• Dr. Richard McIlmoyle BSc, DC, PgCPain

The Pathology of Posture

We humans are interesting creatures…creatures of habit, social creatures, creatures with grand ideas and drives. We move through life with purpose, sometimes beyond merely surviving and reproducing… We have motivations to have purpose and community (which, I suppose you could argue reflect back to desire to have status, and therefore reproduce to pass on our genetic code…that is not for this discussion)

How we hold our body has become somewhat of a fixation for people in the health care field, especially manual therapy professions, such as Chiropractors, Physiotherapists, Massage therapists and Osteopaths, but IS IT HELPFUL ???

Good summary of the history of posture here… https://medium.com/@thomas_jesson/upright-and-uptight-the-invention-of-posture-fe48282a4487

I would give you a resounding NO!!! Most research does not support the concept that posture matters much in any situation… Whether we are talking correlation to pain, for “optimal function”, for loading to prevent injuries, for maximum effort in lifting. All of those postural arguments are unsupported or wildly variable in their support through the evidence. (I could do a reference dump here, but I will leave that for the end) Some of the things that I feel like we could talk about with respect to posture is the need to have many possibilities…If we start to get into a habit of a posture and don’t modify it when we need to have prolonged loading…like sitting at a desk, or standing at a counter, where there may be secondary negative “loads” on us (like unhappiness with our work, or mundane tasks) we may have an increased incidence of persistent or recurrent pain. I believe that postural variability makes more sense with respect to research and how we function as humans. Another driver of postural variation gives a window into the concept of humans as ecosystems existing within wider ecosystems, rather than machines…. Our thoughts and beliefs will drive how we hold ourselves and how we move through the world… I have heard many times and seen it over the years. Concepts of bodily shaming or protection of self driving posture…. Women with large breasts feeling like they need to stoop to hide their body either because of shitty societal beliefs and attitudes or just to protect themselves from misogynist, sexist intent and behaviour.

I have a friend who is 6 feet seven inches tall and he relayed how he had adopted a posture of stooping because he is a kind, empathetic person and has internalized that people find him intimidating and wanted to shrink himself to make others more comfortable.

Now, I’m not saying that posture is “a problem” here but we can see that it is an expression of the environment in which those people exist and is an expression of their internal environment that is them wholistically as a human. We really need to get to a place where we have evolved with the totality of the research and with that a better understanding of human experience. We, as manual therapists of many stripes need to move beyond viewing the body as a machine and applying physics alone to how we function. The complexity of human experience, whether that be an embodied experience such as pain or stiffness or fatigue needs to be better comprehended by practitioners and the people we treat to help explain “the why” for which they seek our help. Let’s do better…

Stop vilifying posture and planting thoughts of fragility along with an inability to adapt to the environment that we create and that exists external to ourselves. If someone has beliefs or ideas about posture that may be unhelpful, let's help them understand as best we can. Build them up and encourage positive adaptation in all aspects (physical, psychological, emotional). We can help change societal beliefs through our caring interactions with others who seek our help.

Barrett, E., O’Keeffe, M., O’Sullivan, K., Lewis, J., & McCreesh, K. (2016). Is thoracic spine posture associated with shoulder pain, range of motion and function? A systematic review. Manual Therapy. https://doi.org/10.1016/j.math.2016.07.008

Syazwan, A., Mohamad Azhar, M., Anita, A., Azizan, H., Shaharuddin, M., Muhamad Hanafiah, J., … Malaysia, T. (2011). Poor sitting posture and a heavy schoolbag as contributors to musculoskeletal pain in children: an ergonomic school education intervention program. Journal of Pain Research, 4–287. https://doi.org/10.2147/JPR.S22281

Frey, M., Poynter, A., Younge, K., & De Carvalho, D. (2019). The relationship between lumbopelvic flexibility and sitting posture in adult women. Journal of Biomechanics, 84, 204–210. https://doi.org/10.1016/j.jbiomech.2018.12.048

Lederman, E. (2011). The fall of the postural-structural-biomechanical model in manual and physical therapies: Exemplified by lower back pain. Journal of Bodywork and Movement Therapies, 15(2), 131–138. https://doi.org/10.1016/j.jbmt.2011.01.011

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