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It's been more than 20 years since my mother ordered me to "Stand up straight!" and "Stop slouching!" But it seems that now I need those gentle reminders more than ever.

I think my posture took a serious turn for the worse in med school, when I spent long nights slumped over stacks of medical books and bad coffee. After graduation, the situation worsened. As a hospital intern, my lab coat served as a traveling office. I wore it fully loaded with an impressive assortment of medical doo-dads -- otoscope, stethoscope, reflex hammer, calculator and several dozen tongue depressors.

And since I possessed only the barest of clinical knowledge, I found it necessary to lug around at least 10 pounds of reference books in my pockets. After three years of residency training, I had become a well-trained pack mule, and I had the slump-shouldered posture to prove it.

Posture is simply defined as the position of your body in space. Good posture puts your body in a state of precise muscular and skeletal balance, minimizing stress on joints, bones and muscles.

Incorrect posture, on the other hand, places a tremendous strain on your body. It can lead to joint and muscle pain and stiffness, especially in your back and neck. Bad posture doesn't just affect your bones and muscles; it can have a negative impact on your respiratory, digestive and circulatory systems.

While poor posture is often the result of poor effort, it can be the consequence of a medical malady. Sometimes, bad posture is caused by an injury to the muscles, joints, or bones in your neck, back or legs.

Adolescents who can't seem to stand up straight may have an abnormal curvature of the spine, called scoliosis. Older adults who find themselves slumping could have osteoporosis. Deterioration of the bones in the spine can lead to compression fractures of the vertebrae, resulting in a stooped posture commonly known as a dowager's hump.

For some folks, poor posture can be blamed on physical fatigue or emotional stress. Jobs that require you to sit slumped over a keyboard or stand bent over a workstation day after day can take a serious toll on your spine.

If you want to perfect your posture, you may have to put forth some serious effort. Contrary to common belief, there's a little more to it than just standing up straight or walking around with a book on your head.

Achieving good posture requires you to maintain the natural curvature of your spine in a relaxed manner. The best way to accomplish this feat is to stand with your ears, shoulders, hips, knees and ankles stacked in a straight line. This stance will encourage the correct positioning of the three natural curves in your spine -- inward curves at your neck and lower back, and an outward curve at your shoulders.

Most of us with poor posture fall into one of two categories -- slouchers or swaybacks. If you're a sloucher, your shoulders are rounded and rolled forward, causing your head to droop toward your chest. Slouching strains the muscles of your neck and shoulders, increasing your chances of developing headaches and neck problems.

The opposite of the slouch is the swayback position. If you have this type of posture, your stomach sticks out in front, and your buttocks protrude in the rear. Your lower back takes on an exaggerated curve, straining the muscles and contributing to low back pain.

If you're not sure how your posture stacks up, you can take this simple test in the privacy of your own home. Standing with your heels about two to four inches from a sturdy wall; place the back of your head, your shoulder blades, and your buttocks against the wall. In this position, you should be able to fit your hand snugly between the wall and your lower back.

If you're swaybacked, you'll be able to fit more than a hand's thickness in the space. If you're a sloucher, you might find it difficult to make room for a single finger.

If your posture is less than perfect, you can take steps to change it. Exercises that stretch and strengthen the muscles of the back, abdomen and chest can bring about dramatic improvements.

If you've been neglecting your posture for a few years, you shouldn't expect to correct it overnight. But with some hard work and persistence, you'll eventually develop a posture that will you -- and your mother -- can be proud of.

Dr. Rallie McAllister is a family physician in Kingsport, Tenn. Her column appears three times a month on this page.

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