Why posture is no longer important

Why posture is no longer important

A common narrative that I hear when working with clients is “I just need to fix my posture”..

“It makes sense I have ‘x’ pain I have such bad posture”, and following this is a belief that if they ‘fix’ their posture, or stay in better posture for long enough, the pain they experience will be resolved. Whilst I understand this idea, and there are elements that have some validity in relation to our ability to function, but the answer for how posture impacts us is a little more nuanced. Before we begin however, there are some terms we need to understand, which are – ‘thoracic spine‘ (which is the middle portion of our back that has all of our ribs attached to it) and ‘kyphosis‘ (this is the natural concave curvature of our thoracic spine).

So does posture impact my pain?

Your posture can have relations to your pain and be a factor that is part of the picture. There are not strong links for poor posture having a causal nature in low back pain. There are stronger links for posture being related to neck pain and thoracic pain. However, this is provided that we have a thoracic kyphosis that is at an angle greater than 40 degrees and, even then, this does not guarantee pain will be experienced as a result of poor posture. Evidently, we see an increase in thoracic kyphosis with age even amongst healthy older adults.

So if my posture doesn’t have a strong impact on my pain should I care about it?

Whilst posture may not have strong links with pain, we should still care about it, because poor posture can have negative impacts on our function including:

• Negatively impacting the function of our shoulder blade and therefor shoulder range of motion
• Negatively impacting balance and proprioception
• Causing forward head posture in the neck, which can have negative impacts on neck pain.

What should I do to help my posture then?

Posture is negatively impacted by pain, which normally occurs due to impacts on our stabilising muscles through our spine. However, due to these muscles stopping doing their job, the spines stability is impacted and we start to see this process where someone’s posture begins to deteriorate.

Therefore, when adults engage in an exercise program that works on the strength of these stabilising muscles, range of motion exercises, and make the necessary lifestyle changes that enable them to avoid being trapped in hunched positions for hours on end. This way we can then prevent the progression of poor posture, improve it and have positive impacts on function and pain.

If I could choose two takeaways for you after reading this article I hope it would be this..

1. Pain can impact your posture, but it is not a two way street. So focusing purely on posture is not the silver bullet to pain.
2. Poor posture is improved by exercise that focuses on the strength and function of your postural muscles.

References

1. Kripa S, Kaur H. Identifying relations between posture and pain in lower back pain patients: A narrative review. Bulletin of Faculty of Physical Therapy. 2021 Nov 30;26(1). doi:10.1186/s43161-021-00052-w
2. Kataria J, Sindhu B, Pawaria S. Effect of mechanical neck pain on neck disability and scapula position among school teachers in Delhi and NCR. International Journal of Research in Pharmaceutical Sciences. 2021 Apr 19;12(2):1260–5. doi:10.26452/ijrps.v12i2.4672
3. Sebaaly A, Farjallah S, Kharrat K, Kreichati G, Daher M. Scheuermann’s kyphosis: Update on pathophysiology and surgical treatment. EFORT Open Reviews. 2022 Nov 1;7(11):782–91. doi:10.1530/eor-22-0063
4. Zappalá M, Lightbourne S, Heneghan NR. The relationship between thoracic kyphosis and age, and normative values across age groups: A systematic review of Healthy Adults. Journal of Orthopaedic Surgery and Research. 2021 Jul 9;16(1). doi:10.1186/s13018-021-02592-2
5. Cheng X, Yang J, Hao Z, Li Y, Fu R, Zu Y, et al. The effects of proprioceptive weighting changes on posture control in patients with chronic low back pain: A cross-sectional study. Frontiers in Neurology. 2023 May 19;14. doi:10.3389/fneur.2023.1144900
6. Letafatkar A, Rabiei P, Alamooti G, Bertozzi L, Farivar N, Afshari M. Effect of therapeutic exercise routine on pain, disability, posture, and health status in dentists with chronic neck pain: A randomized controlled trial. International Archives of Occupational and Environmental Health. 2019 Oct 25;93(3):281–90. doi:10.1007/s00420-019-01480-x
7. Katzman WB, Parimi N, Gladin A, Wong S, Lane NE. Long-term efficacy of treatment effects after a kyphosis exercise and posture training intervention in older community-dwelling adults: A cohort study. Journal of Geriatric Physical Therapy. 2020 Aug 12;44(3):127–38. doi:10.1519/jpt.0000000000000262

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