• There is no association between leg length differences and back pain.
• 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.
• 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.

Why does posture not associate 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 (http://www.bettermovement.org/blog/2012/the-trouble-with-mris-and-my-brother).
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?

1. Don’t focus on pain or even posture. Instead, focus on moving better. Ergonomics, though important, have limits in 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.
2. Pay attention to postures with strenuous activity. Perfect posture isn’t necessary, but keeping your movement 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 or waking up on the couch with a kinked neck. For this reason, we regularly preach the value of recovery stretching, which is simply using movement to deliver blood & 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’re in a static posture.
4. Dose your stress appropriately. The value of physical therapy, 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.

How can we help?

Call 866-588-0230 with any questions you have about posture or other musculoskeletal problems. We’d love to help you find evidence-based answers so that you can move better, feel better, and function better.

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