POSTURE MATTERS, BUT NOT MUCH
Human beings are designed to walk upright. A curve in the lower spine, specially adapted pelvis and thigh bones, the spinal cord at the base of the skull rather than at the back, all uniquely equip humans for standing and running on two legs. But a vertical spine also comes with the special challenge of maintaining muscle balance against gravity and minimising compressive loads on the spine to avoid damage to the vertebral tissues.
Since spinal problems are extremely common in humans, and we all want to avoid being in pain, it’s not surprising that are commonplace explanations about what causes all this spinal pain.
Probably the most widely embraced explanation is the idea of ‘bad posture’. In fact, most of us have become haunted by the pervasive social meme that unless your posture conforms to certain rigid standards you have resigned all self-defence against common spinal problems, like headaches, neck and and shoulder pain, and low back issues. The physical therapy professionals have become the most vocal alarmists about the dangers of poor posture, and whole industries are built around fixing the ‘problem’. However, while posture is probably relevant in some pain problems for some people, the impact of posture on spinal pain is often significantly overstated. The evidence that there is a strong and direct relationship between posture and musculoskeletal pain is actually so thin it’s hard to understand what all the fuss is about.
Let’s dispel a few myths..
Myth: There are Universal Standards for Good Posture
Stretch tall, chin in, shoulders back, chest out, tuck your tummy…
There, perfect! Feels great, huh? Now hold it all day. And if you can’t, strap yourself in this harness to do the job for you.
The use of “technical” and “advanced” methods promoted by posture gurus is unsupported by scientific evidence and should be approached with caution.
We all have a different shape, different tissue quality and different natural mobility, which means that good posture largely relies on each individual’s sense of ease and comfort and how long that lasts in any single position. When you are standing or sitting comfortably, you have found your own body’s sweet spot. Trying to align your stance with someone else’s standards for good posture can actually do you more harm than good. Instead, finding a comfortably balanced posture that does not strain specific muscles or joints is one important way to keep pain at bay. But even that position will hurt if you stay there long enough. So, in fact, regular moment is an essential part of good posture.
There is now an increasing emphasis on the importance of dynamic posture, which encourages movement and change, rather than a specific, static position. The advice to lead an active lifestyle and engage in a variety of physical activities is supported by evidence, as sedentary behavior has been linked to a variety of health problems, including pain. The suggestion to strike a balance between being too passive and overly aggressive in postural habits is also reasonable, as avoiding both extremes can lead to a more well-rounded approach to posture. However, it is important to remember that individual needs and preferences will play a role in determining what is considered “good posture” for each person.
It is important to note that good posture is not a static position, but rather involves dynamic alignment and balance of the body. Maintaining good posture requires awareness and effort, as well as regular stretching and physical activity to support flexibility and muscle strength.
Myth: Bad Posture Always Results in Pain
Research has failed to show a good correlation between poor posture and the severity or frequency of pain. Chronic pain typically has more than one cause. It’s related not just to physical factors but also to your individual physical and psychosocial history. This helps explain why some people who slouch are not in pain while some with ‘perfect’ posture are.
When your brain senses an immediate physical threat, it alerts you with pain. Your body’s sensory system, your memory of previous injuries and even social or environmental factors tell your brain whether your safety is at risk. In fact, it’s far more likely that stress or anxiety is triggering your neck pain and headache than slumping in your chair. If you feel comfortable slouching at your desk, your brain does not perceive a threat nor does it create a pain alert. Stay there long enough and it may start to hurt, but that is not due entirely to the position as much as a signal simple lack of blood flow in whichever tissues are under pressure at the time.
Some people will experience posture-related pain while others in similar situations will not. The causes of pain are more complex than posture alone. Are you stressed at work? Have you been at your desk too long? Are you staying fit and strong? Do you have a previous injury or some other physiological problem in that region.
Your tissue health and strength helps determine how much activity or strain you can tolerate before your pain system rings the alarm bells to tell you it’s time to change what you’re doing. If you are healthy and fit and relaxed, you can tolerate most positions for a longer duration than someone with suffering chronic stress or a musculoskeletal injury. Your posture isn’t inherently bad, but it’ll hurt if you exceed your current tolerance for it.
Is posture actually important?
People have a natural tendency to avoid ineffective responses to postural challenges and, unsurprisingly, prefer comfort. Whatever activity you are doing, there will be positions that minimise the amount of strain in your body and allow you to remain comfortable for longer. And, we naturally maintain postural fitness for things we care about and do often. Poor posture can still occur, though, due to carelessness, prioritising other things, or lack of awareness. Such positions aren’t necessarily damaging but you may exceed your tolerance sooner and therefore need to move or change your position towards comfort more often. However, the impact of this ‘bad’ posture is mostly minor and self-limiting.
Poor posture and postural stress are often the result of poor ergonomics and other factors, rather than postural habits. Additionally, the benefits of attempting to change posture are limited and may not be worth the effort for most people. The best evidence suggests that increased physical activity and ergonomic adjustments may be more effective than addressing supposed postural issues in reducing pain.
Because everyone’s comfort range and tolerance to strain is different, postural management has to be based on your own physical awareness. Postural awareness can be an important part of osteopathic physical therapy, but a broader perception of pain’s multiple causes can focus treatment more effectively. A holistic approach that addresses not only posture but also individual characteristics, past experiences, social and employment factors and environmental impacts is more likely to get to the roots of your chronic pain.
Spinal conditions that might limit your ability to maintain a good posture
There are several spinal conditions that can affect the ability to maintain a normal posture and contribute to musculoskeletal pain. Some common spinal conditions that may affect posture include:
Scoliosis: where the spine curves to one side, affecting the alignment of the body and making it difficult to maintain a neutral spine.
Kyphosis: where the upper back rounds forward, affecting the alignment of the neck and shoulders, such as Schuermann’s disease and advanced osteoporosis.
Spinal Stenosis: a condition where the spinal canal narrows, affecting the alignment of the spine to protect local nerve tissues.
Herniated Disc: a condition where a portion of the spinal disc bulges out and presses on a nerve, affecting the alignment of the spine and causing pain.
Degenerative Disc Disease: a condition where the spinal discs lose their elasticity and ability to absorb shock, which can affect the alignment of the spine and cause pain.
While these conditions can cause pain, limit mobility, and affect the ability to maintain good posture, the resulting pain is usually unrelated to factors that are addressable by attempting to voluntarily ‘improve’ posture.
A simple posture exercise:
Sit completely relaxed in your chair; so relaxed that your shoulders and head slump forward. Now bring your attention to your chest and abdomen and try to take a slow, full breath without moving from the position you are in.
Notice that it is impossible to take a full deep breath in this position.
Now, without moving yet, imagine being able to take a full breath and now change your position to allow that to happen – so your lungs can fill right to the top.
Notice that the only way you can breathe deeply is to lengthen all the way through your spine, but also that you don’t need to pull your shoulders back or tuck in your chin or arch your spine. Your neck and shoulders can stay relaxed and at ease.
If you are ever worried about your posture, just ask yourself:
How can I be more comfortable right now?
Can I take a full breath?
Am I relaxed?