Posture and whether or not we as therapist should work to improve it in our patients has been under some debate in social media, blogs, and in the literature. There has been limited research showing that individuals with greater postural dysfunction have increased chance of developing back or neck pain. Back pain is common in people with both good and bad posture, and people with bad posture don’t always have pain. In addition, newer research has advanced our understanding of the physiology of pain states and their complexity. Detractors have argued that postural dysfunction is common (and therefore insignificant) and that educating someone about changing it can add to their overall fear and anxiety surrounding their condition which is undesirable. I believe posture/body alignment is one of the most important key educational components we can provide to our patients for a variety of reasons.

First, the human body is subject to and governed by the laws of physics. As the provided pictures will illustrate. Picture A is and example of the “Ideal Posture” (which is rarely seen) from a classic text by Florence Kendall, which allows visualization of spine structures and the dotted weight bearing line. Picture B a person who stands with their pelvis sheared forward and with increased kyphosis (curve) in their thoracic spine increases forces subjected to their spine and muscles in the following ways.

The weight bearing line is shifted from the vertebral bodies (most efficient weight bearing portion of spine) to the facet joints in the spine, nerve space is narrowed in the central canal/foreman, and the back muscles at the apex of the thoracic curve have increased tensile stress. Does this in and of itself mean person will develop pain? No, our body is able to adapt when stress is applied slowly over time and the development of pain has many other precipitating factors. However, when someone is acutely irritated or has chronically sensitive tissues changing their body position can immediately reduce their symptoms. There is a multitude of empirical evidence, as this has been demonstrated consistently in the clinic with my patients over the last 15 years of practice.

Second, body alignment has a profound effect on how our nervous system responds and muscles function. For the preceding example when a person corrects their pelvic shear/body alignment they exhibit less pelvic drop at mid stance of their gait (if they had a stability deficit to start with), and their core stability with resisted trunk perturbation improves significantly. So their core activation and hip strength/stability is increased improving their movement/stability. Examples of how posture effects your movement can be felt by trying the following. Sit in a slumped position then try taking a deep breath, rotating your head/neck left/right, and then raise your arm overhead (not all at once try one then the other) paying attention to how difficult it is to perform. Then sit in an upright relaxed position and repeat the preceding. How difficult is slumped versus sitting and does it feel any more stressful to the body? How do you feel when you sit in an upright, confident, and relaxed posture?

And last but not least, studies have shown that your body position or posture causes hormonal fluctuations in cortisol and testosterone levels. Cortisol is a stress related hormone that can increase inflammation in the body and perception of pain. By positioning yourself in a more upright confident position for as little as two minutes cortisol levels reduce, testosterone levels increase, and the person feels more confident and empowered. So posture has rapid implications on what we think and feel. Here is a link to a TED talk on the subject http://articles.mercola.com/sites/articles/archive/2012/12/31/body-language.aspx .

There are several important points to remember. First posture/body alignment is the foundation from which we move. How we hold our body and how we move impacts us physically and emotionally. All of us have posture and alignment inefficiencies that can be worked on and improved. Try to think of it as improving to a positive baseline position which is relaxed and confident. Good body alignment should not add to fear or worry, but rather be viewed as a method of moving more efficiently and with less pain that can empower you to better health. Lastly, improving your body alignment and posture involves changing long time movement habits and is therefore not easily accomplished, which is one of the reasons it is difficult to prove its efficacy as an effective intervention in the literature. However if you can increase your awareness and work to improve, without being worried about achieving perfection, you can make long term change that can positively impact your physical and mental health.

By Clarke Tanner PT, MPT, COMT, ATC, CSCS, FMSC and your team at THRIVE PT

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