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  • Paul Killen

Straight Talk About Posture



You’ve probably all heard it before…’Sit up straight or you’ll get a bad back!’ Your parents probably said it and (if you’re like me) your Granny probably even said it. But is there any evidence to support this long-held belief? Does ‘bad’ posture cause pain? Does ‘bad’ posture exist? Or is this just an ‘old wives (Granny's)’ tale?


A basic Google search on this topic results in literally hundreds of posture ‘correcting’ products and treatments. All sorts of techniques are used to try to sell you a ‘fix’ for your ‘bad’ posture feeding off the belief that YOUR posture is causing (or will cause) pain. The textbooks I used when studying Physiotherapy in the early 90s emphasise an ideal posture – I particularly remember one with a plumb line running down from ear to shoulder to hip to knee to ankle. We were taught to observe the patient and take note of anything that deviated from that plumb line. These ‘abnormalities’ would form the basis of your treatment plan as they were often blamed for the patient’s pain. However, 25 years on (as my own middle section extends in front of that imaginary plumb line) this all seems laughable and I regret the time I wasted on this.


If you take a look around you in public you will see lots of people with lots of postures. None of these will comply to the text-book ‘normal’. All will have right to left differences. Some will have rounded shoulders, poking chins, kyphosis, scoliosis, long leg/short leg, pelvic shifts, one shoulder higher/one shoulder lower, sway-back, flat-back etc… etc… It’s part of what makes us unique individuals! If these postures that lie outside the textbook ‘normal’ are ‘bad’ and if ‘bad’ posture causes pain then it follows that everyone should be suffering. This is clearly not the case and is yet another myth in the medical world.


In reality, there has been no scientific evidence to date showing that posture causes or is linked to pain. In fact the contrary is true. A recent systematic review (where lots of similar research studies are clumped together and analysed) showed that patients with back pain had all sorts of postures across the board. No one postural type was more common in individuals with back pain. However, the common factor in those with back pain was that they moved more slowly and had less range of movement than those with no back pain.

The current view supported by scientific evidence is that there is no such thing as a ‘bad’ posture – or for that matter, ‘good’ posture, yet this ‘fear’ is how a lot of products and treatments are sold. So why are we still getting this negative info.

Here are some possibilities:

1. It is known to take on average 17 years for research to filter into clinical practice so clinicians and companies may not be up to date.

2. Financial incentive – Companies and clinicians may be aware of the research but choose to ignore it to avoid becoming ‘turkeys voting for Christmas’.

3. Clinicians can be lazy, ignoring evidence and continuing to do what they did 20 or 30 years ago while passing these beliefs on to patients, reinforcing fear and reliance on the clinician.


Persistent Back Pain and Posture

In clinic I see a lot of patients who have ‘chronic’ (or as we now like to say ‘persistent’ back pain). Mostly, these patients have ongoing pain where no anatomical structure can be blamed (ie. they’ve had Xrays, scans and tests without identifying a structure or disease causing their pain). A consistent feature in this group of patients is that they all seem to have a near ‘textbook’ posture in clinic. For years I thought they were just sitting up straight because they were in front of me as a Physio!!?. However, what seems to be happening is that they adopt what they believe to be a ‘good’ posture and move (or not) in a way that they feel ‘protects’ their spine. My previous blog on ‘fear’ discusses this in more detail. The vast majority of these patients demonstrate an inability to move out of their posture during the examination due to fear, stiffness, pain or all of the above.


Summary

In light of the current evidence and my own clinical experience, my opinion is that posture itself is not the problem. The problem seems to arise when an individual loses the ability to move out of a posture (any posture). Your spine is built for movement.

A useful mantra is:

‘Your best posture is your next posture’ (author unknown).


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