Regarding the debate on posture – where do you stand? Sit? Slouch? Sprawl?

recent article in the Guardian newspaper (click here) discussed posture, or more to the point the common perception of posture held by the general  public. What is refreshing is that the article questioned the general view that posture is all about “sitting up straight” or “standing tall”. This is a perception often held by the public and time pressured medical professionals alike, based on what they may have been told anecdotally or historically.

 

The article author points out that the human spine consists of 4 curves and that “good posture” is often an attempt to straighten these curves. To add to that consider that the fundamental function of the spinal curves is to absorb and distribute gravitational force and external load throughout the spine, joints, muscles and associated soft tissues.

If we reduce a curve, we reduce the number of spinal joints and tissues available to absorb, share and distribute load, potentially shifting greater forces elsewhere.
Add on the additional effort it will take for muscles and soft tissues to straighten these curves against gravity and we start to appreciate why neck, shoulder or low back pain is often posture related.

The renowned biomchanist Stewart McGill stated that there is not a specific sitting posture that causes low back pain, it is the duration of a sitting posture that can cause problems. This refers to the biomechanical and physiological principle stating collagen structures held on a stretch for more then 20 minutes will start to deform in a phenomenon called “creep”. McGill suggested a simple solution – regularly change position so that a singular posture is not held for longer than 15-20 minutes.

Easily said, but hard to put into practice. We can all appreciate how easy it is to neglect our position when we are engrossed in work or when watching a film.

 


To give a simple example, ten people sit in an office, carrying out the same sedentary task, all sat on the same type of chair for the same length of time. If all 10 workers conformed to the common postural belief and “sat up straight” for the duration of their work, would they all remain pain free? Put the example into your own working context and you’ll probably disagree. The reality is that there would be 10 variations of “good posture”, some strategies would work whilst would fail with differing levels of discomfort and pain.

Yet if all of those staff have the same work task, same chair, same sitting duration and ultimately the same spine how can some still have pain?

Posture is a set of subconcsious automatic reflexes that allow us to orient ourselves in space and stop us falling over. The brain continuously reacting to subconscious (joint position sense, weight transfer, chemical environment etc) and conscious (visual/audio input, cognitive commands etc) stimuli to direct appropriate and efficient movement. Put another way, we all have the same basic hardware (brain and central nervous system) but different software (bones, muscles, soft tissues) and apps (behaviours and beliefs). Each of these interact and affect each other continuously.

But spare a thought for the lack of joint position sense your brain receives when you sit in the same position for several hours, day in day out. Consider how decreased blood and fluid flow leads to stagnation and chemical change in tissues.

Your subconscious brain becomes only too aware and sets off an ache as an alarm to get you to move, to circulate fluid and provide some joint position sense. But all too often that ache in the shoulders after sitting hunched over a laptop for hours, is cognitively ignored and dismissed as getting your work done is the priority. Most people will be unaware of the underlying physiology and dismiss aches and pains  “poor posture”. Yet the body and its governing central nervous system has continued to evolve and refine itself over thousands of years to give us amazing freedom of movement. You would think that such a sophisticated machine would be able to avoid or resolve such trivial issues…

Another sobering thought to reflect on is that the statistic that 2.5 million people suffer with low back pain everyday is based on occupational health research data. The number would probably be higher if the retired and those not working were consulted. The fact is that the current evidence for low back pain prevelance is related to work. If we think about what people do at work then we could consider that a common general cause may be some sort of sustained or repeated posture, position or movement that appears to facilitate work productivity but ultimately costs the worker.

We all have pressures at work to ‘get the job done’ and we force our bodies to conform into unnatutral positions for unnatural lengths of time whether in a sedentary role or physical demanding manual job. With the advent of the mobile phone, tablet and social media we are willingly lured further into a state of pixel paralysis in our free time.

 

As you may be detecting, addressing postural related pain is much harder than thinking “sit/stand straight”. Hopefully you are beginning to appreciate that posture needs to be an open and continuous discussion between brain, body and environment. If you struggle with pain or dysfunction that does not have an obvious cause, it may well be postural. Contact Nick for some advice or to book an appointment to find postural strategies that work for both your body and your brain.

 

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