Sitting Posture

The alignment of the ideal sitting posture involves the body being optimally stacked over each other in a natural and relaxed manner.

Here’s an analogy: Do you remember that game called “Jenga”?

Essentially, it is a game which involves a neat stack of blocks in which its stability is progressively challenged as players remove pieces of wood from its structure.

This process continues to a point where the stack becomes too unstable and the structure collapses.

Like your posture, I believe the structures in your body need to be stacked over each other in the most organized way to achieve ideal stability.

Failure to accomplish this may result in the muscles and joints over working to maintain an upright position.

The alignment of the ideal sitting posture

The ideal sitting posture can be illustrated as a straight line through the ear canal, shoulder joint, thorax/ribs, pelvis and the hips. The aim of your sitting posture is to achieve as much symmetry as possible. Have a look below!

sitting posture

How do you know if you have good posture? Let’s do a quick test…

Stand up and stand your back to the nearest wall. You should be able to touch the back of your head, shoulders, bottom and ankles comfortably. If you can, well done, you have the potential to have good posture.

However, the question is: Can you maintain this right posture all the time whilst sitting? If you can’t, it’s time for you to do something about it now!

Note: Of course, this is a very general way of determining your posture. I strongly recommended getting assessed by a qualified health professional if you have any doubts. 

The ideal sitting posture

Let’s have an even closer look at how we should be positioning our body. I have devised this section into 7 separate areas, however, it is important to note that they are all interlinked and synergistic with each other.

Any change in one area will cause a chain reaction in the whole posture.

1.  Pelvis

If your pelvis is not in the right position while you’re sitting, it is impossible to have good posture! It is the foundation as to which your posture is based on.

The aim is to position the pelvis so that you are sitting directly on top of your “sit bones”.

How to do this:

  • Whilst standing, place your fingers on your bottom and locate your sit bones (see blue dots as above: they are the pointy parts of your bottom).
  • As you sit down, pull these sit bones away from each other.
  • Your pelvis should be tucked into the back of the chair and slightly tilted forward.
  • Distribute your weight evenly between both buttock cheeks and ensure that you do not lean to one side.

If you would like to know more on the correcting your pelvis position in sitting, check out this post: How to correctly position your pelvis in sitting.

2. Lower back

Maintain the natural curve in your lower back.

Remember – Not too much, but not too little.

The arch is directly linked to how you position your pelvis (as mentioned above).

You should feel a small amount of tension in your lower back at all times when sitting to ensure that your lumbar spine arch is supported.

Note: Make sure that you do not feel the tension in the middle back as this probably means that you are over arching!

3. Thorax/Ribs

a) Your rib cage should feed directly into your pelvis.

People who tend to stick their chest out too much (for whatever reason) tend to be over extended in the lower/middle back. Stop puffing out your chest like that!

Self assessment:  Whilst sitting down, place one hand flat on your chest and the other on your pubic bone. Make sure your hands are parallel and in line with one another.


b) Your upper back should remain up right. Do not hunch your back! Don’t be lazy! Sit up straight!

Self assessment:   You should already know if you slouch or not. The question is: Are you willing to do something about it?

c) There should be no rotation or tilting of your thorax.

Self assessment:   Have a look in the mirror: Are your shoulders/nipples/collar bone/finger tips level? Do you have symmetrical waist creases? Is your belly button facing forwards? Or is it to the side? It is very common to have these sort of deviations in the thorax region and unfortunately many people fail to realize this!

4.  Shoulders

Your shoulders should remain relaxed in a wide and backwards/downwards position.

The ideal shoulder position can be achieved by:

1. Lifting your arms to the side (to the horizontal) with palms facing forward,

2. Gently pulling your shoulder blades in a backwards/downwards motion and

3. Keeping your shoulders where they are, let your arms drop back down by your side.

Self assessment: Drop your hands by your side. Are your thumbs pointing forward? People who tend to have hunched shoulders will have their thumbs facing inwards towards their body.

5.  Head

Front view:

Your head should sit naturally and symmetrically between your shoulders. There should be no tilting or turning of the head in this position.

Self assessment: Look into a mirror – Are your eyes/nose/mouth level? Can you see both ears clearly and equally? If not, your head is probably in the wrong position! If you are unsure, I find it easier to draw lines on a picture of your face.

Side view:

Gently tuck your chin in. Your head should not poke forward.

Neck alignment

Self assessment:  Take a side view photo of yourself: The ear canal should approximately be in line with the middle of your shoulder joint.

Ideal leg position

(Note: The following are dictated by the chair that you sit on.)

5. Hip

The angle of your hip joint should be around 90-100 degrees.

6. Knee

The angle of your knee joint should be around 90-100 degrees.

7. Foot

The angle of your ankle joint should be at 90 degrees. The foot should ideally remain completely flat on the ground.

Let’s run through a few questions that you may have:

Why is it important to have good posture?

I have essentially outlined the reasons why at the post here: Start here.

But to put it simply: the body works at its best when in the ideal postural alignment. If you do not have good posture, then your body will be working much harder than it should. This will commonly lead to your typical symptoms like tightness and pain.

I have had bad posture for a long time now, can it still be fixed?

Generally speaking, the longer you have had your bad posture, the harder it will be to influence any change. However, having seen many patients with longstanding postural issues, I have found that there is always something that we can improve on.

When addressing my patient’s posture, I strongly urge them to aim for progression and not perfection.

Can one really achieve perfect posture?

Let me throw a question back at you.

Can one really be 100% perfect in anything?

The answer is no.

But there should be nothing stopping us from trying to achieve the best in ourselves. The closer we can resemble the “perfect posture”, the more we can be assured that our body is working at its best.

Doing the best with what you have is your relative perfection and is something that we all need to try to strive for.

Final Thoughts

Due to the immensity of problems that arise from bad sitting postures, I have the need to stress the urgency of fixing your posture. It would be crazy not to even consider it!

Please do not delay! Don’t be like those people who say, “some day I’ll fix it. Some day I’ll DO some exercises.” Some day… Some day… The time is NOW!

My goal with this blog is to help you with your pain by providing simple ways to achieve your best possible posture for your body.

120 thoughts on “Sitting Posture”

  1. Hi Mark,
    When I sit I can only feel my right sit bone and my left sit bone goes forward and can’t feel it. My left foot arch is collapsed and have trouble internally rotating my left leg. My right hip flexor is tighter than my left. My right shoulder is further forward. I tried to fix it through right pelvic rotation exercises but then my pelvis rotates to left. This has really got me down as I have had to stop horse riding as to not make my horse crooked. Any advice would be much appreciated
    Thank you,

    • Hi Holly,

      I haven’t assessed you, but it sounds like your pelvis is oriented towards the right? If your pelvis rotates towards the left after the exercises, this might be due to over shooting the correction. Does it stay stuck in that position or does it go back to the right?

      If you can’t feel your left sit bone, this suggests that you might be leaning into your right sit bone more? Does your torso also tend to bend towards the right side? Do you tend to rest you elbow on an arm rest throughout the day? I suspect that there may be rotation and side bending also occurring in your torso. See post: Scoliosis Exercises and Twisted Spine Exercises.


  2. hi, i have problems with my posture. i read all your blogs and i really want to do something about my posture. is it possible to buy special posture advices from you by personally ? waiting for your reply

  3. Hi Mark, I sent an e-mail to you regarding a flat back issue that I have. I had a sports injury at my L4 , and a disc herniation at my T-spine. After years of dealing with those and recovering slowly, my back has become flat, loss of lordotic curve and kyphosis and a fairly straight neck. I am getting CBP to address the curvature but I have pain when I’m sitting at the thoracic T6-T8 area, even after 15 minutes of sitting. I feel tension in the muscles right away and after a short period of time pain.

    What can I do to accommodate a flat back while sitting? Would you not recommend sitting at all and try a different position? I have a recliner and because of the contact with the thoracic facet, it causes a little pain too. I tend to stand alot, and lay on my side on the bed. Let me know what you think! Thanks

  4. Hey Mark,

    Love your stuff! Very detailed.
    I had a question about how breathing is related to posture. Ive realised I was never really breathing from my diaphragm. Even when I did all the exercises suggested by you, breathing from the diaphragm never came naturally to me. Could you let me know if correct breathing will actually bring about good posture and how important it is. Also what is the correct way to breathe when I’m going about my usual day. Thanks a lot for all your info.

    • Hey DP,

      If you are not using your diaphragm during quiet breathing, you are likely overusing other muscles to help you breathe (eg. scalenes, sternocleidomastoid just to name a few)

      I go through an exaggerated breathing technique in this post. (Scroll down to the Breathing section).

      In terms of relaxed breathing throughout the day, whilst keeping your neck and torso relaxed, you want to imagine that you are inhaling deep into your stomach.

      I might need to do a blog post on this in the future!


  5. Hello Mark,

    Regarding sitting posture – is there a way to sit with a reasonably good posture while reading outside in a park, especially if a book is a bit too heavy to hold it upright for long? That could be on a bench, on the grass or even propped against a tree.

    I must add that you have made an amazing website, I really appreciate the effort you put into it. The explanations, pictures and exercises all help me a lot with fixing my posture issues.
    Thank you!

    • Hello Jane,

      My first recommendation would be to slightly shift your sitting position every 15-20 minutes (approximately).

      If this is too much of a hassle, I would recommend that you lean your back against a tree or bench (as opposed to free-sitting on the grass with no support).

      To keep your book in a slightly higher position than normal, it is best to prop your elbows on top of a pillow/bag to help support the weight of your arms.

      If you don’t want to bring a pillow or big bag with you to the park, you can also try maintaining reasonable posture as you use your eyes to gaze down towards the book ( as opposed to the whole torso hunching forwards)

      Hope these quick suggestions help!


      Ps. You could also try audiobooks too!

  6. Hey Mark I have a recliner that reclines if I want it to. I was wondering with my posture issues I feel guilty just sitting in it. Sometimes I game while sitting. How would you recommend sitting in the recliner chair? And is a pillow nessacary?

    • Hi Jay,

      Sitting on a recliner is fine.

      You might need to position your TV screen much higher though so that it is more line with your gaze in the reclined position. (Otherwise you’ll slouch forwards to look at the tv/computer)


  7. Hello Mark! Do you have any guidance on how to best maintain posture sitting on the airplane – especially for long haul international flights? I am of small stature (161cm), so the headrest always puts me in horrendous forward head posture and a hunched back. Thank you for any advice!

    • Hey Tiff,

      Air plane seats are the worst!

      My only advice would be to recline that chair as much as you can. This should take some pressure of your postural muscles.

      You can also consider placing a small pillow behind your lower back. Make sure your bottom is tucked all the back into the chair.

      And of course – try to get up every hour if possible.


  8. Hello Mark,

    If one has multiple posture issues addressed here (Forward Head Posture, Rounded Shoulders, hunchback posture, Hyperlordosis) is there a specific order to address them in?


    • Hey Daniel,

      You can start in any area, however, there is likely some areas that would make more sense to start with.

      In your situation, I would go with Hunchback as this can help with forward head posture, rounded shoulders and hyperlordosis.


  9. Hey Mark,

    Do you have any tips or guidelines on properly setting up a kneeling chair? I have a few questions that the internet hasn’t been very helpful with:

    How do I determine the best height and angle for the seat and kneepads?
    Does my desk height need to be adjusted?
    Should my feet be in the air or touching the floor?

    Many thanks!

    • Hey O P,

      I don’t have a specific guide on that.

      General points:
      – The angle of the sitting pad should be enough to encourage an anterior pelvic tilt (relative to the femur bone). I have my hip angle at approximately 130 degrees.
      – In terms of height of the chair, it should be high enough to match your desk height. (When sitting up right and elbows bent at ~90 degrees , this is where your keyboard and mouse should be)
      – Have your toes in contact with the ground. Make sure that the foot does to splay outwards.


  10. Hi Mark,

    Great content, especially relevant as people stay at home more during covid.

    Do you offer remote/online posture therapy sessions, either free or by payment?

    • Hi Arjun,

      Thanks for your comment.

      At present – I do not offer any online sessions. (This could change if there is a high demand for it)

      Have a great day.


  11. Hi Mark, I’m 63 years old and I have a severe Degenerative scoliosis, I’m doing some of your scoliosis exercises. During last 3 years my right leg became shorter then the left and very weak by lifting it up. What exercises do you suggest to strengthen my leg. Thank you

  12. Hi Mark,
    Can I lean on the back rest while sitting directly on top of my “sit bones” and with maintaining the natural curve in my lower back? I felt easily tired when not leaning to the back rest.

    • Hey Scott,

      Yes, this is fine.

      Sounds like your muscles that support your posture have low endurance.

      It should get easier with practice!


  13. Hi Mark
    I read all your posts and I’m struggling with finding the ideal sitting posture for my body type and my deficiencies . How do I determine the best position. I have seen numerous physios and Ot and no one can find the ideal position.I have rounded shoulders and forward neck posture which i am working on .I am 5 “10 and slimmer build.I have tried every chair possible.

    Any ideas ?.I can’t figure out where to position my pelvis .My neck gets super tight with any changes.Also not sure where my monitors should be ?


    • Hi Suzie,

      On top of the forward head posture and rounded shoulders, do you happen to have thoracic hyperkyphosis as well?

      The presence of a locked hunched upper spine will make it difficult to position your pelvis in a neutral position when sitting.

      If you can’t position the pelvis properly, you will tend to over use other muscles to help hold your body up (like the muscles in the back of your neck!)


    • Yes I think I do have a locked upper back.So i am thinking I work on that then how do I find the best sitting posture.I am a bit lost on where hips should be for me or lumbar support etc?.Sorry probably not explaining well.

  14. Hi Mark,

    My body often leans on left side. Sometimes it is easily visible sometimes its not.
    However, recently I noticed the tilt is very noticeable when I bend forward.
    Can you please help to get this fixed?


    • Hey Paresh,

      Do you mean you shift your torso towards the left?

      If this is the case, go to the following blog post:

      Thoracic spine exercises.

      … and scroll down to exercise number 13: Translations. Try to perform this moving the torso towards the right side.


    • Thank you Mark! I will certainly try the exercise.

      I want to show you photos my tilted torso. How can I share?


    • I appreciate your information.
      So for scoliosis, your strategy is to get the spine to stretch/strengthen into the concave curbs and to stretch and untwist the vertebrae that have rotary-twisted?

  15. Hi Mark,

    Firstly let me just say that your blog is easily one of the most valuable sources of information I have encountered on the internet. I direct to it as many people who seem like they would benefit from it as I can – and benefit they do. So thank you. I am kind of stumped on one thing. When I am studying/working at a desk, walking, or standing, it is not too difficult for me to implement (or do my best at implementing) the posture corrections outlined in this and other posts. What about when I am just relaxing though, reading recreationally on the couch or watching a movie while sitting on an armchair? It seems that these types of furniture encourage poor posture, and make it difficult to correct yourself. Are there pieces of furniture that are comfortable/relaxing that do not have these qualities?

    Many thanks,


    • Hi Rath!

      Thanks for your comment.

      In the initial stages of addressing your posture, aim for a 20-30% improve in your posture.

      It is very difficulty to do a 100% correction right from the start! (A lot of tight muscles, weak muscles and bad habits will get in the way.)

      If you are relaxing in a chair, try to support your back with pillows. Try to keep your posture as elongated and as long as possible.

      (keep in mind – don’t feel bad if you start to slouch on the chair. Just make sure that you are stuck in this position for too long. Move every 20-30 minutes!)


  16. Hi Mark!

    So happy to found your work here which is so helpful to me!
    I have a question: Some famous YouTubers in Germany promote their new
    “Paleo Chair” ( as an alternative to a common
    chair that is much healthier. Such a chair in combination with a
    standing desk is said to be the best possible solution for the workspace.
    What do you think about such a chair and given I can use a standing desk
    how long should one stand and how long should one sit and how often
    should one change posture?

    Would be so happy if you reply to my question. Thank you so much!

    • Hey Philipp,

      I haven’t heard of the paleo chair before!

      It looks like an okay chair to me, but keep in mind, you can still slouch in this chair (just like any chair really!)

      In terms of how often you should switch between standing and sitting… I personally like to do any where from 30-60 minutes.



  18. Hi, this site has been so helpful! I do have a question. When I consciously align everything where it should be, I find it very difficult to hold the proper posture for more than a few minutes. It starts to hurt and I have to slump a little just to relieve the pain, and then I try again and continue to do this repeatedly as my body fights the change.

    Are there any tips or things I could be doing to make this more bearable? Also, will it get easier?

    • Hey Laura,

      Here are some quick pointers:

      1. You might need to try a smaller % of correction. Instead of trying to force your posture, try to correct it 60-70% and see how you feel. Over time – you can increase the correction.

      2. Your muscles aren’t used to this new position. Try to move in and out of the good posture. Give it some time and the body will become more comfortable with the new position.

      3. You might need to address other areas that might be making it more difficult to naturally hold good posture. Eg. You have may be trying to pull your shoulders back, but it might be the fact that you have thoracic spine kyphosis that is forcing them forward in the first place. To address the shoulder position, you will need to address the thoracic spine as well.


      • Hi Mark,

        Thanks so much for the feedback, I appreciate it. The tips are very helpful, especially the first two tips as I have been trying to hold 100% full posture, so I will try a more gradual approach. I am not too familiar with the spine kyphosis you mentioned, so I’ll try to research more about that to see if there’s anything I can do in that regard as well.

        Thanks again,


  19. Hey Mark,

    After some time sitting in the burmese position with my right leg in front and hips elevated in a seat I feel my right leg going numb (from the knee to the foot) and a pain in the right knee primarily (right at the outside of it). If I take the seat (hips not elevated) my pain goes to the left hip. I tried the rotated pelvis exercises but although they help they are probably not the real cause.
    My background is: an accident on my right foot (a long cut from the middle between second and third finger to the middle of my foot) which made me walk crawling with it (using primarily my left and scare of pulling the stiches when pressing the right, so stand more on my heel on that recovery time).
    After a year and done with the scar, I have done a lot of strenght training (without fixing my posture) which might have exarcebated the muscles on one side (like I have told on another post, a left lumbar with more mass than the right).
    What could I be working on to help with that?

    Thank you in advance!

    • Hi Gabriel,

      If your numbness is only from the knee down to the ankle, I would think that a nerve may be compressed in the Burmese position. (If I were to guess, I’d say between the calf muscles and/or popliteus region (behind knee).

      Try releasing and stretching these area before you go into the position and see if that makes a difference.


      • Hey Mark,

        I tried it but I could not have any result. The numbness might be present at my upper leg also (to my sitting bone), but to a extent that it is not as intense as from the knee (which starts to be in pain in the lateral part of it).
        The reason might be in my posture overall, I do have a degree of scoliosis (maybe 10 to 20) with concavity to the right. And doctors do not understand that I have a scoliosis to one side but more weight to a side that does not make sense (I dont remember the sides right now). But I did walk a lot with my right foot (leaning on the left) crawling during recovery.
        Do you have any suggestion on the matter?

        Thank you.

      • Hey Gabriel,

        I have a blog post on Scoliosis. You can check it out here.

        You can also try to release/stretch the piriformis muscle as it sits right on the sciatic nerve.

        The “figure 4” stretch is great for a tight piriformis.

        Failure to respond to this, you might need to consider looking at your lumbar spine and how the nerves are up there.


  20. Hi Mark! I tend to read a lot and also like to chill on the sofa/bed.. what are the best ways to do this without worsening my already bad posture? One needs downtime too, so suhgestions for relaxing but good positions when not sitting/standing/walking would be appreciated! Especially because I’ve had posture problems for so long it is really impossible for me to maintain the good sitting position 24/7 at the beginning..

    I have very short feet so I find chairs unergonomic for me, so i tend to sit on the floor whenever possible. How should one do this in the best possible way?

    • Hi Henna!

      If you want to lie down whilst reading, the best way is to bring your book up to around eye level.

      If this feels a bit awkward, consider changing positions so that you are not stuck in one position for too long.

      If your feet don’t touch the floor whilst sitting, you will probably benefit from a foot rest.


      • Thanks for the reply! Is reading lying on your stomach in a ”sphinx” position also ok? How about sitting on the bed legs straight but back against the wall?

        Footrest is a great solution for a fixed office job but I go t school and change classrooms often and I also have to use the public transport a lot (I have a very ling commute to school). A portable footrest feels difficult/over the top – are there any other solutions?

      • Hi Henna,

        The positions you mentioned are perfectly fine. Just keep switching positions if possible.

        Portable footrest is an option, but might prove more troublesome more than anything.

        Standing up during your commute on public transport can break up the monotony of sitting.

        If you don’t have a set work place, this might be a bit difficult! Perhaps you can store a foot rest in multiple rooms?


  21. Hey Mark

    Indeed a great article you have shared here. I’m working from home and by sitting for around 8-9 hours daily, I used to have pain in my lower back. But now I think, this article will help me cure my back pain problem. Thank you very much…

  22. Hello Mark,
    I have pain primarily in my left hip (especially when sitting and sometimes I feel the right leg go numb after a while in the burmesse position). I also look to have more mass in my left lumbar than in the right (seems that in my chest too) and it is harder to feel my right lumbar. It seems that I have a rotated disc and although I have been going through postural reprogramming the doctor says he does not know if he will be capable of doing the work. I sent you in the pictures of the X ray through facebook and I would like to know what you have to say about the subject because it is really important for me, it impacts a lot of the things I do and enjoy to work on so anything you have to say that can help I will try to put on my routine.
    Thank you in advance.

      • Hello Mark,

        Thank you very much for the reply. It does seem that I have a left rotated pelvis. I will work on the exercises (for my side) on the post!

        Thank you for all the work and help you provide!

  23. Hi Mark
    I am suffering from slip disc. Can u please guide me how to get rid of this. I am feeling very low as I can’t play or do lift weight and other stuffs.

    Please guide
    Sahil Suri

    • Hi Sahil,

      If you have a posterior disc bulge in your lumbar spine, you can try McKenzie Lumbar spine extensions.

      Do not push deep into your pain. It should feel comfortable.


  24. Hey Mark,

    Thanks for making good content and replying to your readers!

    Few questions I think others will find helpful too:

    – How can someone detect the difference of nerve vs back pain from muscle? I have pain in center of my mid back and when breathing in it gets worse. While I’m active it’s better, but I had trouble sleeping last night.

    – My right shoulder blade leans a bit forward compared to my left side. It’s especially obvious as I lay on the flat floor. I try to flex my back straight but it’s always hard to keep this position for long. How can I specifically fix the uneven shoulder blade issue?

    – Lastly, I also believe I have a slight case of lumbar lordosis that I’ve been working on fixing with pelvic tilts, hip thursts, planks, and stretches. I also lay against the wall and after moving my feet away from the wall, I lower myself till the lower back touches the wall for 1 minute. I also try to get in the habit of inhaling stomach to straighten my spine while popping my chest out slightly. How does this all sound? (also would it potentially fix some of my other issues?)

    Thank you so much!

    • Hello Arsh,

      – Nerve pain tends to have symptoms such as burning sensation, weakness/loss of control of muscles and tingling. If your pain is quite localised, it is probably a joint/muscle issue,

      – It could be that you have a rounded shoulder.

      – This exercise is fine to do


  25. Hi Mark,
    While sitting , a region somewhere in the middle of the glutes and the hamstrings pain.( or probably the muscle which connects it ), though I sit normally. I do not have any burning sensations.
    The pain gets worse with time. So what could be this ??

  26. i am curious as to how sitting on a toilet for long periods of time can affect you. some people have digestive problems, and may end up sitting on the toilet for a long time. it’s hard to sit straight on a toilet

    • Hi,

      The time you spend on the toilet is unlikely to be as long as you would sitting in front of a computer, watching tv etc. For this reason, it should not influence your posture significantly.

      However- whilst on the toilet, you actually want to sit with a bit of posterior pelvic tilt to help with the process.


  27. Hi Mark,

    Thank you for the great post, it helps me a lot to remember correcting my posture when I am sitting on my desk with my laptop. Still, I cant figure out the correct way to sit while writing with a pen on an actual paper on my desk. It is like I *have to* curve my body or lean forward to be able to write. Could you maybe describe the correct way? Or am I missing something?

    • Hi Lydia,

      This a great question.

      I personally like to remain as elongated throughout my spine as I write.

      Make sure that you do not have vision issues which may require you to get closer to the paper to see what you are writing as this will force your body to lean forwards.

      On top of that, make sure that the table that you are writing on is at an appropriate height for you.

      Hope these tips help you out!


  28. Dear Mark > I have same problem (sway back posture)…. I am from Pakistan. I am in trouble with this problem please solve my problem to give me your email address and phone no… i will contact you personally and tell you full detail please solve my problem…. My age is 22..Please help me

  29. Dear Mark,

    I know you are probably very busy, so thank you for this website (and I understand if you are not able to respond to this message).

    I have seen 8 providers and 4 PTs for debilitating upper back and neck pain. By the end of a workday (as a lawyer at a desk, with a standing and sitting desk), I am in 9/10 pain and sometimes cannot even converse with others my pain is so severe. The pain seems to come after being in a compromised position for only a short time. In other words, if I go for a 10 min car ride or work at my desk for 20 min, the pain arrives and will not leave. On the other hand, if I hike all day or am upright, my pain is a 2/10. When the pain arrives (shortly after waking), my upper back hurts (near the spine on both sides), my neck muscles spasm and I get a referring pain in my right temporal region. When I run, the pain ceases and if I lay on my back on an acupressure mat, the pain ceases – if only momentarily. The second I compromise posture, the pain is severe. Posture, weak muscles, skeleton and stress.. I often struggle to understand which is the main culprit if not all are contributing factors……

    I have read through all your posts and incorporated many of your techniques and exercises–I have not seen any improvement yet. I have a couple questions if you have time to address any of them, I would greatly appreciate it.

    1. Stretch v. strengthen– many PTs have told me to do one or the other (initially) and or both. I am confused as to which I should focus on.

    2. Posture shirts? I ordered a posture shirt and jacket from allignmed. What are your thoughts on these?

    3. Massage therapy?

    4. Trigger point injections do not seem to help. Thoughts on same?

    5. What would be your other recommendations?

    6. If you were to recommend orthotics (understanding this is not the first stop), what brand do you like?

    7. Any providers you might recommend near (anywhere close) to St. Louis or the Midwest?

    Thanks again for your time,

    • Hi Jordan,

      1) If tight muscles is the main issue, stretch first. If you have weak muscles, do strengthening.
      If you are both tight and weak, you will need to do BOTH!

      2) Posture shirts, taping and braces will help pull your shoulders back, however, they will tend to make your postural muscles lazy if worn long term. They are fine to be worn short term and serve as a reminder to maintain good posture.

      3) Massage therapy is great to help relieve some of your symptoms. You will need to follow up with strengthening exercises after wards for best results.

      4) Trigger points may provide some relief, but it will be temporary. If anything, you will need to find out WHY you are developing trigger points in the first place.

      5) Make sure your work station is appropriately set up to your individual measurements.
      Try not to stay still for more than 15 minutes. MOVE MOVE MOVE!
      Ultimately – it sounds like you need to get stronger in your postural muscles.

      6) I rarely prescribe orthotics as I prefer to try exercises first. I do not have a specific brand that I suggest.

      7) I am not from around there so I unfortunately can’t recommend anyone for you.

      Sounds like you need some help! Please feel free to facebook message me and I’ll see if I can provide value to you.


  30. Thank you so much for all this material. Although I am very fit and toned my body has been a hot mess for quite some time starting with a grade 2 shoulder separation 2 years ago contributing to bad muscle habits and chronic scapular pain. Most recently, I have had sharp thumb, wrist and finger pain and swelling. This put me in immediate contact with a physio who alerted me that my posture needs some reworking with concentration on my c6,c7. So whilst doing exercises for my c6 & c7 I was searching online for more info on my shoulder blade and after 1 day of doing 3 of your exercises things are looking more hopeful. I still have tons of work to do with the physio in my City/Country but I am so grateful for all this information because it gives additional support and helps to assuage fears associated with chronic pain because there is a science behind it and something can be done, with work and dedication. After I get my C6 & C7 by working on my posture I have to attend to my lower back. So much work to do!

  31. Hi Mark,

    thanks for your posts and the effort you put in them. Great job.
    I’m suffering from migraine for years now, and I feel like the cause is my neck pain. I can literally feel the pain coming from the muscles of my neck. What I’ve also noticed is a pain between my shoulderblade and my spine when I pull my shoulders back. I also think that the pain’s reason might be my sleeping position (among others ofc). I slept on my stomach/side (some kind of mixture) for years now, but I can’t bring myself to sleep on the back. Do you have any excersises or general tips? I’d be forever thankful.


  32. Dear Mark,
    I read your article and also the page you wrote about yourself. I really appreciate the job you’re doing. The reason I’m leaving you a message is that I want to know the standard places which should be taken into account in posture assessment, as an example, for assessing Q-angle what parts of the legs should be marked? I’d appreciate if you provide me with a reference which indicates the exact points of markings in both sitting and standing posture.

    Best regards,

  33. Thank you, Mark. I am 62 years old, have thoracic back pain and lumbar back pain for the past 2 years.
    My MRI report says loss of normal kyptosis and lordosis

    My lumbar has been pain free for about a year, but the recent MRI indicates degeneration facet joint arthropathy, ligamentum flavum hypertrophy, mild spinal canal narrowing, dessicated discs at L4/L5/S1 and mild disk bulge at L5.

    I still suffer from my thoracic back pain, luckily alignment still intact, multiple facet joints arthropathy and ligamentum flavum hypertrophy.

    I hope I can be pain free with your posture guidelines, they are giving me the hope I need. Thank you again Mark.

    • Hi Lee Hwa,

      Exercises are the key!

      Just remember – just because you have all those findings in your scans, does NOT mean you will have symptoms for the rest of your life.

      (In fact, if you take someone with no pain at all and scan their back, the results may come up with similar results as yours)


  34. Hey Mark,

    Just found your Blog, there are some really god information.
    My issue is that i have rounded shoulder , anterior pelvic tilt, Duck feet and as a consequence hunchback posture. So i was wondering what can i do daily to fix for good my posture. ( I saw all your articles should i do kind of a sum up ?)
    Also i love going to the gym , and i want to know how can make my workout great for posture too , so i can align proprely my body while gaining some muscle.
    I’m willing to do anything for a good period of time to have a pretty quick fix.
    Therefore did you had a posture issue too ? When i will get a great posture (hopefully) should i do something to maintain it ?
    Thanks in advance for your answer

    • Hi Evil Ryu,

      If you have the time, try to do all of the exercises.

      If not , focus on one area for 6 weeks and see how your body responds.

      Unfortunately- there are generally no quick fixes when it comes to posture.

      With gym exercises, try to maintain good posture throughout your exercises (eg. avoiding rounding shoulders, excessively arching your back in benching press/shoulder press etc)


  35. Hi Mark – i have read your blog and still dont really know what my problem is. Earlier in the summer, i started to develop this nagging pain under my left shoulder blade. I have seen the dr and Chiro both of them told me its my muscle and they are weak. I’m 40 years old and have had a desk job since i was 25. I see you are very experienced PT individual and wanted to get your opinion on it. The other day I used your technique of tennis ball against the wall. it helped me for 1 day or so and this am the pain was back. Its just this dull nagging pain. i started to get a bit of inflammation which i could feel around. since than i have been exercising 3x a week. not sure how long it is going to take to fix? and what exercises i should concentrate on? :-(

  36. Hey Mark My name is Dibya and am from India. I broke both radius and ulna of left hand 2 years ago. Because of inactivity I developed severe APT and False curvature of legs Genu recurvatum. Very much worry about it. Help me as I have no idea about this. Eating for reply

  37. Thank you – great article. I’m working on correcting my posture after years of sitting at a desk with poor posture. I’m finding that good posture is leading to a tight and sore feeling in my inside upper leg on just one side (where it meets my body – the illiopsus?). Are there any exercises I can do to relieve this tension & pain and strengthen the muscles causing it?
    Many thanks

    • Hi Clare,

      What exactly have you changed in terms of correcting your posture?

      You may possibly be forcing good posture as opposed to letting it feel natural.


      • Thanks for your reply Mark. I followed your workstation set up advice – it’s brilliant thank you. So I have changed everything – desk layout, chair position, sitting position, taking breaks. I think I may have been forcing it too much to begin with, it’s definitely getting easier, and is no longer sore just not as comfortable/ easy as slouching!!

  38. Hi Mark,

    I’ve been reading all of your articles on posture. I can achieve much better sitting posture by consciously activating the underused muscles, for example activating my core and pulling my shoulder blades back and down. However, this feels awkward because I have to consciously focus on keeping these muscles active while I’m sitting. Is the solution to keep consciously activating these muscles until we eventually start to unconsciously maintain better posture? Or is it simply a matter of strengthening them until they begin to support us even when they feel relaxed?

    Also, how active should our abs and core be while sitting, standing, and walking? It feels sort of stressful to keep my abs consciously tensed during these activities, but if I don’t, then they’re not really active at all. Is it just a matter of strengthening them, or in the beginning do we need to consciously activate them throughout the day?

    Hope these questions are making sense. Thank you!!


  39. Hi Mark,

    Great site and good work! Having followed all the advice on sitting after only 10-15mins my Lower back begins to fatigue and ache . I’m beginning to wonder the following;

    1) if I’m trying to sit up too stright could lumber spine hyperextension cause pain?
    2) when do you suspect core weakness as a cause of low back pain or a tight ileopsoas?



  40. Mark, Forgot I have curvature of spine. Plus pelvic tilt. Lordosis. Obese. I didn’t care then, I do now, very much. My inches are leaving. Now work pelvic tilt. Weight off hoping will help.?????

  41. Mark, I’m 66 I’ve seen chiropractor for my hip, but it doesn’t stay, he said I have lordosis, I was overweight 260, now working on myself 220, I changed from within, I have weak urethra , just had operation on uterus polyps. I’d still like to correct my self,posture, pelvic tilt, Dr says lose weight it will help your pelvic area, my Dr says uterus is good for my age. I’m still working on my self to get better & feel better.

  42. Hey Mark, I saw you recommend the stretch lying from Esther Gokhale, so I was wondering if you also agree with her way of sitting (stretch sitting)? What I found interesting is that she recommends a J spine, instead of an S spine (because our ancestors had J spines), so therefore she is also against lumbar support and stuff like that. But I see you ARE recommending a lumbar support. Can you please share your thoughts on that?

    Another question: I have kyphosis (rounding shoulders) ONLY when I sit, NOT when I’m standing. Always when I’m sitting my neck pain and headaches get worse (even though I’m sitting with perfect posture). How can I fix this? Would you fix it the same way you would fix “normal” kyhphosis?

    • Hi Alen,

      Great question!

      Both stretch lying and sitting are the ideal ways! This is to get as much elongation and length in the spine in a stacked position.

      Lumbar support is great when you tend to sit with a posterior pelvic tilt. Using the lumbar support is more for the treatment of issues associated with this way of sitting. (such as posterior disc bulges)

      Ideally, one would be better to learn how to sit with out any support and to aim for a more elongated spine.

      With your rounded shoulders/kyphosis whilst sitting, are you able to correct it ? Or is it something that happens immediately when you are in the seated position?


      • Hey Mark, thanks for your message man! Well I’m working hard on correcting it by implementing all your exercises (and others), but I just notice as soon as I’m sitting down for a while (I’m a student) with good posture, I get this tension in my neck (where it attaches to the head) and it reflects pain above the eyes and jaw, I’ve had it for almost 2 years now, and nobody was able to help me, so I decided to take it into my own hands and improve my body posture DRAMATICALLY. I also got an MRI done, everything looks good (nothing is deteriorated, but I have a straightening of the neck curve). Do you think it could have something to do with the straight neck curve? Do you think your exercises can help to REVERSE the normal neck curvature? Or what would you do in this case? I’m a 24 year old student, I’m way too young for this, I hope there’s a solution, I’m willing to do everything it takes.

      • Thanks for your answer Marc! What do you think about those posture blocks than you can put under your neck that are supposed to reverse a straightened neck curve back to normal? There are some posture blocks or even devices (like posture pump) that you can lay on for 10-20min. Do you think that’s useful IN ADDITION to the exercises? Also some people recommend to force in the neck curve with specific exercises and laying postures like this:

        Do you think that’s useful or dangerous?

        Thanks for everything you do,

      • Hi Alen,

        The posture blocks where your neck is on top of are fine to use.

        The exercises on the video are fine to do providing that you keep that chin tucked in more (on that second exercise in the video). I wouldn’t force the movement, but would firmly guide it into position.

        Once again, if it makes any of your symptoms worse, I would re-consider your technique.


      • Thanks for your responses Marc :)

        I’m still kinda confused about the stretching and the releases. Because in my mind, the muscles are tight for a REASON, it’s necessary tension to keep the head level. So why would you want to loosen those muscles, isn’t that going to make the head fall even more forward (given, that’s it’s necessary tension)? Isn’t it a better idea to first strengthen everything and THEN start to stretch the tight muscles? I’m asking this, because my chiropractor told me I’m hypermobile, and that my tissue is very “elastic”, so he said I had to primarily strengthen everything in order to be able to hold good posture for hours at a time, and that stretching might not necessarily be a great idea (but he didn’t say it’s bad neither). What are your thoughts on that? And what do you suggest for hypermobile people?

        BTW: Do you offer any consulting?

        Thanks dude!

      • Hey Alen,

        If you have no tight muscles, then there is no need to stretch. However – if you do stretch and/or release a muscle, you need to follow that by activating/strengthening another muscle that is meant to be functioning in the first place. Otherwise – the tight muscles becomes tight again.

        In your case of hypermobility, your main focus will indeed be to strengthen all of your weak muscles to stabilise your body.

        Note- just because you are hyper mobile in some areas, does not mean you may not be tight in other areas.


        Also – I don’t do consults at the moment. But – that may change if the demand is there :)

      • The thing is that I’m not actually sure if my muscles are tight. My neck and facial muscles (jaw and above eyes) FEEL tight, but like I said, I’m hypermobile so I already have more range of motion than the normal person in the neck. So that’s why I wasn’t sure if it’s a good idea to stretch. It kinda feels like I have band wrapped around my head sometimes, so I was thinking it could also be myofascial pain from tigger points (SCM or occipitals) or stemming from the fact that my neck curve is straigthened out (I’m working on this). What do you think?

      • Hi Alen,

        It sounds like your are describing “tension” and not structural tightness.

        Elongated muscles usually have a lot tension going through it (eccentric load) and can feel “tight”.

        If this is you, I would focus on strengthening through your full range.


  43. Hi Mark,

    My x-rays at the chiropractor today show how horribly incorrect my neck is…I have to do something about it. I’m a headache sufferer, usually in the afternoon after sitting at work all day. I just read your page on forward head posture. I’ll be doing those exercises to try to correct. BUT I also have horrible posture and curvature of my spine causing my hips to be out of alignment as well. I’m 29 and have always had bad posture. I sit all day and find it very difficult to sit in the correct sitting posture as you described above…it’s not very comfortable! I cross my legs constantly, prop my feet up, etc. to try to get comfortable. Do people really sit in the above position all day long?! How?! Thanks for all the great information!

    • Hey Richelle,

      In the ideal world, you should maintain proper posture all of the time.

      Is this realistic for most people? …Absolutely not.

      To begin with, I recommend aiming to sit for 20 minutes with good posture in every hour. Then slowly increase it as your body’s posture improves.

      For someone who has had bad posture for many years, it is quite difficult (and even uncomfortable) to maintain good posture. This is because your body is not used to using your postural muscles.

      Do what you can. Better to do something than nothing at all.


  44. Hi Mark,
    I have ankylosing spondylitis (for 8 years now) which affected my posture.. I have a curved back and a forward head. What exercises would be good for me? Thanks.

  45. Hi Mark, I seem to be suffering from posterior pelvis tilt and bulge disc at L4 L5. What kind of exercises should I do for myself ? If you can help me out I would really appreciate it.

  46. Hello Mark, I seem to be suffering from anterior pelvis tilt and kyphosis as my lower back arched and the middle is rounded forward, how do I fix both? How many excersies would be suffice for both the issues and how long should should I do it ? I bessech that you help me Mark as this posture gas affected my self confidence

  47. This is a really great post about posture covering a variety of aspects. As we are advocating for student posture, we know that students often have to sit for long periods of time and can form bad posture habits. Many students ask about whether we can achieve perfect posture or not and we agree with you – we can only provide an ideal position for sitting and standing, but being more conscious of how one sits and making an effort to change is what can make a difference.

    • Hi J.T.
      Great to hear from someone who sees the importance of good posture! I see so many students (especially from university) coming to see me with a whole lot of pain from the poor sitting posture they adapt whilst studying.

      It’s outstanding to see that you are advocating for student posture!



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