiropractor, who could put my occiput and atlas back in alignment on a daily basis if I could afford it, has recently been helping me address my flat back. I do think over these years that my body has tried to incorrectly brace and protect my neck in a way the has caused the majority of my flat back. In the past two months, I have cut my chronic neck pain of 17 years down 50% by working on the stretches you’ve listed here and really addressing my posterior pelvic tilt. I train horses in the sport of Dressage where I use muscles similar to Pilates to commmunicate with the horse. Posture is huge with the type of riding I do and I am constantly working on it. In the process of working feverishly to change my posterior pelvic tilt and increasing lumbar lordosis, I’m finding new weaknesses that seem to be causing my torso to want to fall backwards behind the motion of the horse. I think I have narrowed it down to the psoas muscle that needs to maintain my torso alignment. Does that sound right and if so, what strengthening exercises would you recommend? I am sorry for the long post!
    Thank you,
    Lindsey

    1. Hello Lindsey the horse trainer,

      Training the psoas will help return you normal lumbar lordosis.

      Here are some examples of exercises that might help with strengthening/engaging this muscle: (maintain curve in your lower back)


      However.. if you feel like you are falling back whilst on the horse after consciously increasing your lumbar arch, you may need to think about engaging your anterior abdominal muscles.

      Here is a great exercise for this: (once again, maintain a neutral lumbar arch)

      On top of this: make sure you are sitting on top of your sit bones:

      Hope this helps!

      Mark

  7. Hi Mark,
    Excellent post! Well-explained, and the exercises are easy to follow. I have a very flat lumbar spine, which I think is from too many front abdominal exercises, as well as very loose hamstrings and weak glutes. I think I have less problem with the thoracic area, and there is no overall discomfort. Can you suggest any abdominal exercises to retain core strength and muscle definition without worsening the problem? I’m thinking that ‘sit ups’ are definitely not good… Also, is there any benefit from lying on a foam roller and stretching/massaging the lumbar/pelvic area where the spine is flattest? To me, it feels like it *could* be encouraging the curvature, and easing the tightness in the area, but I may be mistaken. I’d much appreciate your perspective on this. Thanks! Louise

    1. Hey Louise,

      I would start off with the Dead bug exercise… whilst maintaining a NEUTRAL PELVIS. This means you will perform this exercise with a normal lumbar arch.

      You can also lie on a foam roller as that will help mobilise your joints and stretch out your tight abdominals.

      Mark

  8. Hi Mark, so no one has been able to help me so far from PT, chiros, LMT, etc…I have been having chronic neck pain in back of neck the goes down to throbbing pain between my shoulder blades. I have full shoulder and neck range of motion. I also get some lower back stiffness and I feel like my balance is off like I’m tilting forward. I have high arches and probate. It also gives me chest pain in the inner/sternum area when I retract my shoulders back. I’ve been bodybuilding for 11 years and this problem has been destroying my life for the past 3 years almost now. Any ideas? Thank you

  9. Thanks so much for this awesome site, Mark! Really appreciate it and would love your feedback. Long story short… to my knowledge I have (and always have had) a flat lumbar back, likely thoracic as well. Recent MRIs showed that to be true as well.

    I don’t appear to have a posterior pelvic tilt going by your tests here, but I might be wrong and I do have flat feet that pronate and I am worthless without orthodics. In any case, here is what I got: 9 months ago frequent/nightly calf cramps woke me up to the point of great nausea and near passing out, which soon after led to debilitating claudication (and continues to this day), mostly on the right side. All tests normal. MRIs show only slight bulges at l4/5 s1, but nothing enough to cause nerve impingement.

    I have had every test possible, no luck with spinal injection and have had a dedicated yoga practice for 20 years, as well as qui gong and meditation, etc. I am frequently on the move, in shape, eat well, and have nowhere else to look but my flat back, which most docs write off, with the exception of a few yoga therapists. Does that sound like the culprit to you?

    Any help or feedback would be so much appreciated. My life as I know it has come to a complete stop (not a bad thing for a time, but it’s been 9 months and the pain is too much… I have never ever been in this much pain and I cannot walk more than 5 steps without cramping and nerve pain. I cannot drive more than a mile because my right leg, my driving leg, will start to cramp in the thigh).

    I am supposed to go to Mayo next week, but am losing hope. Any ideas?

    Thanks so much. Rox

    1. Hey hey Rox,

      Based on the information you have provided me with, it’s difficult to say if it is coming from your flat lumbar spine.

      If your MRIs have ruled out any serious/obvious disc bulge pinching on nerves, it is less likely (but not completely ruled out) that the culprit is solely from the back.

      Some questions to help dig deeper:

      Are your cramps accompanied with other neurological signs like pins and needles, numbness and/or loss of muscular control?

      Do you have diabetes?

      Have you had any Ultrasound scan to the blood vessels in your leg to rule out circulation issues/clots/DVT etc?

      Are your cramps worse if you don’t wear your orthotics for flat feet?

      Are your hips in front of your ankles? Or are they stacked properly?

      What happens if you stretch your calf muscle?

      Any issues doing this?

      Looking forward to hearing from you.

      Mark

  10. This is absoloutely without a doubt the best post I have read on these conditions by a million miles. Fantastic. When i saw “i reply to everyone” i couldnt have been happier. My question is whether I should omit or Alter any of these exercises if I have bulging discs and degeneration in the lumbar spine. I recently had a private MRI and have those issues in lower back, mainly a bulging disc to the right at the top thoracic (L1) vertabrae. And have pain in this area. I have flat back with rounded shoulders and very forward head posture, so things like ab stretching would be quite painful/damaging as the pain is quite new. Any tips would be hugely appreciated as you clearly are more educated on this than any other physio I have yet to encounter. Thanks in advance!

    1. Hi Fiachra!

      This is the type of comment that I like to see!

      With a disc bulge in L1 (which I assume is posterior +/- lateral), I would be weary of any forward/sideways bending whilst in a standing position as this may aggravate the area.

      (However – keep in mind, the presence of disc bulges found on a MRI does not always correlate to the symptoms that you may be experiencing.)

      With the abdominal stretch, if your abdominal muscles are indeed tight, you can focus on doing the gentle massage ball releases instead.

      Mark

  11. Hi, first of all thank you fort this great list of exercises. I’m Italian, so I’m sorry if I don’t speak English very well.
    It has been almost 2 years since my back started to feel weak and painful. And now I went to a physiatrist/physiotherapist and I made a full X-ray of my spine. He said that I have a flat back, since I have a loss of lumbar (lower back) and thoracic (upper back) curves, and a straightened cervical tract.
    I’m going to gym now and I am doing squats, in the future surely I will do deadlifts and other things, but I read that they’re nothe recommended at all for people who have flat back. So is there a way to fix these things or should I live the rest of my life like that? And can I do exercises like squats, deadlifts or similar with a situation like that?

    1. Hi Matteo,

      Squats and dead lifts are great for posture! (as long as you are doing them in the right posture)

      So before you start doing them, make sure you focus on these exercises to reclaim your normal spinal curves.

      Mark

      1. Thank you for the rapid answer, Mark! This site is so amazing, I’m learning a lot reading it. But don’t you think squats and deadlifts, with this flat back, can cause more problems to my back pain?
        And another question, when I’ll put more mass to my body doing gym exercises, will I have some aesthetic problems due to this flat back? Because I wanna build mass but I don’t wanna look like a monkey haha.

        1. Hey Matteo,

          Once you learn to control your posture in a more efficient way, dead lifts and squats are a great way to re-enforce your posture. Think of it as a final progression of your postural exercises. You will have to focus on the simpler exercises first.

          If you do your gym exercises with a flat back posture as your foundation, your muscles will grow and re-enforce that posture.

          Mark

          1. Hey Mark, I’ve done some of these exercises on your site. But after I’ve finished the standing intersegmental cat/cow, without a medical ball because I don’t have it, but simply with my arms in front of me, I now have a pain and a sting, a “fire”, in my upper back. Is it normal or did I make some mistake?

          2. I’ve forgotten to say that I’m a 16, almost 17 years old man. I’m a Risser 4. Does that mean that I can eliminate those unhealthy losses of curve?

          3. Hey Matteo,

            If you feel pain then you may have pushed it a little bit too far. But that’s fine. It’s all about getting to know your body better.

            It may just be a muscular strain. Could also be as a result of stretching structures (joints, ligaments, other connective tissue etc) that have never been stretched before!

            Next time push maybe 20% less and see how you respond to that.

            Mark

          4. Hey Matteo,

            It looks like you don’t actually have a flat back in those Xrays. I think you have more of a long thoracic curve.

            Can you take a photo of your posture side view?

            Mark

          1. Hey Matteo,

            It looks you have more of a:
            – Forward translation of the pelvis (Your pelvis is in front of your ankle joints)
            Anterior pelvic tilt
            – Long kyphosis (Which essentially is the opposite of a flat back

            It’s hard to tell for sure looking at this photos, but I do not believe you have a flat back.

            Mark

          2. Thanks for all the answers. So why do I have this pain in the lower back? Because of the anterior pelvic tilt?
            I even have a sensation of “immobility” in the lower back that increases in the morning after I wake up and then it reduces throughout the day.
            Months ago, and even now, I was scared by the possibility of a spondylitis ankylosans, because of my age (17).

  12. Hi. This is my MRI results (I had to translate it to English, tried as best as I could):
    – Loss of lumbar lordosis. Changes after Scheuermann’s disease – Schmorl nodes. Limbus vertebra on L4.
    – Small side protrusion L1/L2 without the pressure on the nerves
    – L2/L3 without protrusion
    – L3/L4 small side protrusion with the small pressure on the left nerve
    – L4/L5 bigger side protrusion with the small pressure on the left nerve
    – L5/S1 without protrusion

    In the links below I attach my Xray photo and map of my pain. I also want to say something about what I went through for now.
    My pain started 2 years ago and it was also 2nd year of my gym story. I started to workout with resistance when I was 16 years old,
    but I didn’t put on heavy weight and I tried to do every excersise technically well (but I know it failed). Suddenly, I felt pain after doing some squats in lumbar spine, but it was mild.
    And that how it started. The first rehabiliation with good results I stated in 2016 in March. It lasted about 6 months and focused on excersises like
    lying on the floor with my core muscles activated and rising my hands, legs up. In August the same year I felt really well, my lumbar spine was fine but I started to have problems
    with my thoracic spine. She couldn’t help me in this problem, I move on to another city and started visiting another physiotherapist (actually manual therapist).
    He is using dry needling on me and some sort of mobilisation. He wanted me to do every day QL stretch and slowly spine twisting with deep breathing, also twice a week
    I should do releasing muscles with small ball. Unfortunately, I don’t feel any better even after one month of doing those excersises.
    I will descript also my pain: I feel really weekness in my back. When I touch these points which I pointed on the picture I feel bloody pain, like tough small points which I can’t get rid of.
    I also have few times a day a pop sound from my lumbar back when I change my posture from posterior pelvic tilt to anterior pelvic tilt, then my spine is blocked in one moment and after a while I feel popping,
    then I feel much better mobilisation. I think that’s everything. Thank you in advice, Dominic.
    Links:
    https://ibb.co/gSP5jk – map of pain
    https://ibb.co/hWvjc5 – Xray

    1. Hi Dominic,

      With Scheuermann’s disease, there might be a certain amount of fusion in your upper back spine. This means, it may not be able to be 100% reversed to a more neutral spine.

      If you have a posterior pelvic tilt, Have you had any success with the specific exercises?

  13. Hello Mark. I really appreciate your knowledge and your articles. The thing that brought me here is my personal problem with spine. I’m (only!) 20 years old man and I have been suffering from lower and mid back pain (particullary whole back :/) for 2 years… I’ve visted about 5 physiotherapists and results are disappointing. I’ve made X-ray of lower and upper back and also MRI of lower back. Every physiotherapist suggested different diagnosis what irritates me a lot, because I don’t know which should I belive in. One thing I know for sure, I have flat back posture and it’s easily to notice that after first look on my body. I feel pain particulary all time, after rehabilitation I can rate it about 3-4/10, but the thing that makes me crazy that it is
    continuous. Pain is local, I mean I don’t feel any pain in my buttocks or legs coming from my spine. Every physiotherapist also didn’t mention flat back posture as a main reason of my condition, they just said that “my spine has a poor ability to absorb and distribute mechanical stress” as you mentioned in the article. I have a serious question for you, becuase my condition is getting worse or stays the same and I’m slowly losing any joy of living, becuase everything what I’m doing means !@#$!$ pain! I’m so tired of it. So, is it possible that this pain comes from my flat back posture? And if so, is it able to cure that somehow, to live without any pain? I’ll also add that my rehabilitaion was mainly focused on stabilization of lower back by strengthening core muscles, I did bunch of excersises like bird dog, planks etc, it helped a bit but sitll there is this pain in my back. Any respose will be helpful, I’m trying to understand source of my pain. Best regards, Dominic

    1. Hey Dominic,

      Can you tell me exactly where your pain is? (also if you could post your results of the MRI)

      Any dysfunctional posture (including flat back posture) can cause issues with the structures in your back. As long as you are not born with this posture (which I doubt) and the spine hasn’t fused together, there is always something we can improve on!

      Mark

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