Not a week goes by when someone doesn’t walk into my clinic saying that they know they have ‘bad posture’. They blame themselves as if they have done something wrong, half expecting a telling-off from their friendly osteopath.
When they explain their pain to me and mention their posture, most people start pointing at parts of their body, saying that they’re a bit hunched here or a bit too curved there. They think this is a bad thing.
I have some good news for you, though. The research is very clear that if you take a large population of people, there are no significant differences in posture between those who have pain and those who don’t.
To say that another way, it is just as likely for someone who doesn’t have pain to have a hunched upper back, scoliosis, or an increased lower back arch than someone who does have pain.
How can we blame posture for causing pain when we see the same postures in those without pain? Well, it turns out, we cant.
Before we move on to ask what might actually be happening here, there’s another curious feature of posture that we need to discuss; posture is constantly changing!
Sure, broadly speaking, your body will have some anatomical patterns that it will be following. However, you are still changing from moment to moment. It will depend on your environment, the task you are performing, how long you have been performing it, your stress levels, your level of fatigue, the clothes you are wearing, the temperature … and on and on. When we talk about posture, which posture are we talking about? There’s an infinite number of them!
So, when it comes to posture, we now know that, on average, people without pain have the same postures as people with pain. And even within one individual, posture will be in a constant flux of change from moment to moment.
So what is going on when someone has pain?
Well, as is often the case when it comes to the human body, it’s complicated.
Many factors could lead to someone having an episode of pain, but there is a pattern.
Someone is more likely to have pain if they are not flexible enough for the tasks they perform, if they are not strong enough, if they are fatigued (either through repetition or due to actual fatigue caused by poor sleep or over-work), if they are stressed or anxious, if they haven’t conditioned themselves to something, if they have a history of injury … and again, the list goes on.
Although there are many reasons why someone may end up with pain (some mechanical, some physiological and some emotional), they all change how a person functions.
When I assess someone, I care much more about how someone moves than how they stand or sit still. When watching a patient move, it’s not just about how far they move (range of motion), but about how much control they have while they are doing it. Also, how do they feel when they are moving? Are they confident, or is there a sense of trepidation and unease? And lastly, how does the whole body move? Is movement travelling nicely through the entire chain?
These are more helpful things to discover because, firstly, it leads to a clearer, more holistic diagnosis, but secondly, it helps us create a plan to come out the problem.
If we blame things on posture, where do we start? You can’t exactly go changing your anatomy very easily. And which of your infinite postures do you want to change? Whereas suppose we discover that someone has good genetic flexibility but a lack of control. In that case, we need to strengthen them up. Conversely, if someone has good strength, but through years in a particular job, they have tightened up, then they will need a good mobility plan. Or maybe, due to a previous injury, someone is nervous to perform certain actions. They need a rehab system to gradually rebuild coordination and confidence in movement.
As I said, it’s complicated … but thankfully, it’s not your posture!