Sit or stand up straight!

One of the most common things that comes up in conversation with my clients is about posture: something along the lines of  them saying “I know my posture is really bad…”.  I try to reply in a non-judgmental way that it might not be helping with whatever ails them.  The topic of posture can be quite controversial.  There are many people on both sides of the argument (Correct posture is everything versus posture makes no difference) and things can get quite heated at times.  I will say from the outset, that this blog is my opinion and is as much me working this through my thoughts on “posture” as it is evidence based.  If I feel I have supporting evidence to a point of view I will state it, and if you know of some really great resources about this, or some scientific research then please let me know.  Just be nice.

So what is posture? If I google “definition of posture” the first definition (from Google’s dictionary) is “the position in which someone holds their body when standing or sitting”, and the Meriam-Webster online dictionary defines it as “the position or bearing of the body whether characteristic or assumed for a special purpose, e.g erect posture”.  In the Yoga world, posture is a word used to describe any of the poses or asanas that we move towards in our practice.  To me, these seem to be very static in their assumption, although the Meriam-Webster does include the bearing of the body, which might include the movement.  That is one area where we can get caught up in: we are very rarely completely still, we move and our posture should adapt to our movements.

Reading this article in The Guardian made me start to think about whether I think posture is important or not.  It says that there is very little scientific evidence of “poor” posture causing back pain.  However, it also says that if you do have a bad back then your posture becomes an important thing.  In clinic I typically see people who have back pain: so their posture and how they hold themselves does seem like it might be important for me to consider.

You may have noticed that I put poor in quote marks in the above paragraph.  It is one of the most contentious things about the posture discussion: what is “good posture”?   The Guardian article criticises people who say posture is everything because there seems to be no gold standard as to what “good posture” actually is.  I think that what constitutes “good” posture will depend upon the individual variability of the skeleton and musculature of the person being looked at as well as the subjective opinions of the person who is looking.  Subjective being that an individual’s opinions colour their view, where as objective is measurable time and again no matter the observer’s perspective, which is considered a better thing as far as science is concerned.  The article uses ballet as an example of good posture because there is a particular, defined standing position that ballet dancers have to adopt that is identical for each and every dancer.  A singular way of standing or posture does not take into account our own individual skeletal structure, such as the shape of the top of the thigh bone where it joins the pelvis (technically known as the head of the femur) which can vary hugely between individuals.

When I was trained as a Sports & Remedial Massage Therapist, and again with my training with Myofascial Release UK, we looked at specific bony landmarks (such as the ankles, knees, pelvis, shoulders and ears) as ways to compare both sides of the body, the front, and the back to get a sense of the individual. These are static ways of looking as a brief way of understanding an individual as they walk into our treatment rooms.  However, these are potentially strange settings and because a person knows they are being looked at they can often stand awkwardly; we are also not seeing the person in the normal, natural work and home setting, doing what ever it is they do.  It does, however, give me a quick visual assessment of them, and allows me to look slightly more globally than where the pain is.

Then to take the discussion of posture into a completely different place is this interesting article about the History of Posture.  I had never really considered the socioeconomic bias deciding what good posture entails.  The article traces the origins of “good” (stand up straight!)  posture back to the Ottoman musketeers, who needed to adopt a very long straight spine to fire their weapons that rested on a stick.  No, I don’t know why they didn’t just shorten the stick.  This posture was then adopted by the nobles, who wanted to suggest that they were musketeers and the rest is a straight backed route to the current day.  A straight back basically meant that you weren’t labouring all day in the fields or the kitchens: you were wealthy enough to pay someone else to do everything for you. This fashion is very much like the changes in desire for having un-tanned skin from the Elizabethan times, when only the rich didn’t have to work in the fields, or the varying trends about what a desirable weight was (historically, plumper meant you could eat more and more frequently).  It was interesting to consider the rise of good posture in this light.

One element that I would be careful of these articles is that they are quite bio-mechanical in their approach: they don’t consider the mind.  There is some evidence that a more upright bearing makes us feel happier and more able to cope with situations compared to slumping. Try it for yourself, really slump (assuming this doesn’t trigger pain in your back) and walk around like this for a few minutes and see how this makes you feel. Then try straightening up so that your shoulders are wide and above your pelvis, and your neck continues comfortably upwards and the heag rests loosely here. How do you feel now? Most people say that being slumped makes them feel less upbeat, and being more upright improves their mood. Is this a possible connection between posture and pain? Slumping for long periods can make us feel less enthusiastic, possibly in a job that we hate and stresses us out, which triggers an inflammatory response, possibly disturbing our sleep, and we notice that we’re uncomfortable and then we develop a niggle that we label back pain. We then try to do something very different to normal, such as getting up and playing sport and our body protests.

So do I mean that poor posture causes back pain, well not really.  I would be more inclined to say that our posture is constantly changing as we move around, but in our current society we end up being in the same position for hours at a time.  Our body then adapts to how we use it, adding more tissue at points of strain, removing stuff we don’t need and so our body uniquely develops along these lines.  This is very eloquently described in the following quote from a fantasy novel I read:

So in clinic I do consider my client’s posture, but I’m not really looking to judge whether their posture is good or bad.  I’m looking to see how they hold themselves and what they consider is upright.  People tend to have a dominant leg that they stand on and this can create a habitual shift of the pelvis to one side, the rib cage to the other, and the neck adapting to keep their eyes level with the horizon.  We can then get other twists and turns introduced to our systems because of injuries, surgery, habitual work posture, and these adaptations and stresses are what I’m looking to identify, and hopefully help ease out to try to return a general symmetry between the two sides.

A good standing posture, to me, is one where you balance the weight evenly between both feet, your feet are roughly under your knees, which are under your hip sockets.  Your hip sockets aren’t the boney bits on the side that most people call their hips, but rather about halfway along the crease of the groin. The pelvis should rest down onto the legs in a position about halfway between an extreme tip forwards and a n extreme tip backwards. The belly is gently held in by the abdominal muscles, which helps to support the whole of the rib cage keeping the diaphragm roughly level. The shoulders can then be wide across the front and the back that lets the shoulder blades slither into a more neutral place, with the head emerging with the boney bit behind the ear being above the shoulders. To me, this positioning makes my body feel at ease with a right amount of tension in my muscles to hold me upright.  And then you move….

…and when you move your posture will change. It’s meant to!  The body has to counter the movements of the limbs so we don’t fall over because we take an arm out to the side (unless we want to). This is the other issue with becoming obsessed about standing well: we don’t actually stand still for very long, ever (unless you’re a soldier standing on guard outside Buckingham Palace or one of those living statue buskers that seem to be everywhere). We are moving constantly and that, to me, is when our habits and posture collide, sometimes to our cost.

There are some positions in which our bodies move more easily in different directions than in others: if you sit and slump it is much harder to turn to look over your shoulder than it is sitting with a longer more upright spine.  Give it a try yourself and see how twisting feels different between slumping and having a straighter spine.  This is down to the way the bones of the spine are formed, they have sticky-out bits that limit certain movements in relation to each other, which vary from bone to bone (have I said that I love the amazing human body).  In a slumped position we are not designed to turn very much, so why force it.

We really want to be able to be in a comfortable position, and then move from that to another and then another as we need to throughout the day.  The transitions between the different positions are where our habits kick in, that we can have movements coloured by our own personal history (accidents, history of pain) where we might move around areas that have caused us issues in the past. The body then keeps adapting based upon these movements, strengthening where we need them and becoming weaker where we don’t. For example, most of us have a thickened band that runs down the outside of each leg from the top of the pelvis to just below the knee, it’s called the Iliotibial Band (ITB, or Iliotibial tract if you’re american), this develops as we learn to walk. However if we spend the majority of our days riding a horse, our bodies adapt and strengthens a band on the inner thigh, and also dissolves the ITB because we don’t need it. Ultimately the body in the cowboy can develop a boney growth at the groin to really strengthen the inner thigh and then make it painful for them to walk in anything other than a rolling gait.

Ultimately, I think we want to keep moving as much as possible, and to do that we need to be able to find ease in the way that we move between the extremes of our possible movements.  And by extremes I do not mean that we need to be able to tie ourselves in knots, but we want to keep our possible movements to the greatest extent.  This involves moving, but also being aware of how we move, and where we hold tension in our bodies, which might be subtly pulling us in a direction that makes completing our move more difficult.  This to me is what movement therapies/classes (such as yoga or pilates or tai chi or chi gung) is about, learning more about how our bodies move in different directions and orientations to the ground.  Once we know this we can make a change, and that to me is where the bodywork I do, especially myofascial release can help ease out restrictions.

The photo below is a quote by Rodin, that I saw at the recent British Museum exhibition and felt it was quite appropriate.