The posture debate

Posture doesn’t matter: what are they actually trying to say and what’s missing from this conversation

We’ve all heard it before: Posture doesn’t matter. And here at LYT, we advocate that posture DOES indeed matter. If you have gone through LYT teacher training, then you understand why we advocate for posture. If you’ve taken a LYT class, you know first-hand how great you feel after a LYT teacher guides you to optimize your postural habits. It may seem incredulous that people don’t believe in the benefits of improving their posture. So, when people say posture doesn’t matter have you ever wondered why? Where is this coming from, and what are they actually saying? And how is this debate being misconstrued?  

We are stewards of knowledge. This means it is important to investigate both sides of a debate. Firstly, the truth lies somewhere in the middle, and we often get so attached to our belief system that we become blind to that middle ground. Secondly, on either side of this posture conversation – when people misunderstand or oversimplify it, they perpetuate further miseducation. I encourage you to read this blog post with an open mind so that you too can embrace your status as a steward of knowledge. (I’m totally picturing us as maesters at the Citadel – shout out to any GoT fans reading this!) The next time this conversation topic comes up, you can truly educate others from a place of understanding, your own experiences, and areas of expertise.

Okay, let’s break this down. A colleague of mine recently presented a journal club all about what he called The Posture Narrative. He presented article after article of studies investigating and disproving “perfect posture”. The article I’ve cited below is what I will be using to explain what this literature is trying to say. Further, I will explain why I think the general statement of “posture doesn’t matter” is perpetuating a false narrative and is NOT aligning with what they are actually saying.

Here are the points they are suggesting are untrue/outdated knowledge:

  • Avoiding spinal flexion is the safest way to sit and bend
  • You must have a straight back or slight bend of the back during lifting tasks
  • There is one single ideal standing position
  • It is unhelpful/incorrect to say, “Sit Up Straight” “Sitting is bad for you” and “your pain is caused by your swayback posture”

The article cites literature that has shown:

  • No strong evidence that avoiding incorrect posture prevents low back pain or that any single spinal curvature is strongly associated with pain
  • People with low back pain bend their spines less and show more trunk muscle activity when forwarding bending and lifting

The authors also suggest that the narrative of “perfect posture” creates and reinforces stereotypes that your posture is a direct reflection of respect, attractiveness, and morality. That fear is being created. That overemphasizing perfect posture creates a belief that slouching and bending one’s back will lead to harm and that spines are fragile which creates fear-avoidance behavior. They then remind the reader to remember that just 40 years ago, the medical community thought that bed rest was the way to treat low back pain and this idea has been disproved by the literature and accepted by medical personnel as more harmful than helpful. They are implying that the idea of “perfect posture” as a treatment approach is the new “bed rest”.

Here are my thoughts on this. The bottom line is that there is no such thing as perfect posture. We should be able to move in and out of any posture or position. Aka Posture = adaptability. I think we can all agree on this. The triple ‘S’ concept is not about creating a perfect posture that we must sustain at all times. It is about aligning your unique anatomy in a way that allows you to optimize the way your joints move, muscle firing potential, and to maintain a peaceful length-tension relationship with your fascial slings. When have we ever given the advice that you have to sit up straight and REMAIN IN THAT POSITION? Never. Postural alignment has always been about the optimization of movement patterns.

I do agree that we cannot put a causation stamp on posture. Did “bad” posture cause the back pain? Or did the back pain cause the bad posture? We don’t know. And while there are correlations between poor movement and pain, the literature is clear that there is no causal relationship here. This is a valid point. Does this mean we should not address posture and movement patterns? No. The authors agree on this point stating “We strongly encourage building a relationship with patients to explore why they adopt certain postures.”  

The main point of this debate is this: “Advice given by clinicians can lead to fear and encourage hypervigilance”. As movement instructors, we should never aim to create fear in our clients. Lara, the founder of LYT yoga, has always been clear on this. The goal is to empower our clients by showing them what they are capable of. To remind them that they are strong. To illuminate the ways they have been neglecting to move and restore total motion if movement abilities have been lost.

Remember the concept of ‘use it or lose it’. If we never get into a ‘triple S’ posture, we may over time lose the ability to find it. I believe that for optimization of the biomechanics of our musculoskeletal system, one should be able to get into a triple ‘S’ or “neutral” spine position, in whatever way that means for that specific person. For someone with a kyphotic thoracic spine, that might mean that their head is slightly forward compared to someone with a less kyphotic thoracic spine whose ‘Triple S’ may look more like what is perceived as “perfect posture”. Both versions of this are still a ‘Triple S’. ‘Triple S’ is flexible.

Static posture is one place we look when going through a physical assessment. It only tells part of the story. “Sitting up straight” will not necessarily keep someone from ever experiencing pain as the article suggests. Matter of fact, if you sat that way for a long time, your muscles would start to ache, shouting at you to move, please. The goal of postural education is not to limit someone’s movement pattern to a strict neutral spine-only movement type as the author suggests it does. That is doing a disservice to what posture advocates like me and the LYT team are educating about. The only goal of postural education is to develop our clients’ understanding of movement patterns to increase the longevity of movement abilities. This means maintaining all movement capacity, including being able to perform a forward fold and flex the spine. Posture education is just the first stepping stone to movement restoration.

Of course, if you stop at static postural “perfection” then you have only given your client the first chapter of the healthy movement book. I believe that in actuality, the posture doesn’t matter article is just trying to remind movement experts to remember to read our clients the whole book.

I hope that you enjoyed reading my thoughts on this debate. I encourage you to formulate your own opinion, even if it disagrees with mine. Let us all remember that our goals are the same. The “posture nay-sayers”, if we want to call them that, want to help their clients get better just as much as we do. Let’s find the common ground that posture does matter and there is no singular “perfect posture”. There are a range of positions that can be considered optimal posture. And it is just one piece of the puzzle. As always, pain and dysfunction are multi-factorial and rarely have one single cause.

If you liked this article, forward it along to a friend! Let’s keep the conversation going in a loving way.

XO,

Dr. Thalia Wynne, PT, DPT, AT, RYT

IG: @thalialovee

Reference: Slater D, Korakakis V, O’Sullivan P, Nolan D, O’Sullivan K. “Sit up straight”: Time to re-evaluate. Journal of Orthopaedic & Sports Physical Therapy. 2019;49(8):562-564. doi:10.2519/jospt.2019.0610

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