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The Posture Series

The POSTURE Series, No. 5

By Sean M. Wheeler, M.D.

IMG 6003Chronic Back Pain Specialist Dr. Sean WheelerOur spines aren't designed to live as we today do. 

Our early ancestors sprinted barefoot across the savanna, spear in hand, the picture of perfect ergonomic position. In contrast, today we sit much of the work day at a desk, hunched over computers and phones. 

However, the evidence is clear: standing longer, when in correct posture, is better for us than sitting.  

Standing in this way reduces risk of obesity, diabetes, cardiovascular disease, cancer and lowers long-term mortality. In contrast, extended sitting causes us to slouch, tightens our hip flexors, rounds our shoulders forward and causes pooling of blood in our legs and feet. 

Standing strengthens our feet, calves and gluteus and puts us in a better posture.

The standing vs. sitting choice sounds obvious I gave it a try. I found boxes and outdated medical books on which to prop my computer screen and mouse. Ten minutes in I was feeling good. By 30 minutes I knew something was wrong and sat down. I was not ready for all-day standing, and in all likelihood neither are you.  

Recent studies, including a medical review published in the Cochrane Library, show that people don’t stand much longer with a standing desk and the standing they do is marked by bad posture. This outcome has much to do with bracing muscle® function.

Bracing muscles in the buttocks stabilizing the hip provide endurance for stabilization during standing, and under-utilized bracing muscles have to be built-up by standing with proper posture over progressively longer periods of time. Running or working out will build strength in the action muscles of the buttocks that move you, but not the endurance needed for stabilization during standing.

If you think you can suddenly just stand all day, you may end up as the above study suggests: sitting.

You can test your readiness for a stand-up desk at work while otherwise waiting in a long line that doesn't seem to move, or after you've arrived late at a function and all the chairs are taken.


Stand with equal weight on both feet without locking the knees and without leaning forward. For a more complicated task, draw your tummy in, bringing your pelvis under you. Then keep track of how long it takes until you lean into one hip. This period of time is how much endurance you have in the bracing muscles of your gluteus.  Typically this period of time is not long. Once you begin to lean, the foot, knee and hip on that side get sore. This is not what you want. In fact, the leaning is actually worse for you than the sitting.

To achieve the ultimate goal of all-day standing at work, and the health benefits that come with it, budget your standing time as you build the necessary endurance. Stand until leaning, then sit. Time this out daily, slowly adding more and more non-leaning time until the day is filled with proper standing. By the way, propping yourself up, bent over the desk, doesn't count. 

Using this better posture you will soon be standing significantly longer. Expect the entire process to take up to six months, as that is the period endurance muscles require to rebuild blood flow for all-day endurance. 

Think of it like this: you have to climb the mountain before you can stand triumphantly atop it.




The POSTURE Series, No. 4

By Sean M. Wheeler, M.D.




Something has changed.

















The POSTURE Series, No. 3

By Sean M. Wheeler, M.D.



Psoas Quadratus LumborumPsoas & Quadrates Lumborum

Two Muscles At Work












What To Do



When To See A Medical Professional


More To Come




The POSTURE Series, No. 2

By Sean M. Wheeler, M.D.

What brings any of us to a point where we are compelled to read an article about posture?

So instead of reading another article, why not just sit up straight?

If only.

In this second in a series, let's discuss the importance of pelvis position in good posture, and how poor pelvis position may indicate a deeper health concern: the possibility your body is losing its bracing functionality. A functionality vital to living without chronic back pain. 

Challenging Assumptions

One can set their phone to remind them to sit up, find a wearable device attempting to pull you into the correct position, and even special seats for posture assistance. New posture reminder devices are coming out all the time and yet…this article exists because good posture remains difficult to achieve.

Let’s start by challenging current thinking. One can’t just sit up straight to solve their posture problem. Not when the pelvis is in the wrong position.

Pelvis Tilted Forward

Dr Sean Wheeler Posture Pelvis ForwardPelvis forward looks like thisSome position their pelvis too far forward, tilted forward. Then they arch their back to get into an upright position. Most people have been taught this ‘pelvis-forward’ position is good posture.  

In fact, although no longer available, years ago I developed a posture App. In the first step I would tell users to maintain this pelvis-forward position. In a video accompanying the App I would explain that in this position your mid-back would get very sore after a few hours and that this was normal. Years later, I can tell you this is not normal.

I actually began to have back pain because of my will power and belief that I could eventually maintain this position all day.

It is reasonably embarrassing to be a published author on back pain and one of the world’s experts on back pain and to actually have back pain. This is NOT a correct position. The pelvis is too far forward.

Pelvis Tilted Backward

Dr Sean Wheeler Posture Pelvis BackwardModel demonstrates pelvis backwardThe next mistake is what is referred to as pelvis posterior [tilted backward]. With your pelvis in this position it is impossible to get your head over your shoulders.

People usually go back and forth between each of these two positions; pelvis tilted forward vs. tilted backward. Maintain one position until they get tired and then go to the other. Some people will spend their day standing with their pelvis forward and sit with their pelvis tilted backward.

Correct Pelvis Position

The correct position is somewhere in the middle. At this point, people will often attempt to roll their pelvis into a middle position. Unfortunately it is not that simple.

If you choose to just roll your pelvis, you will be able to get to good posture, but only when you are sitting.

Standing with your pelvis in the correct position requires bracing muscle strength, and hamstring and hip flexor muscle flexibility.

Improving Pelvic Position For Good Posture

As described in my book UPRISE: Back Pain Liberation, by Tuning Your Body Guitar, bracing muscles are the muscles that brace and stabilize you so you can move. But improving pelvic position can be a nice start on the whole process.

Sometimes people are so tight they can’t move, or so pelvic unaware that they need exercises to loosen and become aware of pelvic position. This is best done in the hands of a physical therapist, but often your personal trainer, yoga or Pilates instructor can show you.

How To Do It

Start by standing. Then draw your tummy in slowly so that your pelvis rotates under you until you feel like you can stand up straight with no strain in your neck and a small arch in your back without tension in your mid-back. It is very important that you use the muscles in your tummy to move your pelvis into the correct position. It is also important that you are not clenching your abdominal muscles tightly, but gently drawing them in so that your tummy is somewhat flat.

Congratulations! Now hold it all day.

Warning: it will take you six months to build the endurance to be able to do this all day. These bracing muscles need to build the endurance to hold you in this position for many hours. Much like preparing for an endurance race like a marathon, this doesn’t happen in 6 days or 6 weeks. It takes 6 months. You have to build blood flow to muscles to get endurance. Circulation training. But it is worth it.

Correct pelvic position will change your posture and correct posture will change your life. A 180 degree turn in your life — for the better — in 180 days.

Seek Out A Professional To Assist

These concepts and instruction can be difficult to understand just reading an article or seeing pictures.

You really must have a professional put their hands on you and show you where your pelvis should be. Where you are weak, where you are tight and what you need to work on to obtain the goals you seek. As with most things worth doing, it is not easy and requires a commitment.

But unlike ‘just sit up straight,’ this advice will actually work.


Sean Wheeler, M.D. is board certified in both Pain Management and Sports Medicine. He is a leading expert on back pain and his recently released book UPRISE is changing the way the world approaches back pain. With a new vocabulary and new medical approach, Dr. Wheeler puts patients back in charge of their health to achieve liberation from chronic back pain. His middle son, Sammy, is a little pensive about having his shirtless photos spread across the world wide web.

Dr Sean Wheeler MaggieFashion icon Maggie Wheeler, demonstrating great postureThe POSTURE Series, No. 1

By Sean M. Wheeler, M.D.

Chronic back pain patients often tell me they want to work on their posture.

They say it in the same way someone says they want to lose 10 pounds. Off-handed and nonchalant, like someone with good intentions who forgets to floss. They want to sit up straighter, but then their day gets busy and they forget.

Posture Awareness

The success and popularity of my posture collection on Google+ tells me people are becoming aware that maintaining good posture is not as easy as they once thought.

Posture is not just sitting up straighter, it is so much more than that. To have good posture, one must have enough flexibility, stability AND endurance to achieve the necessary positions and keep them all day. They must also have an understanding of what they are trying to accomplish. It is discouraging to think that all one has to do is sit up straight and commit to it, and then fail in this effort day after day.

Posture As Body Barometer

Posture is a barometer of a person’s musculoskeletal system. The ability to maintain good posture throughout the day is a positive signal that much is right. And, conversely, that forward head or the incessant heel strike is as much a sign that something is wrong as a weird rattling noise in a sports car. You can turn the radio up for a while to mask the rattle, but eventually the car is going to break down.

More Posture To Come

In a series of columns to be published here, I will define posture, then stability, and begin to fill in all the blanks so that you may avoid a life consumed by chronic back pain. These 'blanks' are often filled in by comments or questions you may wish to ask, so please don’t hesitate send me your questions directly or @DrSeanWheeler.

So…why is posture so important?


Sean Wheeler, M.D. is board certified in both Pain Management and Sports Medicine. He is a leading expert on back pain and his recently released book UPRISE is changing the way the world approaches back pain. With a new vocabulary and new medical approach, Dr. Wheeler puts patients back in charge of their health to achieve liberation from chronic back pain. His youngest daughter, Maggie, has great posture and fashion sense, but a poor understanding of which shoe goes on which foot.


– Sean M. Wheeler, M.D.

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