Rethink Pain: Posture

Xray bronze Vitruvian man isolated on white

I’d say that almost every practitioner who deals with people in pain would have heard a variation on the following a million and one times:

I have terrible posture.

The implication is that this “terrible” posture is:

  1. A problem, in and of itself.
  2. The cause of their pain.

Previously in this series I discussed moving towards a model of pain that focuses on the nervous system, rather than muscles and bones (and other tissues) and osteoarthritis.

This post is going to look at posture and it’s link, or lack thereof, to pain as well as strategies to improve your posture, including the role of osteopathy.

What is posture?

The position of the body with respect to the surrounding space. A posture is determined and maintained by coordination of the various muscles that move the limbs, by proprioception, and by the sense of balance. (1)

What influences posture?

A commonly held view is that posture is purely structural.

Unfortunately, while this would be great, as it would make things simple, it’s not accurate.

Posture, like pain, is an output of the nervous system, which is influenced by (in no particular order):

  • Skeletal structure
  • Psychological factors – mood, emotions etc
  • Physical activities
  • Postural reflexes

Does posture cause pain?

No.

There are people with all kinds of posture who have pain, and there are people with all kinds of posture who don’t have pain.

If posture caused pain, then all people with the same posture would experience pain, or all people with the same pain would exhibit the same posture.

When you understand pain is a protective output of the brain, you can extrapolate that when you have pain, and your posture is altered, these postural changes are protective.

By the same token, changes in posture that occur after treatment for pain, be it hands on or movement based (or anything else really), occur because your brain is no longer needing to protect the affected region, because the perception of threat or danger has decreased.

Do You Need To Improve Your Posture?

Whilst there is a very low correlation between posture and pain, there are at least a couple of reasons why you may want to improve your posture:

  • Improved movement efficiency
  • Improved aesthetics
  • To improve some musculoskeletal conditions (this is a separate issue, because it is specific to the individual and condition)

So unless these are a priority, then you have to ask yourself if you really want to (or need to) improve (or change) your posture.

If you do want to improve your posture, then there are things you can address:

  1. Your mood, emotions and mindset.
  2. You habitual activities and positions.
  3. Improving postural reflexes.

Sorry, but you can’t change your skeletal structure.

So now you know what to change, but how exactly do you do it?

Let me show you.

Change Your Mood, Change Your Posture, Change Your Mood

You can pretty much tell how someone is feeling by observing how they are holding themselves.

What is interesting, is that whilst mood affects posture, posture also affects mood. So if you are in a bad mood, simply changing your posture can change your mood.

Your mood is simply an emotion, a feeling, and according to the theories surround Rational Emotive Behaviour Therapy (REBT) “humans do not get emotionally disturbed by unfortunate circumstances, but by how they construct their views of these circumstances through their language, evaluative beliefs, meanings and philosophies about the world, themselves and others”. (2)

So really, to change your mood, you have to change your emotions by changing the language you use (to yourself and others), examine your beliefs and philosophies about the world. This will then have a flow on effect to your posture.

This is way beyond my scope of expertise, but if you find you are constantly experiencing negative mood and emotions, you could benefit from speaking with a psychologist trained in REBT or Cognitive Behavioural Therapy (CBT).

What You Do, You Become

Most of our day is made up of habitual tasks and activities. From the way you brush your teeth, to the way you pour yourself a glass of water, all the way through to your regular sitting positions and favourite activities (or lack thereof).

As our bodies crave efficiency, they will adapt to accommodate our habitual postures and positions. Some of this adaptation is structural (bone, muscle and ligament remodelling) and some is functional (loss of stability, range of motion, neural tension).

The way to change this is to increase your awareness of what you are doing throughout the day, and pay attention to how things feel while you are doing them. Then modify.

For example, if you always lean up against the left arm of the couch when watching TV, you are habitually shortening one side of your body and lengthening the other. If this was causing you problems, you could practice alternating sides of the couch, which might feel weird at first, demonstrating both the mental and physical adaptations that have taken place.

What You Really Came For – Reflexive Exercises

When we are babies, we have primitive reflexes. Part of our development sees these reflexes “going away”, however, in a way, they remain as our postural reflexes.

For an example, sit tall or stand, close your eyes and let your body sway. Once you hit a certain point, your righting reflex will kick in so you don’t fall over.

Sedentary lives devoid of rich tactile and movement based sensory stimuli can lead to diminished postural reflexes.

One way to “get these back” is to perform reflexive exercises.

These exercises aren’t like traditional exercises which focus on strength, power or endurance. These develop the qualities that underpin movement, which allow us to express and developed strength, power and endurance.

These are performed in a sequence, from most stable to least stable, and from least complex to most complex.

The positions we can use are:

    • Lying.
    • Quadruped (hands and knees).

  • Kneeling and 1/2 kneeling
  • Standing – bilateral stance, split stance and single leg stance

In terms of complexity, we can progress by:

    • Single joint movement

    • Multiple joint movement
    • Contra-lateral arm/leg movement
    • Contral-lateral arm/leg movement that crosses the midline of the body

 

Reflexive exercises are usually rhythmic and self-limiting (you can only perform them correctly, or not at all), which make them fantastic for not only improving posture specifically, but fundamental movement ability in general.*

Can Osteopathy Improve Posture?

Yes, but not in the way you probably think.

Most people assume that if they walk into an osteopath’s office, and come out after a series of treatments standing taller and feeling “lighter”, that the osteopath has somehow “straightened them up” as you would a stack of blocks.

In reality, osteopathy will affect the 3 aspects of posture described earlier:

  1. Interacting with a personable and affable practitioner can help improve your mood, emotions and mindset.
  2. An osteopath can help you identify your habitual activities and positions, as well as help ease some of the strains that these induce using manual techniques.
  3. Finally, an osteopath can help “re-ignite” your postural reflexes, both by using manual techniques to help improve body awareness and help address any issues that might be negatively affecting them, as well as through exercises as described above.

Conclusions

Posture is very poorly correlated with pain, which goes against much of the information you may have read online or heard from health practitioners.

Most of the time, things that are helpful for treating pain, like manual therapy, exercise and cognitive/emotional therapies will also have a positive effect on posture.

In most cases though, treating pain does not require a specific focus on posture, at least in the traditional sense.

 

Nick Efthimiou Osteopath

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

 



 

 

 

References

*I will post up some examples of reflexive exercises on my Instagram and Facebook pages over the next few weeks, so connect with me on those channels to make sure you don’t miss them.

(1) Harris, P., Nagy, S., Vardaxis, N., Mosby’s Dictionary of Medicine, Nursing and Health Professions

(2) Rational Emotive Behaviour Therapy

4 Major Exercise Programming Mistakes

Woman stretching hamstrings.

He who represents himself has a fool for a client. – Abraham Lincoln

In many cases, it could be also said that the person who writes his own training program has a fool for a trainer.

The reason, in both cases, is the difficulty of being objective in deciding your own needs.

It’s only natural to gravitate towards what we like and what we are good at (often one and the same), which means when we write our own exercise programs, we often neglect what we need.

In fact, if you coach yourself, chances are you are making (or have done so in the past) at least one of the following common exercise programming mistakes.

Now, if you are experienced enough, with the accompanying knowledge, you can write yourself good programs, but I would always argue, that these will generally be inferior to a program written for you by a coach with equivalent or greater knowledge and experience than you.

The problem with programming mistakes is that they compound over time (more on that later), and the risks they pose are not insignificant.

Risks of Poor Exercise Programming

Before I go on to describe some of the most common exercise programming mistakes I see, I want to outline the risks involved with making these mistakes:

  • Injury. This is far and away the biggest risk of poor programming. In my opinion, if you exercise for health, you should never get injured as a result of your exercise program. I understand that for competitive athletes, a certain amount of risk is assumed in order to push the limits of performance, and I also understand that on any given day, shit happens, so a random injury might occur. But often, what seems random, is not, and if you look at past workouts, there were modifiable factors that contributed to the injury. The other injury consideration is joint degeneration.
  • Negative postural changes. Posture is complex – it has psychological and emotional components to complement the physical components that are commonly talked about. One of the influences on posture are the activities and tasks we expose ourselves to on a regular basis. With poor exercising programming, you can develop poor postural habits.
  • Suboptimal progress. To be honest, the risk of getting injured is enough of a reason to ensure good exercise programming. However, even if you are a throw caution to the wind type, good programming will ensure you make the best possible progress towards your goals, whatever they may be.

The Most Common Exercise Programming Mistakes People Make

These 4 mistakes are not listed in any particular order, and I would say, based on experience only, that the majority of people who have poor (or no) programming when it comes to their exercise make more than one of these mistakes, if not all!

1. Improper or lack of warm up

There’s a popular quote in trainer circles:

If you don’t have time to warm up, you don’t have time to work out.

Unfortunately, like many things, the quote is more popular than the practice.

Too many people make the mistake of not warming up properly before exercising, or, even worse, not warming up at all.

Excuses range from “it’s boring” to “I don’t have time” and god knows what else.

Like many things, there is a disconnect between what most people do and what those who are succesful do.

For example: professional sports clubs, with million dollar athletes, have staff dedicated to optimising warm ups in order to maximise training and game performance and minimise injury risk.

The bottom line is, warming up is important.

During a warm up, there are 3 main goals:

  • Psychological preparation – a transition period from what you were doing, to what you are going to do.
  • Physical preparation – increase body temperature, address physical qualities like mobility and muscle activation
  • Skill practice to prime the nervous system for the upcoming task

If you don’t warm up properly (or at all), you decrease your subsequent performance and increase your risk of injury. A lose-lose situation.

2. Lack of Flexibility Work

Time magnifies errors in training. – Ian King

Ian King has been a physical preparation coach for more than 30 years, and is often outspoken about many topics. However, his opinion is based upon experiencing of producing real world results with both athletes and coaches over many years, so his opinion counts.

One of the biggest topics he is vocal about, is flexibility training.

I like static stretching. I know, I know…current trends in sport science have found favor in other methods, like dynamic stretching. But, in my opinion, it’s all part of a circle that’s slowly turning. Static stretching was the big hit in the ’80s, and I suggest that it will be again. – Ian King

Not only does Ian promote the less popular static stretching, he also promotes stretching before a workout.

Now, I’m not going to regurgitate his reasons for doing so – you can read the article for yourself – but the biggest take home was that if you are performing activities that stiffen your connective tissue (just about everything involving muscular contraction), then you should be performing activities that decrease this stiffness as well.

To counter the points above, people will cite research that demonstrates decreases in power and force production immediately after stretching (lasting up to 15 minutes).

To paraphrase Ian again, if you did a study that measured strength immediately after a weight training workout, you would see a decrease in strength, and the researchers would conclude, based on that data, that weight training makes you weaker.

The solution lies in watching how top level athletes have prepared for many years, which is generally a variation of the following sequence:

  1. 3-5 minutes of general warm up to elevate body temperature
  2. Static stretching
  3. Dynamic/specific warm up
  4. Workout
  5. Go home

The added bonus of this: after your workout, when you are tired, you don’t have to do anything else, except maybe walk around a bit to cool down and start recovering.

3. Ignoring structural balance

Structural balance is a term I first read about in the writings of Charles Poliquin, another highly experienced strength coach.

Whilst we know that posture is poorly correlated to pain, we also know that the body will adapt to repetitive activities.

Thus, if all you do is run, then your body will adapt to running, which is both good and bad.

Good, because your performance will increase, bad, because you need to do more than run in your life.

Wealso  know from various research, that relative strength imbalances can lead to injury, so the implication is clear: balance your training to reduce injury risk.

This means:

  • Exercising a variety of physical qualities – strength, power, endurance, flexibility etc.
  • Performing a variety of activities.
  • Moving across different planes of motion and different “levels” (ground, standing, kneeling etc).
  • Balancing stresses across joints as best as possible.
  • Allowing for periods of higher intensity/lower volume and lower intensity/high volume.

4. “Too Much”

This is not a specific claim, but rather, an observation that most people, once they cross the line from casual exerciser to exercise enthusiast simply do “too much”.

Whether it is too much strength work and not enough flexibility and endurance work, or too much exercise and not enough rest and recovery.

I’m a massive proponent of doing something everyday if possible, but that doesn’t mean smashing yourself every day.

In my experience, this simply stems from being overly emotional about the outcomes attached to exercise.

You are not your fitness.

If you have an overly emotional attachment to certain outcomes associated with your fitness, I’d suggest you do some deep contemplation to find more balance in your life.

Conclusions

It might seem that I keep repeating myself when I talk about training: warm up, manage your volume/intensity, work on all physical qualities, prioritise rest and recovery etc etc.

That’s because:

  1. This is what the vast majority of people need to do, but don’t
  2. Training isn’t as complicated as the internet makes it out to be.

What is complicated, is you as a person (we all are), and so a good coach helps you recognise where you are, what you need and what you don’t. In fact, many of the benefits of a coach are not that you have the best program (it doesn’t exist), but rather adherence, consistency and progression, regardless of the means.

To avoid making exercise programming mistakes, it’s best to enlist help. There are options to suit all needs and budgets, ranging from free programs online all the way to individualised coaching (both online and in person).

Whatever your scenario, even for a short time it’s worthwhile investing in coaching of some form, in order to learn skills that will stay with you for life.

 

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



 

References

(1) Australian Institute of Sport – The Warm Up and Cool Down

(2) Ian King Blog

(3) Ian King – The Lazy Man’s Guide to Stretching

(4) Charles Poliquin Blog