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What can I do about my adolescent's poor posture?

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Why does my child stand like that??

A frequent complaint by parents (especially mothers) in our office is their adolescent's poor posture. "My child stands with her shoulders slouched and I keep telling her if she doesn't stand up straight, her back is going to be like that forever!" "He looks like the Hunchback of Notre Dame the way he sits...I ask him to sit straight and he does, and then goes right back into that awful position. His back will be ruined for the rest of his life."

As most parents know, these are very common concerns. So lets break this down into digestible parts.

The first issue is whether your child's posture is due to a rigid (fixed) deformity of the spine or is mobile. Rigid deformities are uncommon, and can be related to Scheuermann's Disease (a growth problem of the vertebral bodies that results in progressive rigid kyphosis or roundback) or congenital kyphosis (congenital abnormalities of the vertebral bodies ). These two problems are actually not problems of posture but of the shapes of the bones and your child cannot consciously improve their position without treatment. This is not laziness. Luckily these two problems are fairly uncommon.

Scheuermann's Disease

Scheuermann's Disease is an abnormality of the growth of the vertebral bodies in the front of the spine and is diagnosed by physical examination (a rigid kyphosis) as well as radiographs that will usually show wedge-shaped vertebral bodies, disc space narrowing, and vertebral endplate changes. It can run in families and the curvature can get worse as they get older. Unlike scoliosis, however, it generally does not have any significant effect on the heart or lungs, and is much less common than scoliosis. People with Scheuermann's Disease live a normal life-span. They do complain about more pain then the general population, but they don't miss any more work then anyone else. They get married (and divorced) just like the rest of the population. Treatment usually requires a brace. In severe cases, spinal fusion is performed to correct the deformity.

Scheuermann's disease.

Scheuermann's disease.

Scheuermann's disease postop

Scheuermann's disease postop

Congenital Kyphosis

This is even less common than Scheuermann's Disease. This is a congenital abnormality (the child is born with it) where the vertebral bodies in the front were not formed correctly. Sometimes they are fused in the front (called failure of segmentation) and sometimes there is only a partial, triangular vertebrae (called failure of formation). Failure of segmentation results in a fairly smooth curve. It may get worse but except for the appearance, is usually not dangerous. Failure of formation, with a small triangular vertebrae, can be very progressive and very dangerous. It can result in a very short, sharp kyphosis (called a gibbus), and the spinal cord can be draped over this area. Any increase rapid flexion of that area (even from a fall on the playground) can cause permanent damage to the spinal cord. The only treatment for either of these conditions is surgical.

Congenital kyphosis can be associated with other problems including congenital abnormalities of the heart, spinal cord, and kidneys. So if you child receives a diagnosis of congenital kyphosis, they need to be evaluated for these other issues.

Failure of semgmentation

Failure of semgmentation

Failure of formation

Failure of formation

Flexible kyphosis

Ok. So almost all adolescents with bad posture fall into this category. This is the "slouchy shoulders, sitting crosslegged on the bed over the laptop computer" posture. When you yell at them to stand up straight, they can. But they won't stay that way and immediately go back to the poor posture as soon as you turn your back. This is referred to in orthopaedics as "postural roundback." It is not a fixed or rigid deformity. The bones of the spine are normal.

Here is the hardest part for parents to understand....It really isn't that big a deal.

"What? Blasphemy! That can't be true! Bad posture has to be a problem. My mother yelled at me because of my bad posture so I stood up straight, my grandmother yelled at my mother because of hers..." and so on and so on.

Why has this incorrect concept been propogated?

If you look back over a few millennia, people with bad posture were really ill. They had polio or tuberculosis and truly had spine problems. People recognized this and so those with bad posture were viewed with serious concern.

Fast forward to the 21st century in the developed world, and this isn't the case. We see very few people with tuberculous spines. So what has happened is that the society has translated "bad posture" into "bad cosmetic appearance."

I ask my patients, "who is your favorite actor or actress that you wished you could date?" They give me a name of some handsome person. I then tell them a story. The person they named has an identical twin. However, the identical twin has bad posture. Which one would they rather date? Of course, they pick the one with good posture. I then tell them, "Ok, let's say you have an identical twin who stands up straight and you slouch. If the actor or actress had a chance to either date you or your identical twin, which would they choose?" This usually gets across the connection between posture and appearance.

I also talk to them about pain. There are various kinds of pain; physical, psychological, etc., Some children with postural roundback do have some mild back pain. However it isn't much. I also explain to them that if their mother is unhappy with their posture, their mom will continue to harass them and is less likely to take them to the mall or let them borrow the car or give them money. Thus, they are in fact hurting themselves by having bad posture.

But the bottom line is that bad posture is just what it is..."bad posture." It won't become permanent, won't cause severe deformity, and won't ruin your teenager's life.

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A final note...

My experience with my own daughter (now 19 years old) was very much the same. At 14, she had terrible posture and I complained and complained and she didn't care not one iota. Not until she noticed boys, that is. At 15 1/2, she suddenly straightened up, walked with good posture (especially at school and surely if there were any teenage boys around).

So parents, be prepared. When your child straightens up, it means something!

  • Scoliosis Research Society (SRS)
    This is the website for the Scoliosis Research Society, a non-profit organization dedicated to education, research, and treatment of spinal deformity.

Steven & Alexandra Cohen Children's Medical Center of NY


monners on July 16, 2015:

This has been very informative. I have been concerned for a few years about my daughter's posture. I have taken her to our GP and to a Physiotherapist but, though they agreed her neck was curved (its like a turtle's sticking out of it's shell) they put it down to sitting incorrectly at the computer. She is 16 in two weeks and wanting to have a party with her wearing a lovely halter-neck dress. Unfortunately, this has highlighted to us how curved her back has become. Our once straight athletic child has become an ape!!! She has developed a double chin but is not overweight. We have repeatedly nagged her to straighten up but it has now occurred to me that she actually doesn't know how to. What do I do next?

BoneMD1 (author) from Los Angeles on October 30, 2014:

A children's spine surgeon (pediatric orthopaedic surgeon).

Tony on August 10, 2014:

What kind of doctor would you go see to treat these various problems? My daughter is 16 but looks like a 90 year woman.

BoneMD1 (author) from Los Angeles on February 09, 2012:

Thank you both!

The Finance Hub from Portland, Oregon on February 09, 2012:

Great hub, no kids yet but, one day I will have them and I'm sure this will come in handy! Great hub, voted up, useful and interesting! Hope you enjoy my hubs as well!

Tina Siuagan from Rizal, Philippines on February 09, 2012:

"So parents, be prepared. When your child straightens up, it means something!"

When I did at 16, my parents told me not to overdo it. Hahahaha! Am glad I did, because it helps a lot in the catwalk. :D

Thank you very much for sharing this hub. I learned as much as I had fun! :D

BoneMD1 (author) from Los Angeles on February 09, 2012:


BoneMD1 (author) from Los Angeles on February 09, 2012:

Thank you. Good luck with your daughter.

R K GUPTA from New Delhi on February 09, 2012:

Great hub for teenager, parents should take care about their children posture..

Mardi Winder-Adams from Western Canada and Texas on February 09, 2012:

This is a great read for parents. I wasn't aware of all the different conditions that can be a cause of bad posture. Very useful!

JR Krishna from India on February 09, 2012:

Thank you very much for this informative hub. This is very timely for me. I am now struggling with my daughter of thirteen years, constantly reminding her to stand straight.

Voting up and sharing

mljdgulley354 on February 09, 2012:

This is a very informative hub. I only knew about Scoliosis not the other bad posture diseases. Thank you for sharing this information.

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