Article by Simon Bell
Posture is one of the main topics of conversation I have in clinic with pretty much every back pain patient. There is so much information on social media, google, television and the like about 'good' posture that it seems inevitable. The main question, of course, goes something like this: is my posture causing my back pain?
So, Let's Examine the Evidence:
There are plenty of papers that have analysed this in detail and with good scientific merit. The ones that are most useful in low back pain cases relate to the depth of the lumbar lordosis (lower back curve) and the measurement of an anterior pelvic tilt (how far the pelvis tilts forwards). The theory is the physical connection between your spine and pelvis means that, if your pelvic angle is tilted too far forward (termed anterior tilt), this will inevitably put pressure on the tissues at the back of the spine and potentially cause pain. Authors such as Adams 2004 & Sorensen et al. (2014) along with many others (some as far back as 1980) have pointed out the change in load distribution and stress with an increase in lordotic posture.
From the anterior part of the spine, that is better suited to coping with stress and pressure, to the posterior elements that are, in theory at least, less well suited and contain higher percentages of nociceptors or pain receptors. This has even been noted as to shift from 1% to 16% of the overall compressive load. Sorensen et al.point out in their paper that there appears to be a significant correlation between the depth of lumbar lordosis and symptom intensity in back pain subjects and that back pain 'developers' tend to stand with a deeper lordotic curve than non back pain patients. Compelling stuff!
So, it's settled then: bad posture for low back pain is related to standing with a deep lumbar curve. To avoid pain, all you have to do is reduce it. Problem solved!
Actually, it's a little more complicated than that.
Studies as far back as the late 1980s have already shown the lumbar lordotic curve and pelvic tilt can't accurately be linked. The individuality and complexity of lumbar spine movement makes it a bit more tricky to measure than simply measuring a pelvic inclination!
More recently, Schmidt et al. (2018) found significant variation amongst standing postures within the individual themselves (i.e. people move and change their posture by big percentages depending on what they are doing). Simply put, when the measurements of posture are applied to day to day life, they tend to be over simplistic and fall apart. Again on this point, other authors have shown that the used ranges of motion versus those assessed during a clinic setting vary massively, as does lumbar lordotic curve. From 33.3° average angle reported on assessment to only 8° actually used over a 24 hour period. So, can the depth of the lordosis really be attributed to day to day back pain?
It does need to be mentioned, however, that there is some really interesting stuff regarding 'good' posture when it comes to psychology and endocrinology. Several studies have found, in much the same way as nodding when making a statement can influence a person's belief in it, sitting in a more upright position allows subjects to think more positively/remember positive memories which may be a really useful tool in managing back pain. In addition, there is a whole concept of 'power' posture which refers to changes in an individual's perception and feelings towards a situation simply due to changes in their posture.
So, there are some really useful aspects that can be harnessed when it comes to using posture as part of back pain rehab. But the idea of blaming posture as the actual cause of a person's back pain is perhaps a little more controversial. One of the biggest misconceptions seems to be that 'bad' posture cause pain due to the biomechanics of the system rather than a lack of movement.
There is some good solid research that suggest changes in PH or acidity within muscle tissue can cause pain. Some really old school papers (1960s) even introduced a chemical solution into muscle tissue to change PH levels and discovered definite changes in pain sensitivity. This is probably due to chemical receptors we have within our muscle system. It and similar papers teach us something very interesting: that a lack of movement tends to drive the PH level of muscle down (I.e. causing increased acidity). This is now supported as a pretty major reason in explaining why people have pain when they don't move.
So, What Does This Mean for Me?
As you can probably tell, there are mixed signals coming from the literature, as with pretty much everything in the field of pain! As a general rule, it's probably a really good idea to move as much as you comfortably can during an episode of back pain and to not get too hung up about whether your posture is 'good' or 'bad.' The interesting caveat to this for me is the positive psychological effects of simply sitting up straight. We know how influential psychology is when getting over episodes of back pain and this might be a pretty useful way to rewire a person's painful memories and get faster results.
In any case, there's always going to be more research needed. However, by following the plan tailored for you through the Easy Physio system, you are giving yourself the best chance of a good and long lasting recovery by putting yourself in the capable hands of our expert team!