The definitive guide to posture & pain in 3 minutes flat!

Posture and pain and not well linked in the research

 

This means no if's, no but's, no maybe’s or even worse…… “in my experience”, which of course is completely ludicrous as someone else may have had exactly the opposite experience.

Who is right? Who the f**k knows? That’s why we have science!!!!

Evidence based practice is a game of probabilities and the probabilities are well stacked against posture being a cause of many musculoskeletal problems.

There are far to many papers to list, so here is one each for some different areas of the body. If you think I have just cherry picked these, there really is shit loads of this stuff out there so go and have a look if you don’t believe me!

Shoulder posture

Cervical posture 

Lumbar posture

Thoracic posture

For a more detailed discussion on posture please check this out on anterior pelvic tilt and this on joint centration

We have no gold standard for what is good and bad posture. So what people base their correction or postural goal on has to be a reasonably arbitrary measure.

But just because we do not have a gold standard does not mean the research into posture is invalid because it is not studied in that way anyway!

Most papers seem to take a bunch of people in pain and then a bunch of people NOT in pain and then compare the postures between the two groups not against a gold standard of perfect posture.

Can a posture ever become a problem?

 

Yes.

Especially if it is the only one you have. But that is a movement problem not a postural problem.

The lumbar spine paper above shows this. There were no differences in the lordosis angle of people suffering with LBP but they did move slower and have less range of movement.

Even what we might consider a really good posture could be a problem if it does not have any movement!

We often swap something (bad) for something else (good – maybe) but we should be swapping it for 'something’s' (plural) in the form of movement and the ability to move into many different postural positions.

The postures you adopt for too long may cause problems as well. Take your amazing posture and sit in front of the computer for 8 hours and it may start to let you know about it. The key again maybe the lack of moving not the posture you had to start with.

We have some cool sensors called Acid Sensing Ion Channels or ASICS within our tissues that sense changes in the ph value. If we don’t move around, or put strain on our muscles and nerves that may reduce blood flow, then these little bad boys can sense the tissue becoming more acidic and transduce this into a sensation of discomfort or even pain.

Ever sat for to long in a lecture or seminar and felt the need to get up and stretch as you are feeling a bit sore? You probably just went through this process. ASICs may get even better at sensing changes if the cell body decides to pop some more ion channels down to the terminal ending so that sodium can get into the cell more easily and make you more sensitive to acidosis of the tissue.

What cause poor posture?

 

Well it could be pain.

In fact you may have looked at the problem the wrong way round. Pain may have been a driver to adopt an adaptive or potentially maladaptive position to reduce pain.

People with "poor posture" suffer from bouts of pain like us all, but if posture were the only driver for their pain they would probably be in permanent pain as, lets be honest people rarely seem to change their posture.

The habits people have will also probably outweigh the occasional stretch and strengthening that they do.This paper *here* discusses exactly that!

Their conclusion being:

"objective data to indicate that exercise will lead to postural deviations are lacking. It is likely that exercise programs are of insufficient duration and frequency to induce adaptive changes in muscle tendon length"

In some cases, other factors such as our visual and vestibular systems may affect our postures too so it is not simply "short and tight" and "long and weak" muscles and if it does not seem to cause pain, then who cares anyway?!

Are you justified in attempting to change posture?

 

We may have to realize that success in trying to change posture maybe due to the process (through exercise or movement) of trying to change posture. This maybe the most important element in helping painful body parts become less painful, and not the outcome such as an actual significant change in the posture. So you would be totally justified giving a body part that has a lack of options (stuck) some more options (varied movement).

In fact rehab programs designed to change posture can help people out of pain without changing their posture as we see *here* with resting scapular position!

As discussed before, if it is the only posture someone has - such as we may see at the lumbar spine with being hyper extended - focusing on this can often help. Whether success is contingent on getting a change in the posture is quite another matter entirely.

If your goal is to change the aesthetics of your or somebody else’s body by trying to alter your posture then its up to you….. but good luck with that!

Are you a THERAPIST wanting to know more about a NO BS & evidenced based approach to helping your patients?

Are you a TRAINER wanting to know more about a NO BS & evidenced based approach to helping your Clients?

 

 

 

 

 

 

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