Perpetuating the Idea that Poor Posture Causes Pain…STOP IT!

Earlier today, a colleague sent me a link to an article in a Pittsburgh paper discussing how “Devices, Exercises Can Keep Technology From Being a Pain”.  Out of the gates, the author makes the claim, “After years of telling us to sit up straight and don’t slouch, mom’s advice has stood the test of time.”  I immediately did a #facepalm.   And I did this for a couple of reasons.
Just a few days ago, the APTA announced that Dr. Anthony Delitto, PT, PhD, FAPTA, from the University of Pittsburgh, received a huge grant (millions) to study:  “Targeted Interventions to Prevent Chronic Low Back Pain in High Risk Patients: A Multi-Site Pragmatic RCT.” This study will assess the transition from acute low back pain (LBP) to chronic LBP in an outpatient primary care physician (PCP) setting.  The researchers will be comparing usual care with a team approach of PCPs, and physical therapists who will deliver cognitive behavioral therapy.  This study will further assess the bio-psycho-social complexities of LBP and the effects of approaching care “beyond anatomy”.
Now back to the article in the paper.   It had zero to do with this ground-breaking study out of Pittsburgh.  Zero.  Instead, the author perpetuated the myth that a causative relationship exists between “posture and pain”.   For example, he states: “The role of posture in our lives and the dangers of ignoring it are getting more attention lately, including the development of new products, from posture shoes and shirts to step trackers and home body-alignment systems meant to address it.”   Let’s look at these words closely: “DANGERS OF IGNORING IT”….
In the article, the author cited several clinicians in the Pittsburgh area (again, Dr. Delitto or the funding he received to study the complexity of LBP was not mentioned): “We are seeing injuries arise on a regular basis which stem from poor posture,” Read says. About 20 percent of the patients he treats for low-back pain require education and correction of postural issues. That percentage is more than doubled for patients visiting him for neck pain. 

Technology, including sitting in poorly designed chairs for long periods at computers or bent over smartphones, seems to be the newest culprit.”

Later in the article, this author promotes “posture products”…Yes, products you can purchase to help provide postural control.

We need to quit perpetuating this myth.  Seriously.  We have learned so much about pain.  We are doing wonderful research to better understand the complexities of pain.  So why do we keep doing this?   We all need to be better advocates for what we are doing and what we are learning.  Let’s move past the 90’s…and on to 2015.
 

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  • I would wonder if you are writing this to argue the word “cause?” What if we changed CAUSED to the words ASSOCIATED WITH?
    EXAMPLES:
    1. Cycling is associated with neck pain. Thoracic flexion with an extension stress at a segment of the cervical spine.
    2. Prolonged seated flexion results in stress to collagen, ie. the stress strain curve of tissue adaptation: a low level stress over a long period of time.
    In both these examples place the ‘wrong’ body type in the ‘wrong’ environment and pain will be associated with these postures.

    steve karas March 1, 2015 10:10 pm Reply
  • Glad to see Delitto is/has moved away from his prior algorithms.

    Bill Jones March 1, 2015 11:47 pm Reply
  • Steve,
    What do you mean by “associated”?

    Barrett Dorko March 2, 2015 8:18 am Reply
    • I mean sometimes when you have one (poor posture) you have the other (pain) and sometimes you don’t. So maybe we look at those that are several deviations away from “normal” and are involved in activities, then when modified, decrease the main complaint that they came to us to alleviate.
      I am glad to accept Joe’s title.
      Here is an example: A 300 pound male with severe pronation starts running to loose weight. He presents with complaints of PFP. We provide arch supports and when he runs on a treadmill he has less pain. Certainly not saying in a “normal runner” with some pronation I would treat them same way….

      stevenak66 March 2, 2015 12:54 pm
    • So basically it CAN be a cause of pain. But is not THE cause of LBP. Is that what your driving at?

      ShaneB March 2, 2015 7:41 pm
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    • Not to answer for Steve but i think we have the classic difference between Causation and Correlation. I believe that when Steve uses the word “associated” he could also substitute the word “Correlated”. I believe this distinction should give you a little more clarity.

      therapist84 March 3, 2015 12:41 am
    • Shane,
      Yes, sounds right.
      Looking at EXTREMES of posture, I don’t think we can completely ignore it, but looking for subtleties or correcting posture–in most cases—because of pain, probably not appropriate.

      stevenak66 March 3, 2015 8:46 am
  • I would agree that pain is complex and pain science has come a long way. However also understanding that alignment of joints helps to put much less stress on tissues is also extremely logical. I don’t completely agree with your title to ‘stop perpetuating the myth that posture causes pain’ Maybe the way we move or don’t move in and out or hold postures does create, correlate, associate with what our brain feels as pain.
    Having been a professional athlete for 15 years I can tell you that if I did an extension of my leg to the side (developpe a la seconde) and chose to not utilize my turnout from my hip and instead lift my leg initially with my hip flexors this would cause an impingement in my hip …. this is incorrect alignment and causes stress and friction and overuse of muscles that are not intended to sustain this movement over years of dancing. I am also a DPT and think it is all too common to throw the ‘baby out with the bathwater’ when we learn something new. Let’s think about forward head posture. This puts stress on most if not all of the posterior elements of the neck and can when muscles become too fatigued to sustain this create shearing most commonly at C5/C6. The body responds just as Wolff’s law says and an increase in fatty tissue is laid down over T1 to ‘protect the neck’ thus making the job of taking the stress off these joints even more difficult. Pain can be created by this scenario. I feel that an argument in semantics often ensues about posture/alignment/ and pain. To say ‘Stop doing this ,,,perpetuating the myth.’ oversimplifies the whole picture as well as the neuroscience behind pain.
    That is my two cents.

    Lisa Apple March 4, 2015 1:03 pm Reply
    • Hey Lisa,
      Thanks for the thoughtful reply. This post was in regard to a perpetuated belief that there is a causative relationship between posture and pain. I agree that increased stress may be placed on tissues when we move certain ways. Unfortunately, the word pain is often interchanged with mechanical stress, which complicates things a bit. Dr. Adam Rufa, from SUNY Upstate (and contributor on FTPT) recently published this narrative review on the topic of SAI and posture. I would highlight recommend the readers check this out, to better understand what we know from a research perspective, and tease out what we believe from an antidotal/observational perspective: http://www.maneyonline.com/doi/abs/10.1179/1743288X14Y.0000000151?journalCode=ptr

      josephbrence March 4, 2015 1:21 pm
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