Why you don’t need to worry about posture
It seems that everywhere you turn, people are talking about posture as the root cause of back, shoulder, or neck pain. Whether it's on social media, in gyms, or even in physiotherapy/ sports injury clinic settings, the idea that "bad posture" leads to pain has become deeply ingrained in public perception. But is this connection between posture and pain really as straightforward as it seems? The latest research suggests otherwise.
Does Posture Actually Cause Pain?
The belief that posture is the primary cause of pain is so widespread that many assume poor posture equals inevitable discomfort. However, numerous studies have compared the postures of people with pain to those without and found no significant differences. For example, a 2016 study examined lumbar lordosis (the curve in the lower spine) and found no correlation between increased or decreased spinal curvature and back pain.
This raises an important question: If both people with and without pain exhibit the same postural characteristics, can posture really be blamed for pain? It seems unlikely.
What Are You Really Measuring?
A common issue with posture Physiotherapy assessments is their variability. For instance, measuring lumbar lordosis (spinal curve) or pelvic tilt often doesn’t give consistent results, even within the same individual. In a study of 400 people, researchers found that posture varied significantly each time someone stood, regardless of whether they had pain or not. This inconsistency makes it difficult to determine if posture is even relevant in causing pain.
Additionally, pelvic tilt—a common marker for assessing lumbar curve—doesn't reliably correlate with the spine’s curvature. Studies from as far back as the 1990s have shown that the angle of pelvic tilt tells us very little about what’s happening at the lumbar spine, which is often cited as a factor in back pain.
Are Posture Assessments Reliable?
Posture assessments typically provide only a “snapshot” of how someone stands or sits in a clinical setting, which may differ from how they hold themselves throughout the day. Research has shown that the average spinal curvature used during daily activities is far less pronounced than the curvature measured during a typical postural assessment. For example, a study found that while standing lumbar lordosis averaged 33.3°, the average over a 24-hour period was just 8°—a huge difference!
This discrepancy highlights a major flaw in traditional postural assessments. By relying on these brief snapshots, clinicians might misjudge the real extent of the problem and possibly suggest unnecessary treatments.
Can Posture Bias Affect Assessments?
There’s also a question of bias in posture assessments. A study on scapular dyskinesis (abnormal movement or posture of the shoulder blade) found that when assessors knew the patient had pain, they were more likely to report postural abnormalities—even though there was no difference in scapular posture between those with and without pain. This suggests that knowing someone is in pain may lead to over-diagnosing postural issues, skewing the treatment approach.
Do Healthy People Have "Perfect" Posture?
Interestingly, research also shows that people without pain don’t necessarily have what we might consider "perfect" posture. In a study of asymptomatic individuals, many of them naturally slumped when sitting. Despite this, they remained pain-free, further suggesting that posture alone is not a reliable indicator of future pain or discomfort.
Posture Changes With Age—Does Pain?
One of the most compelling pieces of evidence comes from studies on how posture changes as we age. It’s well-documented that as we get older, our spinal curvature tends to increase. However, this doesn’t seem to correlate with increased pain. In a study of 120 participants, all of whom were pain-free, the alignment of their cervical spine changed with age, but without a corresponding rise in discomfort. This strongly suggests that changes in posture over time are a natural part of aging and not necessarily linked to pain.
Key Takeaways
People with pain do not exhibit different postures compared to those without pain.
Posture is highly variable, meaning that assessments may not be as reliable as we once thought.
There’s a risk of bias when clinicians are aware of a patient’s pain, potentially leading to overdiagnosis of postural abnormalities.
Posture assessments offer a mere "snapshot" of how someone stands or sits, which doesn’t necessarily reflect how they move throughout their day.
As we age, our posture changes, but this does not automatically lead to more pain.
In conclusion, while posture is a popular scapegoat for pain, the research tells a different story. Pain is a complex issue influenced by many factors, and posture alone is unlikely to be the sole cause. Instead of focusing solely on correcting posture, it may be more beneficial to address other factors like movement patterns, muscle strength, and overall activity levels to manage pain effectively.
