What is posture?
So often when I read about posture it’s all to do with this mythical position that eliminates pain, strain and dysfunction. It is almost always described as a static position with strict instructions of sitting up straight, shoulders back and down, chin tucked in etc…but that surely isn’t the real world? It certainly isn’t the world I, or the patients I treat, live in!
It is only my opinion and based on my experience up to this point, but it is my belief that posture is a dynamic thing and not a static one. In reality, we are moving all of the time, even when we sitting working on a computer. I feel it is unrealistic to teach this ‘ideal’ posture and ask someone to maintain it for 8 hours a day while they are at work. And even if you can achieve this miraculous position, what happens when you want to pick up your pen to write? Or start typing? Posture is surely a dynamic thing.
I have had many patients that have come to the clinic having previously been given this postural education, they often present with the same symptoms they had previously and are confused and frustrated, because they have been sitting in ‘good posture’. As I have said previously, it is not an easy task to ‘undo’ the thoughts they have programmed into themselves. It sometimes gets the patient into a right mess, not really knowing how to sit!!
The idea of the postural training is well intentioned, but it just doesn’t solve the problem that it is intending to. It is easy to assess for postural position, joint tightness and soft tissue tightness, but I feel that some of the advice given counteracts the manual work used to relieve the joint and soft tissue tightness’.
Over the next week I am going to look at:
- What is the effect of postural advice?
- What does it mean for the therapist/trainer?
- What does it mean for the patient/client?
What is the effect of the postural advice?
It is my belief that the postural advice is counter productive in helping the patient out of their postural dysfunction. So what is the effect of the advice? Well, one thing is it is giving conscious cues to the individual, which they will have to think about constantly in order to maintain the posture. This is a poor substitute for the normal sub-conscious organisation of function our bodies are used to. The major disadvantage of that is that if we consciously over-ride the natural pattern, we replace it with one that has only a few criteria, because that is all we can consciously manage, sit up straight, shoulders back and down, chin tucked in, etc. Consciously we can deal with about 40 tasks, whereas, sub-consciously we can deal with millions. It is impossible for the conscious mind to deal with the sequencing of muscle contraction required to maintain a good dynamic posture, let alone fine-tune their force of contraction! The over-ride pattern with consciously control use gross contraction of relatively few muscles, which is in stark contrast to the finely tuned, balanced, reaction of the body as a whole when ‘choosing’ its posture. The sub-consciously driven postural patterns will use a much lower level of force in a far greater number of muscles, one advantage of which is that when it is time to make a move out of the posture there is far greater flexibility in the system as it is not restricted by over a few over active muscles.
Postural advice is as much of a treatment as the manual therapies that we use to relieve the associated tissue tightness’, however, in my opinion it is given far less consideration and generally taken too lightly. In cases when posture is an issue, there will inevitably come a time when you have to discuss it with the patient. However, I rarely do this straight away, there is often no need. Postural advice is not a magic cure all for poor posture and needs to be implemented in the right way and at the right time in the treatment plan. If there is massive joint, neural or soft tissue restriction in the hips, lumbar, thoracic, cervical, chest and shoulder, don’t expect it to be anything more than massively uncomfortable to attempt to consciously over-ride these restrictions…it’s impossible!!
The reason I think this approach is counter productive is that when you pull back against the tight tissue, for example pulling back your shoulders, the stimulus for the pectorals and anterior shoulder tissue is to tighten!!! When what you actually want is for them to stretch or relax! So if your manual therapy has begun to release these tight tissues and then you give them a home/work exercise that tightens them back up it’s no wonder they are unchanged or worse!
Like I’ve said, there is a time and a place for addressing the postural issues, but in my opinion it is often given too soon and uses conscious strategies that don’t have the desired effect. In the next week I will address the questions of what strategies might be of more benefit from the therapist perspective and from the patient perspective.
All comments and questions are always welcome.