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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19 thoughts on “How to fix Flat back posture

  1. 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).

  2. 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?

  3. 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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