We are all so busy meeting work deadlines, caring for our family and friends, and attending to our homes or physical space and emotional health that considering how posture influences everything we do, think, and feel is overlooked. We’ve all heard the age-old advice to sit up straight and stand tall, primarily to avoid back and neck pain but also to ‘look good’ and express confidence. However, many don’t realize that posture can also be a hidden culprit behind chest pain. Especially since now, we are a culture that is constantly staring for extended periods into computer screens or down at our hand-held devices. Recently, several clients asked: “Can my posture cause chest pain?” The answer is a resounding yes! Often overlooked is the connection between posture and chest discomfort. It is essential to understand how positional changes in your ribs, breastbone, pelvis, and spinal alignment—all of which make up your “posture”—lead to chest pain and, more importantly, how to address it.
In this comprehensive guide, we’ll explore the impact of posture on our quality of life, including causing chest pain, and provide a practical movement solution to alleviate discomfort.
Posture: Good or Bad—Right or Wrong?
We all do it—label posture as poor, bad, or wrong vs. correct, right, or good. Others label posture based on conditions:
- Old person’s posture: bent-over, stooped, or hunched back.
- Barrel-chested posture: chronically hyper-inflated lungs due to COPD (Chronic Obstructive Pulmonary Disease—3rd leading cause of death).
- Slumped posture: diagnostic feature of depression.
- Bravado posture: a chest that is expanded, lifted up with a straight back, with the intent to impress and or intimidate.
Here’s why you might experience chest pain due to posture:
Postural Positions and Their Connection to Health Conditions
In sitting, the position or orientation of the pelvis plays a significant role in spinal and chest alignment. Consequently, it can contribute to the onset of chest pain. How we sit matters, so let’s see if we can move away from the common verbal cueing: ‘Sit Up Straight!” Instead, scoot forward in your chair so your feet are flat on the floor. Feel the bottom of the pelvis on the chair. Besides the fleshy buttocks, there are two points of bony contact, the ‘sitz bones.’ These paired bones, shaped like rocking chair blades, are extensions of the two big pelvic blades. These pelvic blades are the same ones that make up your hip sockets and the top of your waist. These two bones connect in front to form an area called the pubic bone. Large bones often have different names that represent a location on the bone. This naming is helpful as it allows us to direct our attention to that area for the purpose of movement and allows us to feel and notice the connection and understand that the alignment of bones is critical for posture and how we can move more fluidly. Where you ‘sit’ on the ‘sitz bones’ will determine the tilt of your pelvis, the shape of your spine, the position of your chest—ribs and breastbone, and even your head. For instance, see if you can rock across the sitz bones. As you sit near the back of the sit bone, your tailbone tucks under, and the top of your pelvis tilts back. Because of the skeletal connections, your lower back will round outward. Because your nervous system is tasked with always protecting your head, it notices changes in contact and points of pressure across the sitz bones. It will compensate or balance this tilt of your pelvis by exaggerating the normal kyphosis, a rounding of the upper back or spine, and automatically and unconsciously, your nervous system causes you to alter—lower, collapse, or depress the breastbone down and inward. These changes in alignment are so that the back of the head can still stack over the pelvis, protecting it in case of a fall. In sitting or standing, the optimal skeletal contact of the sitz bone rocker is a little bit like the metaphor of Goldilocks and the Three Bears—not too far forward on the rock bones and not too far back. In this optimal place, there will be the least amount of muscle tension needed to hold the skeleton upright.
If the top of the pelvis tilts forward, the pressure is on the front of the sitz bones, and the lower back exaggerates its normal in-curve or lordosis. In scoliosis, an abnormal sideways curvature of the spine either due to traumatic injury or idiopathic, the nervous system will again use certain muscle groups to maintain the posture or alignment—all in service to protect your head and keep you upright.
Over time, if your habit is to sit at either end of the ‘rocking chair sitz bone,’ altering the alignment of the top of the pelvis, the chest and neck muscles must work harder to hold the position. When muscles are overactive, their fibers shorten, and we feel or sense this ‘shortness’ as muscle tightness. Eventually, joints feel stiff because the ball and socket relationship between the ends of the bone changes. Like frayed pieces of a puzzle, the interlocking connection is altered. The mobility that was once there is gone, and it becomes harder to move—soon, you notice you can’t reach over your head or behind your back. And when standing up from a sitting position, you must use your hands and notice that you don’t seem as tall as you once were—completely standing erect.
Overactive chest and neck muscles signal the nervous system to inhibit or turn off other muscle groups that comprise the upper back, shoulder blade area, lower abdominals, and even the buttocks or gluteal muscles. These changes in skeletal alignment and muscle tension are like a dog chasing its tail. The nervous system changes muscle tension, which changes skeletal alignment, which changes the nervous system’s decision-making process, continuously contracting muscles that are already short and thus, changing skeletal alignment—all of this alters our posture and increases not only the level of difficulty to move and function but also begins to negatively impact other systems in the body, such as respiratory, digestive, fascial and circulatory system.
These conditions can set the stage for a cascade of issues, including muscle imbalances, pinched nerves, and discomfort in the chest, ribs, and sternum (breastbone). However, the encouraging news is that these physical conditions and postural changes are typically treatable with the right interventions.
The repercussions of sub-optimal pelvic and chest posture reverberate in the form of muscle imbalances. Whether we realize it or not, our posture can lead to imbalances between the front and back of our ribcage, further exacerbating discomfort. As the top of the pelvis rocks backward, the muscles around the chest, neck, and surrounding connective tissue become overactive and tightened. At the same time, those in the upper back and abdomen are reflexively underactive. Underactive muscles become weak and elongated, losing their tone and making the joint or skeletal connections unbalanced. It is one of the reasons why parts of our body feel so heavy as we try to move. Overactive chest and neck muscles signal the nervous system to inhibit or turn off other muscle groups that comprise the upper back, shoulder blade area, lower abdominals, and even the buttocks or gluteal muscles. These changes in skeletal alignment and muscle tension are like a dog chasing its tail. The nervous system changes muscle tension, which changes skeletal alignment, which changes the nervous system’s decision-making process, continuously contracting muscles that are already short and thus, changing skeletal alignment—all of this alters our posture and increases not only the level of difficulty to move and function but also begins to negatively impact other systems in the body, such as respiratory, digestive, fascial and circulatory system.
One of the most critical aspects of chest pain from poor posture is respiratory distress or ‘air hunger.’ If you have ever had a full-blown anxiety attack or asthma, you may already know what respiratory distress feels like. But for most of us, it is a slow, subtle loss of our ability to expand our lower side ribs and lower abdomen above the pubic bone. Our lungs fill the interior space within our top upper ribs from the top of our collarbones (clavicle) to the end of the breastbone in front and about an inch below our shoulder blades on our backside. Even though the entire shape of the lung expands during an inhalation, most of the oxygen exchange occurs at the base of the lungs. Studies have demonstrated that postures that alter the pelvic, spine and breastbone alignment significantly reduce lung capacity, forcing individuals to rely more on the upper chest and neck muscles for breathing rather than the more efficient muscles of the diaphragm and intercostal muscles (located between the lower ribs). This chronic tensing of the muscles hinders the rib cage’s expansion. One is aware of exquisite tender points by touching the chest muscles, breastbone, ribs, or the space between the ribs. These tight muscles and points of tenderness may lead to chest pain, especially during physical exertion.
Believe it or not, poor posture can influence your heart health. Your heart is located slightly to the left of the mid-breastbone. Regardless of whether you sit slumped or stand in a slouched position, your nervous system keeps your head aligned over your pelvis and signals muscles around the chest and rib to tighten and shorten. Years of an unconscious habit change the physical shape of bones (think osteoarthritis) and the ability of muscles to respond efficiently to move bones. Silently and slowly, the space within the chest cavity can alter, compressing the area around your heart. Sometimes, the compression can become so severe that it impacts the blood flow throughout your body, potentially impacting your heart and other vital organs that rely on proper blood circulation. In the long term, these detrimental effects on blood flow and heart function can lead to serious health consequences, underscoring the critical importance of addressing and correcting your posture.
Thoracic Outlet Syndrome (TOS)
A condition known as thoracic outlet syndrome (TOS) can be a silent instigator of chest pain, often accompanied by numbness and tingling in the arm or the top of the shoulder and collarbone area. Unlike angina pain—insufficient oxygen supply to the heart, TOS pain doesn’t typically escalate with exertional walking but intensifies when reaching the arm overhead and turning the head. This nuanced distinction is pivotal in identifying the cause of chest discomfort. And it is essential to remember that TOS doesn’t happen out of the blue. Years of changes in pelvic-chest-spine-head alignment can be the root cause behind the miserable effect of nerve pain and changes in blood flow into the arms and hands.
Surprisingly, poor posture can also compress the digestive tract, giving rise to heartburn, chronic cough, and pain under the breastbone or along the spine between the shoulder blades. Changes in bowel habits, bloating, and other digestive problems can be secondary issues of postural changes and chest tightness. The stomach and the transverse colon are located at the base of the breastbone and the width of the torso. This further emphasizes the interconnectedness of our bodily systems and the far-reaching effects of posture on our overall well-being.
Don’t Let Pain And Dysfunction Stop You From Living Your Best Life
Posture is more than just a cosmetic concern. It extends beyond labels; it reaches the very core of our chest, perhaps even into the expression of the heart of who we are. Now is the time to move forward and not suffer alone.
If you’re experiencing chest pain due to rib, pelvic, or spinal posture changes, don’t let it hold you back. Seeking assistance from a somatic-trained professional can be the key to finding your best ‘posture’ and enhancing your quality of life.
Try this movement exploration from the movement series: Finding Your Posture of Dignity.
REMEMBER: This is NOT a stretching exercise, nor is it testing your ability to overreach. It is about assessing your ability to track your breath—not holding it during movement, allowing the expansion of the inhale into the lower abdomen, as you slowly explore the following movement sequence.
Equipment needed: A mat for lying on the floor (or a firm bed will also work); support for the head, firm pillow or yoga block for between the knees.
Pre-assessment: Sit at the forward edge of the chair. We are going to answer the questions: What is my posture like now? Do you automatically give yourself a label (good, bad, correct, poor)? How open or wide do you feel across the chest? Describe the tilt at the mid-point of the top of the pelvis: backward, forward, level? Use your hands to locate the top of each pelvic blade. Does the tilt of the pelvis match the position you thought you were in? Describe the weightiness of your sitz bones. Does one side make a deeper impression into the chair? Where on the sitz bone is most of the contact, the forward part, the back part or do you sit right in the middle portion of the bone? If you can’t feel the bony area, then allow yourself to sense the width and depth of one buttock and upper thigh compared to the other. And now, turn to look over your right shoulder, noticing what you see along the way and how far behind you. No need to test the limits of your range or move into pain. You are assessing the quality of your movement (smooth, jerky, holding the breath) just as much as the distance. Come back to the starting position and turn to look over your left shoulder making the same observations. Make a mental note of the quality of head turning. At the end of this movement exploration, we will repeat this assessment and compare the differences.
The Set-up: Lie on your side with hips and knees bent at 90-degree angles. The 90-90 angle of the hips and knees is very important as it will protect the Lumbar Spine (lower back) from rotating and direct the turning along the thoracic vertebrae and ribs. The 90-90 position shifts the axis of rotation along the length of the torso, ribs and thoracic spine, as its skeletal architecture was designed to do. You may find it helpful to place a firm pillow or a yoga block between the knees. Place enough folded towels or pillow to support the head. Adjust the height of the support to align the head with the spine. Also, adjust the forward positioning of your head by bringing your awareness to the earhole that is resting on the support pillow. Glide the earhole back along the length of the support pillow until it aligns over the back edge of the shoulder that is on the ground. Extend the arms out in front, shoulder height and palm-to-palm. The movement you are about to do looks like it is movement of the arms and knees, however, it is more about the action and rotation of the thoracic spine and restoring rib flexibility rather than movement at the shoulders or knees.
- First, bring your awareness to your breath. Notice the natural rhythm and cycle of your breath. In this movement exploration, there is no need to hold your breath or control when you should breathe in or out. Just allow the natural breathing process to unfold and know that it is possible to be aware of your breath in the background as you move.
- Now, slowly lift the top arm away from the bottom, allowing the top arm to sweep up to and across the ceiling and then toward the wall behind you. You are assessing the beginning quality and the range of motion available without strain or force. It is okay to let your head turn, allowing your eyes to follow your hand. Return and repeat. We move slowly at first because it takes time for you and your brain to notice the quality of the turning in the torso. Is there any pull or tug into the chest or back? Return and make a mental note as to how far and the quality of motion is available. Proceed to #3.
- Keeping the palms together and elbows straight, lift the arms from the floor a small comfortable distance, return and repeat this movement 7-8 times. Investigate how you do this. Notice what happens in the rib cage, the chest, and the middle back. Can you allow or activate the lower abdomen to pull in or retract just before lifting the arms? How does this impact the weight of the arms? Perhaps it’s a little easier to lift. Maybe, maybe not. Continue a few more repetitions, going as far as you can without strain of breath and exaggerated muscular effort. What movement or role does your pelvis play in doing this motion? Allow the breath to flow in and out, like background music playing independently as if it were your own soundtrack. Where along the floor could your pelvis, torso, or ribs sink a little more to make lifting the arms smoother, lighter, and easier? Stop. Rest for 2 cycles of breath.
- Check again to ensure that your hips and knees are at the 90-90 position. Keeping your feet and knees connected as though they were glued together, raise only the knees from the floor a small comfortable distance, return, and repeat 7-8 times. Investigate how you do this. Feet stay on the floor, and they could assist in some way to raise the knees. Observe the movement of your pelvis as the knees lift—what points of contact change across the pelvis on the floor as the knees lift? Can you allow or activate the lower abdomen to pull in or retract just before lifting the knees? How does this impact the weight of the knees? Perhaps it’s a little easier to lift. Maybe, maybe not. Notice if the top pelvis can initiate the retraction. Feel the timing that could be there and, simultaneously, the amount of downward pressure on the floor to help the knees lift even easier. Continue a few more repetitions, going as far as you can without strain of breath and excessive effort. Can you play with changing your speed so that you don’t lift as high, but the raising and lowering of the knees is fast and light for 7-8 times? Stop. Rest for 2 cycles of breath.
- Let’s return to your beginning assessment: lift the top arm away from the bottom, allowing the top arm to sweep across the ceiling and behind you. Let your head turn, allowing your eyes to follow your hand. Notice the quality of the turning of the torso—what’s different now compared to when you first did the movement? Observe any changes in the quality of pull or tug into the chest or back. Return and do the motion again. What is noticed now that wasn’t there in the beginning? Or maybe there is the absence of a sensation—tightness, pain, stiffness.
- If you like, repeat the movement exploration onto the other side. Can you repeat the same movements using your memory? Recall the sequence of the movement of the arms lifting, the knees lifting, the breath in the background, etc. When you are finished exploring, come back to sitting in your chair.
- Now, come to sit at the forward edge of the chair. What is your posture like now? How open or expansive do you feel in the chest? Do you automatically assign a judgment of your posture—good or bad, or are you just sitting without thought? Notice the weightiness of the sitz bones. Does one side make a deeper impression on the chair, or has it changed—a little more even? Where on the sitz bone is most of the contact? If you can’t feel the bony area, allow yourself to sense the width and depth of one buttock and upper thigh compared to the other. And now, turn to look over your right shoulder, noticing what you see along the way and how far behind you. Have the limits of your range or quality of movement changed (more smooth, less jerky, breath freely moving in the background)? Return to the front and then turn to look over your left shoulder. What observations draw your attention on this side? What’s different when you compare the movement now to your previous mental note?
- Come to standing. Perhaps a spontaneous breath arises as you look out into your room. Take a moment to appreciate the changes that can occur in our physical—emotional—mental bodies with conscious movement explorations. What is your posture of dignity? Walk about your environment for 2-3 minutes. Notice that you can engage with your environment without losing your connection and awareness of yourself. During your walks or moving about your daily activities, practice the awareness of self as you move. You may notice you are a little less tense, dropping the need to use extraneous muscular action to move and maybe even using or turning on underactive muscles. You may feel less anxious, less shallow breathing, and more expansion of the lower side ribs as you inhale. You may be less judgmental in your internal dialogue and external communication, both verbal and non-verbal expressions. And, of course, you begin to cultivate what your posture of dignity feels like, and how the nervous system can fully activate the right amount of muscular and fascial tension to express your posture of dignity.