Practical Science on Movement and Pain
Practical Science on Movement and Pain
As a Rolfer, I see many people who want to improve their posture. Many are already in the process of applying some questionable advice they may have read on the internet. This post summarizes some of the major misconceptions people seem to have about posture.
It is an article of faith that bad posture will result in pain, and that you can cure pain by improving posture. You can read such claims everywhere. Although these claims have intuitive appeal, they are lacking any strong evidence in support. (If you have some, please send it my way, I would love to know about it.)
If bad posture is a major cause of pain, you would expect to find that people with measurable postural distortions would have more pain than people who do not. But that is not what the preponderance of the studies find. As summarized in a previous blog post, the weight of the evidence is that pain does not correlate very well with measurements of posture such as spinal curvature. This is surprising and somewhat counterintuitive, but it should definitely be borne in mind by anyone who plans on investing considerable time and effort trying to correct posture for purposes of pain relief.
Many of my clients believe their poor posture is the result of failed attention. As a practical matter, we cannot spend all day worrying about our posture. Our bodies are not designed to require conscious monitoring of muscular activity. We can walk without reminding ourselves to activate flexor digitorum longus at the right time, and we can also sit upright without being mindful to activate the core or retract the scapula. In fact, we really have no choice but to allow posture to be dictated by unconscious processes. Even the most vigilant conscious policing of your posture will be abandoned after a second or two, as soon as some other distraction arises. So, if you want good posture, you must somehow make it an unconscious act. (That doesn’t mean that conscious attention to posture is never a good idea, only that it is not a good long term strategy.)
Many of my clients believe their bad posture results from laziness, or possibly poor strength in certain postural muscles. They feel tired after only a few minutes of assuming what they think is a good posture, and then conclude they must increase their endurance at holding the position. This is probably a losing battle.
The solution is usually not to increase your ability to sustain effort, but to find a posture that requires less effort. In fact, the sense of effort associated with movement is a good way to determine whether the movement is right for you. In regard to posture, this means your optimal posture should feel easier, not harder, than your current posture.
Therefore, if a certain posture feels like it requires extra effort, it’s probably not going to work. In any event, your brain, which prefers the most efficient way to do something, will be smart enough to abandon an inefficient postural strategy the very first moment that you stop consciously controlling it. Which should be about three or four seconds.
People think of posture as the opposite of movement – as something that you “hold.” As such, people often become stiff when they assume their “good” posture. This is a bad idea because it interferes with all the movements that must occur constantly during any posture.
Every posture requires ongoing breathing, which is a movement that can involve nearly every muscle in the trunk. This fact works against the common advice to suck in the abs as a means to become more upright and stable. Consciously sucking in the abs might make you feel taller, but it also tends to lock in some of the muscles that must move to allow breathing.
In addition to breathing, static posture (especially standing) involves constant oscillatory movement. Standing is actually a highly unstable position - it’s like balancing a fifteen pound bowling ball on top of a stick on top of two other sticks on top of two bony feet. Standing is a continual process of tiny falls and recoveries, where the muscles constantly adjust to tip the body one way and then the other. This results in a very small but perceptible oscillating pattern where the head moves above the feet in a figure eight or circle. So, posture is not about preventing movement, but about allowing very small movements around a central balance point. Try to imagine that you are a bobble head doll and you can feel this subtle process of movement and readjustment happening constantly and involuntarily.
Another important aspect of posture is that it is the place from which the next movement will come. Optimal posture allows the next movement with a minimum of preparation and effort. This is of course vitally important in a sporting context, where players wait for the next move in a posture (usually a crouch) that allows quick movement in any direction with little effort or preparation. But such a consideration also applies to everyday life, and you can be sure that your brain is constantly anticipating your next move no matter how small, and making postural preparations for it.
One movement that occurs almost constantly in most sitting and standing postures is turning the head from side to side to scan the horizon and take in sensory information. Each head movement, when executed optimally, requires movement of the neck and more subtle compensatory movements in the trunk and even pelvis. Turn your head from side to side while sitting and you may feel your sit bones shifting slightly on your seat. Holding the head and trunk in a rigid position will restrict the freedom of these movements and make them stiffer and less comfortable. Try adopting your “good” posture and then see if you need to soften it a little to turn comfortably from side to side. Again, your brain won’t let you adopt a posture that prevents a quick and easy scan of the horizon, and therefore any such posture is doomed to fail.
Another motion that takes place almost constantly while sitting is reaching for a keyboard, mouse, phone, doughnut, remote control, etc. If the scapulae are held to the spine by the conscious retractions recommended by many posture experts, the arm is not ready to reach. And this is again why advice to consciously stiffen certain muscles is likely to fail. The brain knows that sitting at a computer means constant reaching, and it will not allow the scapulae to be constantly pinned back.
The bottom line is that posture is not a static position to be held, but rather a dynamic and constantly changing series of subtle movements that allow breathing, turning and reaching, preserves easy balance, and prepares for the next movement.
Many people assume their posture will improve if they get “straighter” and more symmetrical. However, it is a bad idea to place too much emphasis on how your posture looks. More important is how it feels and what it can help you do. The visual emphasis on posture probably results from spending too much time looking at pictures of platonically ideal posture shown in books. Trying to deform your body into the shapes in these pictures can be a bad idea.
Every person has a unique bone structure and therefore each person has a unique ideal posture. We all have at least some minor asymmetries in the bones from left to right. If you look closely at a model skeleton you will notice that the ribs on the right side are not the same shape as the ribs on the left. You will also notice places where the spine curves from left to right. Bones are not made by machines like interchangeable pieces of Ikea furniture, they are shaped by years and years of an organic process of growth which responds to tensional and compressive forces. Such forces are bound to be different from side to side and therefore asymmetries are the rule not the exception. If the bones of your spine naturally tilt a little to the left near the sacrum, they will have to tilt back to the right at some point to keep the head over the pelvis. The resulting curvature is entirely natural and perhaps optimal for that particular person. Trying to straighten out the curves works against the grain of the bone, and is bound to cause unnecessary stress and tension.
The same principles apply to the size of the forward/back curves in the low and upper back, which are very much determined by the shape of the bones, particularly the sacrum, whose shape varies markedly between different people.
The bottom line is that ideal posture is different for everyone, so don’t rely too much on how your posture looks, judge how it feels. If it doesn’t feel natural, it won’t work.
OK, so there’s a list of things that probably won’t help you improve your posture. In a future post I’ll write about some approaches that might help.