Posture Exercises for Osteoporosis

Box of stretch bands

Good posture can alleviate chronic pain and reduce pressure on your spine. Achieve it by strengthening your core and your upper back with these exercises.

Disclaimer: If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Well Guide contain information from peer-reviewed research, medical societies and governmental agencies; however, these articles are not a substitute for professional medical advice, diagnosis, or treatment.

Good posture isn't just about looking taller. It can lead to greater functionality as you age. Good posture aligns the spine and other major joints, which keeps the body upright and balanced, decreasing the likelihood of falls and bone degradation. On the contrary, poor posture can cause pain, impair balance, and predispose you to injury. As one can assume, poor posture could be especially detrimental for those with osteoporosis or osteopenia.

What Makes Up Good Posture?

Good posture will look slightly different on everyone, considering no two bodies are the same. However, there are some general guidelines that apply to most people. Good posture involves a little bit of genetics (how you’re built) and a lot of life experience (what positions you spend time in). Your body will be shaped by the positions and movements you practice daily.

Most of our world is in front of us. We wake up, we eat breakfast, we use the computer, we drive, we cook, we read, we care for our family - all activities that are in front of us. It is no surprise that after years of all these forward-facing activities, with the weight of gravity weighing on us, our bodies can assume a forward, rounded, slouched position.

This position can cause the spine to round, or “flex,” putting uneven pressure on the front of the vertebrae and potentially causing neck, upper back, or lower back pain. It can also lead to tightness in the chest muscles and weakness in the upper back muscles. In a person with low bone mineral density, this additional pressure can lead to vertebral compression fractures.

This is why, as we get older, it is especially important to work on avoiding slouching and achieving good posture.

In order to work on improving posture, it is important to know what comprises good posture:

  • Feet about hip-width apart, facing forward or slightly turned outward, and aligned under your hips.
  • Soft knees – not locked out to be straight, but not bent.
  • Maintenance of the natural curves of your spine:
  • Your lower back (lumbar spine) has a slight curve that from the side looks like a “backward C.”
  • Your mid back (thoracic spine) curves the other way, looking like a “forward-facing C.”
  • Your neck (cervical spine) curves in the same direction as the lumbar spine but to a smaller extent since the neck is a smaller area compared to the lumbar spine.
  • Shoulders stacked over your hips.
  • Shoulder blades pulled slightly together and down away from the ears.
  • Core muscles activated and the rib cage tucked down.
  • Ears stacked over your shoulders, chin parallel to the floor.
  • Imagine a string pulling your head up towards the ceiling so that you stand tall.

The Dangers of Poor Posture

Various health risks are associated with poor posture, especially for older adults with lower bone mineral density.

Poor posture can cause you to lean forward. Over time, this forward position can shift your center of gravity. This can affect balance and lead to falls (Cook, 2002).

A forward-rounded posture can also increase the load on your vertebrae, the bones throughout the spine. This can cause pain, disc herniations, or even compression fractures.

Muscle imbalances are also a result of poor posture. When muscles are too tight or too weak, they can impact alignment of the body and a joint is loaded. This uneven support and pull can put your joints at higher risk for injury or arthritis.

Lastly, a forward posture can compress your vital organs, such as your lungs and stomach, impacting your breathing patterns, endurance and digestion.

Improving posture can decrease your risk for all the above-mentioned conditions. Although perfect posture may be unrealistic, better posture can relieve pain and reduce the risk of future injury.

Common Posture Mistakes

So you’re ready to fix your posture. Let’s first recognize what common postural mistakes look like. This is important to recognize because it can also be the result of over-correcting posture and can lead to issues as well.

"Donald Duck posture" is when there is an excessive curve in your lumbar spine. This can happen when the shoulders are pulled back so much that your rib cage and belly flare out. This overarching of the lower back can disengage the core and put an unwanted load onto the lumbar spine. To avoid this, you can work on exercises that promote a neutral spine and strengthen the core.

"Flat back posture” is when no curve is maintained in the lumbar spine. This can cause tightness in your abdominals and hip flexors (the front of your hip), making it hard to stand upright.

If you are still unsure about how your posture stacks up, consult a physical therapist who can assess your posture and your body’s specific needs.

Exercises for Better Posture

There are several exercises you can do to improve your posture. They involve a mix of stretching the tight muscles, strengthening the weak muscles, and improving muscle endurance to maintain good posture throughout your day. But remember: visible changes to your posture take time. It is important to consult your doctor or physical therapist before trying a new exercise program. For those with osteopenia and osteoporosis, avoiding extreme bending (flexing and twisting) is important to maintain bone integrity. If you are unsure whether or not these exercises are safe for you, consult a professional.

1. Child's Pose

This exercise stretches the back muscles in a safe and unloaded position.

  • Start on all fours with your hands under your shoulders and knees under your hips.
  • Without moving your hands, sit your hips back over your heels.
  • Stay here for 30 seconds while taking deep breaths.

​2. Cobra Pose

Cobra pose helps stretch the muscles of the abdomen and get an extension through the upper back. It helps promote extension (the opposite of forward flexion) in both the upper and lower back.

  • Start by laying on your stomach.
  • Bring both hands down just outside your chest.
  • While keeping your hips down, gently press your chest up off the floor.
  • Hold for 3-5 seconds. Relax. Repeat this 10-15 times.

3. Chest Opener (Pectoralis Stretch Over Towel Roll)

This stretch stretches the chest muscles and gives extension to the upper back.

  • Start by rolling up a large towel into a long roll.
  • Place the towel across your back, around where your bra line.
  • Lay down on your back, letting your head and shoulders relax over the towel. Let your arms lay by your sides, palms facing up, or bring your arms to the side to look like the letter “T.”
  • Hold for 1-2 minutes and let gravity do all the stretching! Be sure to maintain a steady breathing pattern.

​4. Supine Marching (Supine Alternate Lower Extremity March)

This exercise works your deep core muscles that help maintain an upright posture.

  • Start by laying on your back with your arms relaxed at your sides. Legs are positioned with knees bent and feet on the floor.
  • Start by engaging your abdominal muscles. Think about keeping your rib cage tucked down and low back flat on the floor.
  • Maintain this abdominal engagement and neutral spine as you lift your right knee up until it is stacked over your hip.
  • Come back to the starting position and then repeat on the other side.
  • The key to this movement is to move slowly and maintain an engaged core.
  • Perform 5-10 reps on each side. Rest for 30 seconds. Repeat 2-3 more sets.

5. Plank

Planks are an isometric exercise. This means that no body part is moving, but you are still improving the strength of a muscle group. Planks improve core endurance by having to hold a neutral spine for prolonged periods of time (instead of performing repetitions).

  • Start by getting into all fours. Check-in to make sure your spine is neutral- not arched or rounded. If you are having trouble with this, perform the cat-cow exercise and find the middle ground between cat and cow.
  • Next, walk your feet back so that you are in a push-up position.
  • Keep core muscles engaged and your back flat. Your shoulders should be stacked over your hands, and your hips should be level with your shoulders.
  • Keep your core, glutes, and quad muscles engaged. Maintain a steady breath and hold for 15-30 seconds.
  • Rest for 30 seconds and rest this for 2-3 more sets. Work your way up to a 1-minute hold and maintain good for the entire time.

6. Modified Side Plank

Similar to the regular plank, a modified side plank works the muscle endurance of your hips and obliques.

  • Start by laying on your side, with your elbow propped under your shoulder and knees bent. Your hips and knees should be stacked.
  • Bend your knees so that there is a straight line from your shoulders, through your hips, and to your knees.
  • Using your elbow and knees as a touch point to the ground, lift your hips up.
  • Keep your shoulders and hips in line and your core muscles engaged. Maintain a steady breath and hold for 15-30 seconds.
  • Rest for 30 seconds and rest this for 2-3 more sets. Work your way up to a 1-minute hold and maintain good for the entire time.

7. Scapular Retraction

This exercise strengthens the muscles of the upper back that help maintain an upright posture.

  • Start by standing with your arms by your sides.
  • While maintaining your arms in this position, squeeze your shoulder blades together behind you.
  • Squeeze and hold for three seconds. Then go back to the starting position.
  • Perform 10 repetitions. Take a rest. And perform 2 to 3 more sets.

8. Supine Deep Neck Flexor Upper Cervical Nod

This exercise (also known as "chin tucks") strengthens the muscles in front of your neck and stretches the muscles at the base of your skull to improve the common forward head posture.

  • Begin by lying down with your knees bent up and your feet flat, with the top of your head resting on a small folded towel.
  • Gently nod your chin towards your Adam's apple.
  • Hold this position for 5 seconds. Then relax.
  • Repeat 10 times.

9. Prone Thoracic Extension

Prone thoracic extension is designed to activate your thoracic spinal extensors, leading to improved posture and preventing a forward slumped position.

  • Begin by lying on your mat face down. 
  • Place your hands out to the side with your elbows bent to 90 degree angles.
  • Gently lift your collar bone off the floor. 
  • Hold this position for 5 seconds.
  • Then, lower back down to the starting position.
  • Repeat for 2 sets of 10 repetitions.

10. Scapular Retraction "I" Exercise on Mat

The "I" Exercise on Mat is designed to strengthen muscles that are essential for pulling your shoulder blades together and helping to maintain proper posture.

  • Begin by lying on your mat face down. 
  • Your arms should be positioned in an "I" by your sides, with your thumbs pointed down towards the floor.
  • Lift both arms up a few inches from your initial starting position by squeezing your shoulder blades together, then return to the starting position. 
  • The movement should be initiated by your shoulder blade muscles.
  • Repeat for 2 sets of 10 repetitions.

Wellen's personalized bone-health fitness program incorporates all of these exercises and more so that you can improve posture while also addressing strength and balance.

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  1. Cook, C. The relationship between posture and balance disturbances in women with osteoporosis. Physical & Occupational Therapy In Geriatrics. 2002;20(3):37–49. DOI: 10.1080/J148v20n03_03
  2. Kado DM, Huang MH, Barrett-Connor E, and Greendale GA. Hyperkyphotic posture and poor physical functional ability in older community-dwelling men and women: The Rancho Bernardo Study. J Gerontol A Biol Sci Med Sci. 2009;60(5):633–637. DOI:10.1093/gerona/60.5.633
  3. Quek J, Pua YH, Clark RA, Bryant AL. Effects of thoracic kyphosis and forward head posture on cervical range of motion in older adults. Man Ther. 2013;18(1):65–71. DOI:10.1016/j.math.2012.07.005
  4. Sinaki M, Brey RH, Hughes CA, Larson DR, Kaufman KR. Balance disorder and increased risk of falls in osteoporosis and kyphosis: Significance of kyphotic posture and muscle strength. Osteoporos Int. 2004;16(8):1004–1010. DOI :10.1007/s00198-004-1791-2

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