Slouch ≠ Ouch Part 1
“Sit up straight.” “Fix your posture.” “Quit slouching.”
We’ve all been told this at some point, either by parents, teachers, or doctors. But did anyone ever actually explain why? If they did, then by all means please message me what their rationale was. My best bet would be to say they didn’t really give you an explanation, but simply used it to justify why they thought your (insert body part) was hurting. Well, fortunately for you I am going to clear all of that up for you.
POSTURE IS NOT THE CAUSE OF YOUR PAIN.
If that’s all you needed to hear for validation to tell the anti-slouchers to buzz off, then there you have it. You’re welcome. However, if you are a reasonable human being with an appropriate amount of skepticism and curiosity then I suggest you keep reading for the research that backs my statement.
So, what is this fallacy that there is a perfect or optimal way to sit or stand? Who determines that? What happened to each body is different? Different strokes for different folks? No? Ok, fine whatever.
This belief that there is a perfect posture that is set to put all of your muscles, joints, etc in perfect alignment flat out does not make sense. Our body moves in a million different ways, so how is there one specific posture that is supposed to be ideal for all of them? There isn’t, and there can’t be. Keep reading to figure out why.
“Posture is a body’s attitude or the positioning of the limbs when standing or sitting” (Kripa & Kaur, 2021). If posture is acknowledged simply as an attitude, can’t we agree that means it is fluid? There is yet to be established, credible evidence that identifies one specific position as ideal to eliminate back pain. The argument that rounded shoulders, slouched posture, or anterior pelvic tilt are associated with increased pain experiences is based on unfounded and biased research that tends to scare people more than help. But that’s the state of modern healthcare for you, unfortunately.
I’m going to start with clearing up the misconception of posture on low back pain with this first post, because that seems to be one that applies to more people. Anterior pelvic tilt for those that don’t quite understand that term is synonymous with lumbar lordosis, or an increased arch in your low back with your hips rocking forward a bit (see image below).
The posture I am referring to in this post is represented on the left in this image - lumbar lordosis.
Yes, this position can place a bit more stress on the joints in your lumbar vertebrae, but the human body is extremely adaptable to load. A study published in 2011 by Lee Herrington looked at resting pelvic angles in asymptomatic adults. The study found that of the 65 male subjects tested, 85% OF THEM PRESENTED WITH A RESTING ANTERIOR PELVIC TILT. For the 55 females tested, 71% OF THEM PRESENTED WITH RESTING ANTERIOR PELVIC TILT. To take things a little further, they assessed the degree of the tilt on the right versus left sides of the pelvis. Remarkably, the males on average showed a 7% tilt differential (6.74° on the left and 6.239° on the right) while the females had a 4% average difference (6.936° left, 6.633° right). Hmm, so anterior tilt is supposedly a big no-no and causes pain…then your back must be completely screwed if even your asymmetry is asymmetrical! Whatever your provider is telling you about your pelvic tilt is most likely painting their finding of your asymmetry as a negative, but that shouldn’t be the case. If it’s not causing you pain, then don’t mess with it. Pretty self-explanatory. I’m sure many of you though are curious what is causing any chronic pain you are experiencing in your low back. Now obviously when something traumatic happens it is easier to point fingers, but if you don’t remember anything major occurring then why is your back all of a sudden hurting?
I mean, it could be a lot of things. In 2002, Nourbakhsh and Arab looked at the potential associations between a bunch of different physical characteristics and low back pain in 600 subjects. Their conclusion was that it really did not have a whole lot to do with their structure or alignment, but more so about the weakness of associated musculature. Curve of their lower back (lumbar lordosis), degree of their pelvic tilt, leg length discrepancies, or even the length of their core muscles were no different between individuals with or without low back pain.
Chart from Nourbakhsh and Arab, 2002.
What was different though, was the strength and endurance of the abdominal and back extensor muscle groups. Individuals with low back pain were found to be significantly weaker in those two categories. The only problem though? Deciding which came first, the chicken or the egg. This study acknowledges its limitations in that it cannot draw a definitive conclusion whether the back pain led to the weakness or if the weakness caused the back pain. Regardless, they agree it is not due to your swayback or your anterior pelvic tilt, i.e. not your posture.
Maybe it is time we start to look not so much at the posture itself, but the associated actions (or lack of action) in that position. The spine is an extremely robust and resilient structure, designed to take on loads and forces from all angles. Clinicians making the claim that there is a one-size-fits-all spinal position implies that each and every person is being exposed to the same movements. I’m not sure about you, but I know I am not enduring the same physical stress as a construction worker. And I know that construction worker isn’t spending as much time sitting down as the librarian. Not that either one is more compromising than the other when it comes to stress on the spine and its surrounding tissues (allegedly), but it just goes to show that everyone moves (and fails to move) in different ways. A JOSPT article from 2019 by Slater and friends lays out a pretty clean outline (below) that sums up most of my ramblings into seven simple guidelines.
Graphic from Slater et al., 2019.
If anything from this post becomes engrained into your memory, please make it be that graphic. No, seriously. Go look at it again.
Well, that concludes the first part of my posture rant. I hope you enjoyed and were able to take away something new from this, and if you didn’t, well I don’t really care. Either way you read my ramblings and have at least been provided the information, what you do with it is up to you. Now sit up straight. JK.
Stay tuned for Slouch ≠ Ouch Part 2, which will be covering the posture’s effect (or lack of) on neck and shoulder pain. #whatsNEXT
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