Chiropractic care for posture
Posture gets blamed for a great deal of pain, and the research has not settled whether it causes low back pain, so an assessment here looks at the whole shape of your day: how long you hold a position, and how little you move in between.
Sound familiar?
- “I slouch all day”
- “I catch myself hunched over the laptop”
- “my shoulders sit forward”
What it actually is
Posture is a shape, and for most people it is the shape a desk day leaves them in: head drifting towards the screen, chin poking, shoulders rolled forward, hips folded into a chair. There is no single correct version of it, which is worth knowing early if somebody has told you yours is wrong.
The spine is not a straight column. It carries three gentle curves, forward at the neck, back through the mid-back and forward again low down, and together they work like a spring that shares load between joints, discs and muscles. Muscles do their best work in short bursts with rest in between, which is the part a working day takes away.
Your head weighs about as much as a bowling ball. Balanced over the shoulders, the bones of the neck carry most of that and the muscles have little to do. Let it travel towards a screen and the muscles at the back of the neck and between the shoulder blades have to hold it out there, the way an arm holds a weight away from the chest. Eight hours of that leaves them tired, tight and sore. The mechanics are set out at length in why does my neck hurt after a day at my desk?.
None of that is damage, and a photograph of your profile is not a prognosis. Joints that stay still get stiff, particularly through the mid-back and the ribs, and once the mid-back stops taking its share the neck and shoulders pick it up. It is a loading pattern rather than a diagnosis. It is the pattern, rather than the shape, that the assessment looks at.
It is worth being equally plain about what posture does not explain. A 2020 umbrella review in the Journal of Biomechanics examined 41 systematic reviews and found no consensus that spine posture or physical exposure causes low back pain. Posture has been associated with it; an association is not a cause. That is a reason to be careful with anybody who tells you your pain is explained by how you sit or stand, rather than a reason to stop caring how you sit.
What people notice
- An ache across the top of the shoulders that builds through the afternoon
- Soreness between the shoulder blades by the end of a work day
- A neck that stiffens over hours at a screen and is worst on the way home
- A low back that objects to the first few steps after a long sit
- A head carried forward of the shoulders, or shoulders rolled forward and one sitting higher than the other
- A mid-back that feels locked when you turn or reach behind you
Where it sits in the body
- The three gentle curves of the spine: forward at the neck, back through the mid-back, forward again low down
- The joints of the mid-back and the ribs that attach to them
- The muscles at the back of the neck and between the shoulder blades
- The muscles at the front of the hips, and the glutes behind them
- The discs at the base of the spine and the ligaments behind them
What the assessment looks for
An assessment here is a look at how you actually move, not a verdict on how you stand. It starts with the shape of your day: the hours, the desk, the commute, where the ache turns up and what settles it. That history narrows things down before anybody puts a hand on you.
From there, what gets looked at is ordinary and physical:
- where your head sits over your shoulders, and what changes when you move it
- how far the mid-back and the ribs turn and extend
- what the hips do as you stand up, and how much give there is at the front of them
- the desk itself: screen height, chair, and how often you leave the seat
- the safety screen that opens every assessment
Whatever that turns up is explained to you on the day, in plain words, before anything is worked on. Some of it will be about the desk rather than about your body. If part of it belongs with your GP, we write to them.
Choosing between professions? Should I see a chiropractor, a physio or an osteopath? compares the three for desk-driven soreness.
What care involves
The work has two halves, and the second is where most of the effort goes. Early on the work is aimed at what is sore, and at understanding why it is there: hands-on work on the joints and muscles the assessment pointed to, gentle manual techniques aimed at held tension, with what was found explained before anything else happens. That is the ground posture care covers.
Over time the balance changes. The hands-on part gets smaller and movement takes over: a short set of exercises you can genuinely do at a desk or at home, strength for the muscles that hold you up, and the unglamorous half, which is the chair, the screen height, the phone and how often you get out of the seat. It is built for lasting improvement rather than short-term relief, and that is why the movement half matters as much as the hands-on half.
People call this "posture correction", or "posture treatment". What it consists of is joint movement, strength and the habits around a desk day, because those are the parts that can change. What we work towards is a mid-back that turns, hips that give, muscles that last the day, and a desk that costs you less of your evening. Not a straighter photograph.
None of that comes with a schedule attached, and the reason it cannot is worth reading in full: how many visits will I need? sets out what a review actually looks at, and what changes when the desk half is the half that has not moved.
Everyone moves through this differently, so the plan is paced to your body, reviewed with you as you progress, not read off a fixed schedule of visits.
What the guidelines say
- Journal of Biomechanics, No consensus on causality of spine postures or physical exposure and low back pain: A systematic review of systematic reviews, 2020. https://pubmed.ncbi.nlm.nih.gov/31451200/
When to get it looked at
Posture is rarely the whole story, and a handful of things get checked before anybody works on your neck or your back. Every assessment opens with that screen.
Call an ambulance if there is any confusion, sudden weakness or numbness in the face, arm or leg on one side, facial drooping, slurred speech, sudden trouble speaking, seeing or understanding, loss of vision, a seizure, or a sudden loss of balance or coordination. Call an ambulance or go to a hospital emergency department straight away if a headache comes on suddenly and severely (the worst you have ever had), if a headache arrives with fever, a stiff neck or a rash, or if a headache follows a knock to the head.
Go to a hospital emergency department straight away if you have numbness or altered feeling around the saddle area, meaning the groin, the inner thighs, the buttocks or the genitals; a loss of normal sensation in the genitals, including during sex; trouble starting to pass urine, or any new change in your bladder or bowel control; weakness in both legs, particularly if it is getting worse; new or worsening pain running down both legs; weakness in one leg that is severe or getting worse, or a foot that has started to catch or drag when you walk; or numbness in a leg that is spreading or getting worse quickly. Go to a hospital emergency department straight away for back or neck pain after a serious fall or a high-impact accident, such as a car accident; back or neck pain with a fever or feeling generally unwell; or new back or neck pain if your immune system is weakened, for instance by long-term steroids or chemotherapy, if you inject drugs, or if you have recently had a spinal injection, spinal surgery or a dental procedure. Go to a hospital emergency department straight away if you have weakness in one arm that is severe or getting worse, or numbness in an arm that is spreading or getting worse quickly. Go to a hospital emergency department the same day if you have new clumsiness in both hands, or new unsteadiness on your feet.
See your GP promptly, before booking here, if you have a history of cancer, unexplained weight loss, pain at night that will not settle in any position, known osteoporosis with new severe pain, numbness that is spreading or getting worse slowly, new, unexplained back pain as an older adult, or pins and needles, numbness or weakness in an arm or hand.
A growing spine is the one case where the shape itself is the question. In a teenager still growing, a curve that looks built into the spine rather than into the habit needs a specialist assessment of its own. We arrange it, keep your GP in the loop, and keep working on the stiffness and the movement patterns around it alongside whatever comes of that assessment.
Otherwise the threshold for booking is unremarkable: the ache has stopped clearing over a weekend, the same spot flares most weeks, or you have started arranging your day around it.
Common questions
Is my posture the reason my back hurts?
Posture on its own is not a cause the evidence can give you. The review this page cites is why we will not pretend otherwise: it records an association and stops short of calling it a cause. What we can say is narrower: what an assessment looks at is how long a position gets held and how often you get out of it, alongside the rest of your day.
Is there a correct posture I should be holding?
There is no single correct version to hold. Muscles do their best work in short bursts with rest in between, whatever shape they are held in, which is why the position most people get on with is usually their next one: shift, lean, sit forward, sit back, and get out of the chair through the day.
Can posture change, or is it just how I am built?
Some of it is inherited, and no amount of work changes the bone you were built with. What a desk day added is a different matter: a mid-back that has stopped turning, hips that have spent years folded, muscles that give out by the middle of the afternoon. Those are the parts an assessment is aimed at.
Do I need a scan before anything can be done?
Not as a starting point. What a posture assessment turns on is movement: what turns, what gives, and what is sore by the end of a working day. Your history and a physical examination are where that comes from. Imaging is arranged when clinically indicated, which means the examination itself has raised something that would change what happens next, and in that case we arrange the referral or write to your GP.
The question people tend to ask on the way out rather than in a list like that one is whether any of it is safe to have done at all. Is chiropractic safe, and what does the evidence actually say? is the full answer, risks included.
Read next
Nearby: Chiropractic care for neck pain and Chiropractic care for lower back pain.
The clinic is at Suite 1, Lower Ground Floor, 225 Macquarie Street, Sydney NSW 2000. How to find us, or read all the conditions we see.
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Suite 1, Lower Ground Floor, 225 Macquarie Street, Sydney NSW 2000. No referral needed to book.