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.

In This Blog Post:

Characteristics Of Flat Back Posture

flat back posture
  • Forward Head Posture
  • Rounded Shoulders
  • * Flat Thoracic Spine (Thoracic Hypokyphosis)
  • * Flat Lumbar Spine (Lumbar Hypolordotic)
  • * Posterior Pelvic Tilt (Pelvis rotated backwards)

(Note: The above areas marked with a * will be specifically addressed in the Exercise Section of this blog post.)


In my opinion – Flat Back Posture is mainly caused by the habitual slouched position adopted whilst sitting.

a) In terms of the lower back:

As the pelvis tilts backwards (Posterior Pelvic Tilt) during slouched sitting, the lower back will lose its natural arch.

This will give the flattened appearance in the Lumbar Spine region.

b) In terms of the upper back:

In an attempt to keep the head in a more upright position (in the context of a slouched posture), segments of the upper back will tend to extend backwards.

This will give the flattened appearance in parts of the Thoracic Spine region.

(Note: If the torso does not compensate for the forward head position, this tends to lead to a more Hunched Upper Back appearance.)

Muscles Involved

Here is a list of the tight and/or weak muscles associated with Flat Back Posture.

a) Thoracic Spine:

Tight and/or Overactive Muscles:

  • Spinalis Thoracis
  • Iliocostalis Thoracis
  • Longissimus Thoracis
  • Posterior Intercostals

b) Lumbar Spine/Pelvis:

Tight and/or Overactive Muscles:

  • Hamstrings
  • Abdominals
  • Gluteal muscles

Weak and/or Inhibited Muscles:

  • Lumbar Spine Erectors
  • Hip Flexors

is having a Flat back posture a bad thing?

Having a Flat Back Posture does not necessarily mean that there will be symptoms associated with it.

However- the natural curves in the spine can help with effective load distribution throughout the spine.

As these natural curves are absent in Flat Back Posture, the spine may have a lesser ability to absorb and distribute mechanical stress evenly throughout the body.

As a result, muscles may relatively work harder to help stabilize and move the spine.

Did you know… A Winged Scapula may arise when you have a flat Thoracic Spine?

How to Determine If you Have This Posture

a) Flat Spine:

Take a side profile photo:

Observe for the presence of a flat segment(s) in the upper and lower 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:

A Posterior Pelvic Tilt is where the pelvis is rotated backwards.

(Think about this position as your tail bone being tucked underneath.)

If you have a Posterior Pelvic Tilt, your lower back will also lose its natural arch.

How To Determine If You Have A Posterior Pelvic Tilt:

posterior pelvic tilt flat back posture


  • Stand up right.
  • Place one finger on your pointy hip bone at the front (called the Anterior Superior Iliac Spine) and the other on your pointy bone at the back (called the Posterior Superior Iliac Spine).

Results: If you have a Posterior Pelvic Tilt, the finger at the front of your hip bone will be higher in comparison to the finger on the pointy bone at the back.

Exercises for Flat back posture

To address Flat Back Posture, You will need to perform exercises for the Thoracic AND Lumbar Spine.

Flat Thoracic Spine

Flat Lumbar Spine

Other Areas To Address

Flat thoracic spine

1. Releases

Release the tight muscles that are associated with a flat Thoracic Spine.

a) Thoracic Paraspinals

flat back posture releases for tight muscles


  • Lie down on your back.
  • Place a massage ball in the area between the spine and the shoulder blade.
  • Do NOT place the massage ball directly on the spine.
  • Place an appropriate amount of your bodyweight on top of the massage ball.
  • Roll your body over the ball to cover all areas of the upper back.
  • Spend at least 2 minutes on each side.

2. Stretches

The next step is to stretch the tight muscles.

I have listed 3 different stretches that all target the upper back region.

Focus on the stretch that gives you the best results.

a) Forward Flexion Stretch

flat back posture stretch


  • Sit down on a chair.
  • Interlock your fingers behind your head.
  • 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.

b) Stretch With Foam Roller


  • Sit down on a chair.
  • Place a foam roller on your lap.
  • Bend and round your back forwards 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.
  • Hold for 30 seconds.
  • Take deep breaths in whilst in this position
    • Imagine the air expanding the area between your shoulder blades.

b) Upper Back Stretch (One Side)

upper back stretches to left or right side


(This stretch is described to stretch the right upper back region.)

  • Sit down on a chair.
  • Fold your torso forwards.
  • Look towards your left knee.
  • Place your left hand behind the back of your head and pull your head towards the left arm pit.
  • Whilst maintaining the downward pressure on your head, start to curve your upper back towards the left knee. (Don’t move from your lower back!)
  • Reach your right arm out in front of you. (Imagine your are trying to wrap your arm around a very wide tree.)
  • Aim to feel a stretch on the right side of the upper back.
  • Take deep breaths in this position to increase the stretch.
  • Hold this position for 30 seconds.
  • Repeat on the other side.

Do you want other ways to stretch the upper back?

See Post: Upper Back Stretches

3. Joint mobilization

The following exercises will help loosen up the tight joints in the upper back region.

a) Thoracic Rotation

thoracic rotation


  • Sit down on a chair.
  • Place your hand on the outer side of the opposite knee.
  • Using the other arm, hook your elbow onto the back of the chair.
  • Using your arms as leverage, start to rotate your spine. (as if to look behind you)
  • Aim to minimize the movement in the lower back. The majority of the movement should ideally occur in the upper back.
  • Perform 30 repetitions.
  • Repeat on the other side.
  • (Note: It is common to have some clicks in the spine as you perform this stretch!)

b) Thoracic Translation

thoracic translation

(This stretch is described to stretch the right Upper back area.)


  • Sit on the floor with your legs towards your left.
  • Place the right hand on the floor to your right side.
  • Keep the right arm completely straight throughout this stretch.
  • Relax your right shoulder as you lean your weight onto the right arm.
  • Glide/Shift your torso towards the right.
  • Aim to feel a stretch in the right upper back region.
  • You can increase the stretch by taking a deep breath in.
  • Hold this position for 30 seconds.
  • Repeat on the other side

4. Improve Control

Once you have performed all of the exercises mentioned previously, the upper back should ideally be able to move more freely.

If you feel that your spine is still very stiff, you will need to focus on the previous steps until it has loosened up.

a) Standing Segmental Cat/Cow

segmental cat/cow exercise


  • Stand up right.
  • 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.
  • Emphasize the rounding over the areas where your spine is the flattest.
  • From here, reverse your movements back to the beginning.
  • Perform 20 repetitions.

b) Segmental Cat/Cow (4 Point Kneel)

flat back posture exercises


  • 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.
  • Emphasize the rounding over the areas where your spine is the flattest.
  • From here, reverse your movements back to the beginning.
  • Perform 20 repetitions.

5. Regain your natural curve

Aim to keep a slight natural curve in your upper back at all times.

(I know… easier said than done.)

Try to keep your upper back relaxed into a more neutral position!

If you don’t do this, your Thoracic Spine will likely revert to being flat again.

Flat lumbar spine

To fix a flat Lumbar Spine, you will need to focus on the position of the pelvis.

For a complete guide on how to address a Flat Lumbar Spine.

See Post: Fix Posterior Pelvic Tilt

Otherwise – You can start by performing the exercises mentioned below.

1. Releases

The first step in addressing a flat Lumbar Spine is to release the tight muscles that may be holding the spine into this position.

a) Hamstrings

hamstring release


  • Sit down on the floor.
  • Place your hamstrings on top of a foam roller.
  • Use your body weight to apply pressure into the back of your thighs.
  • Make sure to cover the whole hamstring muscle.
  • Continue for 1 minute on each side.

b) Abdominals


  • 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.
  • Continue for at least 2 minutes.

c) Gluteal Muscles

glute release


  • Sit on the floor.
  • Place the back of your hip on top of a massage ball.
  • Use your body weight to apply a suitable amount of pressure onto the ball.
  • Roll your body on top of the massage ball.
  • Make sure to cover the entire muscle.
  • Do this for 2 minutes.
  • Repeat on other side.

2. Stretches

The next step is to stretch the tight muscles.

a) Upper Hamstring

stretch for hamstring muscle


  • Whilst standing, place a slightly bent knee in front of you on a step. (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 this position for 60 seconds.
  • Repeat on the other side.

b) Abdominal

abdominal stretch


  • Lie down 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 this position for 60 seconds.

c) Gluteal Muscles

glute stretch


  • Sit down on a chair.
  • Sit up right and keep your lower back arched throughout this stretch.
  • Place your ankle on top of the other knee.
  • Place your hands on the outer side of the knee.
  • Pull this knee towards the opposite shoulder.
  • Lean your torso slightly forwards.
  • Aim to feel a stretch in the back of the hip.
  • Hold this position for 60 seconds.
  • Repeat on the other side.

3. Strengthening

Let’s activate the muscles that will help bring your pelvis and lower back into a more neutral position.

a) Sitting Knee Lifts

This is to activate the hip flexor muscles.

hip flexor activation


  • Sit up right.
  • Maintain the arch of the lower back throughout this exercise.
  • Lift one knee upwards.
  • Hold for 5 seconds.
  • Alternate on other side.
  • Repeat 10 times.

b) Superman

This is to activate the lower back muscles.


  • Lie on your stomach.
  • Stretch out your arms in front of you.
  • Lift your upper body and legs off the floor.
  • Aim to feel a muscular contraction in the lower back.
  • Hold for 5-10 seconds.
  • Repeat 10 times.

c) 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.

bridge exercise


  • Lie down on your back.
  • Bend your knees and keep your feet on the floor.
  • Maintain the arch in your lower back.
  • Push your hip upwards.
  • Aim to feel a muscular contraction in the back of the hips.
  • Perform 10-20 repetitions.

4. Improve Pelvis Control

By improving the control of the pelvis, this will help reclaim and maintain the arch of the lower back.

a) Forward Pelvic Tilt (Supine)

forward tilt of pelvis


  • Lie down on your back.
  • Bend your knees.
  • Keep your feet on the floor.
  • Tilt your pelvis forwards.
  • Your lower back should arch as you tilt the pelvis in a forwards direction.
  • Hold this position for 5 seconds.
  • Perform 10 repetitions.

b) Pelvic Tilt (4 Point Kneel)

pelvic tilt


  • Assume 4 point kneel position. (see above)
  • Tilt your pelvis forward.
  • Your lower back should start to arch.
  • Hold this position for 5 seconds.
  • Perform 20 repetitions.

c) Pelvic Tilt (Sitting)

exercises for flat back posture


  • Sit up right on a chair.
  • Tilt the pelvis forward.
  • Your lower back should start to arch.
  • Hold for 5 seconds.
  • Perform 20 repetitions.

d) Standing Pelvic Tilts

standing pelvic tilt


  • Stand up right.
  • Tilt your pelvis forwards.
  • Your lower back should start to arch.
  • Try not to move your torso or legs as you are moving your pelvis.
  • Hold this position for 5 seconds.
  • Repeat 20 times.

5. 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.

correct sitting

Make sure that you tilt your pelvis slightly forward to a neutral position whilst you are sitting.

(When sitting – Consider using a lumbar arch support pillow on your chair to help you maintain a more neutral position of your lower back and pelvis.

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

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 to get you started. Don’t miss out on the rest!)

Forward head posture

forward head posture

Forward Head Posture is where the position of the head is in front of the mid line of the torso.

If your head is locked into this forward position, the upper back may compensate by extending backwards into a more flattened alignment.

(This is the body’s attempt to keep the head in a more up right position.)

Here are 2 exercises to help you address it:

Keep in mind – You can click here to see a complete guide on how to fix Forward Head Posture.

1. Sub-Occipital Release

sub occipital release


  • Lie down on the floor.
  • Place the ball underneath the base of the skull.
  • Gently rotate your head on top of the ball.
  • Continue for 2 minutes.
  • Do both sides.

2. Chin Tucks + Nods

chin tuck


  • 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.

Rounded shoulders

rounded shoulders

Rounded Shoulders is where the position of the shoulders is slouched forwards.

Here are some exercises to help you address it.

1. Chest Stretch

chest stretch


  • Place your forearm high onto the edge of a wall.
  • 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.
  • Repeat on the other side.

2. Elbow Flares

rounded shoulder exercises


  • 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.


Flat Back Posture is where there is a lack of the natural curve in the spine.

Perform the suggested exercises mentioned on this blog post to address this type of posture.

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!

Medical Disclaimer: 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. Seek medical guidance before starting any exercise. For more informationMedical disclaimer.

138 thoughts on “How To Fix Flat Back Posture”

  1. Hi Mark,
    I have a question about hyperlordosis. With this condition, what is the best way to sit and do lumbar supports/cushions/etc. affect this?

    • Hi Charles,

      Best way to sit is to “sit on your sit bones”. There are these bones underneath your pelvis cause Ischial Tuberosities and can be located by placing your up facing palm underneath your hips as you are sitting. You can look at them as upside down triangle in shape.

      When sitting – tilt your pelvis forwards until you can feel your body weight is resting on the pointy parts of the sit bones and pelvis floor region. This should put your pelvis in a more neutral position.

      This neutral position of the pelvis can be supported with the use of lumbar supports.

      In terms of hyperlordosis – it is possible to have an over arched lower back when standing, and a flat lower back when sitting.


  2. Hi Mark! So I have a flat upper back and I see that in another comment you responded to that this may be a compensation of excessive flexion at the mid back. My thoracolumbar junction is certainly flexed so I was wondering how I would go about getting some extension into that area. Thanks!

    • Hey Mark,

      You’ll need to encourage more extension in that thoracolumbar region.

      Check out this post: Hunchback Posture

      You can use the exercises mentioned on that blog post, but the target area would be towards the thoracolumbar region ( as opposed to the upper back specifically)

      Also another thing – be careful how you are sitting as this is the usually cause for a forward flexed middle back.


  3. Hi there,
    First off would like to say I love your posts! So informative!

    Just a quick question I’m unsure if someone I work with has slight sway back or flat back. Would you be able to define the difference if there is no noticeable swaying of the back?

    Many thanks

  4. Greetings Mark!

    First off, thank you so much for your work here on this site! As a fellow physical therapist, your information is a tremendous resource! I was just wondering if you had any thoughts on exercises or techniques to increase sacral nutation? I have had several SIJ injuries that have led to a flattened lumbar/thoracic curvature, and I believe it is due to my sacrum getting “stuck” in counternutation. Thank you again for any suggestions, and keep up the great work! You’re definitely helping a lot of folks!

  5. My thoracic spine curves inward from doing lots of extension exercises
    (I T Y’s etc)
    I think i have a posterior tilt of the thorax and i suspect scapular elevation, excessive external rotation through my whole body

    would unilateral pushing/rotation exercises be better to round my back?
    like serratus punch, banded oblique twist maybe straight arm lat pulldown?

    or is the hypohyphosis more a lack of expansion in the back from concentric traps

    any input appreciated!

    • Hey Eric,

      If you have a flat upper back, I would check to see if you have
      1) excessive flexion in the mid torso region. (in this case, you’d want more extension in this region)
      2) Excessive flexion at the base of the neck (this may suggest a forward head posture)

      A flat thoracic spine may be compensating for these 2 issues.

      Rotational exercises can help loosen up the thoracic spine. I would follow this up with flexion based exercises with focus on breathing and stretching the upper back.


      • thanks mark yes i do have some excessive flexion but whenever i open up my chest lats and upper abs i go into a sort of military neck posture and can feel myself bending backwards into my matress i actually went deaf in one ear and hear noises from all the compression, stretching the rhomboids and mid traps helps

        i seem to be a rare case of going too far the other way fixing my rounded shoulders and too much retraction

        ill figure it out i think rotation, serratus and hip internal rotation is the key
        your guides have been very helpful!

  6. Hi Mark! Thank you so much for this post! Can “burning” back-of-the legs, tense glutes, and tight hamstrings be a result of trying to correct my posture? Three months ago, I slipped a disc in my lower back, and my chiro also diagnosed me with a posterior pelvic tilt. At that time I assumed the burning leg pain was a result of the slipped disc, so I decided to try to improve my posture to see if that would help. My disc has since healed (per an MRI), but the burning back-of-the leg pain has persisted. It seems to intensify throughout the day, and is worse when I’m tired. Is the pain simply a result of weak muscles trying to hold a posture they are not accustomed to holding? The only relief I seem to find from the pain (while standing or sitting) is to relax back into a posterior tilt. If this is the case, do I just need to follow the advice in your blog post and put up with the pain? Will the pain subside as the muscles regain their strength and flexibility?

    Thank you so much for your time and consideration.

    • Hi Erika,

      It is definitely possible to develop some ache in the muscles when attempting to correct your posture. However- these should be short-lived as your body will become familiar with the new position.

      However, it is also important to note that you can also over-correct your posture which will actually cause an increase in tension in your body.

      Burning at the back of the leg makes me think that you need to check if your sciatic nerve is aggravated (which is commonly seen along side a slipped disc).

      If you are forcing an anterior tilt of the pelvis (opposite of posterior pelvic tilt), it is possible that you are squashing the nerves in the foramina (exit holes for the nerves).

      If you over extend your lower back whilst standing for a period of time, does it make your leg symptoms worse? If so, I think you might be over correcting your pelvis position.


  7. Hey mark, i was told i have flat back posture but i dislocated my left shoulder and i think the other side overcompensated so much everything fell out of allignment, possibly might be the case.
    – my right shoulder is way rounded then the left
    – and my left alot higher,
    what do you recommend for this issue? Proper rounded shoulder exercises dont work for me specifically because I think its more to do with a muscular imbalance in the back somewhere i cant detect.

  8. Hello, Mark!

    I have some flareups in my back sometimes, and it tends to bring out some problems, when I make some mistakes, and now what I feel is, that in my scapula level, one vertebrae on the top, and one on the bottom of it, I can feel, that they are a little bit “slipped” inward. like the whole spinal curve is aligned, but in the scapula’s level, those few vertebraes are running more inside, than they supposed to.
    Do you recommend a chiropractor, to put them back in line, or which exercises are gonna make the trick?

    With this problem, I also experienced that my spine on the neck area were lost stability, and got an unusual side curve, with some hand nerve “effect”, but since I support my back with some towels, I don’t feel the problem…

  9. 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?

    • 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.


  10. 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.

    • 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)


  11. 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?

  12. 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 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?

  13. 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

    • 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.


      • 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?

  14. 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?

    • 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.


  15. 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.


  16. 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

    • 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.


  17. 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?

  18. Dear mark, one year ago i started doing a ridiculous exercise to treat my forward head posture. It involved manipulation of the spine, giving me posterior pelvic tilt and loss of natural curvature in the thoracic area.After that I had intense breathing problem. I counteracted by doing posterior pelvic tilt correction exercises it gave me relief to a certain extent but it is not completely healed. My chests does not appears to be expanding properly and it feels tight, the problem might be with the shape of ribcage or something. And every second of my existence, I am facing this shortness of breath. Local doctors could not diagnose it and declared that I am either fine or I have psychological problem. But I am sure it is physical.(the exercise) from 4:00 and i did them excessively with over intensity and certain modifications

    • Hello Ash,

      The exercises mentioned in the video look fine.

      If you a flat back now, you may have jammed up your joints in the thoracic spine.

      This can affect the ability to completely expand your lungs due the rib position.

      I would focus on flexion based thoracic spine and breathing exercises.


    • hey ash, i was also doing the same thing. i noticed when i was doing alot of chin tucks. i feel hopeless, i’ve been through so many doctors and they said nothing is wrong but i know 100% it doesnt feel right. my shoulders are rounded, really bad forward head posture. and my thoracic spine is flat. when i was doing the chin tucks i was stretching my neck and i think when doing the chin tucks i moved some muscles out of alignment. have you figured out what was going on with yourself?

    • Hi Tom,

      The short answer: As much as you can.

      The more practical answer: Try to do it 2-3/week to start with. See how your body feels and responds do this frequency. Increase/Decrease frequency as appropriate.

      All the best!


  19. I was just wondering if you have ever seen someone restore their thoracic curve with consistency of these exercises. And if so, how long would you say it could take of everything is only postural related?


  20. Will these exercises work for those you have flat back due to Scoliosis surgery. I am 51 now and had surgery at 12. Having two babies and a couple of falls on my back have made my posture worse also I guess the aging process. I have a double curve that was fused using a Harrington rod. The crazy thing is my right shoulder and neck have issues. My left leg, hamstring and back are tight. I tend to favor my left side when sitting. I am trying to do all I can to stay healthy and active. I tend to get stiffer easier and have a harder time walking long distances.

  21. Hi Mark!!

    This site has great content and Knowledge. I thank you for helping people out

    I am 35 and please see below link for my Lower back and neck Xray

    I want to know abot my lower back curve is it normal or i have to work out to make it more curve? I get lower back pain but not regularly.

    For neck as you can see i might have forward head posture but i want to know if i correct my lower back curve then will the neck position improve?

    Also, I tried to do the hamstring test you mentioned by sitting straight against the wall and I really can not put my legs straight to touch the floor nor I am able to bend and touch my toes.

    Please guide me on the exercises I have to start step wise or can I take all 3 simultaneously? i.e lower back, forward head and hamstring?


    • Hey Vipul,

      Looks like the pelvis is in a bit of a posterior pelvic tilt from neutral.

      This can make your lumbar spine flatter.

      If you have identified that your hamstrings are very tight, that might be a good place to help address your flat back.

      Your head is quite forward, but so doing the forward head posture exercises will help. Ultimately – you will also need to address your upper back curve!

      Start with the hamstring and pelvis! See how it goes from there.


      • Thaks i have started few exercises will share you the results soon

        I want to know(looking at my xray and photo) is my Lower back curve too flat or is it close to normal?

  22. Hi MArk

    Really great content and knowledge you have given on this site

    can i have your email id i want to share my lower back spine xray to know your views


    • Hey Andrea,

      I use the standard sized lacrosse massage balls.

      Keep in mind – they all come in different levels of hardness. You might need to start with the softer balls and progress to the harder ones when you can.


  23. Hello, I am thrilled to find you. I have lumbar hypolordosis due to several years of a worsening stenosis between L4/L5. I have had a partial laminectomy of those to vertebrae and had immediate relief from the worst of the spasms and numbness and expect the nerves to continue to heal. This was two months ago. I have started with a physio and I am doing the exercises. He indicated that my flat back might be permanent. I have just found out what the name of the condition is and then found your site. I intend to try very hard for a long time as required if there is a possibility of getting my pelvis back in proper orientation so my hip doesn’t hurt so much. What do you think? Obviously I have to check this out with him too at my next appt.

    • Hey Nancy,

      I haven’t assessed you personally so it might be hard to give you specific recommendations, however, I would give the exercises a good try and see how far they can get you.

      You would be surprised at how the body will respond to consistent exercises!.


  24. Hi Mark.

    Thank you a lot for this post, i think it will help me a lot!

    I’m 28 soon 29, but since year 16 i’ve had problem with my breathing which made me stop pursuing my dream of professional football. I had everything checked, heart, lunges, brain, but as of a few days ago i started to wonder if my back was the problem.

    I have a flat thoraric spine and my muscles around it are nearly ALWAYS tight and sore. Whenever i play football or are psycical active with high intensity, i have troubles breathing the next couple of days. But i don’t experience problems when i ride a bike or use the cross-trainer with low/middle intensivity, probably because i don’t use my back.

    When i sprint i get very tight in my back and i instantly loose my breath and become fatigue very quickly.

    I did some of your stretches yesterday, and already at my football game later the evening i could feel a difference. Quite big actually. Already before the game i felt more loose and light in my back and today (the morning after) i even feel that my legs are light, which they haven’t been for ages. For the first time in 13 years i feel like i’ve found the reason why i have breathing problems when i’m active or sometimes when i just lay on my back or side (Probably because i start to getting tight in the back again)

    Well. My question is. How do i get my back muscles completely released? Do i need to get my flat thoraric spine to curve, before i can entirely get rid of the problem, or can i stretch my way out of it?

    Should i do the above excercies everyday, and that would make the tightness go away, or do you have a suggestion? Maybe especially a suggestion on how NOT to make the tightness come back. Because even when i take a break from football for a month or more, i still feel my back being very tight.

    Again thank you for this post, since i feel this can change my life!

    • Hello Henrik,

      Great to hear you have responded to some of the exercises.

      In order for the diaphragm (your main breathing muscle), you need your back to have its natural curve.

      The exercises in the blog post will help with that! You can do them everyday if you like. More the merrier.

      I would also encourage you to work on Rounded shoulders and a Forward head posture (if you have them) as they can contribute to the flat thoracic spine.


  25. thank you so much for a terrific site! Im an OTA and have some knowledge (always a danger lol) but also had a mastectomy on R 24 yrs ago w lat flap reconstruction which has added to issue (slight lower scoliosis and tendency to forward head-i.e. read, computer, knit, sew, etc) (some hospitals have discontinued this recon procedure, imagine lat mixed with pec location!!) Very grateful for your knowledge and willingness to share.. I’ll be back after I practice the stretches for a while..Namaste..Deborah

  26. Hi Mark! I am wondering if flat back can result from a year of protective measures (ie rest, and holding the body carefully in flexion only positions) from a low back injury causing fear of any extension motion. Prior to now, there was normal curvature of the lumbar region.

    • Hey Sandy,

      Yes – changes in how you habitually hold your torso can change your posture as a whole.

      You will need to retrain your spine to tolerate extension!


  27. Hey mark, before I was able to find this post I first did the routines posted on the posterior pelvic tilt and Hyperlordosis blog along with hunchback. My posture and symptoms were improving but after stumbling onto your 17 exercises for thoracic mobility the tension in my upper back was finally released and I had much better control of my scapulas. I realize now I most likely had flat back posture and my question is does it matter if you start working on your posture from the pelvis and up or does it have to be from the neck down? I was a little upset because I thought all the work I did was for nothing if my thoracic spine wasn’t in a neutral position. Also thank you for posting such quality information for free! A chiropractor tried to charge me $2000+ for a 3 month program to fix my posture, a true hero you are. Haha

    • Hey Louie,

      Great to hear that the thoracic exercises have helped you! That’s really awesome!

      In regards to your question: Put it this way. There is no wrong way you can start. Just start and see how the body responds. If it’s going all well, keep going with the exercises. HOWEVER- if you feel you aren’t getting any where with it, try tackling another area!


      Ps. Wow- $2000! I hope you got some improvement from that!

  28. Thank you so much for sharing your knowledge, I found all of this useful as I am a
    new personal trainer. I appreciate the simple and to the point explanations and exercises.

  29. Hi Mark

    Have you ever heard of Dr John Sarno and his books “Healing back pain” and “the mind body prescription”? Would love if you could read them and tell me what you think. There was a study done with 100 people with NO BACK PAIN, 68 of those people’s xrays came back and showed everything from herniated disks to more serious conditions yet they had *NO pain.* In all his years of treating people who had chronic back pain, neck pain or any body ailment it always lead back to one thing; unconscious repressed rage. It’s not a structural problem, it’s repressed emotions. The books are a must read.

    • Hi Star,

      I have not heard of him but his concepts do sound quite interesting.

      It is 100% true that what they find on imaging scans does not always reflect on what symptoms the patient may have. (if any)

      Emotions have a HUGE influence on your body.

      (Think of people who are stressed. They will generally have a tensed up body.

      Or even people who lack self confidence. This can be reflected in there over all posture.)

      I would not be surprised if other non-structural factors like unconscious repressed rage would have large effects on the body as well.

      Thanks for your input!


  30. Hi! I’m really excited to have found this blog today. I’m 40 and have been battling flat back issues since about 28 when it was discovered that I have no curvature- not one bit- top to bottom, skull to booty. Since 28 I’ve had: a c4/5 herniation, c5/6 broad bulge, L5/s1 herniation, c7/T1 left sided pinched nerve, and now have a c3 over c4 instability from a minor car accident. What’s weird about me is I’ve never been a sloucher so I don’t know where this came from. I’ve had SOOOO much radiology, every injection, tons of PT, you name it- I’ve probably done it (except surgery- I won’t do that till absolutely necessary).

    I’m VERY active, have done triathlons, obstacle course races, I bike, rock climb, run, hop, skip, jump- I just do it all really carefully and honestly I’m a turtle. But I have chronic back pain and neck stiffness, and of course am always keenly aware of my activities and there are just some things I can’t do (like run downhill or do a back bend).

    I’ve been told by EVERY chiro, PT, doc etc that there’s no fixing my abnormal curvature (or lack thereof), but as a healthcare provider (nurse) myself I never believed that I couldn’t at least improve my lot, so I’ve tried to do things on my own that seem to make sense. I don’t think I’ve improved anything, but I think I’ve at least kept it from progressing. There’s a lot out there on neck mobility etc and lumbar exercises, but with three bad sections, I know it’s an uphill battle if I can only address two. What I did not find until today was how to address the thoracic hypokyphosis.

    So I was looking for hypokyphosis info and came across this blog today. I’m super excited and plan to get started immediately with these new stretches and exercises- several I was previously unfamiliar with.

    Thank you for having this here in the universe! I’m hoping in a few weeks or months I’ll be another person who can write you with good news about some improvements in my mobility and pain.

    Thanks a ton!!!

      • Hi Mark, thank you for the information! My posture was recently checked at a pilates centre and they said i have flat back – which makes sense to me because i have felt like my back is the most prone to aching, even when i was little. I am starting to be more aware of my posture and do pilates to try to correct it but my question for you is:
        1. how should your sleeping position be when you have flat back? I have never been comfortable with sleeping on my back and have always slept sideways with a bolster since i was a child. recently though that have not been super comfortable either and i find myself twisting my back, almost like halfway sleeping on my side and halfway on my stomach hugging a bolster to get me to sleep but when i wake up my back will feel very sore. i would love to be able to sleep on my back if possible (i heard it prevents wrinkles, lol). Will sleeping with a rolled towel horizontally under my waist be beneficial or harmful to my flat back?
        2. how should your sitting position be when you have flat back? i have an office desk job and was wondering if you have any tricks to make sitting on a long period of time comfortable for me.
        Thank you!

  31. wow you realy do reply to every comment haha. great work, really informative and clear, ive spent ages looking up trygin to figure out what muscles are tight with flattening or lumbar lordosis and which are loose, first time ive seen a pretty concise explanation. i was just wondering if the posterior tilt is the main reason for flatback? most of the exercises seem to be adressing the tilt, like hamstring glute tightness etc. is this considered the main underlying cause? as opposed to the muscles like psoas, quadratus, or other vertbabrae attached muscles etc. that attach to the spine? my pelvis doesnt seem posterior tilted (to my very basic understanding of course), but my lumbar lordosis is pretty much non existent. and i dont know if the muscles that actuallt attach to the lumbar vertabrae like the hip flexors are considered a cause of flattening the lumbar lordosis? are there any muscles which attach to the front of the mid back (upper lumbar/lowar thoracic) vertabrae which could be tightened to pull the mid spine forward to increase the curve, if that makes sense?

    was also wondering if there where any exercises in gym to avoid? tomorrow for example im doing my first back workout in a while, trying to get some strength into my rhomboids as they are clearly weak( to address my forward head and rounded shoulders) but since the traps being overly strong and tight is a cause of rounded shoulders, im just wondering if there are any of the major exercises i should avoid. not looking anything too comprehensive or in depth, was more concerned about my first question. im just looking at some of the back work i have planned, and ended up wondering if some of the exercises I plan to do will strengthen already overly strong muscles etc. and maybe make some things worse (not knowing if a particular exercise that im usuing to target my rhomboids or posterior deltoid for example maybe use a muscle that is already too strong and tight as a stabiliser? i had downward rows in the workout, but since the traps are helping round my shoulders I think maybe remove that and stretch them instead as you demonstrate.
    great work by the way, im serious when i say this may be the best site i have found yet, i was on it a year ago when i also had pain, but between a few things in life i stupidly let it slip away from my mind again until recently when the issues have become real bad again and forced me to be discplined this time and properly address the issue. thanks in advance, and sorry for the length, if you dont have time to reply its completely understandable. even all this info up here is massively helpful already, and for free no less, witout any sensationalist ” does THIS hidden muscle cause x problem? nonsense i keep seeing before someone asks for my credit card 2 minutes later. Im much more concerned about the first question of wether there are any muscles that attach to the mid spinal vertabrae which could be strenthened to pull the lordosis curve back into place, or if the pelvic tilt is widely considered the cause, and the effect the flattening.

    • Hi Fiachra,

      Thanks for your questions.

      I was just wondering if the posterior tilt is the main reason for flatback?

      The most common cause of a reduction in a normal lumbar lordosis is due to the posterior pelvic tilt.

      However – that being said, it is possible to have a neutral pelvis with a flattening of the lower back.

      In this case – you will find more progress by addressing the lumbar spine it self. (ie. strengthening the psoas and erector spinae muscles, releasing abdominals (and possibly upper psoas fibres)

      Additionally – you will need to address the thoracic spine as this can dictate the position of the lumbar spine.

      was also wondering if there where any exercises in gym to avoid?

      In regards to having a Rounded shoulders, you want to prioritise strengthening the rhomboids and lower trap region.

      However- one you are able to keep your shoulders in a more neutral position, you actually want to strengthen the chest muscles with your shoulders in neutral.

      There isn’t any exercise you should specifically avoid as long as you can maintain a good alignment and technique.

      If you are a bit worried that you will train an already over used muscle, you can avoid things like shrugs.


  32. Hi Mark, I got xrays awhile ago showing loss of cervical curve and I also have lower back pain and keep straining muscles between my shoulder blades and neck. I think I have flat back posture but I’m not sure. Do you have an email I can send u pictures of my posture? Would greatly appreciate it. I’ve been dealing with these pains for 6 years. I’ve been everywhere.

    Thanks, Jake.

  33. Hi Mark,

    Thank you so much for generously posting all this fantastic information for free! I have found a number of helpful posts that have helped me manage my pain and hopefully gradually become pain-free!

    Best wishes,

  34. iH
    I am very happy to know your website is useful new
    I have a Charcot-Marie-Tooth disease with my fingers. How can I treat the condition through exercise? Thank you.

  35. Thank you very much, Mark.
    I don’t look at my body in the mirror often, but recently noticed that my lower back has become more straight and my head is leaning forward.
    Your site offers the best advice and you are very generous to offer your expertise.
    I will follow your exercises and will report back. Thanks again.

    • Hi Mark..I’m feeling so thankful for your site. I’ve been diagnosed with piriformis syndrome and was just recovering from another setback after having lifted a senior daily who out weighted me. I had previous bouts with it and therefore have a litany of physio exercises, all resulting from lifting a heavy board while in a two point kneel and arms outstretched in front of me. I injured pretty much every joint in between and ultimately required two canes. It was determined that my atrophied glutes from a sit down job contributed to the development of sciatica pain and piriformis syndrome. I had healed with physio but then in 2017 i tripped while carrying a guitar in a hard case and broke the outside bone in my left foot. The aircast left me with shortened muscles . But I managed to heal. What happened in the interim was that my left leg and hip is now considerably atrophied. I cannot curl the toes in my left foot and I have some issues with my fingers. No arthritis but I do take recommended supplements. I have forward head thrust which i have corrected pretty much and good posture but I the issue right now that the swelling from the lifting of the senior that I really just noticed is my back is very very flat from neck to tailbone. I lose hip rotation and cannot walk right now for more then a few paces though I’m not bedridden in excruciating pain any more right now. I have always had tight hamstrings. And I have a lot of foot pain under my high arches and right now increased activity I find I have pain everywhere. I am wondering if something about how I walk could be affecting my condition? I don’t seem to be gaining muscle and strength and it’s not due to any medical condition so I wonder if I am defeating my gains in some way that could also explain the pain in my feet? Thanks

      • Hi Cheryl,

        The symptoms of Wide spread atrophy,weakness, shooting pain down several areas in the leg, inability to move your toes, shuffling feet make me think there is some issue with the nerve that goes down the leg.

        The 2 main issues that can lead to this are 1) Piriformis syndrome and/or 2) Nerve impingement in the lower back.

        Have you had an MRi to rule out involvement of the lower back? I would start here first.

        If that is clear, this might increase the chance that you do have piriformis syndrome.

        Are you able to stretch the muscle? (see image)


  36. Hi Mark;
    I founded out that I have flat thoracic spine because my back looks flat and sunken in the upper back area as if I have scapular winging. When I was 13, I fell from wall 1.5m high and landed on my back. I am 22 now.
    Can it be the reason why I have flat back?
    Is my back restorable?
    Thanks for posting this awesome article by the way.

    • Hi Mehmet,

      A flat thoracic spine can influence your scapula winging as it changes the shape of the rib cage.

      In terms of what causes, past injuries can definitely affect it.


  37. Hi Mark,
    First of all, thank you very much to sharing your knowledge and educate the people. You are saving lives. Really appreciate.
    I am 36 yrs old man and I am suffering from mid to lower back pain since last 3 years. I am web designer and so I need to seat in front of computer at least for 8:30 hours days. I doing job since last 14 years. Since last 3 years my back pain make my lives worst. I can’t enjoy my life always thinking on pain and how to cure it. I saw 3 to 4 doctors but there is different opinion for each there is nothing any surgical that stop me to stand up or get up but the routine pain make my day worst from morning to night. And again every day and need to seat and work.
    From one my best doctor of city I found that I have little flat spine structure and its cause back pain. I check my spine structure and compare with other person, I found that I have little flat spine at lumber area. I don’t know my pain is due to this or something else.
    Check some of my below picture of my spine, MRI report and some X-ray picture.
    1) Is it cause due to Flat back?
    2) Is it also called Posterior pelvic tilt?
    3) Is it possible to restore and how can I do this?
    4) What is the best chair to seat? How should I seat?
    5) What about sleeping position and mattress?
    6) I had try some exercise before and also doing some exercise and but it’s not relief me. Even sometime I feel that it’s make me more pain.
    7) I am not doing much activity but I’m walking every do around 30 min.
    8) I feel that my back side have not that much fat at both side of vertebra. Is it also something that cause back pain and weak muscles? How can I make some fate and strong? Any specific diet can help me?
    9) I am also take care to get up after every 30 to 40 min.
    10) I also massage my back every day. Is it helpful?
    Mark, please help me because if it’s not resolved in earlier, it make me finish. I might not able to do job.

    Best regars,

  38. Dr i totally lost control of all the muscles due to over stretching of hip flexors by going into a posterior tilt and lats when i had an ecto belly .then i did shoulder scapula rectraction and excercises by shoulder bones not really by i totally lost control of my body .if i correct my hips shoulders are falling.if i correct my shoulders hips become loose .in mri scanning complete flat cervical thoriac and lumbar came.pls dr help me

      • My xray shows my spine is straight not curved is structural change to spine or it is due miss muscle alignment

      • My xray shows i have flat lumber spine is it permanent or it can reversed to s curve by doung your given excercise ….do every flat back posture patient has flat lumber spine ….is it temporary or permanent

  39. Sir i have flat back from 6 or 7 years which i came to know after reading your blog also my one shoulder is elevated but when i arch backwards standing and gets to normal position my elevated shoulder gets lower for some times and then again gets elevated is this is due to flat lower back ….i have flat lower back and i check it from wall how much time i would restore my curve…also when i am sitting my shoulders are equally positioned sry for my english

  40. This is by far the best site I’ve seen. Excellent information and clear instruction. Thank you!

    I’ve had chronic daily headaches for nine years. A physical therapist recently told me that both upper and lower back are very flat, causing me to want to lean forward and put head forward. I believe this is contributing to the problem.

    The headaches are always accompanied by:

    Very tight back and shoulder muscles
    Scalp is very tight with painful areas, sometimes on raised bumps
    Hot behind eyes
    Tender eyebrow area

    Over the years have tried these things that did nothing:
    Botox to scalp
    Trials of medications from Neurology
    Nerve Block
    Trigger point injections
    10-week chronic pain program
    They wanted to fuse three neck vertebrae but I declined.

    These things are helpful temporarily:
    Massage to back and sub occipital area
    Relaxation with mindfulness
    Ice to head and sub occipital area
    Heating pad to back tight muscles
    Lie down for a while
    Lying lengthwise on a foam roller and moving arms is the best relief so far.

    I worked at a computer for 30 years, plus bad posture all my life.

    A physical therapist recently told me that both my upper and lower back are very flat,I really believe this may be a major contributor to problem.

    Do you have any suggestions for me other than the exercises on this page?

    Thank you,


    • Hi there Anne,

      For your headaches, check out this post: Forward head posture correction

      It sounds like your muscles at the base of your skull (ie. sub-occipitals, SCM, semispinalis) may be causing your headaches.

      A lot of the treatments that you mentioned appear to only treat your pain (symptoms), and not so much the reason as to WHY (cause) you have the pain.

      It is common to have a poked neck/forward head posture with a flat back posture. To completely fix your head issues, you will need to address the underlying postural issues as well (ie the flat back).

      Hope this helps!


  41. Hi Mark,

    It was just brought to my attention that I have a flat back. I have a anterior pelvic tilt as well. My symptoms include right side neck pain, right side poor scapular recruitment upper trap overactive. I also have left hip pain which comes in goes. Any ideas what I need to focus my energy on. Thank you!


  42. Hi Mark,

    Thank you for all the interesting articles.

    Just some background on my history and whether you will be able to provide some insight.

    I have had winged scapula in my left shoulder for many many years (initially started as a pinched nerve.) My injury is to such an extent that I cannot do upper body weight exercises in the gym(I used to train through the pain.) My left bicep gets stiff much quicker than my right and the pinch worsens when I gym. It just doesn’t feel right and I am super conscious of it.

    I have been to physical therapists, Chiropractors, Biokineticists but all they told me was to strengthen my Serratus Anterior, but all this has done is worsen the pain. During my search for the root cause of my problem I was told that I have flat back posture. Do you think that the flat back posture could be the cause to my problems?

    Another thing that was quite interesting was when I went for lynotherapy (fascia release in areas to help re-align the body.) It was found that my left hip was very stiff and once the fascia was realeased my shoulder was much better, but this was only a temporary fix. I am very much conscious of the fact that when I walk my left hip gets more strain than my right. How can that be?

    I suspect that my Winged scapula is either due to my flat back posture or left hip problem? I’m just struggling to find the link between everything.
    It is also worth noting that I sit infront of a PC all day and used to have a rounded shoulder posture in my younger days.

    Your feedback would be much appreciated. Please let me know if you require more information.

    Many thanks

    • Hi Arnaud,

      If your issue is mainly poor muscular control of your shoulder blade muscles, check this post: How to fix a winged scapula.

      However- A flat upper back can disrupt the concave/convex relationship between the scapula and thorax. This can lead to winging of the scapula.

      Fascial line connect the whole body (Including a link between hips and shoulders). You might consider checking your pelvis alignment out to delve a bit deeper into your postural issues.


  43. Hi Mark- Thank you so much for your article. I have just started to sit on my sit bones and doing your suggested exercises for Flat back.

    I have had my right hip higher then the left, since a small child, (I’m 54) as Im pretty sure that when I had a motorcycle accident at 8 yrs old and fractured my leg and pulled all the ligaments, is were it all began. (No physical therapy after my leg healed)

    So, here Iam at 54 with lots of pain. I have always had low back pain, but it never reached a 10, (1-10 pain scale) until 8 yrs ago when I was at the gym doing adductors on the machine. It felt like I pulled a muscle on the inside of my right leg.

    As the pain got worse, finally got Mri and did physical therapy. Was told I had Spinal stenosis and was treated for that. I have been to 5 different Physical Therapist in 8 yrs for treatment with little success.

    The last Therapist told me I had “Flat Back” I had to stop treating with her because of insurance. It has only occurred to me with in the last two months, that maybe my flat back (Thoracic and Lumbar) is the root of all of my issues.

    Here is what my last MRI, a yr ago said:
    CERVICAL-Cervical spinal cord is normal. There is a levocurvature of cervical spine. Minimal to mild posterior disc bulging.

    THORACIC -Thoracic spinal cord is normal. There is a mild upper thoracic spine kyphosis with Schmol’s nodes which may reflect old Scheurmanns disease. No cord compression. Mild central and mild posterior disc bulging.

    LUMBAR-Severe Spinal Stenosis on my right side and moderate on left.

    I realize that I may not feel the effects of evrything on the MRIs. When I went to see if surgery on my Stenosis was needed, the Dr said that “Even tho my MRI said severe, his physical exam of me says, not so severe. I have had no cortisone shots as well.

    As I work on my posture, my stenosis is getting in the way. I have read so much information, I feel overwhelmed. I would love for a fresh pair of eyes to exam me and start over.

    Also, for the last year, I have been working out at the gym. ( the senior citizens classes) Walking, lifting weights and doing Ab exercises to stabilize my spine from the Stenosis. Stretching everyday. All day, sometimes. My Right lumbar hurts at a 7 or 8 most of the time.

    Any of your thoughts are appreciated.

    Thank you!

    • Hey Kim,

      With severe spinal stenosis, it is important to make sure that swelling of the nerve and/or any posterior disc bulges in the area are kept to a minimum (relative rest from aggravating activities, cortisone, anti-inflammatories etc). This is to reduce the chance of the nerve getting squashed.

      If your stenosis is due to bony/joint changes, there is not too much we can do to remove it without surgical intervention.

      Your certain posture may also predispose you to placing too much compression stress to your lower back resulting in your right lumbar spine pain. (esp. if your right hip is higher. Check this post out: Lateral pelvic tilt)

      You have also pointed out that any findings of the MRI does not necessarily mean it will manifest as symptoms. And this is very true!

      It sounds like you are doing the right thing and keeping as active as you can… which is exactly what you should be doing.

      Please message me on facebook if you would like more specific help!


    • Hello doctor i am saif from india.i have a low back pain its loss of lumbar lordosis my spine has become flat.i have started doing physiotherapy from last 20 days now i feel less pain.dr how long will it take for my spine to get curve if i do regular exercise.and can i do forward bending in yoga once my pain is gone.or do i have to avoid it for my whole life.

  44. Hi Mark,
    Thank you for your fabulous post on flat backs! I wish I would have had you on my “team” 17 years ago when I sustained a terrible whiplash induced concussion on a horse. I have been to countless physical therapists and doctors of all kinds over the past 17 years. Not a single one mentioned that I have a flat back which hasn’t allowed me to heal properly. I even saw a neurologist at the Mayo Clinic a year ago with negative MRI’s of my head and neck (with the exception of white spots on the brain from chronic migraines/headaches and some minor soft tissue calcification). He just told me I have occipital neuralgia and tried treating it with cervical vertebrae and occipital nerve injections. I even went as far as having nerve ablations done with hardly any improvement. Physical therapists have told me just to strengthen my neck which has always ended in extreme pain. With the recent help of my chiropractor, who could put my occiput and atlas back in alignment on a daily basis if I could afford it, has recently been helping me address my flat back. I do think over these years that my body has tried to incorrectly brace and protect my neck in a way the has caused the majority of my flat back. In the past two months, I have cut my chronic neck pain of 17 years down 50% by working on the stretches you’ve listed here and really addressing my posterior pelvic tilt. I train horses in the sport of Dressage where I use muscles similar to Pilates to commmunicate with the horse. Posture is huge with the type of riding I do and I am constantly working on it. In the process of working feverishly to change my posterior pelvic tilt and increasing lumbar lordosis, I’m finding new weaknesses that seem to be causing my torso to want to fall backwards behind the motion of the horse. I think I have narrowed it down to the psoas muscle that needs to maintain my torso alignment. Does that sound right and if so, what strengthening exercises would you recommend? I am sorry for the long post!
    Thank you,

    • Hello Lindsey the horse trainer,

      Training the psoas will help return you normal lumbar lordosis.

      However.. if you feel like you are falling back whilst on the horse after consciously increasing your lumbar arch, you may need to think about engaging your anterior abdominal muscles.

      Here is a great exercise for this: (once again, maintain a neutral lumbar arch)

      On top of this: make sure you are sitting on top of your sit bones

      Hope this helps!


  45. Hi Mark,
    Excellent post! Well-explained, and the exercises are easy to follow. I have a very flat lumbar spine, which I think is from too many front abdominal exercises, as well as very loose hamstrings and weak glutes. I think I have less problem with the thoracic area, and there is no overall discomfort. Can you suggest any abdominal exercises to retain core strength and muscle definition without worsening the problem? I’m thinking that ‘sit ups’ are definitely not good… Also, is there any benefit from lying on a foam roller and stretching/massaging the lumbar/pelvic area where the spine is flattest? To me, it feels like it *could* be encouraging the curvature, and easing the tightness in the area, but I may be mistaken. I’d much appreciate your perspective on this. Thanks! Louise

    • Hey Louise,

      I would start off with the Dead bug exercise… whilst maintaining a NEUTRAL PELVIS. This means you will perform this exercise with a normal lumbar arch.

      You can also lie on a foam roller as that will help mobilise your joints and stretch out your tight abdominals.


  46. Hi Mark, so no one has been able to help me so far from PT, chiros, LMT, etc…I have been having chronic neck pain in back of neck the goes down to throbbing pain between my shoulder blades. I have full shoulder and neck range of motion. I also get some lower back stiffness and I feel like my balance is off like I’m tilting forward. I have high arches and probate. It also gives me chest pain in the inner/sternum area when I retract my shoulders back. I’ve been bodybuilding for 11 years and this problem has been destroying my life for the past 3 years almost now. Any ideas? Thank you

  47. Thanks so much for this awesome site, Mark! Really appreciate it and would love your feedback. Long story short… to my knowledge I have (and always have had) a flat lumbar back, likely thoracic as well. Recent MRIs showed that to be true as well.

    I don’t appear to have a posterior pelvic tilt going by your tests here, but I might be wrong and I do have flat feet that pronate and I am worthless without orthodics. In any case, here is what I got: 9 months ago frequent/nightly calf cramps woke me up to the point of great nausea and near passing out, which soon after led to debilitating claudication (and continues to this day), mostly on the right side. All tests normal. MRIs show only slight bulges at l4/5 s1, but nothing enough to cause nerve impingement.

    I have had every test possible, no luck with spinal injection and have had a dedicated yoga practice for 20 years, as well as qui gong and meditation, etc. I am frequently on the move, in shape, eat well, and have nowhere else to look but my flat back, which most docs write off, with the exception of a few yoga therapists. Does that sound like the culprit to you?

    Any help or feedback would be so much appreciated. My life as I know it has come to a complete stop (not a bad thing for a time, but it’s been 9 months and the pain is too much… I have never ever been in this much pain and I cannot walk more than 5 steps without cramping and nerve pain. I cannot drive more than a mile because my right leg, my driving leg, will start to cramp in the thigh).

    I am supposed to go to Mayo next week, but am losing hope. Any ideas?

    Thanks so much. Rox

    • Hey hey Rox,

      Based on the information you have provided me with, it’s difficult to say if it is coming from your flat lumbar spine.

      If your MRIs have ruled out any serious/obvious disc bulge pinching on nerves, it is less likely (but not completely ruled out) that the culprit is solely from the back.

      Some questions to help dig deeper:

      Are your cramps accompanied with other neurological signs like pins and needles, numbness and/or loss of muscular control?

      Do you have diabetes?

      Have you had any Ultrasound scan to the blood vessels in your leg to rule out circulation issues/clots/DVT etc?

      Are your cramps worse if you don’t wear your orthotics for flat feet?

      Are your hips in front of your ankles? Or are they stacked properly?

      What happens if you stretch your calf muscle?

      Looking forward to hearing from you.


  48. This is absoloutely without a doubt the best post I have read on these conditions by a million miles. Fantastic. When i saw “i reply to everyone” i couldnt have been happier. My question is whether I should omit or Alter any of these exercises if I have bulging discs and degeneration in the lumbar spine. I recently had a private MRI and have those issues in lower back, mainly a bulging disc to the right at the top thoracic (L1) vertabrae. And have pain in this area. I have flat back with rounded shoulders and very forward head posture, so things like ab stretching would be quite painful/damaging as the pain is quite new. Any tips would be hugely appreciated as you clearly are more educated on this than any other physio I have yet to encounter. Thanks in advance!

    • Hi Fiachra!

      This is the type of comment that I like to see!

      With a disc bulge in L1 (which I assume is posterior +/- lateral), I would be weary of any forward/sideways bending whilst in a standing position as this may aggravate the area.

      (However – keep in mind, the presence of disc bulges found on a MRI does not always correlate to the symptoms that you may be experiencing.)

      With the abdominal stretch, if your abdominal muscles are indeed tight, you can focus on doing the gentle massage ball releases instead.


  49. Hi, first of all thank you fort this great list of exercises. I’m Italian, so I’m sorry if I don’t speak English very well.
    It has been almost 2 years since my back started to feel weak and painful. And now I went to a physiatrist/physiotherapist and I made a full X-ray of my spine. He said that I have a flat back, since I have a loss of lumbar (lower back) and thoracic (upper back) curves, and a straightened cervical tract.
    I’m going to gym now and I am doing squats, in the future surely I will do deadlifts and other things, but I read that they’re nothe recommended at all for people who have flat back. So is there a way to fix these things or should I live the rest of my life like that? And can I do exercises like squats, deadlifts or similar with a situation like that?

    • Hi Matteo,

      Squats and dead lifts are great for posture! (as long as you are doing them in the right posture)

      So before you start doing them, make sure you focus on these exercises to reclaim your normal spinal curves.


      • Thank you for the rapid answer, Mark! This site is so amazing, I’m learning a lot reading it. But don’t you think squats and deadlifts, with this flat back, can cause more problems to my back pain?
        And another question, when I’ll put more mass to my body doing gym exercises, will I have some aesthetic problems due to this flat back? Because I wanna build mass but I don’t wanna look like a monkey haha.

      • Hey Matteo,

        Once you learn to control your posture in a more efficient way, dead lifts and squats are a great way to re-enforce your posture. Think of it as a final progression of your postural exercises. You will have to focus on the simpler exercises first.

        If you do your gym exercises with a flat back posture as your foundation, your muscles will grow and re-enforce that posture.


      • Hey Mark, I’ve done some of these exercises on your site. But after I’ve finished the standing intersegmental cat/cow, without a medical ball because I don’t have it, but simply with my arms in front of me, I now have a pain and a sting, a “fire”, in my upper back. Is it normal or did I make some mistake?

      • I’ve forgotten to say that I’m a 16, almost 17 years old man. I’m a Risser 4. Does that mean that I can eliminate those unhealthy losses of curve?

      • Hey Matteo,

        If you feel pain then you may have pushed it a little bit too far. But that’s fine. It’s all about getting to know your body better.

        It may just be a muscular strain. Could also be as a result of stretching structures (joints, ligaments, other connective tissue etc) that have never been stretched before!

        Next time push maybe 20% less and see how you respond to that.


      • Hey Matteo,

        It looks like you don’t actually have a flat back in those Xrays. I think you have more of a long thoracic curve.

        Can you take a photo of your posture side view?


      • Hey Matteo,

        It looks you have more of a:
        – Forward translation of the pelvis (Your pelvis is in front of your ankle joints)
        Anterior pelvic tilt
        – Long kyphosis (Which essentially is the opposite of a flat back

        It’s hard to tell for sure looking at this photos, but I do not believe you have a flat back.


      • Thanks for all the answers. So why do I have this pain in the lower back? Because of the anterior pelvic tilt?
        I even have a sensation of “immobility” in the lower back that increases in the morning after I wake up and then it reduces throughout the day.
        Months ago, and even now, I was scared by the possibility of a spondylitis ankylosans, because of my age (17).

  50. Hi. This is my MRI results (I had to translate it to English, tried as best as I could):
    – Loss of lumbar lordosis. Changes after Scheuermann’s disease – Schmorl nodes. Limbus vertebra on L4.
    – Small side protrusion L1/L2 without the pressure on the nerves
    – L2/L3 without protrusion
    – L3/L4 small side protrusion with the small pressure on the left nerve
    – L4/L5 bigger side protrusion with the small pressure on the left nerve
    – L5/S1 without protrusion

    In the links below I attach my Xray photo and map of my pain. I also want to say something about what I went through for now.
    My pain started 2 years ago and it was also 2nd year of my gym story. I started to workout with resistance when I was 16 years old,
    but I didn’t put on heavy weight and I tried to do every excersise technically well (but I know it failed). Suddenly, I felt pain after doing some squats in lumbar spine, but it was mild.
    And that how it started. The first rehabiliation with good results I stated in 2016 in March. It lasted about 6 months and focused on excersises like
    lying on the floor with my core muscles activated and rising my hands, legs up. In August the same year I felt really well, my lumbar spine was fine but I started to have problems
    with my thoracic spine. She couldn’t help me in this problem, I move on to another city and started visiting another physiotherapist (actually manual therapist).
    He is using dry needling on me and some sort of mobilisation. He wanted me to do every day QL stretch and slowly spine twisting with deep breathing, also twice a week
    I should do releasing muscles with small ball. Unfortunately, I don’t feel any better even after one month of doing those excersises.
    I will descript also my pain: I feel really weekness in my back. When I touch these points which I pointed on the picture I feel bloody pain, like tough small points which I can’t get rid of.
    I also have few times a day a pop sound from my lumbar back when I change my posture from posterior pelvic tilt to anterior pelvic tilt, then my spine is blocked in one moment and after a while I feel popping,
    then I feel much better mobilisation. I think that’s everything. Thank you in advice, Dominic.

    • Hi Dominic,

      With Scheuermann’s disease, there might be a certain amount of fusion in your upper back spine. This means, it may not be able to be 100% reversed to a more neutral spine.

      If you have a posterior pelvic tilt, Have you had any success with the specific exercises?

  51. Hello Mark. I really appreciate your knowledge and your articles. The thing that brought me here is my personal problem with spine. I’m (only!) 20 years old man and I have been suffering from lower and mid back pain (particullary whole back :/) for 2 years… I’ve visted about 5 physiotherapists and results are disappointing. I’ve made X-ray of lower and upper back and also MRI of lower back. Every physiotherapist suggested different diagnosis what irritates me a lot, because I don’t know which should I belive in. One thing I know for sure, I have flat back posture and it’s easily to notice that after first look on my body. I feel pain particulary all time, after rehabilitation I can rate it about 3-4/10, but the thing that makes me crazy that it is
    continuous. Pain is local, I mean I don’t feel any pain in my buttocks or legs coming from my spine. Every physiotherapist also didn’t mention flat back posture as a main reason of my condition, they just said that “my spine has a poor ability to absorb and distribute mechanical stress” as you mentioned in the article. I have a serious question for you, becuase my condition is getting worse or stays the same and I’m slowly losing any joy of living, becuase everything what I’m doing means !@#$!$ pain! I’m so tired of it. So, is it possible that this pain comes from my flat back posture? And if so, is it able to cure that somehow, to live without any pain? I’ll also add that my rehabilitaion was mainly focused on stabilization of lower back by strengthening core muscles, I did bunch of excersises like bird dog, planks etc, it helped a bit but sitll there is this pain in my back. Any respose will be helpful, I’m trying to understand source of my pain. Best regards, Dominic

    • Hey Dominic,

      Can you tell me exactly where your pain is? (also if you could post your results of the MRI)

      Any dysfunctional posture (including flat back posture) can cause issues with the structures in your back. As long as you are not born with this posture (which I doubt) and the spine hasn’t fused together, there is always something we can improve on!



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