Aching back? Your bad posture may not be to blame after all, experts say

The Sunday Magazine17:43Are you worried about your posture? You can probably just relax

If you search the Internet for “back pain and posture,” you will find articles about the effects of poor posture on the body, guides on how to reduce your back pain with posture exercises, and advertisements for all kinds of posture-correcting back braces and ergonomic devices.

It seems logical. After all, we’re told that good posture makes us healthier and less prone to injury, and that poor posture leads to aches and pains over time.

But several researchers and doctors say there isn’t much evidence to support the commonly held belief that poor posture leads to pain.

“As a young physiotherapist I realized there was very little research evidence,” says Peter O’Sullivan, professor of musculoskeletal physiotherapy at Curtin University in Perth, Australia.

O’Sullivan has spent the past twenty years researching back pain, its causes and how to deal with it. Back pain is the leading cause of disability worldwide, according to the World Health Organizationwhich predicts that by 2050 there will be 843 million cases of low back pain worldwide.

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He says he first became interested in the connection between posture and back pain after a skiing injury left him with excruciating chronic back pain. He started holding himself straighter and stiffer, thinking this would help protect his back.

But “my pain just got worse and worse and worse,” he said.

Eventually, O’Sullivan began to relax his body and noticed his pain slowly subsiding.

“Personal experience has shown me that I really got into trouble when I tried to hold these tense, upright positions,” he said.

In a article published last year in The Lancet, O’Sullivan and his team described a clinical trial in which people with disabling back pain were explicitly taught not to protect their backs. Instead, they were given cognitive functional therapy exercises, such as reflecting on their pain beliefs, practicing relaxation techniques, moving their bodies naturally and developing healthy lifestyle behaviors around sleep and nutrition.

After a year, O’Sullivan says, participants who received cognitive functional therapy experienced less pain and disability compared to those who received only usual care, such as physical therapy, massage and medications.

“They had more positive views about their backs, they were less afraid [and] they felt more confident when we taught them not to protect their bodies,” he said.

Postural panic increases

Our obsession with perfecting posture is not new.

Medical historian Beth Linker of the University of Pennsylvania delves into the history of what she calls “the bad posture epidemic” in her book Slouch: Attitude Panic in Modern America.

“You can find plenty of evidence to suggest that we are obsessed with posture,” Linker said in an interview with The Sunday Magazine Piya Chattopadhyay.

“And it’s not just the obsession — it’s the assumption that it’s clearly right, that we need to somehow discipline our attitudes and that that will lead to better health, or that it will prevent back pain.”

A collage with a portrait photo of a woman smiling at the camera and the cover of her book.
Beth Linker is the author of Slouch: Posture Panic in Modern America. (Matthew Hamilton, Princeton University Press)

Associating being slouchy with negative character traits such as laziness or laziness has been around for a long time, Linker says. But in the twentieth century, these ideas about how a person behaves “became scientific and medicalized in this way.” [that] seemed to make that even more entrenched.”

In 1914, the American Posture League was founded by educator Jessie Bancroft. It promoted the ideal of the ‘perpendicular pose’ – which required ears, shoulders, hips, knees and ankles to be stacked vertically along an imaginary line.

Around the same time, many American universities introduced posture exams, including posture exams taking pictures of unclothed freshmen — to measure the health and physical well-being of students.

Attitude scientists also adhered to “soft eugenics,” Linker said.

“They were not concerned with sterilization, with controlling reproduction, as hardline eugenicists would do,” she said. “But they did believe that if we did not pay attention to the attitudes of the citizenry, there would be a potential de-evolution.”

Meanwhile, the market for posture-correcting devices, which Linker says continues to this day, really took off with the posture anxiety of the 20th century, even though she says there’s little “hard evidence” to show it’s actually worth it is what we pay’. for.”

But what’s missing from all these concerns about slouching is solid evidence, says Linker, who also has clinical experience as a physical therapist.

“We need more research into it instead of just accepting that it’s automatically obvious that we all need to maintain our posture,” she said.

What actually is a ‘good’ attitude?

Trying to define “good” posture is elusive, says Krista Madsen, associate professor of kinesiology at McMaster University.

“There can’t be one right posture because we all have different shapes, sizes and distributions of the way our bodies are made,” Madsen said.

“It makes sense that there has to be some variation or some variability in the way we stand, or in the way we sit.”

When teaching her students how to conduct attitude assessments on other people, she says to simply describe what they see and not make judgments about whether it is “good” or “bad.”

A woman sits in the middle of a group of students across from another seated student and points to something on their knee.
Krista Madsen, center, teaches a group of students at McMaster University. (Greg Atkinson/McMaster University)

Although some researchers question the claims that poor posture causes pain, Madsen says they may still be related – and possibly point to another problem.

Pain is complex and can be caused by several factors, including stress, trauma, anxiety and depression, experts say. These same things can also affect the way a person carries their body.

“Maybe that pain isn’t really from the breakdown, but maybe that pain is related to the anxiety and depression,” Madsen said.

She admits that there may be other reasons why people want to develop a more upright posture, such as exuding self-confidence. She recommends a thoughtfully designed exercise program that includes resistance exercises and mobility exercises, or simply more daily physical activity, which would be beneficial regardless of position.

But Madsen says that if you’re not actually experiencing any pain or problems, and your body seems to be functioning well, “then you may be in your ideal position.”

For those who experience chronic back pain—and have ruled out serious problems such as fractures, infections, or cancer—O’Sullivan recommends determining whether it could be caused by major stressors, past trauma, or other lifestyle factors such as insufficient sleep or physical activity. .

“Pain is complicated. It’s multifactorial,” he said. “And the best way to focus on this is to identify which factors are relevant to that person and then target them.”

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