Pain and Posture
Is it directly related? Seems to be some room for argument because there are some people with horrible posture that suffer no pain at the moment and some people with better posture that do have pain. The answer to this is unfortunately not a bold black and white statement. Firstly, let’s define Posture. Here is an accurate but mouth full definition by the Brookbush Institute: “Ideal arthro- and osteo- kinematics maintained by optimal myofascial activity and length, as a result of accurate sensation, integration and activation of the nervous system both statically and dynamically” or more simply it is a balanced tension across all the joints in alignment and out. Is the spine the only part of the body responsible for posture? No, every joint in the body has posture from your toes, feet, ankle, knees, hip, ribcage, shoulders, arms, neck and even the tongue. Posture is a very inclusive and whole body definition. To isolate an issue to only one aspect of posture is a very unjustified and problematic analysis.
Secondly, let us ask if there is a perfect cookie cutter posture that everyone can exactly maintain and measure? Everyone has their own personal asymmetries as it relates to proportion, bone formation, muscle structure, muscle attachments, broken bones, surgery and body types. It will be very difficult to calculate a definitive value that can’t be argued with so many variants. Nature is not either perfect or definitive in its results. So to calculate a perfect posture will always be moot. Is it a waste of energy? I'll explain my stance in a moment And lastly, what is pain and why do we feel it? Pain is a signal to the brain reporting there is something wrong and attention is needed. The sensation of pain is often tethered to an instinct to withdraw and protect that has guarded us from damage and death for epochs. Without it we would likely not have survived. So, ignoring the pain or numbing it away can likely lead to more damage, injury, surgery or all three. Is pain avoidable as we age? Is there even a relationship to posture and pain? What about the studies that looked at Anterior pelvic tilt for hundreds of individuals and concluded that the degree of tilt did not correlate with lower back pain because some subjects did not express pain at the moment? Scientific evidence right? Short sighted and limited but scientific. Most of the tests simply compared a group of people in pain to a group of people not expressing pain. There have been tons of similar studies on the shoulder, cervical spine, thoracic spine… all concluding that position is not the definitive driver of pain. I will partially agree. Is the posture causing the pain or the pain causing the posture? Several studies have also proven posture is relevant to pain. They are both NOT WRONG. There is missing context and many layers to decipher. There is so much more to the relevance of pain than posture alone. All the people in those studies have adapted to their environment, some better than others at the moment but, what happens over time.
Off hand none of these studies compared dynamic movement patterns or force loading through the body with a decent gait cycle analysis.
Notice, I have said “at the moment” a couple of times. As a student and as an educator I have learned to pay attention to things that repeat.
These studies that disprove and prove posture is related to pain are both isolated in their approach. Comparing two people with excessive lordosis, one with pain and one without. Comparing a single joint action to a person in pain to one that is not. They are missing so much context for the sake to simplify the study and control parameters.
The missing context is dynamic movement. Within movement, if the joint is unstable while it accepts a load from deceleration or acceleration it will have a tendency of moving out of position. This puts stress on the cartilage, ligature and causes overuse of the antagonist muscle as it struggles to protect the joint from damage. This is where posture, alignment and muscle length tension relationships come into play as it relates to pain and non contact injuries. It is not solely posture that dictates pain but posture is a predictable pattern of instability. Our posture is designed to resist gravity and optimize our joints for horizontal motion and efficiency. I will venture to say there is no perfect poster just an ideal one. An approximation of perfection within a imperfect body.
Here is my current understanding. An unstable joint that has become sloppy will cause friction in the joint capsule itself or the surrounding tissues eventually causing inflammation that will irritate a nerve. That discomfort often causes a guarding reflex and the body will adapt to avoid that issue which can cause an imbalance somewhere else in the body. But the poor posture has avoided the pain at the moment. You can see how this can compound and lead to discomforts far from the original location of pain. Inflammation or cumulative micro traumas from friction of misaligned joints is the usual suspect when it comes to pain. So give it time. I have conducted hundreds of interviews with our elderly and they often repeated in some form “I wish I would have paid closer attention to my body when I was younger”.
If a joint can remain in alignment with the rest of the body and a balanced tension can be maintained during its operational range of motion the likelihood of damage has just been minimized. Avoiding unnecessary wear and tear is paramount for longevity and freedom of movement into the golden years.
Posture, Movement Patterns, Time, Inflammation, Diet, Stressors and Impacts have relevance to pain and injury all in tandem. The body is a series of integrated systems that responds as a whole. If your training doesn't take posture into consideration then at some point it boils down to likelihoods, percentages and playing the odds against pain and injury. So in conclusion, YES, posture is part of the puzzle when it comes to pain and injury but not the sole proprietor. "Good" and "bad" posture isn't the problem. It is us getting stuck in a particular posture and being unable to move through it to find the ideal few. It all depends on context.
Let's do our best to retrain our training methods and medical practices to include the body as a whole and not individual pieces. Look a little deeper.