Massage Myth #3 – Posture Assessment

The posture assessment has been part of the manual therapy experience for decades.  It’s all about the spine, just the right amount curves in just the right places.  This is based on a compelling and seemingly logical narrative that ‘poor posture’ is the cause of aches and pains and correcting it alleviates or cures.  30 years ago pelvic tilts and head positions became the key indicators of a variety of abnormal postures.  And indeed these established ideas made sense to me when I came to it in 2014.

Here’s the shocker…  Despite still being taught, there has never been any good data to support these ideas.  Moreover, in the last 10 years numerous high-quality studies have demonstrated that there is no causal link between posture and pain.  The whole idea is hugely problematic, so I’ve summarised some key points.

Here’s 8 problems with posture assessments (number 8 is the best!):

1. There is no normal posture

It’s not a mathematical geometric constant with perfect ratios and no one has it.  You will literally never meet someone with perfect posture.  It’s a cultural ideal that’s evolved over centuries and more to do with notions of class or race superiority.  It’s just an idea.

2. There is no poor posture

Posture is just posture.  Your body grows and adapts according to its environmental demands, nutrition, activity, genetics, injuries, habits, and mental health.

3. Judging posture is unreliable

Ask a cohort of therapist to assign a posture type to subjects, and they give different responses, i.e. it has poor inter-rater reliability.  It’s very subjective, so human error flourishes.  It’s also been shown that a group of students asked to stand for assessment, stand differently each time.  So double useless.

4. The method of assessing pelvic tilt is flawed

There are a couple of boney bumps on the pelvis used as landmarks to assess a person’s pelvic tilt.  But, these can be in slightly different places on each of us and can skew the apparent tilt by up to 23°.  More than enough to for ‘normal’ to seem ‘abnormal’.

5. Pelvic tilt does not correlate with back pain.

Really.  Never been proven.

6. No amount of pulling or rubbing will change it

I can’t change your posture with my hands.  No one can.  Save your money.

7. Pathologises everything

This means it’s used to make perfectly normal ‘imperfections’ into problems you didn’t know you had.  Problems the therapist can fix of course.  Beware the ‘Free Posture Assessment’, it is a gimmick.  Gets you through the door, pathologises your ‘imperfections’ then offers a round of treatments you don’t need.

 8. Posture doesn’t correlate with, or predict back pain

And this is the most important point of all.  This alone is more than enough reason to seriously challenge the need for posture assessments.  Research into the predictors of back pain show high correlations with depression, anxiety, low activity levels, poor quality sleep and stressful life events.  Posture doesn’t even get a look in.  There are much more worthwhile, evidence informed possibilities to pursue when tackling back pain.

Why is it still going on?

Assessing posture is easy to learn, easy to dispense and easy to convince patients who want to get better that it’s the cause of their pain.  It seems so logical.  It’s just not supported by evidence – which is hard to read, hard to evaluate and hard to explain.  It is a blunt and redundant instrument that represents a spectacular over-simplification of a mind-bogglingly complex relationship between the nervous system, the brain, the body and social in which it exists, all of which must be studied if we want to understand pain.

The good news is, it’s ok to be a wonky donkey.  If you find that you’re getting into a position everyday that’s uncomfortable, make some changes until it settles.  If your office chair is making you ache, buy a nicer one – it’s worth it, it’s your back.  If you are experiencing aches and pains, there’s probably something we can do about it, and it’s highly unlikely to have anything to do with your posture.

Abnormal is normal.

I hope this is helpful,

Tris