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Bad posture is a common thing people consult with an Osteopath for, but do you really need to fix your posture?
Poor posture is one of the most common complaints I get in my practice as an Osteopath. People associate it all the time with the reason they have developed neck pain, or back pain, or shoulder pain, or some other issue. It makes good, logical sense to our mechanistic brains. The concept essentially runs like this: If you sit(or stand) poorly, eventually you will develop poor posture. And poor posture causes imbalance and pain.
But the Posture is much more complex a subject than that. And if we look a bit deeper, the popular understanding really starts to unravel. Lets take a look:
"Dont slouch!" "Stand up with your shoulders back"
What is posture?
Posture is defined as an attitude adopted by the body. It can be used in a dynamic (as in running, riding or performing an other activity) or a static sense. Most people thing of posture in a static sense- i.e. how they stand or how they sit.
Can Posture Actually Be Good or Bad?
It depends. These are loaded terms. How should a posture be bad, exactly? At its heart, Poor Posture is a social concept, loaded with the scorn for the imperfect, the physically asymmetrical, and the socially disadvantaged. "Ideal" posture as a concept seems to be able to be traced to late-Victorian and Edwardian era England, where a burgeoning field of medical pathology was just starting find hints to the real causes of many of the maladies that had afflicted humankind for millennia. Rickets, hunch-back deformity (kyphosis and scoliosis) and club foot (talipes equinovarus) many other viable physical deformities were associated with the poor and disadvantaged classes, whom struggled to get adequate nutrition and worked under horrendous conditions.
In a rigid class society (such as 19th century England), upright or "good" posture came to be a morally virtuous nature, and of course, good breeding. These values still run deep in our society. Look at the postures prized by military organisations across the world. Hyper upright, vigilant postures standing straight or "at attention". These postures are communicating something very subtle to other humans around. When we use the term as a verb - "Posturing" - we hint at this.
"But I have Terrible Posture..."
In my practice I regularly see people who are worried that their poor posture - their hunched upper back, their exaggerated lumbar lordosis or their short leg or scoliosis is casing their pain and needs to be fixed, OR it will cause them pain and disability in the future. Here is the cultural pressure coming to bear on the individual.
And now for the rub: There is actually much more evidence that postural variations ARE NOT associated with increases in back or neck pain. Researchers are very coy about blanket statements like- poor posture does not cause pain- it is very hard to be black and white like that if you want to be accurate- but most research investigating common postural issues like:
Let Length Difference
Lumbar Lordosis
Neck Posture
Kyphosis
Pelvic Tilt
Scoliosis
Found no increase in pain when studying large groups of people who suffer these issues- That is, sufferers are NO MORE LIKLEY TO HAVE BACK OR NECK PAIN if they have one of these postural 'faults' compared to normal populations.
(The excellent Todd Hargrove has summarised this for clinicians and people interested in references far better that I can if you want more detail)
There are other related and equally cherished assumptions we make that are just as hard to prove- like can we actually change a persons posture using clinical interventions.
So what should you do?
Think of posture more as a range of options your body has available based on its fixed structure- and work on improving your bodies fitness to maintain more effective options for longer. What we think of as poor posture is much more likely to represent tiredness or certain mental states in the short term, and possibly some weakness or increased fatiguability in your trunk muscles when doing long or repetitive tasks- especially if you're not enjoying them.
See a good clinician for your pain, but don't buy into any postural correction nonsense. (Screening X-Rays are a postural correction non-sense). Stay away from gimmicks like posture correctors that appear on social media promotions. Make sure you have good habits at work in sustained postures. Sustained posture- even in "good" postures- ARE associated with pain- so take a break every 25 minutes and change positions. Practice varied exercises for your trunk, shoulders and hips that engage large muscle groups with control (a good clinician can help you with this). Keep working on your cardiovascular fitness. This is my advice to patients who are concerned about their posture- and give yourself a break. There is enough judgement in the world. Worry about pain if you are in pain- come and see an Osteopath, or your chosen healthcare person, but don't demonise your posture.
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