Surviving vs. Thriving

A quick look at what's on our food labels, at what a visit with a medical professional generally entails, or at public standards of "health" reveals something troubling: the way the general public seems to think about and measure health and wellness is overwhelmingly based on mere survival.

Our food labels tell us (often somewhat erroneously) about how much of a particular nutrient we should consume in a day to not take a step closer to the grave. Visits to medical professionals are usually based around something like, "Doc, I can't feel my left leg anymore," or "Doc, I'm in excruciating pain most hours of the day and I can't bend over to pick up my kid," or "Doc, I haven't pooped in two weeks and my gut feels like it has a school of hungry piranhas tearing my bits apart." Most people don't seek out a medical professional or pursue self-education and improvement when they have trouble falling asleep at night, when they feel low on energy and their performance in the gym or at work is declining, or when they have unexplained aches and pains in half of their joints, because all of this is considered "normal." So many of us don't even think about the fact that we are in a dismal state, dragging day-to-day, until our bodies start sending us really loud and clear signals saying, "Hey, we're starting to die here! A little help?"

It's good to survive, of course—no argument there. But should that be our standard? Should we all be leading our lives with "not dying today" as our primary goal? That's like saying that pulling a solid D- in Pre-Algebra is good, or that having your kids grow up to only be petty thieves and not serial killers qualifies as good parenting—it means you probably managed to show up some of the time, and that's about it. The human body and mind have such enormous potential, yet most of what the public qualifies as acceptable and normal equates to "not dead yet." 

My mission in life is not merely to survive, but to thrive; and to do so with some passion, some compassion, some humor, and some style.             ~Maya Angelou 

I'm of course not arguing the we all ought to live our lives like Olympic athletes—that sort of lifestyle, while it does embody pursuing the limits of human potential (or at least human athletic potential) to the fullest, requires immense sacrifice in other parts of life, and is often not ideal for longevity. Rather, I'm proposing that our standards ought to be based in thriving, not just surviving. We ought to seek pleasure and accomplishment in our existence. Instead of settling for not quite dying today or tomorrow, we should establish feeling alert and energized every morning, thinking clearly, performing well, sleeping easily, and improving consistently as our standards of living. 

It is ironic also that a lifestyle with mere survival set as the standard often falls short of its own goal. Modern lifestyles focused on survival essentially ask the question "what is the least amount I can invest in myself and still manage to drag my tired ass out of bed tomorrow morning?" It should be no surprise that doing the bare minimum does not lend itself to longevity or health. Sure, modern medicine can keep us (more or less) alive for longer than ever before; but spending the last decade of life as a semi-conscious and physically incapacitated sack of meat being kept alive by various machines is about the farthest we can get from thriving, and barely even hits the survival mark.

So what is thriving? What does it look like? 
Thriving is an exploration and pursuit of what the body and mind are capable of. It is embracing human existence and seeing what we can achieve. It is constantly seeking self-improvement. 

Sometimes thriving takes work, and sometimes it is pure, unadulterated pleasure. But thriving is always satisfying and rewarding. Many of the details of thriving are rather intuitive. We know, deep down, that our bodies crave movement, crave fresh food, crave having fun and being outdoors, crave human relationships, crave mental challenges, and crave rest and relaxation. 

Just thriving, ya dig?

Thriving is a conscious and intentional pursuit. It is a decision that we can make for ourselves and it embodies a lifestyle. Surviving can happen by accident; thriving cannot. Thriving requires a commitment to and a grabbing hold of your life, and it takes effort and discipline. But ultimately, the rewards far outweigh the effort, and often the "effort" that goes into thriving is itself pleasurable. Eating fresh, homemade food, getting quality sleep for 8-9 hours per night, leading an active lifestyle, enjoying time with loved ones, reading good books, and taking time off from work to de-stress and get away from the hustle and bustle don't sound like tortuous efforts to me. And yet these simple changes can have profound effects on how we live, and can be the difference between thriving and just surviving. So, what'll it be?

---

Be sure to subscribe, share, and comment. 
Follow me on Twitter @PSprimont and on Instagram @PSprimont

Stay swole.

Does Posture Matter? Episode 4: A New Hope (for the Posturally Impaired)

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. 

---

Be sure to subscribe, share, and comment.
Follow me on Twitter @PSprimont, and on Instagram @PSprimont

Stay swole. 

Does Posture Matter? Episode 3: Revenge of the Slouch

This is the third installment in a series about posture and its significance in preventing pain and optimizing performance and function. In the first and second posts, we addressed the strengths and weaknesses of the current body of research on posture's relation to pain, and the significance of static posture with consideration to how it influences dynamic posture. If you have not yet, please read the first and second posts.


More Than Just Pain
As mentioned earlier, most all of the research on static posture and its effects on the body focus exclusively on pain, and therefore these studies do not tell the whole story. Among some health practitioners there is such an intense focus on pain-treatment that other important elements of wellness and performance are neglected or forgotten. This is an understandable trend—most people don't go to a physical therapist or doctor because they have trouble reaching their arms overhead without breaking into overextension, or because they suffer from dreaded "butt wink" syndrome when they squat, or because they feel tired, tense, and stressed every day and can't take a deep breath without great effort. Most people go to the physical therapist or doctor when something really hurts or when they've completely destroyed their tissues and need surgical intervention, and they ask to be put back together and have their pain alleviated ASAP. Obviously, pain treatment should be a primary focus in physical therapy and similar professions, but it should not be the only focus. Focusing only on pain at the exclusion of other important factors that contribute to wellness puts physical therapists, doctors, and other rehabilitation specialists about on par with a bottle of Advil (and a hell of a lot more expensive). 

Posture has dramatic effects on everything from the functioning of the heart and respiratory system to feelings of confidence and emotional well-being. Even if some people can get away with hunching over desks and cell phones and laptops day after day without any aches and pains, they are putting their bodies in suboptimal positions for maintaining basic bodily functions and are detracting from their overall health and well-being. 

Ah yes, it looks like a classic case of your posture sucks.  ¹

The performance of the respiratory system is hugely dependent on posture. Imagine trying to inflate a basketball while someone is standing on it. Not only will it be incredibly difficult, but you'll probably reach a certain point where you just can't inflate the ball any more. Something similar happens when we try to breathe in a crappy, compressed position. When we sit or stand rounded forward, we put additional resistance on the structures of our respiratory system and limit how deeply we can breathe and how much effort each breath takes. In suboptimal positions, the physical structures involved in respiration simply cannot do their jobs as well. Hunching over restricts the expansion of the ribcage (and thereby decreases lung capacity) and limits the action of the diaphragm (the muscular structure primarily responsible for inhalation). Over the long-term, thousands of hours in this position keeps all of the respiratory muscles of the chest and abdomen in a continually shortened and under-active state, which can cause adaptive shortening and weakening of the respiratory muscles. This, in turn, will limit the functioning and capacity of your respiratory system even when you are in an upright, neutral position. To make matters worse, your body will quickly get sick of putting up with your crap and will try to find a work-around to the limits you've placed on its beautiful and efficient respiratory engine. In order to do this, the neck muscles involved in breathing (the sternocleidomastoid and the scalenes) will be called on to work overtime. It won't be long before these muscles get tight and overworked, opening the door to a host of other potential unpleasantness: neck pain, shoulder pain, jaw problems, headaches—you get the idea. 

More or less what bad posture does to your breathing. ²

It is easy to see for yourself the detrimental effects of poor posture on breathing mechanics. First, stand up tall, with a neutral spine, shoulders back, looking straight forward, and take a few deep breaths, initiating from your diaphragm and allowing expansion in the abdomen (belly breathing). Feels great, right? Next, sit down in a chair and hunch over with your elbows on your knees. Get nice and rounded forward and try to take some deep breaths. Or, for a more exaggerated demonstration, stand up and then reach down to perform the classic reach-for-your-toes stretch (this is a terrible stretch, by the way), making sure to round all the way over, and try to take some nice deep breaths from this position. Spend an hour or two in these positions and you're going to be a tensed up, stressed, ball of under-oxygenated misery. With the recent mainstream popularity of yoga and meditation, we should all know by now the therapeutic and health-promoting effects of deep and controlled breathing. Yet so many of us still sit, stand, run, lift, etc. with our respiratory prime movers compressed and restricted. It's no wonder so many people have trouble feeling awake, clear-headed, and calm as they sit hunched over their desks all day. 

As implied previously, posture also has a profound effect on our mental and emotional well-being. Again, I do not intend to delve deeply into the psychological and psychosocial effects of posture in this post, but it deserves mentioning. It has been shown that, in addition to our posture being a form of non-verbal communication to those around us, it directly affects how we feel. Particular posture archetypes are associated with feelings of confidence, happiness, power, and well-being. A "closed posture," in which someone is rounded forward, taking up a smaller amount of space, and closing off/covering more vulnerable body structures (abdomen, genitals, and throat), is generally associated with feelings of submissiveness, malaise, and discomfort. On the other hand, an "open posture," in which someone is more erect with head held high, chest open, limbs spread, and vulnerable body structures exposed, is associated with feelings of confidence, power, and comfort and relaxation. 

As if that wasn't enough, posture can have both immediate and long-term positive (or negative) effects on our hormones and, in turn, physical and mental health. A 2010 study on "power posing" demonstrated that posing in a "power position" for even a few minutes can increase confidence, affect risk tolerance, and increase testosterone and decrease cortisol levels, whereas spending a short time in a "low power" position brings about the opposite effect. That's huge. Simply changing our posture habits can have a considerable effect on our attitudes, energy, stress levels, performance, and overall feelings of well-being. (Go here for an interesting TED Talk on body language and power posing.) 

Finally, our posture has an effect on our performance. For anyone who is at all interested in athletic performance, attention to good posture is a no-brainer. Just like a finely tuned Italian sports car, our bodies are designed to perform best under optimal conditions and in optimal positions. For the same reasons that no one in their right mind would take a Ferrari out on the track with its lug nuts loosened, alignment off, and a poorly functioning fuel pump and expect to perform well (or safely), humans should not be surprised when their bad posture habits bleed into their athletic life and they have trouble breathing when they run a 100m sprint, or can't overhead press a barbell without hyperextending their low back and losing stability, or can't perform a squat without their torso caving over. From optimal leverages and joint positioning to breathing mechanics to emotional well-being and confidence—posture affects it all. 

Good posture is not a magical life hack that's going to turn you from a desk jockey into a record-breaking athlete or cure you of all your ailments, present and future. And honestly, nothing is. Excellence requires lots of work. Posture is, however, a foundational piece of a healthy lifestyle, and merits attention and discipline. 

---

Be sure to subscribe, share, and comment. 
Follow me on Twitter @PSprimont, and on Instagram @PSprimont

Stay swole. 

---

Photo credits
1 Fuente: COM SALUD via photopin (license)^↩
2 Tsukioka Yoshitoshi [Public domain], via Wikimedia Commons^↩

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.

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. 

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)^↩

Does Posture Matter? Episode 1: The Postural Menace

¹

There has been a recent buzz online about posture, and particularly about its importance in clinical settings for assessing, treating, and preventing pain. A growing number of physical rehabilitation specialists (physical therapists, chiropractors, etc.) are pointing to the fact that the current body of research does not definitively demonstrate a strong link between static posture and pain. Articles and debates are popping up on physical therapy and chiropractic blogs and websites suggesting that attention to static posture and treatments or preventative measures related to static posture do not have any place in therapy/rehabilitation practice [1] [2] [3]. However, as is often the case with the internet, conversations and articles over a parallel topic with a diametrically opposite viewpoint are making their rounds on everyone's Facebook feed at the same time. One in particular that has garnered its share of attention recently is the topic of "text neck" [4] [5] [6]. Given that most citizens of the Western world have a smartphone surgically attached to their hands by now, this is an eye-catching and relevant topic. As is also typical of mainstream articles on health and medicine that are desperately clamoring for your clicks, the writing is sensationalized and full of scary words and phrases like "epidemic," "permanent damage," and "wreck your spine." The text neck crusaders are out to remind the public that poor posture can cause pain and affect your health, and that it deserves attention and correction.


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.

²

It should also be noted that none of my caveats about the condition of current research really prove or suggest that posture does correlate in any way to pain or dysfunction. As with most contentious scientific matters, there is research that supports both hypotheses; but the research indicating correlations between posture and pain all face the same short-comings and challenges as the research proposing the opposite. Looking only at the research, we end up with something of a moot point.

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.


---
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. 

---

---

Photo Credits:
1 Thinker, Texter, Reader via photopin (license)^↩
2 Spine Cervical and Upper Thoracics via photopin (license)^↩