Desk worker or manual labourer? Heavy handbag or backpack carrier? Athlete or couch potato? The condition of the musculoskeletal system and the structures of the back reveal a lot about a person’s lifestyle. But someone’s attitude towards life, be it positive or negative, traumatic experiences and mental stress can often be read from their posture as well: insecurity and a lack of self-confidence are reflected in a stooped back, slumped shoulders and a bowed head. An upright back, a raised head and a firm step, on the other hand, radiate confidence and give the impression of a ‘strong backbone’.
Muscle starting point
The core muscles are crucial for a strong, healthy back. They consist of extremely different types of muscles: there are short and long muscles, small and large muscles, and deep and superficial muscles. Some run transversely and others longitudinally. Each muscle fulfils a specific function.
Small deep muscles run along the spine, connecting neighbouring vertebrae. These belong to the so-called deep back muscles, whose main function is to stabilise. The large muscle groups lying on the surface, in interaction with the deep muscles, are primarily responsible for balance and creating movement.
Players and opponents
The spine consists of a chain of individual vertebrae that are flexibly connected to each other by joints and intervertebral discs. In order to keep the spine in position and enable movements to be carried out as well as an upright posture, permanent muscle tension is required. The muscles of the core, primarily the back and abdominal muscles, are responsible for the stabilisation and mobility of the spine. The muscles of the musculoskeletal system never work in isolation; they always interact with each other.
One example of how this interaction works is the movement of our bones. The skeleton is moved by muscles that run through one or more joints. If a muscle contracts, this causes flexion in the joint, meaning that one of the two bones connected by the joint moves. A second muscle is responsible for the opposite movement. For example, in a biceps curl, as the biceps contracts, the arm bends at the elbow. In return, the triceps lengthens. In this movement, the biceps is called the player or agonist (ancient Greek for ‘the doer’). The triceps takes on the role of the antagonist (ancient Greek for ‘the opponent’). Only through this interaction is the flexion of the elbow joint possible. This principle is precisely why the skeletal muscles are arranged as opposing muscle groups.
What lies behind imbalances
To ensure harmonious, smooth interaction between players and opponents, the basic requirement is that there’s a balanced tension and strength ratio between the two. If the original tension of the muscles becomes imbalanced, for example because one muscle has too much tension while the other has too little, a muscle imbalance can develop that will greatly influence strength and mobility. Typically, muscle imbalances occur between the left and right sides of the body and the abdominal and back muscles. This, in turn, results in weak posture, poor posture or even postural defects, which can be categorised as follows:
Weak posture: Weak posture is caused by weakened or shortened muscles. This is not a disease, but rather a misalignment that results in functional impairments. It’s usually the result of a lack of exercise and occurs together with a general reduction in performance.
Poor posture: Poor posture is when the spine becomes misaligned as a result of weakened muscles. In order to avoid resulting damage, this posture needs be corrected through targeted training.
Postural defects: Postural defects develop as a result of uncorrected poor posture of the spine. That is, if poor posture has been left to develop over time, the spine may become permanently significantly restricted in its function and mobility.
Vicious circle of relieving posture: Typical posture mistakes
The most widespread posture mistakes are those that are rooted in weak posture. The starting point for optimal strain of the musculoskeletal system’s structures is a dynamic upright posture. Certain observation criteria are used to check for misalignments of the spine and, if detected, the type of misalignment and how it can be corrected. Observation criteria for poor posture include features visible or palpable on the body that provide information on whether and to what extent certain factors deviate from a dynamic upright posture, in order to conclude where shortened or weakened muscles are present.
Hyperlordosis (hollow back)
One of the most widespread forms of poor posture is hyperlordosis. This means that the curvature of the lumbar spine is excessively pronounced, causing the pelvis to tilt too far forward and the abdomen to bulge outwards.
Hyperlordosis is usually caused by weak abdominal muscles and shortened musculofascial structures. This results in the pelvis tilting forward. In turn, there is excessive pull on the lumbar spine, and hyperlordosis develops as a result. In order to compensate for the exaggerated tilting of the pelvis and the forward pull of the lumbar spine, and to keep the body upright, the muscles in the lumbar region subsequently come under stress, harden and shorten, leading to pain for the person affected.
Advice on how to correct the issue
The pelvis is straightened by the straight abdominal muscles, the gluteus and the hamstrings (ischiocrural muscles). It is tilted by the hip flexor, the anterior thigh muscle (rectus femoris) and the sartorius muscle, as well as the tensor fasciae latae muscle. To correct hyperlordosis, the focus should be on the interaction of the back and abdominal muscles as agonist and antagonist. If these muscles become imbalanced as a result of weakness and shortening, the pelvic position changes. The pelvis, in turn, influences the position of the spine, which becomes misaligned as a result of the muscle imbalance. In order to bring the pelvis back into its physiological position, first and foremost, the weakened abdominal muscles need to be strengthened, and the shortened back muscles need to be given back their full range of motion.
Hyperkyphosis is a typical consequence of our modern lifestyle, which is characterised by a lack of exercise, a lot of sitting, a posture that is constantly bent forward and psychological stress. Furthermore, when we move, it’s usually only on one side. Our arms are almost exclusively in front of our bodies all day, for example when driving, at the computer or using our smartphones. In addition, we remain in the same sedentary position for hours at a time.
This results in the upper back muscles becoming weaker and weaker and losing tension. In return, the muscles and fascia at the front of the upper body shorten and harden, causing the upper back to lean even further forward.
The weakening of the agonist in the back causes a shortening of the antagonist at the front of the upper body. This also constricts the chest. Breathing becomes shallower and an excessive kyphosis forms in the thoracic spine, further exacerbating the poor posture.
Advice on how to correct the issue
To correct hyperkyphosis, the muscles between the shoulder blades, the middle and ascending branches of the trapezius muscle, the rhomboid muscles and the deep muscles that provide stability between the vertebrae need to be strengthened. By strengthening the back muscles, the upper body returns to its upright posture. The chest muscles need to be returned to their physiologically intended length through targeted strengthening and stretching. It is important to use the full range of motion of the chest muscles during the exercises in order to open up the constricted chest.
Kypholordosis (hollow round back)
Kyphosis and lordosis often occur together as kypholordosis. In this case, the lumbar region is heavily curved outwards, while the spine in the chest region is excessively bent backwards. As with kyphosis, breathing can be difficult as a result.
Identifying features and advice on how to correct the issue
The spinal column consists of individual vertebrae and intervertebral discs that are stabilised by the muscles. Any disorder, even if it occurs only in certain areas, has a considerable effect on the entire spine. If, for example, hyperlordosis occurs as a result of weak and shortened muscles, the upper body tries to compensate for the resulting disorder with bad posture and develops hyperkyphosis. An example of this is kyphosis resulting from lack of exercise and prolonged sitting: as a result, the abdominal muscles weaken and cause a hollow back. That means that when treating kypholordosis, the causes and effects of both types of poor posture must be given equal consideration when taking corrective measures.
People with a flat back lack the natural S-shape of the spine. Instead, their spine is completely straight, almost like a broomstick.
The natural lordosis and kyphosis of the spine are missing. As a result, the spine loses stability and has difficulty, or may be completely unable to, compensate for any compressive or spring loads. This results in permanent pressure on the spine, which has other serious consequences: since there is no natural alternation between load and relief, the intervertebral discs are undersupplied. Important metabolic processes are thus severely restricted, leading to further complaints.
Advice on how to correct the issue
To improve a flat back, all of the back muscles need to be strengthened, and special attention needs to be paid to the deep, stabilising effect of the spinal erector (erector spinae). At the same time, it is important to develop the oblique and straight abdominal muscles. When performing exercises, make sure to use your full range of motion during movements.
The role of the fascia
When examining the origin and searching for the causes of back pain, one topic has become an integral part of the discussion: the fascia. But what is fascia anyway? Fascia is not a new phenomenon. As long as we humans have existed, fascia has been an intrinsic part of our bodies. Every person carries up to 25 kg of fascia. However, fascia has been given far too little or no attention at all for far too long. Its significance for the human body has long been underestimated. However, focused research in recent years has revealed how important fascia is for a healthy and flexible body. Fascia (Latin for ‘band’) is part of the connective tissue that extends through the entire body. Fascia is like a fine-meshed network that surrounds the muscle fibres, muscle strands, musculoskeletal tissue, bones and organs and runs through the whole body from head to toe.
Fascia doesn’t just serve as mere ‘packaging material’, it also supports and shapes our bodies as well as taking over and coordinating the transfer of force between muscles. It ensures that our movements literally run smoothly. To do this, the fascia slides in the body and holds together what belongs together, while in other places, it keeps apart what must remain separate – thus ensuring, among other things, that muscles do not rub against each other during movement.
Through their harmonious interaction, the fascial bands are perfectly coordinated with one another. However, the fascial bands are not only closely connected to one another – as a central sensory organ, they also interact with the immune system and the psyche. Fascia has far more pain receptors than our muscles. If back pain occurs, the cause won’t necessarily be related to the muscles or intervertebral discs. On the contrary, fascia that has hardened, stuck together or matted is often the cause behind the discomfort.
Why fascial bands stick together
Almost everyone has seen fascia and even held it in their hands. For example, when you’re removing the fine white and silver skin on a piece of meat in the kitchen, this unassuming material is actually fascia. Fascia is composed of around 70% water as well as collagen fibres and elastin. Healthy fascia is extremely tear-resistant yet also elastic and supple. A lack of exercise, one-sided strain, ageing processes or even psychological stress lead to changes in its structure: the fascial bands stick together or become matted and also cause restrictions and pains in the surrounding structures.
Our bodies reflect our habits – the good and the bad
The human body is a master of adaptation in both negative and positive ways. If a person spends the whole day sitting with bad posture and barely moves, the fascia and muscles are trained to hold precisely this poor posture over time. This means that the muscular and fascial structures shorten, contract, stick together and become matted. However, just as the body adapts to these ‘adverse conditions’ and warps accordingly, this physical adaptability can, of course, also become a positive: good posture, regular movement, exercise and mindfulness towards your own body ensure long-term healthy body structures and freedom from pain.
Healthy fascia – the key to a pain-free back
The back fascia (thoracolumbar fascia) is the largest fascial structure in our bodies. It forms the centre of the entire fascial network. It runs directly under the skin and extends from the lower rib area to the upper part of the pelvis and holds many nerves, pain receptors and movement sensors.
Fascia loses its elasticity owing to poor posture, incorrect or excessive strain and lack of exercise. It sticks together, becomes matted and hardens. Tiny cracks can also appear, triggering painful inflammation. This leads to back pain and impaired muscle coordination.
In the past, back problems were often blamed on the intervertebral discs or muscles. It has become clear, however, that in many cases, the pain is being caused by fascial bands that have stuck together in the back. There is a way to combat this: targeted stretching exercises can loosen the stuck fascia again. Stress reduction and relaxation exercises also have a positive effect on the body and help to loosen matted fascia.