“I have terrible posture. I need to fix it.”
“Should I buy a back brace to keep my posture right when I’m working at my desk?”
“I sit with a straight back but I still have pain!”
If you work in outpatient PT I am sure you have heard all these things at least a time or two. PT has somewhat become known for working on “postural re-training”. Many patients and other healthcare professionals think PTs are there to help people learn how to “sit right”. Many believe perfect posture is the fix for a lot of neck, shoulder, and back pain.
But how much does posture matter reeeaaallllyy? Let me ask you this – What does your posture look like at the end of day as you’re typing notes? I’ll share mine. I look like the human version of a banana. So why don’t I have consistent, recurring, or debilitating neck, back, or shoulder pain? Let’s dive into the mystery of posture and what’s worth teaching and not teaching to our patients.
Some Posture Research
There is a lot of research out there on posture and rehab in terms of causes and treatments. When looking at causes it appears that not moving or keeping one sustained posture definitely has a negative effect on posture and the pain associated with it. One study found increased pain in young adults who reported frequently being in a text-neck posture and phone overuse/addictive behaviors. A.k.a they sit doom scrolling for AWHILE and multiple times a day.
Another study reported individuals who had low levels of physical activity were more likely to have poor shoulder posture and increased pain. Notice on this one they just say physical activity. They don’t even look at one posture like a text neck or how much time subjects spent sitting at a desk. They infer low physical activity just means you’re doing a lot of sitting, no matter what posture that’s in.
If we’re looking at treatment, movement and strengthening still seem important. This study found manual therapy only helped in the short term with forward head and kyphosis, but had little to no effect on the shoulders or scoliosis. A lot of the people who come in with pain associated with postural deficits are tight and would maybe like/want massage. I’m sure some of us have had these patients. However, while it feels good for a little while, it definitely doesn’t fix the issue. I don’t know about you, but I’ve never had good luck with just using a lot of soft tissue treatment for these patients. Doing soft tissue twice a week isn’t going to undo days of repeated inactivity and sitting in sustained postures. These patients truly need a behavior change in order to reduce their pain
Lastly this study demoed lower trap strengthening seems to be part of an effective treatment plan for neck pain associated with poor posture. So those “postural exercises” do have some benefits.
There is a ton more research out there looking at a lot of different things related to posture and rehab. Based on this research it seems movement, frequent movement, and some strength are key. What I definitely did not find anywhere in any study is that training a person to sit straight as a pin all day, every day, helps pain caused by poor posture.
Not How You Sit, But For How Long
So maybe it’s not so much how you sit, but for how long. Now some people may get a little upset with me saying that. You may be thinking “but what about text neck?!” Yes, the “text neck” position isn’t great. It’s certainly a 21st century problem that requires 21st century solutions which we’ll talk about later.
Again, I ask you though, how do you look when you text? And do you have classic text neck symptoms? The answer is probably your posture isn’t great when you text, but no you don’t have bad neck pain. However, due to having a job in healthcare, you’re probably not on your phone as much as some people, or at least not for prolonged periods. Not to mention you’re up and moving around most of the day. Which probably counteracts a lot of periods you’re sitting using your phone.
Our bodies were made to move. At the end of the day, any posture, whether text neck or something else, is ultimately just some flexion or extension of the spine, some rounding or retraction of the shoulders, or some posterior or anterior tilting of the pelvis. Regardless, our body was made to do all those movements. If it wasn’t, it wouldn’t. So I definitely don’t think sitting up so straight and tall you could balance a book on your head is the solution. Someone may impressively be able to hold that for most of their day. Except if they’re sitting two, three, four hours at a time, multiple times a day, they’re going to still have pain. Any posture can be bad posture, if held for long enough.
Patient Posture Points
So if I don’t tell my patients to strive for perfect posture then what do I tell them? I want to share some of the points I like to stress when talking to patients about posture. I find my patients almost get more benefits from the education surrounding this topic than any exercise I give them. There are several more things you could educate and spend time on besides these. This is just what I’ve found personally works for me.
Posture is never going to be perfect 100% of the time.
Once patients, for whatever reason, think posture is the source of their pain they get the idea they have to have perfect posture all the time in order to not hurt. I am pretty quick to tell them it’s not realistic to have perfect posture all day everyday. Remember in the beginning when I mentioned how shitty my posture is during afternoon charting. Yeah, I tell my patients that. If they see even their physical therapist doesn’t worry about having proper posture 100% of the time, they stop worrying about it too and focus their attention on better things.
Switching It Up Is the Key
Like we said before, it’s not so much what posture you sit in, it’s how long you sit in it. Patients like “it depends” answers about as much as student physical therapists do, so I like to give black and white rules when I can. Here’s one of them. I tell patients for every hour you sit, you’re up and moving for at least 5 – 10 minutes. Take a walk, get some water, do some of your exercises – anything.
This mostly becomes a problem for my desk workers. For patients who aren’t always able to get up around that hour mark I encourage using standing desks so they can at least switch their position. Some of these patients are also guilty of being in the zone where they don’t even realize the time that’s gone by. I tell them to set a timer to remind them. Sometimes it becomes necessary that the timer be set in a position where they must physically get up to go turn it off 🙂 Annoying? Hell yeah it is. Does it work? Hell yeah it does.
Regular Exercise Program to Counter Sitting
Okay so besides helping the patient’s pain, this one is a shameless plug for some general health and wellness too. The body is all about balance. I’ll use yoga as an example, there’s a reason it works. It’s all about moves that balance each other out. If you look at a typical yoga routine, you’ll see an extension movement typically follows a flexion one. That’s to balance everything out.
So I’ll bring it to the patient’s attention if they’re primarily sitting at work and home, that’s A LOT of sitting. There’s nothing to balance it out. That pain is the body’s way of saying something is out of whack. A regular exercise routine, whether it’s cardio, weights, yoga, you name it, is a great way to bring the scales back in alignment. Patients usually agree and it gets them at least contemplating a healthier path if they’re pretty sedentary.
What’s your take on posture? Should we still be stressing “proper posture” so much? What do you teach your patients about posture? Or what exercises do you like to prescribe? Share all your favorite postural tips in the comments section here. I would love to hear some other opinions or ideas. Don’t forget to hit subscribe to get all new PT Page blog posts directly to your inbox to stay up to date on all things PT!
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