How to fix Flat back posture

What is a Flat back posture?

Flat back posture is a type of posture that is characterized by the lack of natural curves in the spine.

As a result – the alignment of the spine (as viewed from the side) is flatter than normal.

The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content on this blog post is at your sole risk. For more information: Medical disclaimer.


Characteristics of Flat back posture:

flat back posture

  • Forward head posture: The head is poked forward.
  • Rounded shoulders: The shoulders are slouched forwards.
  • * Flat thoracic spine: Lack of upper back natural curve (Thoracic Hypokyphosis)
  • * Flat lower back: Lack of lower back natural curve (Lumbar Hypolordosis)
  • Posterior pelvic tilt: The pelvis is rotated backwards.

(* This blog post will cover these main areas to address your Flat back posture.)

a) Flat thoracic spine

This is where there is a loss of natural curve (kyphosis) in the upper back.

The thoracic spine is locked into extension.

This can change the shape of the rib cage which may result in winging of the scapula.

Cause: This occurs when the thoracic spine attempts to position the shoulders and head (which are generally slouched forwards in most people) into a more up right position.


Muscles responsible:

  • Spinalis thoracis
  • Iliocostalis thoracis
  • Longissimus thoracis
  • Posterior intercostals

b) Flat lumbar spine:

This is due to a Posterior pelvic tilt.

This is when the pelvis is rotated backwards.

Cause: Sitting with a slouched posture.

This leads to an imbalance of the forces around the pelvis causing a net force to tilt backwards.


Muscles responsible:

Tight/overactive:

  • Hamstrings
  • Abdominals
  • Gluteal muscles

Weak/inhibited:

  • Lumbar paraspinals
  • Hip flexors

Note: If you would like to know more about the ideal pelvis position, check out this post: The correct pelvis position in sitting.

Why is having a Flat back posture a bad thing?

… because curves are sexy! (… in moderation, of course)

Having natural curves in your spine is actually a good thing! (… plus it’s normal)

It helps with load distribution.

In Flat back posture, the spine has a poor ability to absorb and distribute mechanical stress evenly throughout the body.

As a result, the muscles may have to work harder to help stabilise and move the spine.

How to test for it?

a) Flat thoracic spine:

Take a side profile photo:

Observe for the presence of a flat segment in the upper back region.

Note: Make sure that you do not confuse the shape of your shoulder blades as a curve in your upper back.

b) Posterior pelvic tilt:

posterior pelvic tilt flat back posture

In standing, place one finger on your pointy hip bone at the front, and the other on your pointy bone at the back.

If you have a Posterior pelvic tilt, the finger at the front of your hip bone will be noticeably higher in comparison to the finger on the pointy bone at the back.

Exercises for Flat back posture

Image courtesy of Idea go at FreeDigitalPhotos.net


Note: All exercises are to be performed gently and pain-free


Flat back posture:

1. Flat thoracic spine

a) Releases:

Thoracic paraspinals

releases for flat back posture

Instructions:

  • Place your body weight on a massage ball in the areas to the sides of the spine and between your shoulder blades.
    • Find all of those tender areas!
  • Roll over the ball in a circular motion.
  • Spend at least 5 minutes to do the whole area.
  • Do NOT place the ball directly on the spine. (… It’ll hurt!)

b) Stretches:

Stretch into flexion

Instructions:

  • Whilst sitting, interlock your fingers behind your neck.
  • Proceed to gently pull your neck downwards.
  • Focus on bending at the upper back as much as possible.
  • Aim to feel a stretch in your thoracic spine area.
  • Hold for 30 seconds.
  • Take deep breaths in whilst in this position
    • Imagine the air expanding the area between your shoulder blades.

Stretch with foam roller

Instructions:

  • Whilst sitting, place a foam roller on your lap.
  • Bend and round your back whilst your chest is in contact with the foam roller.
  • Focus on bending at the upper back as much as possible.
  • Aim to feel a stretch in your thoracic spine area.
  • Hold for 30 seconds.
  • Take deep breaths in whilst in this position
    • Imagine the air expanding the area between your shoulder blades

c) Joint mobilisation:

Rotations

Instructions:

  • Get into the 4 point kneel position. (see above)
  • Place one hand behind your head.
  • Proceed to twist your body to the side where the hand is on your head.
  • To isolate the thoracic region:
    • Do not allow your lumbar spine to move:
      • Brace your abdominals.
      • Keep your ribs cage low.
  • Repeat 20 times.
  • Repeat on the other side.

Translations

Instructions:

  • Whilst keeping your pelvis stationary, slide your upper torso to the side.
  • Try to also lift the shoulder on the side you are sliding to.
  • Aim to feel a stretch on that side of your torso.
  • Alternate both sides.
  • Repeat 15 times.
  • (This is a difficult one. Don’t worry if you can’t get it the first time!)

d) Improve Control

Standing Segmental cat/cow

Instructions:

  • Whilst standing, wrap your arms around an exercise ball as much as you can. (see above)
    • Try to get your fingers tips to touch.
  • Starting from the neck: Proceed to round your spine down one vertebra at a time until you reach mid-back.
  • Emphasise the rounding over the areas where your spine is the flattest.
  • From here, reverse your movements back to the beginning.
  • Repeat 20 times.

Intersegmental cat/cow

flat back posture exercises

Instructions:

  • Get into the 4 point kneel position.
    • Hands in line with shoulder joint. Knees in line with hip joint.
  • Starting from the neck: Proceed to round your spine down one vertebra at a time until you reach mid-back.
  • Emphasise the rounding over the areas where your spine is the flattest.
  • From here, reverse your movements back to the beginning.
  • Repeat 20 times.

e) Regain your natural curve

It may take some practise… but you want to keep a slight natural curve in your upper back at all times.

If you don’t do this, your thoracic spine will likely just go back to being flat again.


2. Flat lumbar spine

a) Releases

Hamstrings

Instructions:

  • Place your hamstrings on top of a massage ball.
  • Use your body weight to apply pressure onto your hamstrings.
  • Make sure to cover the whole hamstring muscle on both sides.

Abdominals

Instructions:

  • Lie on your stomach.
  • Place a massage ball under your abdominal region
  • Gently circulate your body weight on top of the ball.
  • Do not to apply too much pressure. 
    • (Do NOT squash your organs! STOP if it hurts.)
  • Use deep breaths to help relax your muscles.
  • Spend at least 1-2 minutes.

b) Stretches

a) Upper hamstring

Instructions:

  • Whilst standing, place a slightly bent knee in front of you. (see above)
  • Lean forward by hinging at the hips.
  • Remember to keep your back straight!
  • Aim to feel a stretch in the upper portion of your hamstrings.
  • Hold for 60 seconds.
  • Alternate legs.

b) Lower hamstring

Instructions:

  • Whilst standing, place a straight knee in front of you.
  • Lean forward by hinging at the hips.
  • Remember to keep your back straight!
  • Aim to feel a stretch in the mid/lower portion of your hamstrings.
  • Hold for 60 seconds.
  • Alternate legs.

c) Abdominal

Instructions:

  • Lie on your stomach.
  • Place hands on floor directly under shoulders.
  • Straighten your elbows.
  • Arch backwards.
    •  (Note: Be careful if you have lower back issues)
  • Aim to feel a stretch across your abdominal region.
  • Breathe and expand your stomach as you stretch.
  • Hold for 60 seconds.

c) Strengthening

Sitting knee lifts

This is to activate the hip flexor muscles.

Instructions:

  • Sit up right.
  • Whilst keep your back still, bring one knee up towards the roof.
  • Hold for 5 seconds.
  • Alternate on other side.
  • Repeat 30 times.

Superman

This is to activate the lower back muscles.

Instructions:

  • Lie on your stomach.
  • Stretch out your arms in front of you.
  • Lift your upper body and legs off the floor.
  • Hold for 5-10 seconds.
  • Repeat 30 times.

Pelvic tilt (4 point kneel)

Instructions:

  • Assume 4 point kneel position. (see above)
  • Tilt your pelvis forward.
    • Your back should start to arch
  • Hold for 10 seconds.
  • Repeat 30 times.

Pelvic tilt (In sitting)

exercises for flat back posture

Instructions:

  • Whilst sitting up right, proceed to tilt the pelvis forward.
  • Hold for 10 seconds.
  • Repeat 30 times.

 Glute strengthening

You will also want to strengthen your gluteal muscles whilst in the correct pelvic position. I’ve written a whole post on this here.

d) Maintain neutral pelvis

If you do not maintain a neutral position of the pelvis throughout the day, then your posterior pelvic tilt will continue to be an issue.

Make sure that you tilt your pelvis forward to a neutral position whilst you are walking, standing, sitting etc.

As your body has had this posture for a long time now, it will try to go back to it as a default settingYou need to resist this!

3. Other areas to consider

*** READ THIS ***

If you have a Flat back posture, then you will most likely have:

I have already covered these areas in detailed posts that include EVERYTHING that you will ever need to know.

(Click the links above!)

(I’ve only included 2 exercises for each area in this post just to get you started. Don’t miss out on the rest!)

a) Forward head posture:

Sub-occipital release

sub occipital release

Instructions:

  • Place the ball underneath the base of the skull.
  • Gently rotate your head on top of the ball.
  • Continue for 3-5 minutes.
  • Do both sides.

Chin tucks + nods

Instructions:

  • Gently tuck your chin in.
    • “Make a double chin”
  • Aim to feel a gentle lengthening sensation at the back of your neck.
  • Make sure to keep your eyes and jaw level. Move the head horizontally backwards.
    • Think of the movement like a book sliding back into the shelf.
  • Whilst maintaining this position, nod your chin downwards.
  • Hold for 5 seconds and repeat 30 times.

b) Rounded shoulders:

Chest stretch

Instructions:

  • Place both hands on the door frame.
  • Lunge forward.
  • Do not flare out your ribs.
  • You should feel a stretch in the front part of your shoulder/chest region.
  • Hold for 30 seconds.

Elbow flares

Instructions:

  • Start position: Place both hands (elbows forward) on the sides of your head.
  • End position: Pull your elbows all the way back.
  • Aim to feel your shoulder blade muscles contract.
  • Hold for 5 seconds.
  • Repeat 20 times.

What to do next…

1. Any questions?… (Leave me a comment down below.)

2. Come join me on the Facebook page. Let’s keep in touch!

3. Start doing the exercises!

120 thoughts on “How to fix Flat back posture”

  1. Hey Mark,

    I have a flat back upper (more flat) and lower, I started doing this routine for the upper back combined with some heat to relax even more between the shoulder blades and traps. So far after a couple of sessions I feel my upper back a lot more loose.

    Meanwhile I started the lower back also, but I noticed that in movements like superman, standing hamstrings stretches my upper back kicks in dominating the movement and after that my upper back gets stiff again.

    Do you have any suggestion to reduce this compensation of the upper back or should I do first the lower and after the upper back or maybe fix both on the same routine?

    Reply
    • Hey Fabio,

      You can address both at the same time.

      Probably best to substitute with forward tilts of the pelvis. You could also do lumbar extensions over an exercise ball as well.

      You can also substitute the hamstring stretches with ones lying down. See post: Hamstring stretches.

      Mark

      Reply
  2. Hi Mark,
    I am generally very fit and active with good postural awareness , but I have a problem with recurrent episodes of acute flat back syndrome when I can’t straighten up, worse if I’ve been sitting. This can last some days, no stretches or exercises seem to help much. It eventually resolves and then I’m fine again. Sometimes accompanies by my pelvis shifting left. My thoracic spine is a bit flat normally.
    Any insight would be very much appreciated.

    Reply
    • Hi Marie,

      Have you had any scans to the spine to check for any structural changes that might explain your symptoms?

      Apart from that, reducing time spent in one position should help out with that. (especially with prolonged sitting)

      Mark

      Reply
  3. Hi Mark,
    Do I have to do all excercises of flat thoracic spine or one of them is enough??
    How long time do i need to restore my thoracic curve?

    Reply
  4. Hi,

    Thanks for your amazing website. I have been having back and cervical spine pain for the past 2 years. I have been going to PT and it has helped reduce the pain, and now I have some cervical spine/neck pain. However, the back pain is concentrated to the left of my mid to upper spine and is most painful when raising my hand to my head, with a 90 degree angle at my armpit. It is even more painful when moving my elbow back. I have started giving up on PT and was wondering if you know of what I can do. The pain sometimes centers on the spine in the middle, but is rarely on the right side. I have been using some of the stretches and exercises on your website, but it is still sore and painful.

    Thanks,

    Abe

    Reply
    • Thanks Mark!

      I was doing some of those exercises, and they have been somewhat helpful but I am not sure if that is the problem. The pain is only on the left side of my spine, and I am having difficulty wokring on those specific muscles. Do you have an idea why this might be?

      I thought that it might have to do with the erector spinae muscles. What do you think?

      Reply
  5. I would love your help, i am in so much pain for a long time. I have bad hip/gluteal pain where my hips feel dull and my glute minimum/medius goes in to spasm with minor sciatica. I think it has to do with my posture but i am not sure sure if i have sway back from my stomach sleeping, flat back syndrome from how i sit or even a pelvic tilt i am quite confused and in pain ? also messaged on fb my name is Daniel Shaw

    Reply
    • Hello Daniel,

      You will have to determine whether if your symptoms are originating from the glute muscles, nerve and/or lumbar spine.

      Pain in the glute medius could potentially be related to a hip bursitis.

      Have you gone for a scan to rule out any pathology in the spine? Perhaps ultrasound to hip to asses for any tendon issues +/- bursitis.

      Mark

      Reply
      • Hi Mark,
        Thanks for the great blogs! I am unable to sit on the floor with my legs straight in front of me and straighten my lower back (it curves out and back), I think tight hamstrings etc contribute but even if I bend my legs I can’t do it. I can only achieve proper curve standing or sitting on the front of a chair. Is that probably due to a flat back posture, a posterior pelvic tilt or what? Which set of exercises would be most helpful?
        Thanks!

        Reply
  6. Hey marc if i have scapula winging from flat thoracic spine will correcting the spine correct the scapular winging or would i still need to do the scapular wing excercises as well?

    Reply
    • Hey Chad,

      Due to the concave/convex relationship between the scapula and rib cage, it is important that the the flat thoracic spine is addressed.

      Although your winging can improve by just addressing the thoracic spine, it is likely you will need to address both.

      Mark

      Reply
  7. Hi Mark,

    Thank you for your elaborative website. Very helpful and informative!

    I’ve always had winged scapula and rounded shoulders. Though I never thought it could be because of a flat back.

    What I am planning to do now is focus on excercises for my flat back/forward head/rounded shoulders and winged scapula.

    My idea is to make a program of 3 excercises per segment (so 12 in total) and do these 3 times a week.

    Would you think this is a good idea or should I rather focus on one or two segments with more excercises.

    Also, can I rotate these excercises weekly (because 1 segment might have 6 excercises in total) or is it okay to do just 3 the same.

    Rens

    Reply
  8. Hi Mark

    How do you know when to stop doing these exercise? I know I am lack of natural curve on neck, chest and lower back by x-ray. Should I get a x-ray every period time or something else? It is possible that people over do things. I think it is a good idea to mention it on the article.

    Kind Regards
    John

    Reply
    • Hey John,

      You can stop the exercises if your posture has been corrected.

      But even then – I would still continue at a lesser frequency to make sure that you do not revert.

      Mark

      Reply
  9. Hello Mark,
    I am 22 years old.
    I have a flat lumbar spine, forward head posture, rounded shoulders, scapular dyskinesis on the right side. I cannot sit for more than 15 mins without pain in the lower back that goes up into my thoracic spine region. I also have weak deep abdominal muscles (i have the external abs visible tho). Should i work on strengthening my core alongside the exercises here in this post? Or should i focus on fixing the flat back first?

    Reply

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