Wednesday November 25, 2015

It seems pretty obvious, doesn’t it? The premise seems absurd that bad posture would be okay for you. Second only to “if you make that face it will stick that way,” we all can recall the voice of our mothers telling us to “sit up straight!”

I’ll admit it. At times I operate from a physical therapy worldview that encourages symmetry and balance, neutral positioning, and postural alignment. Seems natural, doesn’t it? But, as therapy providers focused on evidence-based practice (EBP), we at Kinetic Edge consistently seek confirmation of the benefit of our treatment techniques. So, we need to find the answer to this critical question: What do well-designed scientific studies find about the connection between posture and pain?

The results from well-designed research studies for the most part do not support the claim that bad posture causes back pain. Todd Hargrove, author of A Guide to Better Movement: The Science and Practice of Moving with More Skill and Less Pain, also has a blog called Better Movement. In September of 2014 he posted the following findings about the link, or lack thereof, between posture and pain (

  • There is no association between leg length differences and back pain.
  • There is no significant difference in low back posture between people with severe, moderate, and no pain.
  • There is no association between neck curvature and neck pain.
  • There is no significant differences in muscle length (i.e. flexibility) of abdominal, hamstrings, and hip flexor muscles in people with and without back pain.
  • Teenagers with funky back postures were no more likely to develop back pain in adulthood than those with “better” posture.
  • Pregnant women with increased low back curve were no more likely to develop back pain.
  • People who perform work involving frequent exposure to awkward postures do not have higher levels of back pain.

The preponderance of evidence indicates that if any correlation exists between posture and pain, it is weak. And even if a correlation  between pain and posture does exist, that does not prove a causal relationship. In other words, it may be that pain causes bad posture, not the other way around.

Hargrove goes on to explain three reasons why posture does not associate well with pain:

  1. Tissues adapt to stress over time – If your muscles get stronger when exposed to the stress of lifting weights, it is plausible that your joints, ligaments, and tendons will as well.
  2. Tissue damage does not equal pain – If you are over 30 years old, an MRI will almost assuredly show cumulative trauma (i.e. arthritis) in a variety of places, even in places that you experience no pain (
  3. Different people are different – Asymmetry is the rule, not the exception. Being irregular is regular. Therefore, what is dysfunctional for one may very well be optimal for another.

With this surprising evidence, what must we do to stay healthy and reduce pain? I have several recommendations:

  1. Don’t focus on pain or even posture. Instead, focus on moving better. In my opinion, ergonomics, though important, has limits in its value. If your primary focus is in making static postures ideal, you’re missing the boat. However, if you preserve your ability to move to your fullest, you will be able to reduce stress – and therefore wear and tear – on specific body parts. In fact, I believe that individuals (and corporations, for that matter) will succeed physically in the future if they focus on strategies that emphasize moving better for longer.
  2. Pay attention to postures with strenuous activity. I don’t believe that a perfect posture is necessary, but keeping your movement near the “middle third” of movement (i.e. near neutral) will make you more efficient and enhance your muscular endurance. Yes, posture (or, more specifically, biomechanics) still matters. For this reason, how we land after jumping is critical. Your spinal alignment during a deadlift matters greatly. The angles of and forces on a pitcher’s various body parts can enhance throwing tolerance. When mechanical stress is greater, so too is the need for good alignment.
  3. Change postures often. We’ve all experienced the discomfort after a long plane ride in a cramped seat. Waking up on the couch with the neck cranked. Moving the neck or shoulder after a long cell phone conversation. For this reason, we regularly preach the value of recovery stretching, which is simply using movement to deliver blood (and key nutrients) to the tissues that are prone to overuse and overexertion. Make it a habit to do active movement for 10-15 seconds every 10-15 minutes you are in a static posture.
  4. Dose your stress appropriately. The value of physical therapy and occupational therapy – and even physical fitness – is taking advantage of the body’s ability to adapt to change. It takes advantage of a concept known as Wolff’s Law ( At an appropriate time, a broken bone needs to experience weightbearing loads. The right dosage at the right time helps the bone strengthen. We now know that people with osteoporosis do well with walking programs for the same reason. Think about how you work in the garden each spring. With appropriate dosage (and gloves), you’ll develop a callous instead of a blister. Regular movement at the right dosage helps create a physical stress that makes the tissues become stronger.

If you’ve ever received messages that encourage you to perfect your posture, I encourage you to ask good questions. Have you ever asked your medical provider why they are using a specific technique to help you? If so, I hope they have evidence to support their interventions. I encourage you to email me any questions you have about your musculoskeletal health. I’d love to help you find evidence-based answers so that you can move better, feel better, and function better.

Make 2016 the year you resolve to move better!