Being one of the most noticeable dissimilarities of appearance, posture has become the most blamed asymmetry for almost everything.
Let’s see how posture myths and advice affect us.
‘ Posture is a composite of all joint positions in space at any given time ‘
Although defining posture in this manner is sufficient to serve the purpose. But, misinterpretation of the syntax and pulling the terms out of proportion to ‘give a meaning’ to already meaningful words produces the current posture consensus’s disarray.
An example of misinterpretation of syntax, in this case, would be to think of posture as only a static entity or something that is entirely biomechanical and can be evaluated in a certain manner under similar conditions accurately and similarly for every individual.
Also, common practice is to pull the definition out of its intended meaning to accommodate ideologies and beliefs, for instance, the phrase ‘all joint positions’ from the definition can very conveniently be dissected into local anatomical landmarks; which are to be blamed for very specific problems, as this has been the trend in all posture literature and discussions for a very long time now.
Does this mean it is wrong? Blaming certain postures for certain conditions is too far-fetched? Does the evidence say something else?
All this is up for discussion, debate, research, and further scrutiny, but what we have to keep in mind is; is the ‘blaming’ posture justified? Are we blaming posture too much? Are we overanalyzing that which is affected by many more aspects of life than just anatomy or biomechanics?
Let’s just take a look at what Google has to say about posture and what to do about it.
With all the literature and evidence of posture available currently, this definition of posture is indeed correct in defining ‘posture’ but is also very limited in how it educates and how much it leaves for the imagination of the general population, leaving them very much in doubt and susceptible to the qualms of the ‘Posture Gurus’.
What all the popular ‘tips and tricks’ segments related to posture seem to be advising is; to be wary of the ‘bad posture’ or to be ‘as straight as a pole’ when you sit, this is backed by the claims that what ‘text neck’, ‘smartphone syndrome’, ‘slouchy sitting’ and all such positions does to your spine is responsible for any or every ache and pain in your back, neck, hip, knee, foot, shoulders, soul, spirit, and consciousness.
There is some merit to these claims though, as habits (*habits does not mean bad posture) trigger pains when other factors are contributing as well, but there is very little evidence that supports such statements, in fact, researchers absolutely disagree with most of these direct associations.
Unfortunate is the fact that most practitioners still subscribe to this school of thought, this shows that there still exists a rigidity and resistance towards change in medical perspective from biomedical to the biopsychosocial model. Still, the universal agreement of non-evidence-based practice is to advise everyone to “sit up straight” with no exceptions.
This has been going on for far too long to be questioned lightly now.
This belief of wrong sitting, standing, bending, and lifting has not only led to the notion that bad posture is all there is to blame for back pain, but it has also led to a myriad of interventions and miracle devices that claim to ‘fix’ posture instantly.
Ads about posture aids, articles about ‘incorrect’ or ‘damaging’ postures, and social stereotypes that relate posture to desirability, attractiveness, morality, dignity, etc. reinforce these non-evidence-based beliefs even further.
The most infamous of all, Spinal Flexion;
Spinal flexion has already been criminalized enough for low back pain that avoidance of spinal flexion during sitting and lifting is considered to be the safest bet, this has also led to some very mechanical and almost comical ways of lifting without spinal flexion; that can even cause LBP (Low Back Pain) in some if not most.
Although some evidence states a relation between awkward postures while lifting and low back pain, none equates avoiding spinal flexion to a lowered incidence of low back pain. Another claim stems from this: core activation protects the spine from getting injured, and it produces correct posture in all. Even though the increased muscular effort of core activation activities produces a more erect posture, this too isn’t equated to more stability and reduced incidence by evidence, instead, these ideas produce movement avoidance and lead to low self-efficacy in movements that can cause injury secondarily.
Rather, it is important to be aware that certain postures may not be tolerated well while in pain, but are in no way causing back pain, and that people have all sorts of variations (in spinal curvature, body fat distribution, personal habits, emotional and psychological factors), individual nuances can not and must never be ignored when posture comes into mind, as comfortable posture isn’t same for all.
Words and their impacts are often underappreciated in clinical communication, instead of guiding our patients to sit a certain way, sit up straight, tuck this in, lift that, levitate, be invisible, etc.
Advising and reassuring the patient into a more relaxed posture must be considered. Educating them about the fact that protective avoidance for acute pain might not be needed anymore, and even if one necessary posture (used in activities of daily living or professionally) is provocative there can always be a modification in movement and not moving in a certain way or direction should never be the way out.
Almost everyone has at least once been schooled on their posture and how “your back pain is all due to bad posture, you should buy that posture belt, or you must sit up straight or else…”, posture education somehow has become an endless loop of ‘or else’ and threats.
So, next time any such advice comes your way, be respectful and spread some lovely corrections their way, but be gentle, their ‘posture views’ could be very old, rusty, and fragile.
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Cover Photo by Polina Tankilevitch from Pexels
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