The posture nonsense is getting out of control. While preparing for a residency lecture this week, I came across an article on posture written by a physician. It was hard to contain my frustration.
“Sitting badly or standing in a slouched position stresses your lower back, weakening and damaging an intricate network of muscles, discs, and joints. And once you’ve damaged your back it’s hard to repair.” — Dr. Michael Mosley
This is a load of BS and has no research to support it. The article will cause harm, not help people. Ok, I’m still a little frustrated.
It's not just the public that is being provided with poor information. Every year I teach a fresh batch of physical therapists and every year I have to repeat the same message, with mounting research.
There is no such thing as bad posture. Seriously. You won’t damage your back. Also, a damaged back, such as from a car accident, can be repaired. Again, the Dr. Mosley article is outrageous and wrong.
Am I saying your family doctor, school teachers, coaches, physical therapist, chiropractor, and favorite social media influencers are all wrong? Yep.
Research shows people with pain often attribute their pain to posture and make “corrections” — such as keeping a straight low back when standing or lifting. Herein lies the issue. It is not the position of the spine that is the problem, it is the beliefs.
Fear and anxiety are primary drivers of pain, not physical positions of the spine. Our spines are robust. The “text neck” graphics that depict the weight of your head increasing as you bend forward are nonsense. The increased force is accurate but the risk it poses is not. The spine barely notices the changes.
Adding more load doesn’t change the story. Research is clear: lifting weights with a rounded back is safe and effective. Even at work, repeated lifting is not a problem. There is no need for training in workplace ergonomics. The frequent focus on ergonomics may cause more harm than benefit.
A recent study tested whether fear-avoidance beliefs influenced spinal motion during lifting. The study used a healthy group of pain-free adults without a history of chronic pain to limit potential variables. The results showed people’s actions when lifting objects are related to their beliefs about body position while lifting. The relationship was negative. The more people flex their backs, the more they expect and fear pain.
The same is true for sitting positions.
Sitting in a slouched position all day may lead to pain, but it’s not the slouching, it’s the sitting all day. Am I saying the thousands of ergonomics sessions at work have been a waste of time and money? For the most part. If the instructors encourage frequent position changes and stepping away from the desk, then that’s sound advice. If they set up a computer station to achieve “optimal” joint angles, then they exacerbate the problem.
Posture Is Often a Symptom, Not a Cause
The causal fallacy is highly prevalent when evaluating health. It is easy to cherry-pick a cause-and-effect relationship. If you tell a friend your neck is hurting, what is the first follow-up question? Chances are it was about sleep or posture. If you had a poor night’s sleep and you don’t like your pillow or mattress, or if you often slouch while sitting, the mystery is marked solved.
That is a causal fallacy.
The pain could have resulted from stress, diet, workload, or a change in an exercise routine. Sleep may have contributed to the pain, but not because of the position you slept in because there is no ideal sleep position. The pain is because of the quality or duration of your sleep.
The issue with determining a cause and effect relationship is identifying which came first. With respect to posture, the pain usually comes first, causing the “bad” posture.
Research shows that if you are in pain or a foul food, you are more likely to adopt a closed, slouched posture.
Adopting multiple postures is a part of life. You are free to bend, twist, and sit like a shrimp. You won’t develop a hunchback or slip any discs. If you have degeneration or herniations in your back — which are often not drivers of pain — it wasn’t caused by any standing, sitting, or lifting.
Pain is multifactorial and is influenced by biological, social, and psychological factors.
Everyone Is Unique
One of the biggest issues I see in my profession is the attempt to “fix” everything. Corrective exercise is a cringe-worthy term as it implies something is broken. Patients across the world are told they have unstable spines, scapular dyskinesia, leg length discrepancies, thoracic kyphosis, poor hip and shoulder mobility, core weakness, and poor posture. Scary list, huh?
None of it matters.
Your spine is robust and stable, your body is unique and adapts to the rigors it faces, and there is no ideal amount of strength or mobility. None of the listed “impairments” predict future pain or injury. They are scare tactics that make people spend money on professional help. They all fall in the categories of health misinformation and disinformation, depending on the motives of the provider.
That’s not to say there’s nothing about your health that matters. Exercise, stress, sleep, and diet all influence your health and wellness. Instead of focusing on the distance between your ear and shoulder or if you have symmetrical shoulder blades, assess your overall health and whether you are able to do the tasks and activities you love and need to do for your job.
When I work with patients, I tailor my treatment to their goals and needs. Jefferson curls, deadlifts, squats, presses, and rows are natural, everyday movements, therefore, they are staples in my programming. If someone wants to lift their grandchild, they need to stoop over and scoop them up safely. They need to build up strength and endurance with that movement, not avoid it.
If you sit all day for your job, build in breaks and focus on other factors that contribute to pain — your diet, sleep habits, stress, and physical activity. Don’t waste your money on posture correction devices or workstation equipment. A standing desk is a good way to change your position often — I have one — but standing in place all day isn’t the answer. Our bodies are designed to move. There is no ideal static position, yet, posture remains a treatment focus in healthcare.
Treating Posture Doesn’t Change Posture
Healthcare providers enter evaluations with tunnel vision, looking for posture deficits and immediately targeting them in interventions. After a few sessions of patient improvement, physical therapists and chiropractors pat themselves on the back and continue believing posture was the cause of the patient’s discomfort. But what if posture didn’t change?
A 2007 study used manual therapy and postural exercises to treat headaches. Both at the end of the three-week trial and at the one-month follow-up, patients reported that the frequency of their headaches had been reduced and that their headaches were less intense. They also reported that their range of neck motion had improved.
Their posture didn’t change.
So, did the treatment work? Yes, but not because it changed posture. The exercises reduced fear and anxiety with cervical movements, loaded craniofacial muscles, and ligaments, stimulated metabolic adaptations, and, most importantly, provided the patient with expectations of improvement.
This is why some posture correction devices seem to work. They provide a solution and fulfill expectations. They are a placebo. The improvements are real, but they aren’t a result of changes in posture.
Now, you might ask: If the product helped the individual, what is the problem?
The issue is the dependence on an external source for pain relief. Removing autonomy and creating dependence on a product or service can lead one down a road of excessive and unnecessary treatment.
Does Posture Ever Matter?
There are cases when posture matters. If you have an interview tomorrow, adopting an upright posture may help your self-esteem, rate of speech, mood, and resilience to stress. Sitting up straight may command you more respect since you’ll probably appear confident and in control.
The focus on posture was born in military culture and extended into fashion. It didn’t become a health concern until the past few decades. Unfortunately, that concern didn't develop from research. As with most health misinformation, it didn’t matter. Once an idea grabs hold and is routinely repeated, it is challenging to uproot it. Posture isn’t the first medical myth to endure and fall victim to theory-induced blindness.
As a healthcare provider, I continue to see pain be mistaught in school and continuing education courses. Healthcare is slow to adapt to new research, often waiting a couple of decades to integrate research into clinical practice. This leads to people receiving ineffective and potentially harmful treatment.
The postural model of pain has been debunked for a while. Help me spread the word.