Adapted from Dr. Carb’s interview with Rachel Salaman of

1. Why is posture important?

In answering that question I’d first like to define terms so we have a common understanding.  Posture refers to body position and alignment.  Good posture practice refers to both maintaining the normal shape of the spine, and satisfying the body’s ongoing desire for motion.So, posture is important on a few different levels, but perhaps the two most important are health and image.

Health and posture refers to the predictable consequences of poor posture practice on the body such as spinal and soft-tissue degeneration including degenerative disc disease, compression of internal organs, muscular strain, the suppression of certain important hormones such as lipase which increases the risk of cardiovascular disease, diabetes, and obesity.

Image and posture refers to body language, and what your posture is telling others about you.  For example, during a job interview, your posture will say as much about you as the clothes you’re wearing for that interview.  As I said in my book, “there is something subconscious in us that still recognizes good body form when we see it and associates that quality with grace, health, and distinction.  The opposites also apply.” I think that today, because so many people have minimal posture self-awareness, someone with remarkably good posture is more likely to be noticed and remembered in a positive way.

2. Most people think of a standing position when they hear the word posture, but your sitting posture is just as important, isn’t it?

Sitting posture is perhaps more important because most people spend the majority of their waking hours these days in a seated position, including work time, commuting, eating, relaxing, and during many forms of electronic entertainment such as watching TV.  When people stand, they tend to fidget a bit, shift their weight, and move around more compared to sitting.  So standing is typically more dynamic and sitting more static, which makes proper sitting all the more important because one position is often being held for a longer time.  Also, poor sitting has the possibility of increasing spinal disc pressures higher than other body positions, so sitting is potentially more damaging than other common body positions.

3. How can sitting posture improve productivity and performance, as some doctors have suggested?

We know quite well through scientific investigation that poor posture practice causes problems like increased muscle, joint and disc strain in the body, general fatigue, and a higher incidence of various RSI’s.  So the short term outlook is that a person with poor posture habits is more likely to be in some discomfort, which can be pretty distracting when you’re trying to work, meaning you’re likely to get less done but take more time doing it.  The long term outlook is that RSI’s can become so severe that they can literally disable a person, so that would be a maximum loss of productivity and performance.
Good sitting posture practice, which includes body position and alignment, good ergonomics, and periodic activity breaks, has been associated with significantly lower levels of discomfort and RSI.  In addition, the activity break component of good posture practice stimulates blood flow and breathing which provides a direct benefit in terms of mental sharpness and emotional outlook.

4. Who needs to start thinking about their posture – just those who are worried about it, or everyone?

Well, gravity doesn’t discriminate between people that believe in it and those that don’t.  Everyone, at every moment, is being pulled toward the center of the earth with great force.  How efficient you are at managing that compressive force over a lifetime will have a significant effect on your body’s frame and on your health.  In fact, it’s been shown that the health risks related to poor posture practice overall are as significant as the health risks associated with smoking, direct sun exposure, and high cholesterol.  That means the average person, at this time in our society, really has little appreciation and knowledge of the risks associated with overly sedentary, poor posture habits.  So, knowing what I do, I think that everyone should be concern with increasing their understanding and attention to good posture practice.  Now, that being said, this information is primarily aimed at desk workers and others that sit a lot throughout their day.

5. Your new book The Science of Sitting Made Simple is dedicated to improving people’s sitting posture.  Why did you think a book like this would be useful (and who’s it aimed at?)

I started working in the health care field about twenty-five years ago, just about the time personal computer use really proliferated.  Since that time, the number of people suffering from cumulative strain and repetitive strain injuries associated with sitting posture has skyrocketed.  Most people intuitively know, or they have been told, that their posture habits could use some serious improvements.  However, most people don’t understand 1) why posture really is important, 2) what the predicable consequences of poor posture practice are, and 3) what practical steps they can take to make a difference in their posture.
So, I saw a need to provide this information in an easy-to-understand format with lots of illustrations and practical examples.  Frankly, there's plenty of information out there on the internet and in the bookstores on posture and ergonomics, but I don't believe (regardless of how important it is) that the average person wants to dedicate a whole lot of time and effort on the subject of posture.  I think that what people want is what I call just the "need-to-know info" presented in a step by step plan â€” and that's what my book aims to provide, along with some unique perspectives on explaining posture in ways that you won't find anywhere else.

6. In your book, you outline 10 steps to getting a better posture.  Let’s talk briefly about those.  The first is Understanding Your Spine’s Normal Shape.  What is the spine’s normal shape?

I think it’s first important to remember that the spine is very three-dimensional, so the shape will appear differently depending upon how you’re looking at it.  From the back view, as if someone was standing in line in front of you, the spine should simply be straight, running from the bottom of the head down to the top of the pelvis.  From the side view, that same spine should not appear straight at all, but rather it should have several contours, one arching forward in the neck area, one arching backward in the mid-back area, and one arching forward again in the lower back area.  There are a few smaller spinal curves lower down in pelvis but they don’t generally change with posture.  So we basically have a vertical spine as seen from the back or front view and three major contours in the spine as seen from the side view.  I’d also like to add that with this normal shape of the spine, a person’s head (at the top), ribcage (in the middle), and pelvis (at the bottom) are all perfectly aligned, from top to bottom, from front to back, and from side to side.

7. Why is it important to understand it?

The basic concept of good posture is maintaining a neutral spine position, so in order to do that, you have to know what the normal shape of the spine is.  Then, you should be better able to appreciate poor posture positions that are bending the spine out of its normal shape.  For example, we just talked about how the spine is normally arched forward in the neck area.  If a person often reads with a book placed on their lap we know that their head is going to be bent down, which actually bends the spine backward in the neck area.  So I think a person can better understand how bad it is to read with your head down and your neck bent backward knowing full well that the normal shape of the neck is actually arched forward.  In fact, if the basic concept of good posture is maintaining a neutral spine position, then the basic concept of poor posture would be bending your spine out of shape.  So we must understand the normal shape of the spine to appreciate both good and bad posture.

8. You call the second step Keeping It Together, and it focuses on the soft tissue that holds the spine together.  What should we know about this?

Connective soft tissues hold the spine together and also play a major role in guiding and limiting spinal motion.  In the book I say that the spinal bones give rigid support to the body’s frame while the soft tissues give flexible support.  So the connective soft tissues are things like the discs, ligaments, and to some extent muscles, that join the spine together segment by segment.  Most people don’t directly injure their spinal bones through poor posture—a bone injury is a fracture.  However, people often injure their soft tissues, and that is a strain or sprain.  Here’s another way to think about it: If we were able to express posture changes in the body as some sort of equation, for most people the spinal bones would more or less be a constant in that equation and the soft tissues would be the variable.

9. Step three is Learning How You Get Bent Out of Shape, which looks at the effect of poor posture on the spine.  Can you explain this process?

Sure. We just talked about soft tissues as being variable.  That’s because the connective soft tissues are adaptable.  Their flexibility is what gives us a range of motion, but they can also become chronically over-strained.  In poor posture, as we know, the spine is bent out of its normal shape.  When this is repeated over long periods of time the connective soft tissues actually begin adapt to the position you’re most often in, and this gradually changes your alignment.  So people tend to repeat the same posture patterns—like sitting with their backs rounded, standing with their head and shoulders forward, and sleeping curled up in a fetal position.  What they are literally doing is molding their spines into a new shape.

10. The next step is Understanding How Degeneration Happens.  This is about wear and tear on the spine. Is this something that only affects older people or should everyone be concerned about this?

Let me start by saying that the wear and tear process we are talking about affects both the spinal bones and the soft tissues.  So these are things like osteoarthritis, degenerative discs, and scar tissue.  For the most part, older people have more degeneration simply because they’ve been around longer to accumulate damage.  So it really matters how long you’ve been exposed to adverse stresses and strains.  The scary thing is that young people are subjecting themselves to postural strain early in life like never before and they’re going to have a long road ahead for all this wear and tear to show up and cause problems.  So, it’s really a concern for everyone.

11. Step five is Understanding Your Correct Posture.  You’ve made a case for why it’s important.  Now can you tell us what our correct posture should be?

Essentially, I find that many people with poor posture practice have little awareness of the natural forward arch in their lower back.  So one of the exercises in this step is to stand on your own two feet, back up against a wall or a door, and then place one hand behind you in that space just above your hips and below your ribcage to feel that space in your lower back.  Most people are surprised to feel how significant that space is, and the problem is that most people flatten or round out their lower back when they sit.  So the correct posture when you are standing or sitting is the posture that maintains the natural forward arch in the lower back.

12. Step six is Sitting Up When You Sit Down.  Can you talk us through this?

My premise is that good posture essentially comes down to one concept, and that concept is to keep the ribcage upright.  If you think about, almost everything else in your body attaches to the ribcage, your head and neck, your arms and shoulders, and your lower back.  So instead of trying to do ten things at once to track your posture, I recommend that all you need to is keep your ribcage up, and the position of your head, shoulders, and lower back will all improve automatically.  Now, that being the case, when you sit, you are going to need a chair with a seatback that is upright and locked in place, ideally with a well-fitting lumbar support to fit into the forward arch of your lower back.  Then you need to sit well back into your chair and place your upper body weight fully against the seatback with your feet flat on the floor or a footrest.  This actually helps to even out your weight distribution over a larger area of your body so you’re not over-stressing any one part.

13. Step seven is all about awareness, and how it can prevent us from slumping.  Do you have any tips for building up that awareness?

Well, I think that a lot of people do have a chronic problem with posture awareness, which is in part due to a lack of understanding of the normal shape of their spine.  So taking that first step to better understand how your body is built is a good starting point to building your awareness.  From that point forward it’s pretty much a matter of using simple reminders such as post-it notes, setting a timer, or using a computer program that reminds you to periodically check your posture, take a break, adjust your chair, or perform some simple stretches.  On my website,, there are free downloadable items such as a computer monitor placard that sticks to the top of the computer screen and shows correct and incorrect illustrations of posture, and a weekly self-care record form that helps people track symptoms, stress, workload, and the various movement techniques I recommend for activity breaks.

14 .The next step is called Undoing Damage with Extension Stretching.  When should we be stretching?

The purpose of the extension stretching is to offset the inevitable forward rounding that occurs with sitting deskwork and many everyday standing activities such as cooking and cleaning.  Remember that the connective soft tissues adapt to the position you’re most often in, so to preserve a neutral posture, you have stretch in extension to maintain some balance in tissue tension.  There are two types of stretches to do.  One is short-term, for only ten seconds or so, just to take your muscles through a range of motion, and this should be performed several times a day.  The other is long term, for about ten minutes continuous, which is required once per day to achieve a deeper stretch and lengthen the connective tissues.  The bottom line is, you can stretch to provide yourself with a cumulative benefit everyday, or you can neglect to stretch and accumulate damage everyday.

15. How do you do this “extension stretching?”

Basically the head, neck, arms and shoulders will be extended backwards.  The short-term stretch can be done sitting or standing, but the long-term stretch is done lying down, on your back, near the edge of a bed.  It’s important to understand that this long-term stretch gives a unique benefit that can’t be achieved through exercise, medication, supports, ergonomic devices, or any other method.  I should also mention that there are some medical conditions that would rarely prevent some people from performing this stretch and those precautions are mentioned in the book and on the website.

16. You call step nine Moving It Instead of Losing It. What’s your main message here?

Our bodies were made to be in motion, considering all the many muscles and joints we have.  Motion is necessary for circulation, digestion, and respiration.  If you don’t move, you will lose your flexibility, strength, and energy.  And our need to move cannot be satisfied in one lump sum, we need movement on a periodic basis all day long.  The movements can be as simple as standing, and then turning and tilting your body right and left.  Maybe two or three times a day you need to do something somewhat more strenuous to increase your heart rate like taking a flight of stairs or brisk walking.  Of course, almost anything is better than just sitting there.

17. As with all endeavors, practice makes perfect. This is step ten: Practicing Good Posture. What’s the best way to practice?
The answer to that question is to maintain the normal shape of your spine in all of your rest and activity positions.  Start by putting your attention on the places that you spend the most time, and for many people that's sitting at their desk, driving in their car or riding on the bus or train, and sleeping in bed.  Those postures should be as neutral as possible and that will make the biggest difference.  It's a good idea not to skimp on a good bed or a good chair because you'll probably spend the the majority of your life in those two places.  Also remember good posture practice means not sitting for too long at any one time, because even if your sitting posture is perfect, it's still sedentary.

18. If sitting is so bad for us, should we aim to stand more? I know some people have desks that can be raised to accommodate a standing position.

Sitting is only bad if you do it incorrectly or for too long at any one time.  Because so much work is computer based these days and people tend to commute and travel a lot as well, sitting is mostly unavoidable.  So we need to learn how to sit smarter so that sitting is supportive, comfortable and relaxing.  I think that standing workstations are a valid alternative to sitting, although they can present some problems of their own such as causing sore feet or varicose veins in the legs.  So it’s fine to alternate sitting in a supportive chair with other positions such as a standing workstation, but for most people it’s not going to be practical to completely replace their chair with some other setup.

19. What tips do you have for people who want to start improving their posture today?

Learn about your body and how your frame is held together.  Put your attention on keeping your ribcage upright at all times when you are standing or sitting and everything else will follow that.  When sitting, always try to sit well back into the seatback of your chair and avoid reclining unless your head can recline as far back as the rest of your spine, and then it’s OK.  No matter how good your sitting posture is, try to avoid continuous sitting for more than 30 minutes at a time without standing and moving your body in some fashion.  And take some time every day to stretch your body in extension on a gym ball, on a foam roller, or at least just let your body return to a neutral position by lying on your back flat on the floor with your palms facing up, for about ten minutes each day.