This article provides a viewpoint on the mounting yet established research evidence suggesting posture deserves less focus when managing pain, and the importance of understanding when to provide specific postural advice. Information technology argues that, in general, posture is less relevant than move itself, and creating change in patients’ behaviour and beliefs requires understanding, physical examination, clear communication and not necessarily deeming the role of posture every bit irrelevant.
Posture is a contentious subject amongst health professionals and the wider public. It holds potent cultural, political and societal meanings, merely these ingrained behavior are often unsupported by bear witness. ‘Good’ posture is by and large idealised as existence ‘direct’ and ‘upright’, while ‘bad’ posture is associated with slumping and stooping. Physiologically, each of these postures or movements loads tissues differently. It is frequently the context of the total strength through particular musculoskeletal tissue (tissue loading) that is key, rather than ready definitions of expert and bad.
In this commodity, posture is divers every bit the position of the human body, including all appendages at any moment in time. However, ofttimes as health professionals, and a wider society, we are mainly concerned with sustained postures; that is, how we sit and how we stand up.
History of postural beliefs
Posture is a cultural obsession, spanning thousands of years. Ancient Greek philosophers determined upright posture was ‘linked to the divinity and intelligence of human beings’.one
This idea persisted through history, and upright, rigid posture was widely adopted for correct armed forces drills during the 16th century. Over the 17th and 18th centuries, ‘practiced’ posture came to signify health, forcefulness and beauty. ‘Bad’ posture became an indicator of not but disability but also moral degeneration, unremarkably described in racial sciences in the early 20th century.2
These ideas of posture were also a pillar of the Majestic Fundamental Institute of Gymnastics in Stockholm in the early 1800s, an antecedent of mod physiotherapy.iii
The postural dichotomy of ‘skilful’ and ‘bad’ posture causing and contributing to pain and disability became endemic in medical science and societal beliefs and is however present to this twenty-four hours. Korakakis et al, when surveying 544 physiotherapists in 2019, found the vast bulk considered upright lordotic sitting postures as optimal,iv
a view shared past lay community members when assessing ‘optimal posture’.5
Some credence can be given to this historical ideal, as severe progressive kyphosis is a hallmark of untreated spinal tuberculosis or Pott’south spine, one of the oldest diseases known to mankind and associated with significant morbidity and mortality.6
Similarly, spinal deformity resultant of other spinal infections or conditions such as skeletal dysplasia was as well associated with disability and poor health prior to the appearance of modern medical care and early diagnosis/intervention.7
However, in the absenteeism of such affliction, this dichotomous relationship of ‘adept’ and ‘bad’ posture is non supported past the testify. As far back as 1967, John Keeve, a professor in public health, presented work supporting his statement ‘there are no scientific facts to substantiate the benefits of this (postural) aesthetic ideal, withal a dandy bargain of attending is devoted to “correcting faulty posture”’.eight
This is also supported by more recent work. A cantankerous-sectional written report of 1108 Australian teenagers institute that while forward/slumped neck postures were associated with a higher incidence of depression, they had no clan with cervix pain and headaches, challenging widely held beliefs nearly the role of posture in neck pain.ix
This finding was also shown in a recent meta-analysis by Mahmoud et al, in which forrad caput posture was not correlated with incidence of neck pain in adolescents and older adults (aged >fifty years).viii
The same meta-analysis did find a weak correlation in adults (aged eighteen–50 years), but when studies with poor-quality assessment were eliminated, these findings were not significant.10
The same analysis also suggested that in those with neck pain, increased pain was associated with increased forward caput posture in older age groups.10
This is not supported by more recent studies and again brings into question the relevance of generalised cohort studies on posture and pain.xi,12
Like testify exists for back pain, with a contempo systematic review finding no link between slumping postures and pain, besides as any other lumbar posture and pain.thirteen
Awkward postures were likewise shown to have no correlation with pain.fourteen
In fact, a contempo study interviewing participants with low dorsum pain (LBP) showed even proportions of participants described sitting upright as their best (relieving) and worst (aggravating) posture.15
This written report further highlights context and private preference as important factors for identifying advisable posture.
Clinically, context is the well-nigh important factor when considering posture in presenting patients. Consider a patient with symptomatic spinal stenosis; prolonged continuing or positions of relative spinal extension often lead to worsening symptoms and disability, generally eased with positions of spinal flexion such equally relaxed sitting.sixteen
In this case, advice to maintain an upright posture is in conflict with their condition.17
Neck and caput posture can influence jaw function and may be relevant in patients with temperomandibular pain.eighteen
Thoracic and scapular posture can influence respiratory mechanics and rotator gage function.19,20
A detailed clinical history may be of import for identifying specific aggravating and easing positions. This can provide specific context relevant to the patient and will give clinicians insight into what specific postural advice to provide the presenting patient (Figure ane).
Tips on providing postural advice
Additionally, posture may too provide insight into a presenting patient’south psychological state. As mentioned earlier, Richards et al establish that frontward/slumped neck postures in teenagers are significantly associated with a college incidence of low.7
This may add further clinical context for in-rooms assessment – while it is definitely not a sole indicator of mental health bug, it may add farther weight to clinical suspicion.
Cess of posture is therefore not irrelevant, rather merely needs to be considered in the context of the individual patient. Contextual considerations are outlined in Tabular array one.
|Table 1. Points to consider when developing an appropriate prototype in which posture should be considered and addressed|
Advice and counselling:
Posture versus movement
As discussed, current evidence does not back up the dichotomous thought of ‘good’ and ‘bad’ posture beingness linked to hurting. Nevertheless, sustained postures can significantly contribute to pain. Bontrup et al found that in that location was a meaning association between less movement between postures when sitting and increased run a risk of chronic LBP in a sample of call eye workers.21
This finding is reflected past Hanna et al,22
highlighting LBP risk showed a strong correlation with increasing time sitting but not seated posture.
With the current plethora of bear witness suggesting ‘sitting is the new smoking’, movement and changing positions to reduce time in sustained postures are likely more important than posture itself. Fifty-fifty in adults achieving the World Health System’due south targets for weekly do, sedentary behaviour of as little as 4 hours daily is linked with increases in both morbidity and mortality.23
Educating and empowering patients to feel confident almost this will ideally let them to manage many ‘postural’ atmospheric condition; priority is given to movement and changes in position, with less time and energy spent on finding the platonic posture. Although there is no consensus on the best way to suspension sedentary posture, a recent review summarised key points that clinicians tin consider with patients to reduce sedentary postures, equally shown in Table 2.24
Table 2. Strategies to reduce sedentary posture24
Method of reducing sedentary posture
|Increasing incidental exercise||
Posture and obesity
Obesity is a well-documented significant contributor to increased morbidity and bloodshed, but recent evidence suggests that information technology also affects postural adaptions.25
A recent cantankerous-sectional study of 420 students constitute a statistically meaning increment in the prevalence of knee valgus, exaggerated thoracic kyphosis and lumbar hyperlordosis in students who were overweight and obese.26
This finding is shared by several other studies, only so far there has been no clear evidence of this change in posture directly causing pain.27,28
However, as discussed previously, this is important to consider within an individual’s context. Consider an adolescent who is overweight playing a high-bear upon sport, such as basketball or netball, presenting with anterior knee pain. Increasing human knee valgus, a sign of poor rotational control of the lower limb, increases anterior human knee loads.29
Therefore, correcting this posture, and consequently improving control over knee valgus, would likely be cardinal to reducing symptoms and maintaining participation. Withal, information technology is of import to keep in mind that not anybody with increased knee valgus volition experience pain because of this.
Posture is virtually certainly associated with pain and morbidity, but this is likely to exist a much weaker association than previously thought. There is also a strong statement that this association is more attributed to sedentary behaviour, which inherently involves sustained postures. Still, in cases of articulate pathology and/or specific context for the presenting patient, specific postural advice may exist necessary to reduce tissue load, compression and sensitivity and to reduce ‘postural fearfulness’. This is done with the evidence of a clinical history and physical examination. More broadly, information technology is important that clinicians ensure the linguistic communication used promotes movement and reduces fear or fixed behavior about posture and its role in spinal hurting. Overall posture is a complex interaction of multiple factors, and a broad-brush approach of ‘skilful’ and ‘bad’ is not applicative.
- The concept of ‘skillful upright posture’ and ‘bad slouched posture’ is unsupported past enquiry evidence.
- Patient history and beliefs and clinical test are important for because patient-specific contexts before giving advice.
- Clinician language and communication tin can assist reduce fright and improve understanding.
- Movement is more important than whatsoever given posture.
Competing interests: None.
Provenance and peer review: Commissioned, externally peer reviewed.
Posture is a Good Indicator of
Originally posted 2022-08-05 08:07:30.