What can I do about my adolescent's poor posture?
Why does my child stand like that??
A frequent complaint by parents (especially mothers) in our office is their adolescent's poor posture. "My child stands with her shoulders slouched and I keep telling her if she doesn't stand up straight, her back is going to be like that forever!" "He looks like the Hunchback of Notre Dame the way he sits...I ask him to sit straight and he does, and then goes right back into that awful position. His back will be ruined for the rest of his life."
As most parents know, these are very common concerns. So lets break this down into digestible parts.
The first issue is whether your child's posture is due to a rigid (fixed) deformity of the spine or is mobile. Rigid deformities are uncommon, and can be related to Scheuermann's Disease (a growth problem of the vertebral bodies that results in progressive rigid kyphosis or roundback) or congenital kyphosis (congenital abnormalities of the vertebral bodies ). These two problems are actually not problems of posture but of the shapes of the bones and your child cannot consciously improve their position without treatment. This is not laziness. Luckily these two problems are fairly uncommon.
Scheuermann's Disease is an abnormality of the growth of the vertebral bodies in the front of the spine and is diagnosed by physical examination (a rigid kyphosis) as well as radiographs that will usually show wedge-shaped vertebral bodies, disc space narrowing, and vertebral endplate changes. It can run in families and the curvature can get worse as they get older. Unlike scoliosis, however, it generally does not have any significant effect on the heart or lungs, and is much less common than scoliosis. People with Scheuermann's Disease live a normal life-span. They do complain about more pain then the general population, but they don't miss any more work then anyone else. They get married (and divorced) just like the rest of the population. Treatment usually requires a brace. In severe cases, spinal fusion is performed to correct the deformity.
This is even less common than Scheuermann's Disease. This is a congenital abnormality (the child is born with it) where the vertebral bodies in the front were not formed correctly. Sometimes they are fused in the front (called failure of segmentation) and sometimes there is only a partial, triangular vertebrae (called failure of formation). Failure of segmentation results in a fairly smooth curve. It may get worse but except for the appearance, is usually not dangerous. Failure of formation, with a small triangular vertebrae, can be very progressive and very dangerous. It can result in a very short, sharp kyphosis (called a gibbus), and the spinal cord can be draped over this area. Any increase rapid flexion of that area (even from a fall on the playground) can cause permanent damage to the spinal cord. The only treatment for either of these conditions is surgical.
Congenital kyphosis can be associated with other problems including congenital abnormalities of the heart, spinal cord, and kidneys. So if you child receives a diagnosis of congenital kyphosis, they need to be evaluated for these other issues.
Ok. So almost all adolescents with bad posture fall into this category. This is the "slouchy shoulders, sitting crosslegged on the bed over the laptop computer" posture. When you yell at them to stand up straight, they can. But they won't stay that way and immediately go back to the poor posture as soon as you turn your back. This is referred to in orthopaedics as "postural roundback." It is not a fixed or rigid deformity. The bones of the spine are normal.
Here is the hardest part for parents to understand....It really isn't that big a deal.
"What? Blasphemy! That can't be true! Bad posture has to be a problem. My mother yelled at me because of my bad posture so I stood up straight, my grandmother yelled at my mother because of hers..." and so on and so on.
Why has this incorrect concept been propogated?
If you look back over a few millennia, people with bad posture were really ill. They had polio or tuberculosis and truly had spine problems. People recognized this and so those with bad posture were viewed with serious concern.
Fast forward to the 21st century in the developed world, and this isn't the case. We see very few people with tuberculous spines. So what has happened is that the society has translated "bad posture" into "bad cosmetic appearance."
I ask my patients, "who is your favorite actor or actress that you wished you could date?" They give me a name of some handsome person. I then tell them a story. The person they named has an identical twin. However, the identical twin has bad posture. Which one would they rather date? Of course, they pick the one with good posture. I then tell them, "Ok, let's say you have an identical twin who stands up straight and you slouch. If the actor or actress had a chance to either date you or your identical twin, which would they choose?" This usually gets across the connection between posture and appearance.
I also talk to them about pain. There are various kinds of pain; physical, psychological, etc., Some children with postural roundback do have some mild back pain. However it isn't much. I also explain to them that if their mother is unhappy with their posture, their mom will continue to harass them and is less likely to take them to the mall or let them borrow the car or give them money. Thus, they are in fact hurting themselves by having bad posture.
But the bottom line is that bad posture is just what it is..."bad posture." It won't become permanent, won't cause severe deformity, and won't ruin your teenager's life.
A final note...
My experience with my own daughter (now 19 years old) was very much the same. At 14, she had terrible posture and I complained and complained and she didn't care not one iota. Not until she noticed boys, that is. At 15 1/2, she suddenly straightened up, walked with good posture (especially at school and surely if there were any teenage boys around).
So parents, be prepared. When your child straightens up, it means something!
- Scoliosis Research Society (SRS)
This is the website for the Scoliosis Research Society, a non-profit organization dedicated to education, research, and treatment of spinal deformity.
Steven & Alexandra Cohen Children's Medical Center of NY
- Steven and Alexandra Cohen Children\'s Medical Center
Dedicated to the highest quality care in pediatrics and the only level one trauma center on Long Island.