THE TRUTH ABOUT POSTURE

We often blame postures we assume throughout the day as the main cause of back pain. A lot of sources on the web and google searches may advocate having a good posture and why bad postures often results in pain.

Now with many people working from home amid this pandemic, we often work relentlessly focussed on our screens ignoring what body position we assume.

Now consider this, when we sit we often are advised about keeping spine straight with shoulder relaxed and elbows supported. And when we try to maintain a good posture by following the rules we often find it exhausting and tiring.

Also, the idea of good and bad posture has become so engrained in our thoughts that we often blame our bad posture for our low back pain and neck issues. Now to do something about it, we often consider purchasing those lumbar and cervical support belts, ergonomic chairs, posture correction belts. Which has become a big business in today’s world. We may also go one step ahead to ergonomically optimise our workplace environment.

What is posture?

Posture is generally explained as relative positions assumed by body parts. A good posture being where there is muscular and skeletal balance that protects the part of the body from injury and progressive deformity. A Bad posture can be explained as any position assumed which causes increased strain on the supporting structures of the body and less efficient balance of the whole structure over its base of support.

Why do we blame bad posture for our back pain?

We often experience observation bias. When we observe something which is far from normal or as an imperfection we often blame it for the cause of our problems. Same happens to a health care professional addressing your back pain issue.

Many studies have shown that no single factor often causes back pain. We fail to observe the underlying process which often results in back pain. And in no time it becomes a wild goose chase.

EVIDENCE Studies have found that there is no difference between postures assumed by healthy and low back pain individuals. Moreover, no difference between lumbar lordosis (lower back curvature), range of motion of lumbar spine and lumbo-pelvic rhythm was found among the two groups. Now if no difference is there between the postures assumed, the question why do some people suffer from low back pain and others don’t remain unanswered. How consistent are lordosis, range of movement and lumbo-pelvic rhythm in people with and without back pain?

Do healthy people always maintain a good posture?

Now, if bad posture was really bad then healthy people must be into a healthy habit of assuming good posture. Contrary to that idea, healthy individuals sit more often in slump or stooped position and often maintain the so called bad posture.

EVIDENCE A study has shown that in 10mins duration of sitting, it was observed that spinal angles were flexed 24degress at lumbar and 12 deg at thoraco-lumbar regions in relation to standing erect in healthy as well as people with low back pain. This example shows that sitting in slump position doesn’t correlate with pain. Hence not all bad posture results in pain. Relationship between Hip Extension Range of Motion and Postural Alignment

What really causes back pain?

The main culprit for back pain is lack of mobility of the spine. Assuming prolonged posture irrespective of good or bad often results in back pain. Lack of mobility causes certain muscles to tighten and others to shorten (known as muscle imbalance). The inactivity also results in weakness of the postural muscles of the back and compromises core stability.

Why using posture correction belts worsen the situation?

Using an external support such as the lumbo-sacral or posture correction belt offloads our postural muscles from performing their basic function (which is to maintain posture). This overtime results in progressive weakness of these muscles and increase in pain. Moreover it also increases our dependency on these belts rather than our postural muscles to provide us support. The only time you might need such corsets is when you have undergone a major trauma of your spine or recovering from spinal surgery.

Why maintaining good posture is still important?

Good posture in sports has been advocated since a long time. While performing strenuous powerful and agile activities such as playing a certain sport, good posture helps in prevention of injury. While lifting a load or performing a certain action the force is transmitted through the kinetic chain. Kinetic chains are the neuromuscular and connective tissue interconnections from head to toes. For efficient transmission of force it’s very important that joints are aligned properly which only happens while assuming a good posture. Change in joint position may affect the transmission of force. As it influences recruitment sequence of the muscles and hence influences the overall movement pattern.

What can be done?

Addressing the underlying cause is very important. Mobility drills helps to improve the mobility of the spine. A planned and supervised flexibility and strengthening programme helps to improve the strength and postural stability of the body while performing any task. A very recent published in Systematic review analysing 45 RCTs (randomised control trials) shows that strength/resistance training along with coordination/stabilisation exercise programmes treat low back pain than any other therapeutic intervention. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials

This is the reason why McKenzie exercises and Alexander technique have gained so much popularity because when it comes to back pain #movementismedicine

TAKE HOME MESSAGE

• Posture is not the problem its your MOBILITY.
• Lumbar corsets and belts can make symptoms worse.
• Supervised mobility and strength training helps to treat and prevent back pain.
• Whether you’re on the floor, sitting in at your desk or even standing- always MOVE.

The best position is your next position.

David grey