Postural Defects in Children

Postural Defects in Children and Adolescents Meanings

The posture of humans is completely different from that of vertebrates, which (mostly quadrupeds) always use their upper extremities for locomotion. While some vertebrates are able to temporarily walk or stand upright, upright gait is by no means their sole mode of locomotion. In terms of posture, the ape is the animal that most closely resembles man, although it also uses its arms to move around in the branches of trees or on the ground. Its forelimbs are considerably longer and the trunk posture is much more forward than that of humans.

Functioning of the body & spine

Our body, on the other hand, is designed in such a way that the legs are only there for walking and standing, while we use our arms and hands to do all the smaller and larger tasks that arise on a daily basis. As a result, the bones and joints of the legs are primarily designed for support and locomotion, but the arms and hands can perform much more extensive and finer movements. A basic requirement for the correct interaction of the various organs of the human postural and musculoskeletal system is a free and upright posture.

The condition of the spine and its active and passive holding devices are of crucial importance for posture, which depends on many factors. The shape of our spine is essentially determined by the position of the pelvis, which is normally slightly tilted forward.

If the spine were fully extended, it would tilt forward and the torso would fall in the same direction. Our body is kept upright by the fact that the spine bends backwards in a gentle arc in the lumbar section, i.e. it describes a slight forward curve ( lordosis ) and is slightly curved backwards above the lumbar spine.

Development of the spine in children

This backward curvature ( kyphosis ) of the thoracic spine is in turn compensated for by a forward curvature of the cervical spine that supports the head. Seen from the side, the normal spine has a slightly S-shaped curve. Seen from behind, it forms a straight vertical line. Human beings are not born with their upright posture. He only has to acquire it in the first two decades of his life. In a child in the womb, the spine curves backwards in an arch, the chin rests against the chest, and the legs are strongly bent at the hip joints.

Even in infancy, this prenatal position is clearly recognizable. Only when the infant at the age of two to three months raises its head in a prone position does the cervical spine curve slightly forward for the first time. When the child then sits at the age of about six months, later makes the first attempts to stand and finally starts to walk, the spine continues to straighten. But mostly a child does not have an upright posture until the end of the second year of life. However, this was subject to many changes in the following years.

As we know, human posture is largely dependent on the condition of the muscles and ligaments. We distinguish between a resting posture and a working posture. While the ligaments keep the body upright, the trunk musculature ensures that the body is straightened into the working position. However, the muscles not only serve to straighten the spine, they also serve to ensure mobility.

The abdominal muscles act as opponents to the back muscles and act on the spine from the pelvis through the chest from the front. The development of the back and abdominal muscles is therefore of crucial importance for a normal posture. If the development tendencies of the muscles are inhibited by external influences, muscle weakness is inevitable. This in turn affects posture and physical performance.

Developmental disorders of the muscles

That is why everything must be done to promote the development of the muscles and the entire postural and musculoskeletal system in every way. The principle “who rests, rusts” already applies in childhood. Muscles that are not used regularly do not grow and remain underperformed. Parts of the body that are immobilized over a long period of time, for example by means of a plaster cast, regularly show a loss of muscle mass and their growth lags behind.

However, excessive stimuli also lead to functional disorders, because all organs only work properly when they are stimulated by external or internal influences in a way that is conducive to their normal function. We must therefore constantly monitor that the growing organism is only affected by stimuli that serve as normal a development as possible.

Bones, ligaments and muscles of the spine should therefore be used to a reasonable extent, because normal function is always the best incentive for healthy development. It must be taken into account that the growing organism is more irritable than the fully grown one.

Growth & posture of the spine

In the 5th to 7th year of life and in the 11th to 15th, in the times of increased growth in length, the irritability of the tissue is particularly increased, and therefore there is a risk of overstressing especially in these phases of life. These are the years in which the child starts school and the young person transitions into working life.

Accelerated growth during puberty is – as is well known – quite normal, but growing too quickly at this stage of development can very easily lead to a reduction in the performance of the supporting tissues, especially when no muscular demands are associated with the biologically determined growth tendency of the bone system.

The supporting tissues then cannot keep up with the increased growth in length and are therefore quickly overwhelmed. The adolescent is then no longer able to maintain a normal upright posture; and posture decay or posture damage occurs. Constant overuse then quickly leads to permanent damage.

It is not possible to say with absolute certainty which stimuli damage the child’s body and which stimulate it in its development. However, we know from experience that constant stress of all kinds is harmful to a child. Short-lasting, moderately strong stimuli, the intensity of which can be increased over time, are better.

Symptoms, Ailments & Signs

Postural errors and postural damage in children and adolescents do not necessarily lead to symptoms quickly. It is often the parents or the pediatrician who become aware of the postural damage. Even if there are no specific symptoms yet, it makes sense to treat the postural damage.

If the incorrect posture is not corrected, the body assumes an unfavorable or physiologically permanently impossible position, which will sooner or later lead to pain. Back pain in particular, which does not result from an accident, is often a sign of postural damage that has existed for a long time. Neck pain or headaches can also result from untreated postural damage.

Many children and young people show a bad posture over a long period of time and still do not feel any symptoms. However, since the body cannot maintain a bad posture for years, complaints can also occur in adulthood.

Evidence of postural damage can be found particularly in children and young people who do little sport, have trained muscles and sit a lot. A rounded back, a posture bent forward and a shuffling, seemingly powerless gait are also the first signs of postural problems and should be discussed with the pediatrician as soon as possible.


It goes without saying that we always proceed individually, because children of one age group can be very different in their development. All deviations from the normal posture that persist over a long period of time are referred to as poor posture and sooner or later lead to premature wear and tear of the bones, joints and ligaments of the spine. The muscle forces are used up prematurely, so that the person ages quickly and the feared early disability can occur. For this reason alone, all postural damage must be recorded as early as possible, because only then can it be effectively combated.

It is often very difficult to identify postural damage early on, because it is only in the rarest of cases that it causes pain right from the start. At first they develop slowly and imperceptibly. Pulling or dull back pain, which sometimes radiates into the legs, only occurs when it has reached a certain level.

Unfortunately, by then it is often too late for a complete recovery. We must therefore constantly monitor our children and young people in order to be able to detect and combat any deterioration in posture or posture damage in good time. The deviations from the normal posture can be very different.

Hollow back

One speaks of a “hollow back” or ” hollow back” when the curves of the spine described above are increased. With this pronounced backwards curvature of the spine, a reinforced hollow back can be seen at the same time. Bulges of the normal S-shaped spine are not uncommon. Furthermore, the entire spinal column can be bent backwards, with the forward curvature of the lumbar spine being completely eliminated and included in the overall arch. This form of the spine is called the “totally round back”.

Flat back or flat back & drooping shoulders

It is often very difficult to identify postural defects early on, because they only cause pain at the very beginning in the rarest of cases.

An excessively straight spine, in which all curves are flattened, is also pathological and is referred to as “flat back”. Physical changes caused by slackening of the muscles that straighten the spine also belong to the area of ​​postural defects. In this context, drooping shoulders – both shoulders can be unequally high – and protruding shoulder blades should be mentioned. If the abdominal muscles relax, because this phenomenon is also a deterioration in posture, the stomach sags forward. The upper body is shifted backwards to compensate, which in turn makes the hollow back more pronounced.

Signs of postural damage can vary in intensity. If the child or young person is still able to consciously straighten himself up from a relaxed to a normal posture by tensing his muscles, then we speak of a “postural error” that is relatively easy to combat.

The treatment looks much more difficult when it is no longer possible to sit up on encouragement. In such a case, one has to determine whether or not a normal shape can be restored by external forces, for example by hand pressure against the spinal column concerned. If this is possible, it is a “position error”.

However, if it is no longer possible to change the pathological shape of the spine using external forces, then there is a “form error” which unfortunately cannot generally be remedied even with intensive medical treatment. Appropriate treatment must then be used to counteract further deterioration. The transitions from posture mistakes to position mistakes to form mistakes are fluid. Due to the different prognosis of these individual degrees of severity, it is necessary to detect and treat these pathological changes as early as possible.

When should you go to the doctor?

Postural damage and postural errors in children and adolescents usually always have to be examined and treated by a doctor. In this way, further complications and complaints in the adulthood of the patient can be avoided. A doctor should be consulted if the parents notice a bad posture in their child. In many cases, this incorrect posture is also associated with pain and is intended to suppress it.

If the bad posture does not disappear on its own within a short time, you should definitely consult a doctor. A visit to the doctor is also necessary if the parents notice that the child is developing incorrectly, in particular where the spine can show an unusual curvature. Pain in the muscles and ligaments also indicates postural damage and postural errors in children and adolescents and should be examined.

The first examination and diagnosis of postural defects and postural defects in children and adolescents can be carried out by a pediatrician or a general practitioner. The treatment itself usually takes place with a specialist or with the help of various exercises and therapies. Early diagnosis of this damage has a very positive effect on the further course of the disease.

Treatment & Therapy

In the treatment of poor posture or postural damage, the focus today is primarily on active measures, i.e. conscious training of the muscles, which causes a normal upright posture. In the case of simple posture errors, muscle-strengthening gymnastics, which is best carried out in gymnastics groups, is generally sufficient.

With small children, these exercises have a playful character, with skillful physiotherapy guidance systematically training all the relevant muscle groups. During this gymnastics, it is important to ensure that there is a sufficiently long break between the individual exercises.

Children with poor posture should also sleep hard and flat, as often as possible on their stomachs, as this strengthens the back muscles. Swimming is also of particular importance. All children and adolescents with a position error require targeted orthopedic treatment, with special gymnastic and orthopedic exercises geared to the individual case being carried out.

There are numerous specific orthopedic treatment methods for this, for example Klapp’sche creep exercises, which lead to excellent results. However, all of these exercises must be performed regularly and consistently over a period of time.

Dry brushing the back is also beneficial as it stimulates blood flow to the muscles. In the same way, the shape defects of the child’s and young people’s spine are treated. Under certain conditions – especially as the condition progresses – surgical treatment may become necessary.

Finally, it should be emphasized once again that all deviations from the normal shape of the spine in children and adolescents urgently require medical treatment, even if they do not cause any pain. Otherwise, permanent damage can occur very quickly, which significantly impairs performance in later life. If postural damage is detected early, it can be effectively combated. However, the chances of recovery decrease the later the treatment begins.

Outlook & Forecast

Postural defects and defects appear to be an increasing problem in children. As soon as parents themselves notice an abnormal posture, this should be addressed to the pediatrician. He can decide whether further diagnostics and, if necessary, therapy are indicated. The prognosis of a postural error is all the better, the earlier the problem can be recognized and treated in a targeted manner.

Postural errors that persist over a longer period of time creep in and are more difficult to correct. This in turn results in the problem that long-standing postural errors can also lead to serious postural damage. A bad posture, if it persists long enough, can cause damage to the spine, tendons, and ligaments. These can be painful for the child and lead to unfavorable protective postures.

On the other hand, existing damage also has an overall poorer prognosis of disappearing completely. If therapy is initiated early, there is a good chance that an ergonomically correct posture can be achieved again, especially for children, who are more malleable than adults in terms of spine and erection. This is also important because postural damage in adults caused by decades of incorrect posture can often hardly be corrected and has left permanent physical damage.


In the case of postural damage and postural errors in children and young people, there are a number of aftercare measures available to those affected. In any case, the patterns that led to this damage must be avoided in order not to stress the body again. An early diagnosis of postural damage and postural errors in children and adolescents is also very important, so that parents in particular must pay attention to the symptoms and complaints and then contact a doctor.

In most cases, these symptoms are treated with various exercises or physiotherapy. It is very important that the parents encourage the children to do these exercises and that the children do the exercises regularly. They can also be performed at home, which may speed up healing.

Parents should also point out to the children a correct and healthy sitting position and try to comply with it. In the case of pain caused by postural defects and incorrect posture in children and adolescents, painkillers can be taken, avoiding excessive and long-term use. In general, a healthy lifestyle with a healthy diet and physical activity also has a positive effect on these symptoms.

You can do that yourself

Poor posture can in many cases be corrected and thus minimized in partnership with the children and young people through the intervention of legal guardians. If there is a friendly relationship with a lot of understanding, calm and informative conversations can be held with the adolescent.

Educational work makes it clear to the youngsters the importance and explosiveness of postural errors. Instructions can be given as to what a healthy posture should look like, alternative postures can be practiced and implemented together. In addition, sporting activities help to build up muscles and stabilize the skeletal system.

Children and young people should not be allowed to carry heavy objects. Hard physical labor should also be avoided. If the legal guardians do not have access to the child or if the adolescent goes through a phase of defiance, adults who have the child’s trust should take over the educational work.

These can be tutors, doctors or people with a role model function in the immediate vicinity. The distance between the desk and the chair of a growing person should be adjusted to current requirements at regular time intervals. Care must be taken to ensure an ergonomic workplace, since children and young people in particular spend a lot of time in front of a computer.

The selection of healthy and suitable footwear and means of transport that are continuously adapted to the child’s height should be used.

Postural Defects in Children