Redefining What We Mean by “Posture”

A quick Google search for ‘”posture” and “injury”‘ will lead you to an extensive list of articles telling you that “poor posture can lead to more injuries” and “you can prevent injuries with better posture” and “this is the best way to stand/lie/sit”.

But of course the conversation surrounding posture always has been and is still based in a discussion of rules surrounding static posture, rather than the application of those postural rules to a dynamic environment.

And whilst that makes sense if we take standing in the queue at Sainsburys or sitting at your desk or lying in bed as the context for the conversation, in reality most of us move in some way during the day.

Not only that, but “posture” is commonly purely defined as “where your shoulders are”. But every joint in our body is placed in a position to suit our current task, within the more global position of our body. So why aren’t we talking about ALL joints when we describe posture?

In truth, it’s almost certainly because it’s too complicated, but a few patients I saw this week certainly got me thinking about these ideas of posture as a response to a given task in a dynamic setting and the postural elements of all joints of the body.

So, posture as a dynamic idea. This first patient I have been working to improve their understanding of posture as a general concept with a focus on when to apply tension and with how much force. You see they are a) very analytical and b) very hyper-dominant in their big, powerful muscles (namely lats and pecs). This has led them to be stuck in a paradigm of posture being a single position and fighting to hit that exact position no matter what, causing significant pain and dysfunction as they have been in an internal war for control of this position.

This week, we workshopped the idea that posture is a dynamic concept. Within this is the idea that the basic concepts are the same (sternum elevation/thoracic extension, shoulder blade retraction, chin flex/tuck), but rather than trying to hit an exact position, you are trying to balance the position of the 3 structures and accepting that one or other may be sub-optimal at any given time during the movement.

I used the deadlift as an example to explain this concept. At the bottom of the lift – the set – we’re able to perfectly balance the 3 components to hit a nice, strong shape. Halfway through the lift, we may lose our neck position as we fight to keep sternum elevation and scapula retraction. Then at the top of the lift, we can re-stack our cervical and thoracic spine into strong flexion and extension positions respectively, but we may be in more scapula protraction than we would ordinarily be if we compared that “posture” to our normal relaxed standing “posture”. Both of these 2 “dysfunctional postures” (mid way through the lift and at the top of the lift) are perfectly acceptable for that given task, even if they are at odds with the accepted idea of “good posture”.

Secondly, applying posture as a concept to all joints.

This other patient was a foot issue where, amongst other things, position of the foot on ground contact through to toe-off was sub-optimal. This was also observed in normal stance – the patient was excessively everted (“flat-footed”) leading to them standing and walking off of the inside of their big toes.

If this was the shoulder girdle, we would refer to it as a “postural” problem and fix it with “postural correction exercises” – but why don’t we do that with the foot? In reality, it’s the same concept. In a static stance position, the patient’s feet are in a sub-optimal position which is causing discomfort and is magnified under load (dynamic positions).

So if we do strength exercises to help the patient position the foot more appropriately under both static and dynamic settings, should we call these “postural correction exercises”?

I discuss both cases in this weeks episode of “Injury of the Week”