This is the fourth post in a series about posture and its significance in preventing pain and optimizing performance and function. If you haven't yet, please read the first, second, and third posts in which we address the status of posture research, how static posture affects more than just static posture, and why posture is essential in more than just preventing pain.
What is Good Posture?
Everyone's anatomy is different, and therefore we don't have a singular image or ideal for "perfect posture." We're all going to look a little bit different. But, we have a basic set of principles that are universally applicable to identify good posture vs bad posture.
When we're on the hunt for good posture, there are three main things we should pay attention to:
1) a neutral spine - The spine is the centerpiece of it all. If your spine game isn't right, it means: a) you're sending out an open invitation to pain and injury, and not functioning as well as you could (should); and b) something connected to the spine (namely, everything else) isn't sitting right. If your spinal positioning is out of whack, it's a red flag that something needs fixing, ASAP.
2) positions of joint stability - Whether your focus is high-end athletic performance or just being a fully functional human being, your body is going to operate best and with the lowest risk for pain, injury, and dysfunction when you put it in the most stable positions. Hang out in sub-optimal positions where joint stability goes out the window, and you are willingly sacrificing performance, safety, and efficiency.
3) anterior-posterior balance - Your body is full of opposing forces. When they are in equilibrium, these opposing forces actually help provide an environment for optimal function and performance. But if one side is consistently favored, we find ourselves again sacrificing function and inviting injury. Think of the bony structures of your body as a stack of Lincoln Logs with all of the soft tissues (tendons, ligaments, muscles, skin) overlaying them and determining their inclination and position. If the soft tissues overlaying your beautiful Lincoln Log tower of bones are constantly pulled tight and tug extra hard on one side, what's going to happen to your tower? It's going to start caving over, and the tissues on the other side are going to be overstretched and have to put in extra work just to keep you from collapsing into a heap of dysfunctional misery.
All three of these basic principles tie into each other. If one is out of whack, chances are the other two will be as well. Also, all of these principles stem from the same goals: safety, efficiency, and proper function and performance. And we all want that, right? Do your body right and respect your posture.
Lastly, it should be noted with all of this talk about posture: all of the good posture in the world isn't going to fix your problems or help your performance if you're not moving. Your body needs to move, and good posture is our recipe for helping your body move right (read: safely, efficiently, and with the highest levels of performance).
In upcoming posts and videos, we will address, in further detail, what good posture looks like. We will break it down to focus in on major joints of the body and how each plays into good posture, and will touch on some common faults and ways to fix them.
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Stay swole.
Showing posts with label back pain. Show all posts
Showing posts with label back pain. Show all posts
Thursday, October 15, 2015
Thursday, October 1, 2015
Does Posture Matter? Episode 2: The Attack of the Misaligned Bones
This is the second post in a series addressing the hot topic of posture and whether it affects pain, function, and performance. In the first post, we concluded that, given the condition of current research, it is an error to dismiss the importance of posture in clinical practices and our everyday lives. (If you have not yet, please read the first post before continuing.)
In this post, we will look at a few reasons why posture does indeed matter.
Definition Interlude
Before proceeding, we should clarify in detail what posture is. In its most general sense, posture is a set of consistent positional patterns. Posture is reflexive (an unconscious response to stimuli) and habitual, and the physiological and psychological mechanisms that affect posture are always at work. Posture should not be confused with position—position is the alignment/orientation of the joints and soft tissues at a given moment, whereas posture represents an aggregate of the positions that we consistently and habitually occupy.
In addition, posture is a sort of self-expression. It is how you hold and present yourself in your given surroundings; and, in the same way that driving a red '70 Corvette says something different about you than driving a beige '99 Hyundai Accent, posture is an outward expression (sometimes genuine and sometimes contrived) of who you are. I don't intend to delve deeply into the psychological and psychosocial elements of posture in this post, but it deserves mention.
As suggested in my first post, posture can also be broken down into either dynamic or static. As the names imply, static posture refers to posture while not moving—sitting, standing, kneeling, seated in the bottom of a squat, lying; and dynamic posture refers to posture while moving—everything from strolling in the park to performing a heavy back squat to underwater acrobatics. Dynamic posture refers to our consistent and habitual movement patterns, and static posture refers to patterns in our positioning while idle. (Note: The line distinguishing static from dynamic posture blurs a bit when we attempt to strictly apply these definitions to everyday life and (particularly) sport. For example, is the defensive tackle who is in his three point stance, wound up like a spring and poised to charge at the quarterback, exhibiting static posture? Or is the weightlifter holding the 340lb barbell that he just snatched overhead exhibiting static posture? Is the gymnast holding an Iron Cross on the rings exhibiting static posture? The subjects of these examples are indeed static in the technical sense, but these are generally not the situations being described by the term "static posture." Obviously load, position of lever arms, etc. come into play here, so there can be quite a bit of grey area. I point this out to remind us that rather than being a simple 'yes or no,' 'black or white' description, static and dynamic posture occupy more of a continuum.)
For further specificity, posture can also be broken down into loaded and unloaded. Again, the names tell most of the story. Loaded posture refers to posture while holding or supporting some external load—a ruck pack, a heavy barbell, a child, bags of groceries, etc.—and unloaded refers to posture with no external load. It's important to note that the term "unloaded" is not entirely accurate: unless you're hanging out on the International Space Station, you are always under load by your own bodyweight. Really, "unexternallyloaded" would be the most precise nomenclature, but that's too many syllables. So for now, just recall that loaded vs. unloaded is a matter of degrees of loading more so than absolute presence of loading.
Common Sense and Something About a Duck
In the ongoing conversation about whether posture merits our attention and the attention of the health and medical community, the thing that continues to come to my mind is the classic duck test: if it looks like a duck, walks like a duck, and quacks like a duck, it's probably a duck.
Let me explain. Every physical therapist, MD, trainer, and coach will agree that proper dynamic posture, and particularly dynamic loaded posture, is important in preventing pain/injury and optimizing function and performance. We should all know by now that deadlifting with a rounded lower back is dangerous and that athletes with patterns of valgus collapse in their knees are probably going to miss a season or three when they inevitably blow out their ACL. Yet many of these same health professionals argue that static posture is of no importance in preventing or treating pain and dysfunction.
Here's where our duck friend makes an entrance. If someone spends 95% of their waking hours sitting or standing with their head hanging out in front of their body, their upper back rounded, shoulders forward in the sockets and internally rotated, and with severe anterior pelvic tilt, how do you think their positioning will be when they help a friend move a couch? Or when they spend 8 hours installing new siding on their house? Or when they perform a heavy squat or deadlift? Or when they go head-to-head with a 320lb lineman on the field? You get the idea. Of course there is a chance that their proprioception will kick into high gear and they will suddenly assume a perfect, stable, and safe position for their dynamic or dynamic loaded effort—there are always exceptions, and athletes in particular are great at finding ways to work around their postural and movement deficiencies—but this is a compromise and a self-imposed burden and risk. You wouldn't willing wear stilettos on a 10 mile hike through mountainous terrain, and you shouldn't willingly teach your body to spend all of its time in suboptimal positions.
In the end, if someone sits with poor posture, stands with poor posture, and walks with poor posture, they're probably going to run, jump, lift, throw, and so on from suboptimal positions as well. I saw this first-hand working with high school athletes. Day after day, the same kids who sat in the classroom and at the lunch tables with rounded and internally rotated shoulders defaulted to benching with their shoulders forward and elbows flaring out to their ears. The same kids who sat and walked in an overextended position all day defaulted to performing the classic "stripper squat," shooting their butt back and breaking into hyperextension at the lumbar spine, and would complain of low back and hip pain. The same kids who sat, stood, and walked with turned in knees and turned out feet would squat, deadlift, sprint, and jump the same way—with valgus knees, collapsed ankles, and feet turned out. Ducks tend to be ducks, no matter the circumstances—if it looks like a duck, walks like a duck, and quacks like a duck, it's probably not going to run like a bengal tiger.
Running Like You Stand There are a number of reasons for this carryover from static posture into dynamic posture.
First and foremost, posture is habitual. It is an ingrained motor pattern, and it is constantly "at work," whether you're conscious of it or not. Posture involves physiological adaptation of the nervous system as well as adaptation in the soft tissues. The human body is an extreme adapting machine, and when you spend 95% of your waking hours in a particular position, your body is going to adapt to that position.
In the same way that you become proficient at squatting by doing a lot of squatting (think of the 10,000 rep or the 10,000 hour concept—the idea that it takes thousands of reps or hours to gain mastery), you become proficient at being in a crappy position by completing a huge number of "reps" of crappy positioning; and you become proficient at being in a good position by completing a huge number of "reps" of good positioning. This is part of why it's so challenging to improve poor posture. The body has adapted, through tens of thousands of cycles, to be incredibly comfortable in and proficient at maintaining that positioning. For most people, it is a motor pattern that has been formed and reinforced through years and years of repetition. Yes, we can consciously adjust our positioning when prompted (everyone's grandmother has reminded them a few times to "stop your slouching and sit up straight!"); but as soon as our conscious attention wanders on to something else, we slowly return to our default, habitual posture.
Default Settings
As an example, let's look at the classic slouchy standing posture. The upper back is rounded forward (hyperkyphosis), the head juts out in front of the body, the shoulders are rounded forward and internally rotated, and the lower back is often in some degree of hyperextension from anterior pelvic tilt. When this position becomes a habitual posture after years of reinforcement, the central nervous system adapts to make this your body's default setting. The central nervous system recognizes, "okay, this is the position I spend most of my time in, so I should get really good at being in this position." This means that when it comes time to move from static to dynamic—say, to quickly run to grab your toddler before he puts your cellphone in the microwave—your body will be inclined to revert to this default position.
The body also undergoes physical adaptations in the soft tissues. Have you ever noticed that your hips feel tight and achy after being packed in like a sardine, sitting idle on a 4-hour flight? That "tightness" is fairly easy to undo with some walking around and some light stretching and movement. Now imagine spending 12 hours per day (and this is being generous for most people's lifestyles) in that position for 10 years. That's 43,800 hours. Probably not going to be able to just walk that one off.
To understand the soft-tissue adaptations that occur, we can take a look at another example: the common slumped over a computer/book/cellphone posture. With the accumulation of thousands of hours in this position, the tissues in the front of your neck will become adaptively short, the tissues in the upper back and back of the neck will become overstretched and overworked, the tissues in the front of your shoulder and chest will become tight, the shoulder capsule will adapt to keep the head of the humerus forward in the socket and internally rotated, and the tissues of the back of the shoulder will be stretched out. Assuming most of your time is spent sitting rather than standing or moving around, the tissues at the front of your hip will also become adaptively short, further locking the hips into anterior pelvic tilt when standing/walking/running/squatting, and your lower back will adapt to be inactive and flexed. This all means that when it does come time to move something heavy or run or jump, even if you are intensely aware of your dynamic posture and of optimal body mechanics and positioning, your body will physically have a harder time getting into these good positions. Your body will have adapted to be really good at hanging out with a rounded upper back with shoulders and head pitched forward, and it will fight to stay in this crappy default position that it has become so good at.
A Final Game of Connect-the-Dots
Ultimately, this tells us a few things about your ability to be a pain-free, optimally functioning human being. First, the cascading effects of poor posture put you at risk for injury. When your default static posture has an effect on your default dynamic posture (and it does), we can play a little game of connect-the-dots and see that static posture is a factor in preventing pain and dysfunction and optimizing performance. It also tells us that, being creatures of habit, it is in our best interest to enforce habits that are safe and effective both on and off "the field." Most of us manage to go an entire lifetime without spending a day fighting for our lives on the battlefield or competing in high level professional sports; but everyone's life puts them on "the field" at some point—it could be rushing your family from a burning home, running from a predator, playing an intense game of freeze tag with your kids at the park, or competing and pushing yourself for a PR in the gym—and we owe it to ourselves and each other to be prepared to function optimally and, to the best of our ability, walk away from the field unscathed.
---
In the next post, we will discuss a number of surprising ways that posture can effect your life, from how well you breathe to how cool you look.
Be sure to subscribe, share, and comment.
Stay swole.
Photo Credits:
1 USS Bataan (LHD 5)_140420-M-HZ646-055 via photopin (license)↩
2 048 via photopin (license)↩
In this post, we will look at a few reasons why posture does indeed matter.
Definition Interlude
Before proceeding, we should clarify in detail what posture is. In its most general sense, posture is a set of consistent positional patterns. Posture is reflexive (an unconscious response to stimuli) and habitual, and the physiological and psychological mechanisms that affect posture are always at work. Posture should not be confused with position—position is the alignment/orientation of the joints and soft tissues at a given moment, whereas posture represents an aggregate of the positions that we consistently and habitually occupy.
In addition, posture is a sort of self-expression. It is how you hold and present yourself in your given surroundings; and, in the same way that driving a red '70 Corvette says something different about you than driving a beige '99 Hyundai Accent, posture is an outward expression (sometimes genuine and sometimes contrived) of who you are. I don't intend to delve deeply into the psychological and psychosocial elements of posture in this post, but it deserves mention.
As suggested in my first post, posture can also be broken down into either dynamic or static. As the names imply, static posture refers to posture while not moving—sitting, standing, kneeling, seated in the bottom of a squat, lying; and dynamic posture refers to posture while moving—everything from strolling in the park to performing a heavy back squat to underwater acrobatics. Dynamic posture refers to our consistent and habitual movement patterns, and static posture refers to patterns in our positioning while idle. (Note: The line distinguishing static from dynamic posture blurs a bit when we attempt to strictly apply these definitions to everyday life and (particularly) sport. For example, is the defensive tackle who is in his three point stance, wound up like a spring and poised to charge at the quarterback, exhibiting static posture? Or is the weightlifter holding the 340lb barbell that he just snatched overhead exhibiting static posture? Is the gymnast holding an Iron Cross on the rings exhibiting static posture? The subjects of these examples are indeed static in the technical sense, but these are generally not the situations being described by the term "static posture." Obviously load, position of lever arms, etc. come into play here, so there can be quite a bit of grey area. I point this out to remind us that rather than being a simple 'yes or no,' 'black or white' description, static and dynamic posture occupy more of a continuum.)
For further specificity, posture can also be broken down into loaded and unloaded. Again, the names tell most of the story. Loaded posture refers to posture while holding or supporting some external load—a ruck pack, a heavy barbell, a child, bags of groceries, etc.—and unloaded refers to posture with no external load. It's important to note that the term "unloaded" is not entirely accurate: unless you're hanging out on the International Space Station, you are always under load by your own bodyweight. Really, "unexternallyloaded" would be the most precise nomenclature, but that's too many syllables. So for now, just recall that loaded vs. unloaded is a matter of degrees of loading more so than absolute presence of loading.
Common Sense and Something About a Duck
In the ongoing conversation about whether posture merits our attention and the attention of the health and medical community, the thing that continues to come to my mind is the classic duck test: if it looks like a duck, walks like a duck, and quacks like a duck, it's probably a duck.
 |
| Everyone's judging your rounded back, bro. 1 |
Let me explain. Every physical therapist, MD, trainer, and coach will agree that proper dynamic posture, and particularly dynamic loaded posture, is important in preventing pain/injury and optimizing function and performance. We should all know by now that deadlifting with a rounded lower back is dangerous and that athletes with patterns of valgus collapse in their knees are probably going to miss a season or three when they inevitably blow out their ACL. Yet many of these same health professionals argue that static posture is of no importance in preventing or treating pain and dysfunction.
Here's where our duck friend makes an entrance. If someone spends 95% of their waking hours sitting or standing with their head hanging out in front of their body, their upper back rounded, shoulders forward in the sockets and internally rotated, and with severe anterior pelvic tilt, how do you think their positioning will be when they help a friend move a couch? Or when they spend 8 hours installing new siding on their house? Or when they perform a heavy squat or deadlift? Or when they go head-to-head with a 320lb lineman on the field? You get the idea. Of course there is a chance that their proprioception will kick into high gear and they will suddenly assume a perfect, stable, and safe position for their dynamic or dynamic loaded effort—there are always exceptions, and athletes in particular are great at finding ways to work around their postural and movement deficiencies—but this is a compromise and a self-imposed burden and risk. You wouldn't willing wear stilettos on a 10 mile hike through mountainous terrain, and you shouldn't willingly teach your body to spend all of its time in suboptimal positions.
In the end, if someone sits with poor posture, stands with poor posture, and walks with poor posture, they're probably going to run, jump, lift, throw, and so on from suboptimal positions as well. I saw this first-hand working with high school athletes. Day after day, the same kids who sat in the classroom and at the lunch tables with rounded and internally rotated shoulders defaulted to benching with their shoulders forward and elbows flaring out to their ears. The same kids who sat and walked in an overextended position all day defaulted to performing the classic "stripper squat," shooting their butt back and breaking into hyperextension at the lumbar spine, and would complain of low back and hip pain. The same kids who sat, stood, and walked with turned in knees and turned out feet would squat, deadlift, sprint, and jump the same way—with valgus knees, collapsed ankles, and feet turned out. Ducks tend to be ducks, no matter the circumstances—if it looks like a duck, walks like a duck, and quacks like a duck, it's probably not going to run like a bengal tiger.
Running Like You Stand There are a number of reasons for this carryover from static posture into dynamic posture.
First and foremost, posture is habitual. It is an ingrained motor pattern, and it is constantly "at work," whether you're conscious of it or not. Posture involves physiological adaptation of the nervous system as well as adaptation in the soft tissues. The human body is an extreme adapting machine, and when you spend 95% of your waking hours in a particular position, your body is going to adapt to that position.
 |
| 2 |
In the same way that you become proficient at squatting by doing a lot of squatting (think of the 10,000 rep or the 10,000 hour concept—the idea that it takes thousands of reps or hours to gain mastery), you become proficient at being in a crappy position by completing a huge number of "reps" of crappy positioning; and you become proficient at being in a good position by completing a huge number of "reps" of good positioning. This is part of why it's so challenging to improve poor posture. The body has adapted, through tens of thousands of cycles, to be incredibly comfortable in and proficient at maintaining that positioning. For most people, it is a motor pattern that has been formed and reinforced through years and years of repetition. Yes, we can consciously adjust our positioning when prompted (everyone's grandmother has reminded them a few times to "stop your slouching and sit up straight!"); but as soon as our conscious attention wanders on to something else, we slowly return to our default, habitual posture.
Default Settings
As an example, let's look at the classic slouchy standing posture. The upper back is rounded forward (hyperkyphosis), the head juts out in front of the body, the shoulders are rounded forward and internally rotated, and the lower back is often in some degree of hyperextension from anterior pelvic tilt. When this position becomes a habitual posture after years of reinforcement, the central nervous system adapts to make this your body's default setting. The central nervous system recognizes, "okay, this is the position I spend most of my time in, so I should get really good at being in this position." This means that when it comes time to move from static to dynamic—say, to quickly run to grab your toddler before he puts your cellphone in the microwave—your body will be inclined to revert to this default position.
The body also undergoes physical adaptations in the soft tissues. Have you ever noticed that your hips feel tight and achy after being packed in like a sardine, sitting idle on a 4-hour flight? That "tightness" is fairly easy to undo with some walking around and some light stretching and movement. Now imagine spending 12 hours per day (and this is being generous for most people's lifestyles) in that position for 10 years. That's 43,800 hours. Probably not going to be able to just walk that one off.
To understand the soft-tissue adaptations that occur, we can take a look at another example: the common slumped over a computer/book/cellphone posture. With the accumulation of thousands of hours in this position, the tissues in the front of your neck will become adaptively short, the tissues in the upper back and back of the neck will become overstretched and overworked, the tissues in the front of your shoulder and chest will become tight, the shoulder capsule will adapt to keep the head of the humerus forward in the socket and internally rotated, and the tissues of the back of the shoulder will be stretched out. Assuming most of your time is spent sitting rather than standing or moving around, the tissues at the front of your hip will also become adaptively short, further locking the hips into anterior pelvic tilt when standing/walking/running/squatting, and your lower back will adapt to be inactive and flexed. This all means that when it does come time to move something heavy or run or jump, even if you are intensely aware of your dynamic posture and of optimal body mechanics and positioning, your body will physically have a harder time getting into these good positions. Your body will have adapted to be really good at hanging out with a rounded upper back with shoulders and head pitched forward, and it will fight to stay in this crappy default position that it has become so good at.
Ultimately, this tells us a few things about your ability to be a pain-free, optimally functioning human being. First, the cascading effects of poor posture put you at risk for injury. When your default static posture has an effect on your default dynamic posture (and it does), we can play a little game of connect-the-dots and see that static posture is a factor in preventing pain and dysfunction and optimizing performance. It also tells us that, being creatures of habit, it is in our best interest to enforce habits that are safe and effective both on and off "the field." Most of us manage to go an entire lifetime without spending a day fighting for our lives on the battlefield or competing in high level professional sports; but everyone's life puts them on "the field" at some point—it could be rushing your family from a burning home, running from a predator, playing an intense game of freeze tag with your kids at the park, or competing and pushing yourself for a PR in the gym—and we owe it to ourselves and each other to be prepared to function optimally and, to the best of our ability, walk away from the field unscathed.
---
In the next post, we will discuss a number of surprising ways that posture can effect your life, from how well you breathe to how cool you look.
Be sure to subscribe, share, and comment.
Stay swole.
Photo Credits:
1 USS Bataan (LHD 5)_140420-M-HZ646-055 via photopin (license)↩
2 048 via photopin (license)↩
Friday, September 18, 2015
Does Posture Matter? Episode 1: The Postural Menace
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| 1 |
So, who's right? Does posture deserve your and your physical therapist's attention? Does static posture put you at risk for developing pain or dysfunction? If you have poor posture but are pain free, is there any reason to put effort into improving your posture? Is your spine going to explode if you look down at your cell phone for too long? Are the robots taking over?
Graciously, the internet's mystical and dichotomous ways have presented us with a perfect opportunity to challenge and question conventional wisdom regarding posture and pain, to ask questions that likely are not asked enough, and to ensure that we are not letting tradition supersede knowledge and thoughtfulness.
(Note: Throughout this post and further posts on this topic I will be using the term "posture" to refer just to static posture, and will specify dynamic and/or loaded posture when that distinction is needed.)
My Point Is...
Ultimately, yes, posture does matter. We can all agree that the articles on "text neck" are over the top, and that some of their tactics for gaining readership have a tinge of blatant sensationalism. However, these articles and others like them are not without their merits. No, your spine will not explode from looking down at your phone for too long to get your Twitter fix; however, day-to-day posture and accumulation of time in poor positions is something that deserves your attention and the attention of health professionals alike. It may not be the most imminent threat facing our society today, but it behooves everyone—from high level athletes to desk jockeys—to understand the how and the why of posture's effects on pain, function, and performance.
In this post and the rest in this series, I will address the major aspects of this ongoing discussion on posture and its significance in preventing pain and optimizing function and performance.
The Research
A few minutes of Googling will reveal that, to date, there really isn't much out there in the way of scientifically conducted research that definitively shows a link (causative or correlative) between posture and pain. But, on the other hand, there really isn't much out there in the way of scientifically conducted research that definitively shows there isn't a link between posture and pain. Most of what we have is research concluding that "the results are inconsistent, and therefore don't show a strong correlation." So those who argue that posture is largely irrelevant in treating pain are absolutely correct about the current standings of the body of research.
But honestly, it should not be surprising that research has yet to definitively demonstrate a link between posture and pain. Research conducted on this issue is mostly limited to cross-sectional studies, retrospective studies, and prospective studies with small groups of subjects; and, any study that sets out to examine something as variable (and often ill-defined) as posture and as mystifying as pain is bound to encounter limitations.
In cross-sectional studies, researchers take a group of people with back/neck pain and a group of people without pain and, using radiography, a flexicurve, and/or some other postural assessment tools, examine the positions/alignment of their joints (particularly in the spine) to look for patterns in posture that can be linked to the pained or pain free group. The greatest limitation of this method is that it only looks at a snapshot of the individual's posture and pain. The complexity of posture cannot accurately be captured in a snapshot. Posture is not a position at a given moment, but a series of ongoing positional patterns (it could be considered an "average") for sitting, standing, lying, etc. In addition, being aware that they are part of a study on posture, it is entirely possible (if not likely) that subjects' body positions during their examination for the study will not be true to their day-to-day posture.
In retrospective studies, groups of individuals with back/neck pain or a history of back/neck pain are asked to report, retrospectively, on their posture. These studies may also been done in combination with a cross-sectional study. The limitations on this one are rather obvious: most people can't remember what they ate for breakfast yesterday, much less how their posture has been since middle school. Additionally, much of the population is largely unaware of their posture (lacking proprioception) and general movement patterns. This does not lend itself to detailed and accurate self-reporting.
In prospective studies, researchers focus on a group (or groups) of people with a common hypothetical risk factor—in this case, poor posture—and look for the development of conditions, such as neck or back pain, over time. Of the three, this research method is the most likely to produce consistent and revealing results. However, it still has a few considerable limitations. Because prospective studies require researchers to follow subjects for long periods of time, it is generally the most costly and demanding type of study. In order to get substantial and revealing outcomes, any study on posture will require a large population to be examined; however, the cost and labor demand of prospective studies will present a limit to the number of subjects that can be followed. For this reason, long-term follow up with subjects of the study may be conducted via a mail or phone questionnaire and rely upon self-reporting rather than the more costly and impractical (but more accurate) option of assessment by a medical professional. Therefore, even in prospective studies, researchers end up with only an initial snapshot of the subject's posture; they do not collect measurements of long-term trends or changes in one's posture, and therefore face similar limitations as in a cross-sectional study. In addition, the primary strength of a prospective study—that it examines subjects over a long period of time—also presents a challenge in this type of research. Posture and posture-related habits can (and often will) change over time, and the challenge of tracking the introduction or cessation of additional risk-factors in each patient over an extended period of time mars the clarity of any results from such a study.
In addition, all of these methods fall short in that they focus almost exclusively on pain (specifically, back/neck pain). While pain is incredibly deserving of researchers' and practitioners' attention—it is our body's primary way of saying, "hey, something's not right here!"—it does not tell the whole story, and is a phenomena that follows rather inexplicable patterns. A considerable population (I've seen estimates between about 20-60%) of individuals with considerable tissue damage (think torn or frayed ligaments, bulging and degenerating spinal disks, damaged cartilaginous tissues, etc.) walk around with no pain at all [7] [8] [9]. And meanwhile, people with no signs of tissue or nerve damage find themselves in constant and severe pain [10] [11]. When health practitioners and researchers focus exclusively on pain, they ignore the relevance and importance of other factors affecting function/dysfunction, and they do themselves and their patients a disservice.
Ultimately, posture is a difficult beast to pin down and track. Life does not occur in a laboratory, and therefore something like posture which is, by nature, very dependent on and related to a massive diversity in lifestyle and individual physiology, will always challenge our research methods. Even the researchers conducting these studies and health professionals arguing against the use of posture-based practices in clinical settings punctuate their claims with qualifying terms like "probably," "inconclusive," "likely," "possibly," and "unclear," and most online articles denouncing posture-based treatment outright admit: most of these studies are poor quality and the evidence is not entirely clear one way or the other.
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| 2 |
However, some argue that because the body of research more strongly leans (by volume) to the side of "no considerable correlation," that physical therapists, trainers, and other health professionals should forego posture-related corrections and diagnoses from their practice. In other words, because our current body of research cannot not provide evidence that poor posture does cause pain, it must not cause pain. This, to me, looks like a classic case of argumentum ad ignorantiam (shout out liberal arts education). It is an appeal to ignorance.
To further support their argument, some contend that continuing to enforce the importance of "good" posture in the medical field is actually a disservice to patients, as it runs the risk of causing a nocebo effect. While this is a potential risk, I ultimately believe that the potential benefits of postural awareness and practicing good posture far outweigh the potential risks. It is the duty of any health practitioner to be familiar with up-to-date research and to understand the medical field's official (or unofficial) stance on an issue. However, I believe that it is also the duty of any health practitioner, and of any free-thinking human being with a fully functioning brain and internet access, to examine the research within a more holistic context and with a hefty dose of common sense.
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In the next post of this series, we will take a look at how and why posture can affect pain, function, and performance.
Be sure to subscribe, share, and comment.
Stay swole.
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Photo Credits:
1 Thinker, Texter, Reader via photopin (license)↩
2 Spine Cervical and Upper Thoracics via photopin (license)↩
Friday, July 3, 2015
In Injury and in Health... Training Through Injury
So, you've injured yourself—hopefully nothing serious—perhaps a muscle strain or a minor sprained joint, or a minor case some sort of "-itis" brought on from overuse and/or poor movement patterns. It's not going to kill you or permanently disable you, but it's enough to piss you off and get in the way of your training; and now you're left, angry and in pain, wondering what the next step is. When will you be able to get back to training? Are there any movements you can do to keep up progress while you recover? Is there anything you can do to speed up recovery?
I've found myself in this situation a number of times, and each time I come out of it with a little more wisdom, patience, and insight. It's one of those things that, while difficult and incredibly frustrating, gets easier with experience, and can ultimately teach some very valuable lessons.
Sound of Mind, Sound of Body
Hopefully this is obvious, but it should probably be mentioned anyway: if your injury is serious, or you think it may be serious, or your buddy keeps telling you it looks serious, see a doctor. If your femur is sticking out of your thigh or you can't move half of your body, you should probably get your business taken care of and not worry about keeping up on your training for the moment. Having a full knee replacement at 28 years old because you're too macho to be slowed down by serious pain or injury doesn't make you a badass. Seriously, when in doubt, see a medical professional.
Hopefully this is obvious, but it should probably be mentioned anyway: if your injury is serious, or you think it may be serious, or your buddy keeps telling you it looks serious, see a doctor. If your femur is sticking out of your thigh or you can't move half of your body, you should probably get your business taken care of and not worry about keeping up on your training for the moment. Having a full knee replacement at 28 years old because you're too macho to be slowed down by serious pain or injury doesn't make you a badass. Seriously, when in doubt, see a medical professional.
So, rule one: don't be stupid.
I could probably just end the post here—this principle will take you pretty far in training (and life)—but I like to hear myself talk, so I'll press on.
Most of the time we know when we're about to do something really stupid; yet, fueled by hubris or stubbornness, we press on and make a mild injury worse or delay our recovery. The body does a pretty good job at letting us know when it's injured and telling us what movements are going to make things worse. So, unless you're being chased by a pack of pissed off, hungry bears, you probably shouldn't be running on the ankle you just sprained. Curiosity kills cats and cocksure stupidity kills athletes' knee joints. Don't be that guy!
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| Because in the end, running on a sprained ankle is still better than being eaten. |
Listen Up
Rule two: listen to your body.
This one pairs closely with not being stupid. The body wants to protect itself. It does not want you to destroy your already abused tissues. Fortunately (or unfortunately), we have the pain response. Pain is a powerful mechanism that allows your body to tell you what's going on inside. While it is not always an accurate measurement of tissue damage or injury (damaged tissues can be asymptomatic and pain is sometimes not associated with injured tissues), it's wise to take heed of the pain signals your body is sending to you. There's a chance your body may be sending an "inaccurate" message, but usually (particularly with acute pain) the pain signal is being sent for a reason. And it's better to play it safe than to "tough it out" until you need of a new kneecap.
To take this all a bit further, let's consider an example. You tweaked something in your left shoulder doing a snatch last week. There's no swelling, and no real loss of range of motion, but your shoulder feels a bit achy and swinging your arm overhead doesn't feel great; but otherwise, doesn't seem too serious. Today's workout calls for dips. You get up on the dip bars and start your first rep only to find that you get some pretty serious anterior shoulder pain in the bottom of the dip, and your left shoulder feels pretty shaky and unstable. The pain isn't excruciating, but it's enough to give you pause.
So, should you press on (no pun intended) and impress your bros and brodettes?
Well, is there a $30 million contract on the line? Does your life or the life of a loved one depend on getting these dips done today? If the answer to both of these is 'no,' then you should probably stop dipping, pronto. Your body is telling you, loud and clear, that this position and/or this movement is taking your damaged tissues to a place they shouldn't be. Push it too far, and there's a chance your irritated labral tissues are going to turn into completely torn labral tissues. And that's just not cool.
Know Thyself
Rule three: understand what's injured, and understand how those tissues are involved in movements.
If you can figure out, even in a very general sense, what tissues are injured and to what degree, you can generally extrapolate what kind of movements you should avoid until you're healed up and what kinds of movements you can do to keep your training progress up and speed recovery. With minor aches, strains, and pulls, there's usually no need to see a doctor and order an MRI or CT scan to get an insider's view of the damage, so you'll have to do a bit of detective work. With an acute injury that came from some sort of trauma or mishap, it's pretty easy to get a general idea about what's injured.
For example, if you were running, rolled your ankle, and now you have lateral swelling and bruising, it's safe to say you caused some damage to some of the ligaments on the outside of your ankle. From here, you just need to do a bit of thinking about what movements are going to put stress on those tissues and avoid those movements. On the other hand, radiating pain from nerve compression or the like can be a bit more mysterious. Shooting pains in the leg can be caused by an issue in the back, shoulder and arm pain can be traced back to neck injury, and so on. However, some Google-fu can generally shed some light on the root of the problem. Understanding what nerves run along the path of your pain, and the origin of these nerves can give you a pretty good idea of what you're dealing with. For example, shooting pains down the leg and into the foot that seem to appear out of nowhere may be caused by irritation of the sciatic nerve, which originates from the L4 to S3 vertebrae. Knowing this can help you decide what movements will be off-limits and what movements will help your recovery.
For most minor injuries, some due diligence in educating yourself on the injury and anatomical structures and thinking about how those tissues are involved in movements should give you a pretty good blueprint for what should/should not be done while you're recovering.
Less Pain, More Gain
Rule four: figure out what you can do pain-free and with proper function.
Again, lucky for us, our bodies have provided us with a pretty simple and effective tool for assessing whether a movement is a going to make things better or worse—pain! While it may not be 100% accurate, and while there are times that painful movements actually should be done will help with recovery, these exceptions should be left to healthcare professionals. In addition to pain, injured tissues can also cause some pretty massive instability in an injured joint. If your shoulder gets shaky and feels like it's going to pop out of the socket when you try to perform a push-up, you probably aren't in any shape to being doing push-ups right now (and should probably see a doctor). The general rule for training through an injury is this: if it hurts or it feels super sketchy, don't do it. Simple stuff.
It's important here to also recognize the difference between injury pain and soreness or some other types of pain. If you did 50 heavy back squats in your most recent workout, your legs are probably going to be sore. While soreness is painful, it is not injury. With soreness, it's actually generally a good idea to push through the pain and do some lightweight movement of the sore tissues. This will increase blood flow to the area, prevent excessive and perpetuating stiffness, and will help alleviate the soreness quicker.
It's also important to recognize the pain involved with soft tissue work and mobilization and how this differs from injury pain. Unless you have the tissues of a young and supple demigod, rolling your quads on a lacrosse ball can be seriously painful. But this pain is not the same as that caused by doing pull-ups when you have elbow tendonitis or trying to "stretch" your back after you just pulled your lat. The difference is generally pretty evident if you're paying attention to the signals your body is sending, so listen closely.
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| Know your pain! Stretchy pain is very different than torn ligament pain. |
A little bit of quick trial and error can pretty clearly reveal what movements can be performed as you work around your injury. After you've completed the previous step and figured out what's injured and how those tissues are involved in movements, you can start exploring what movements you can utilize in your training as you heal up. Start with light (bodyweight or empty bar), basic movements, and go easy and slow. As you figure out what movements you can perform without pain and instability, you can establish how much of your program you can continue to perform as prescribed, and figure out what exercises you can substitute in for the exercises that would cause pain. And, as your injury heals and start getting closer to feeling 100%, you can perform movements that directly involve the injured tissues and include exercises that were previously painful with very light weights to begin to re-establish stability and strength and encourage blood flow to the recovering tissues.
Let's return to our injured shoulder example for a moment. Let's say that today's workout calls for snatches, back squats, dips, and pull-ups. You start by putting your arms overhead, in a position similar to that in a snatch (with no weight) and it brings up a dull ache in your shoulder, so no snatches today. You do some squats with just the bar, and those feel fine on your shoulder. You slowly add weight to the bar, and it doesn't seem to aggravate the shoulder, so you're good to go on squats. You establish quickly that the bottom position of the dip is painful and sketchy, so those are out of the question. Finally, you start with some light lat pull-downs to mimic the movement of a pull-up. It doesn't seem to bother your shoulder, so you move on to strict pull-ups, and can include those in your workout without issue. So, you're hunting for substitutions for snatches and dips. Snatches are an explosive hip extension exercise, so something like box jumps, standing broad jumps, or even snatch pulls (assuming those don't bother your shoulder) could provide a similar stimulus without putting stress on the injured tissues of the shoulder. For dips, given what you've figured out about the injury of your nature and how those tissues are involved in movement, you're aware that most horizontal pressing movements will be out of the question, as will overhead work. However, you could still get a somewhat similar stimulus by working the triceps. Banded tricep pushdowns, skull crushers, and cable tricep pushdowns might all be good options. You could also include some hollow rocks to mimic the midline stability demands of the dip.
It may take a bit of creativity and trial and error, but often you can find ways to stick closely to the prescribed training stimulus while allowing your injury to heal.
Patience, Young Padawan
Rule five: don't rush it.
Healing takes time. A muscle strain, even if it doesn't seem all that major, can take months to fully heal. One of the biggest mistakes (and one that I think many athletes make) is rushing back into things. Two weeks after straining a muscle in your low back, you wake up with no more pain and are so excited to be pain-free that you jump right into a workout consisting of heavy deadlifts, pull-ups, and atlas stone loads. Probably not going to bode well for you. Being symptom free means you're symptom free, not injury free. I've made this mistake more times than I care to admit, and I've learned that it's much better to give your body a few extra days to heal than to jump back into too early. The most frustrating thing you can do is take an almost-healed injury and make it worse. What should be a three week recovery turns into a total of seven weeks of recovery when you try to get back to it too soon and make everything worse. Strength is something that is pursued over a lifetime. An extra week is not going to ruin all of your gains and make you weak, but it can keep you from hurting yourself more.
Always Look on the Bright Side of Life
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| 1Cheer up bro! Bench press and pull-ups for days! |
I hate being injured. But, I find that I always come out of injuries with a bit more knowledge and perspective. You tend to learn a lot about your body and the way it moves when you are forced to pay close attention to your movements to avoid pain and allow tissues to heal. In addition, it can be a good opportunity to focus on something that you've been wanting to add to your training or improve on. If you rolled your ankle and can't squat for a few weeks, use that time to apply extra focus and effort to increasing your bench press or your pull-ups. The worst thing you can do when you're injured is throw the baby out with the bathwater, adopt a dismal outlook on the whole ordeal, and give up on getting something positive from the whole experience. Keeping a positive outlook will help you trudge through the pain and inconvenience and can help you see the lessons that you can learn from your injury. Don't be a gloomy Gus and don't let your injuries be for naught.
Those Who Don't Know History are Doomed to Repeat It
Rule seven: figure out why you got hurt, learn from it, and don't make the same mistake again.
As I mentioned before, injuries, however inconvenient and painful, can provide us with some valuable lessons. Engaging in some self-reflection and pattern recognition can shine light on some movement deficiencies, poor postural or movement patterns, or weaknesses that you were previously unaware of.
If it is an acute injury, think about what you were doing when the injury occurred. If you were benching and tweaked your shoulder, ask: What did my bar path look like? Where were my elbows? Is my descent slow and controlled, or herky-jerky and uncontrolled? Am I creating torque on the bar? Are my shoulders staying locked into a stable position, or are they shifting all over the place?
If it is pain or injury that you can't trace back to an acute trauma—for example, development of sciatic nerve pain—you need to take a close look at your posture and movement patterns, and recognize what patterns may be have been gradually contributing to this injury that's now rearing its ugly head. Are you sitting, completely idle, for 15 hours every day, and then rushing into the gym to perform a 30 minute high intensity workout without any warm-up or cool down? Are you sitting, walking, running, and lifting from an overextended or flexed position? Do you perform routine mobility to maintain your body and help your tissues recover from all the abuse you throw at them?
Figure out what went wrong, and fix your business.
Figure out what went wrong, and fix your business.
You know what's worse than getting injured? Getting injured in the same way again because you didn't correct the problem. Use your injury as an opportunity to learn from your mistakes and become a better, stronger person.
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In future posts we will delve into specific exercise substitutions and strategies for common training injuries.
Be sure to subscribe, share, and comment.
Follow me on Twitter @PSprimont and on Instagram @PSprimont
Stay swole.
In future posts we will delve into specific exercise substitutions and strategies for common training injuries.
Be sure to subscribe, share, and comment.
Follow me on Twitter @PSprimont and on Instagram @PSprimont
Stay swole.
1 photo credit: via photopin (license)↩
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