It turns out that people naturally avoid the most ineffective responses to most significant postural challenges, because homo sapiens is naturally allergic to strain and pain. And although postural laziness might seem obviously evil,11 people also naturally tend to keep up their postural fitness for the things they care about (if you like playing sports, you play them).
So the “problem” of poor posture is generally minor and self-limiting. The worst problems are avoided naturally. The postural fitness that matters the most is taken care of almost automatically. And the issues that remain are relatively minor.
Doing it the hard way!
How long do you think you could work like this without regretting it?
That said, homo sapiens can also be surprisingly self-defeating! In fact, this seems to be a weird feature of “higher” intelligence.12 Human beings do not always avoid unnecessary strain, and we can be surprisingly prone to doing things the hard way. So we probably do make some postural mistakes and develop bad habits, because we are careless, or our big brain is placing too much emphasis on another priority, or because don’t even know that we’re doing something wrong (like the knees-tucked-under-the-chair example). Fortunately, the scientific evidence strongly suggests that doing things the hard way, posturally speaking, is probably not all that harmful. Here are some interesting examples…
- For instance, a leg length difference is portrayed by many therapists, especially chiropractors and massage therapists, as a serious postural problem that is pretty much guaranteed to cause pain. And yet it’s been proven that people with significant leg length differences suffer from no more back pain than anyone else.13
- And soccer athletes with large differences in the mass of their low back and hip muscles — exactly the kind of “imbalance” that is targeted for repair by therapists everywhere — don’t actually get hurt any more often than soccer players with more evenly distributed muscle mass.14
- Or consider this study of coordination exercises for the neck: it showed that the exercises had exactly the intended effect on coordination and posture … but no effect on neck pain at all.15 What’s the point of posture exercise if it doesn’t actually help with pain problems? Maybe none! That’s the point.
All of this flies in the face of “posturology.” That’s the cheesy, popular term for the mostly made-up “discipline” of studying the relationship between posture and pain, and even between posture and diseases.16 Posturologists (I can barely type that word with a straight face) tend to assume their own conclusion: they assume that poor posture causes pain, and then look for confirmation of that. And so there are many, many scientific papers that seem to present evidence of a connection between posture and pain, but most of them suck — here’s a nice appalling example17 — and “posturology” is mostly a slummy pseudoscientific research backwater. If posturology research was of better quality, we might actually learn something from it. But most of it must be chucked or taken with a huge grain of salt, at best.
Posture is only one of many hypothetical factors that contribute to pain problems, and in many cases it probably isn’t contributing at all. This is obvious from a simple observation: there are a lot of people with perfectly good posture who are in terrible pain, and also many people with terrible posture but no pain.
The most classic poor posture of them all — a hunched upper back, with the shoulders rolled forward — is widely assumed to be a cause of shoulder and back pain… but the assumption is almost certainly wrong. This has been studied to death — for a posture problem. According the collective results of ten different experiments it is almost certainly not a cause of shoulder pain.18 A large 1994 study of kyphosis in older women found no connection either: not even the 10% with the worst kyphosis had “substantial chronic back pain, disability, or poor health.”19 There’s just nothing there. Hunchers are just not wrecking their shoulders and backs.
More exotically, I had a truly scoliotic patient, an elderly woman with a blatant S-curve in her spine that she has had since she was a child. Despite this obvious postural stress, she suffered nothing worse than annoying back stiffness in her whole life. Another much younger woman, but with extreme scoliosis, was also amazingly pain-free.20 Meanwhile, in my ten-year career as a massage therapist, I had a steady stream of people through my office with severe, debilitating back pain … and perfectly ordinary posture. What’s the difference between these patients?
Research has shown that abnormal curvature of the cervical spine is actually not closely associated with neck pain.
Another good example: a client with a pronounced torticollis (“wry neck”), and who was even little deformed by it.21 But, once again, this middle-aged patient suffers from no more than irritating chronic discomfort, while many people with much more normal head posture are just about driven nuts by neck pain (including yours truly, which is why I wrote a book about neck pain).
There are many better-documented stories like this, like the case of a serious traumatic cervical dislocation reported in New England Journal of Medicine in 2010, notable for being mostly asymptomatic: just torticollis and stiffness, but no pain, weakness, or altered sensation. That such a serious injury could ever have that little impact on a person is quite interesting, and it puts the hazard of “poor posture” in some perspective.22 Research has shown that abnormal curvature of the cervical spine is not closely associated with neck pain23 and is probably not clinically significant.24
A particularly larger 2016 study of 1100 Australian teenagers showed that there was no correlation — none at all — between their neck posture and neck pain, contrary to all the fear-mongering we’ve heard about “text neck” in the last couple years.25
For balance, I’ll acknowledge there are studies that say otherwise26 … but mostly just crappy studies in my opinion,27 and regardless they do not remotely prove that abnormal curvature actually causes pain.28
There’s no correlation between this behaviour & neck pain or headaches in teenagers.
In general, the story is the same for the low back — the other posture hot spot. For instance, you could hardly ask for a more clichéd notion about posture than the idea that slouching is bad for your back. Teens slouch a lot, and they do get back pain (though much less than adults do), so if posture is an important factor in back pain, it shouldn’t be too hard to find a connection. But a biggish 2011 study did not: “a greater degree of slump in sitting was only weakly associated with adolescent back pain.”29 No smoking gun there!
Physical therapists tend to make too much fuss over extremely subtle postural “problems,” which match up even more poorly with pain than the obvious postural problems.30 The popularity of such theories generally suggests to me that posture is often a therapeutic red herring. Both its importance and its “fixability” are routinely overestimated by professionals in a self-serving way.
And yet that doesn’t mean there isn’t still something of interest going on. Health problems don’t have to be severe to be of interest.
I enjoy “pathologizing” posture. It gives me a sense of purpose.
Les Glennie, Registered Massage Therapist (yes, tongue-in-cheek)