Is my posture causing my back pain?

I’m sure you’ve heard all the following about posture: 

    • Bad posture will damage you.
    • Bad posture causes chronic pain.
    • You should sit/stand up straight.
    • You should strengthen your core to fix your posture

    But these ideas are slowly being undermined by researchers and physios who have looked at the large body of evidence on posture and pain (this is not an under-researched area!)

    Hopefully if you see a clued up physio these days they will tell you:

    • Posture? You don’t need to worry about it! Your best posture is your next posture : just don’t get fixed in one position too long.

    • Core strength? It has little/no relationship to pain, so just be as active as you can, doing what you enjoy.

    So, is posture causing my back pain?

    Maybe. But often posture is picked on as an obvious visible thing, when actually it is your poor sleep and high stress levels that are contributing more to your pain.

    But your personal experience might feel like your posture is what causes your pain. Are you just one of the few  for whom posture is significant, or might there be more to this story?

    Me as an example: I worked hard at having a good posture and a strong core for years, while my pain worsened and worsened (I’m a ridiculously compliant patient…)

    Also me: my natural posture changed with Alexander technique. I put zero effort into it, but my default posture is ‘good’. I now consider myself recovered from chronic pain.

    Of course this is just an n=1  study, and not a controlled one. Posture was just one of many things that changed for me, so is only a piece of the pain puzzle. But I gave 2 different approaches to posture a good long try and one was associated with recovery and one with deteriorating pain. People do seem to get relief from pain when ‘working on’ their posture with Alexander Technique, so what might be going on? 

    It comes down to the definition of posture

    In order to study posture you have to measure something. You are going to measure the position someone holds, and the relationship of one bit of the body to the other e.g. the head to the spine or how curved the spine is.

    That seems reasonable right? Posture is the position of the body. 

    True, that is the common definition of posture. But perhaps we need to redefine it. 

    If you think about it, the same position could be held either stiffly and tightly, or loosely, like you are balancing in it.

    If you took a photo of each, and drew plumb lines they might be exactly the same. But the experience of being in that posture is very different; a looser posture is much less tense and it’s got a little bit of movement in it all the time, tiny micromovements, rather than being fixed and held.

    If you hold a posture lightly then when you come to move you don’t have fight the resistance of those tight muscles, so you can move more easily. So maybe you make bigger movements a bit more often too, like slightly leaning forward and back at the hip when sitting. As the clued up physios are trying to encourage you, more movement and variety is good for pain. If the posture is a light poise then more movement happens naturally. It might be a rigidly held posture that is causing your back pain, rather than the position itself being a big problem.

    The difference between the stiff posture and the poised posture is not the ‘position’ definition of posture, but the degree and dynamism of postural tone. Postural tone is hard to measure, as the muscle work involved can be so low it’s not reliably measurable on an EEG. So it’s not something is addressed in scientific studies much as yet.

    A more useful way of thinking about posture might be as ‘a state of readiness’. If you don’t have enough tone you will slump and sink and can’t support yourself properly. Too much, and you have to fight yourself just to stay still or to make a movement. Having ‘appropriate tone’ for any given position or movement is what makes our life easiest, and probably the most comfortable.

    So this will probably be a fruitful area for science as we work out how to measure what is different about the way one person holds a position or moves  versus another, and posture, in this sense, is a ’cause’ of pain in more cases. See for the latest on this area.

    What’s the baby and what’s bath water when it comes to posture and pain?

    This is an area I follow with interest and my opinion may (should!) change with the evidence. 

    For now, I find much that’s helpful in the Alexander approach. Being told posture doesn’t matter when your experience is that certain postures cause pain is unhelpful given that not all postures are avoidable.  If it hurts when sitting at your desk? Sure, swap around chairs, take more movement breaks, alternate slouching and sitting up. These are great tips and enough to sort out a pain problem for many.

    But what if none of that helps you much? If sitting or standing remains a torture the instructions to ‘move more’ and ‘change posture frequently’ are more helpful than ‘sit up straight’ perhaps, but can feel pretty inadequate.

    But there is more to posture. It can be changed in a way that may improve your ability to maintain positions comfortably for longer – by learning how to use appropriate postural tone, micromovement, and having greater body awareness that will prompt you to adjust postures more often. That’s the concept of posture that is worth keeping.




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