In Part I, we discussed the reasons why persistent pain cannot be blamed on damage and degeneration, and how medications and surgery are not always the best solutions.
When these things fail, people usually head to a therapist. It could be a physical therapist, chiropractor, massage therapist, voodoo witch doctor, etc. – whatever you like!
Many people don’t even bother with drugs or surgery, and head straight to a clinic looking for special exercises and magic hands.
Once you arrive at a clinic, you’ll probably be told one (or more) of the following:
- your posture is awful,
- one of your bones are oddly shaped,
- a joint is slightly out of place,
- your muscles are either too weak or too “tight”,
- you have a weak or unstable “core”, or
- all of the above.
Do these things really cause pain to persist? In part II, we’ll discuss the first few, and save the rest for part III.
“Poor” Posture ≠ Chronic Pain
Poor posture is thought to place stress on your body’s tissues, perpetuating pain and preventing recovery. At first, this might make sense. But how many of us have friends with awful looking posture, yet do not complain of pain? Is it only a matter of time before they do? Then what about our elderly grandparents with stooped posture who still don’t complain of back pain? Clearly, it’s not so simple.
In fact, the scientific evidence supporting a postural contribution to chronic pain is poor 1, 2, 3, 4, and the whole idea has attracted considerable debate. 5 Just because you have “poor” posture, doesn’t mean you are doomed to have back pain. And if you have back pain, it’s probably not because you slouch at your computer too much.
Even if posture was as important as people tend to believe, healthcare practitioners are actually really bad at assessing it – no matter their level of expertise. A study that tested chiropractors, physical therapists, physiatrists, rheumatologists, and even orthopedic surgeons on their ability to rate spinal curves as normal, increased, or decreased showed that they we’re all equally unreliable! 6 Think about that the next time someone tells you your back is out of line.
And even if you do have poor posture with pain, it may not be posture causing pain – it may be the pain affecting your posture! A small study in 2011 demonstrated that experimentally induced muscle pain impairs postural stability during standing and unexpected perturbations. 7 Altered posture may also be due to avoiding pain, and trying to straighten them up might cause more pain!
Good Posture is Still Good
None of this implies you should slouch at your desk all day. Good posture or not, sitting too much is generally bad for you. If you have a desk job, you should try taking frequent ‘stand and move’ breaks.
There is value in straightening up. If you recently strained your lower back, bending over will probably hurt (just like taking the stairs causes pain in sore muscles). By all means, straighten up and avoid aggravating the injury. But this doesn’t mean poor posture is the reason or cause of your pain – in this example, it’s the injury. “Poor” posture does not cause chronic back pain – but it may provoke it. Scratching your arm doesn’t cause a sunburn… but if you have a sunburn, scratching it will hurt a lot!
Interestingly, good posture has also been shown to improve pain thresholds – but for “psychosocial” reasons! 8 An experiment demonstrated that when people adopt a powerful, tall, confident posture, they have higher pain thresholds, and stronger grip strength! This may be due to changes in hormones 9, and perhaps justifies the ever popular “B-Boy Stance” (in my opinion).
Conclusion – good posture is still good, but worrying about tiny details and imbalances? Not worth the stress.
Perhaps something else is off – something that can’t be as easily changed as straightening up your posture? Maybe you’re somehow “malaligned”?
Shape, structure, and symmetry of the body is often blamed for being perpetuating factors in persistent pain. One of the most common examples is leg length inequality. It’s believed that having one leg longer than the other will cause the spine to become malaligned, causing pain.
But does walking around with a few extra centimeters on one side really cause pain, or prevent it from recovering? According to research, the answer is no – there is no relationship between leg length inequality and the presence of pain. 14, 15
What about joints? Can’t they be slightly out of place (a.k.a. “subluxed”)?
Subluxation of spinal joints have long been blamed for causing pain to persist by pinching nerves and/or stiffening backs, 16 and it’s thought that they need to be manipulated back into place.
However,the idea that joint alignment changes after manipulation (or that subluxation even exists in the first place) is not well supported by high-quality scientific evidence. 17, 18, 19 This isn’t just an outsider criticism – the chiropractic profession itself is actually quite divided on the topic. 20, 21
This doesn’t mean spinal manipulation doesn’t help pain (it does 22, and we’ll discuss this in the future). But it certainly does question the idea that pain persists because a joint is slightly out of place.
Biomechanics are not totally irrelevant. They may be risk factors, but not necessarily causes of persistent pain. Furthermore, a knowledge of biomechanics can help prevent sports injury by identifying risky positions and movements. 23 That’s why improving your coordination works to prevent injuries. And there are other benefits to good posture, as discussed above.
But to blame persistent, chronic pain on poor posture, abnormal body structure, and faulty biomechanics is not entirely accurate. In fact, such beliefs may even be harmful, causing people to stiffen up and fear normal movement (which we will discuss at the end of this series). It may also prevent people from learning more about modern pain science.
Everyone’s posture is different, and there’s a lot of variation in our bodies. Even being slightly asymmetric is normal – it’s a part of how we’re all unique. Worrying about tiny details and imbalances is not worth the stress.
Now, get up from your computer and move around!
References will be posted as a comment below, in the following format:
8. Bohns, V., & Wiltermuth, S. (2012). It hurts when I do this (or you do that): Posture and pain tolerance Journal of Experimental Social Psychology, 48 (1), 341-345 DOI: 10.1016/j.jesp.2011.05.022