Updated: Nov 22, 2021
We all know what good posture is - upright, erect spine, shoulders down and back, chest forward. And by contrast “bad” posture is hunched back and rounded shoulders, chest caved in.
Rounded posture is blamed for back, neck and shoulder pain. Doctors, manual therapists and the general population all tend to agree that posture influences our pain and health. It just makes sense... or does it?
It turns out that this is just cultural conditioning. There is virtually no good quality scientific evidence to confirm this. But there is a lot of poor quality evidence to support it, which is probably responsible for the widespread misbelief. Many scientific papers say “bad posture is bad” simply because the poor methodology in the experiments leads researchers to confirm this bias). But in fact, more recent high quality research has highlighted the exact opposite - that rounded posture/Upper Crossed Syndrome has little correlation with pain.
UPPER CROSSED SYNDROME
Upper crossed syndrome is a fancy term to describe rounded posture, a theory created by Vladimir Janda in 1987. He suggested that Upper Crossed Syndrome is characterised and caused by tight or shortened chest & posterior neck muscles, while the muscles between the shoulder blades (rhomboids) and across the back (latissumus dorsi and lower trapezius) are weak. This theory has become extremely popular amongst manual therapists as a way of understanding and therefore correcting posture.
WHY IS POSTURE CONSIDERED SO IMPORTANT?
Cultural references condition us to believe what’s “right”. The Hunchback of Notre Dame, Frankenstein’s assistant (and many other “evil assistants”) Dr Evil from [my favourite movie] Austin Powers are just 3. Thus hunched posture has become synonymous with evil and bad. Goodies tend to have “good posture” as standard. Power, grace and elegance are associated with upright posture.
Ballet dancers, soldiers, police officers - they need to look official, authoritative and alert, so standing tall is a necessary part of the job. Donald Trump has famously funny posture. Not sure how relevant it is to this article but I just wanted to mention it because it’s so odd. Could he secretly be a centaur?
In cases of neck, shoulder and back pain, other factors are significantly more to blame than posture. You can read more about that HERE. Despite this, there is still a rather firm misbelief that bad posture leads to bad health such as back pain, joint problems, breathing and digestive issues. These are generally untrue.
Our spines are robust and adaptable and can tolerate a whole variety of positions and movements, depending on our load tolerance and how we use our spine. Any messages to the contrary tend to inspire fear, and fear can be more dangerous than the thing we’re afraid of.
DIFFERENCES IN POSTURE ARE NORMAL and not a sign that something needs to be fixed. There are many natural variations in spine curvature across different cultures and people. One is not better or healthier than another or more potentially problematic than another.
A growing body of good quality evidence is finding that posture does not correlate with pain as much as we once thought. There are people with “bad” posture who have had no pain.
There are also people with severe pain and perfectly “acceptable” posture. Why? Because there is so much more to pain than posture.
So while bad posture is vilified by manual therapists, personal trainers, yoga teachers and the like, it may not be all that bad after all. In my view, we are fixated on posture correction for more because of cultural ideals (appearing confident and strong) than avoiding or relieving physical pain.
Like most manual therapists, I used to believe the old theory of poor posture = problems. I’ve therefore also been guilty of trying to change people’s posture by strengthening the posterior shoulder muscles and stretching the anterior chest muscles (as per Janda’s Upper Crossed Syndrome theory) and was disappointed and dismayed when after the session they reverted back to their normal posture. This is because posture is habitual and very hard to change. Even constant reminders aren’t necessarily helpful because
a) the posture gets “corrected” for a brief moment until either muscles fatigue and people revert back to comfort
b) staying in the same position for a long time tends not to represent realistic situations
c) or they just forget.
What's more important is how we are able to move into and out of different positions.