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Is there really such a thing as good posture?

article posture Oct 14, 2021

As a practicing physical therapist for over 20 years, I can’t look at someone and not notice their posture. It would be like trying to look at these words and not read them. I will involuntarily begin to analyze how they carry themselves and consider the reasons their body has adopted that position out of the countless other options it has. I find posture fascinating because it tells a story. Much like a landscape that has been shaped and carved by the elements of nature, your posture is a current representation of the physical and emotional influences that have affected your body throughout your lifetime. Babies’ and toddlers’ postures are generally quite uniform barring any significant physical health issues. As we go through the journey of our lives our postures become more distinct, reflecting the unique experiences, habits, preferences, and challenges we have encountered along the way. As a novice PT, I had no appreciation for this. I was shown an image of what “ideal” posture looked like and was inclined to think that any deviation from this should be labeled as dysfunction and remedied. In PT school we would assess our fellow classmates, a group of generally healthy and pain-free 20 somethings, and inevitably find that every single person deviated from this ideal in some form or another. Dancers, football players, yoga instructors, all the picture of health and vitality, all with some form of “postural dysfunction”. I began to question, does anyone have “good posture”? Does it even exist? Does it really matter?

Throughout my career, the number of postural assessments I have performed is into the thousands. While people can often be grouped into subcategories like round-shouldered or excessively arched or flat-backed, each individual’s position is unique to them and reflects their individual experiences. When I assess a patient’s posture today, I am no longer looking at them critically, trying to figure out how they deviate from the ideal, but rather with curiosity, trying to appreciate why they have ultimately found the position they have adopted. Every deviation from the mythical postural ideal has developed subconsciously as a solution to some challenge or solve some problem. An attempt to accommodate an injury, maintain balance, compensate for inflexibility, or reduce effort. Some challenges are temporary and compel small postural changes that only last for days or weeks. Other challenges are more persistent, such as accommodating inflexibility or a trauma. Even emotional states can impact your posture. You can look at how someone holds themselves and determine if they are nervous or confident,  anxious or calm.

Small movement challenges often require small postural solutions, but sometimes those small changes can create new challenges, which may require additional solutions. A lifetime of layering challenges and solutions can sometimes lead one to assume a strenuous position as their preferred position and lead to pain. Attempts to move out of this position may help alleviate that pain but may cause another. When you are no longer able to move out of pain because you have run out of movement options you end up in a cycle of chronic pain where you are effectively forced to live in a posture that is causing harm. I often like to think about posture like the game Jenga. You start off with a neatly stacked tower of blocks that is stable and secure. As you go along removing blocks from the tower and stacking them on top pressure develops on a few key areas and the entire structure becomes less secure. As you continue the game your options for removing blocks become fewer and fewer. Eventually, you get to a point where any change to the structure will result in collapse. Each final tower will have a different orientation, some lean left, others right, some may have twisted or bent at different areas, but the end result is the same. You are out of options and the only choice is to maintain as-is. This is where many of my patients are when I meet them.

If I take that patient and tell them to stand up straight and pull their shoulders back, it would be like taking that precarious final Jenga tower and just pushing it to align as straight and upright as the original stack. It is an ineffective way to restore balance and stability and frankly a very unfair thing to ask of my patients to do. Attempts to mimic the position that is often thought to be proper posture can often be harmful and generate more pain. Rather I try to figure out where those high-pressure areas are and figure out a way to support them and ultimately have my patients learn to support themselves. We continue to repeat this process together identifying habitual positions of strain and how to find simple and achievable ways to reduce them. As stability and comfort are restored more options become available and more corrections can be made. We continue doing this until the pain is gone and the patient can identify the precursors to pain and manage them independently. During this process eventually, these new movements become integrated into subconscious patterns and become the new normal. I explain that process in detail in this previous post.

In the end, no one ever looks like that mythical postural ideal. Instead, they continue to sustain their own unique positional preferences that they have adapted over many years of lived experiences. Adaptations that they have gravitated to through their body’s wisdom in understanding how to protect and manage itself. Now they have the tools to restore security and ease in a way that is respectful of the journey they have taken to get to this point. That’s good posture.

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