Posture & Pain – Flatback posture

In the last installation of our three part series about Posture & Pain, Principal Physiotherapist Sylvia Ho shares more about the Flatback posture and why people develop this posture. She also shares how to prevent this posture and exercises to get yourself out of the flatback posture and relieve lower back pain.


This posture here is what we call the Flatback Posture. If you look from the side, it’s actually what we call the C-shape posture as well. A C-shaped is just completely rounded without a hollowing in the back. This is also known as the slump posture or the slouch posture.

Why does this posture lead to back pain? If you remember in the neutral posture, this is a neutral posture. In this posture, all the structures are very happy. In a flat back posture, you can see that the structures in the spine continuously stretch in this position.

Imagine you have a Glad Wrap. You have a Glad Wrap that’s running down here. And being held in this posture all the time, your Glad Wrap gets stretched a lot. As the Glad Wrap gets stretched, it’s going to lead to back pain because the Glad Wrap has nerve endings coming into it. That’s why it leads to lower back pain. This is a predisposing factor to disc problems.

Who are the people who have this posture? People who are generally very tall because they have to bend over and everything else is low for them; people who tend to slouch on their chairs when they work – you have seen people who slouch in their chairs and they work like that so, those people generally have that posture; and people who have very week lower back muscles. They are the ones who have this posture.

You can imagine if you are held in this position, all the rubber bands, all your cling wrap gets really stretched up. There’s no ability for the muscle to hold it in a more neutral position. The muscles at the back, they are weak.

What activities aggravate the pain? Anything that cause even more rounding. What are the activities that cause more rounding? Tilt to the opposite to the S-shape posture so rowing, cycling, squatting, sitting on the floors. These are activities that will force the back to round further. Or slumping over your chair without back support will give you lower back pain because you’re causing that to stretch even further.

What are the activities that will ease it which is opposite to the slumping posture? Any activity that encourages more arching. Here we’re happy for you to do yoga, happy for you to do Superman exercises, happy for you to go and walk, swim breaststroke, anything that requires extension because it takes the spine off a stretched position.

This exercise will get her to do is get her to sit more upright. We want to strengthen her back muscles. The first thing we want to do is get her to rock her pelvis forward like we did in lying down. Excellent! Usually in sitting, her lower back will slump. This is a good exercise to do when sitting. Once you can stay in that position in sitting, what we want her to do is lean forward. As she leans forward, we don’t want her to lose the arch in her back. Lean forward for me without that arch. It looks good, excellent. And then, you can come back up. Now, one more time, tilt your pelvis forward and you’re going to lean forward with that.

Why do we want to lean forward? We’re leaning forward to actually stress the muscles at the back. This is a progression, making the muscle work a lot harder. The body becomes the load, and back. Excellent.

Now, the next exercise we’re going to use is to strengthen the buttock muscle. Why do we need to strengthen the buttock muscle for flat back posture? Flat back posture, usually what tends to happens is your hamstring muscles are overactive and it causes the tilt in your pelvis. The question we have to ask is why your hamstrings are overactive. Usually the answer for that is because your tilts are weak. So, we need to strengthen your tilts so it can switch the hamstring, so you can stop tugging into the pelvis.

How are we going to do that? Pop this leg up for me, excellent. Hand on the wall. We’re going to stand up. And as you stand up, you’re going to push your weight through your heels. As you push through your heels, you’re going to be using your buttock muscle. Very good, and back down. Now, just do four more. One, through your heels. Two, three and four.

Core concepts: Get Better, Stay Better.


Related Articles