Posture explained

You're interested in your posture?

Have you tried many different ways of getting rid of discomfort and pain in your joints? If so, you are not alone, and in trying to help people over the years, we have come to the conclusion that right at the root of these problems is a postural cause.

By understanding the cause, one can do something constructive.

Here we try to explain this case and give some pointers. You will not find detailed tips and tricks, but we hope you will gain an understanding that will help you in the future. Of course, we would be interested in feedback to try to improve our service!

The menu on the left is for this article only; you can get back to the home page or the site map from the top or bottom of the menu.

What Is Posture?

Posture is a static state; "A position of the body" or "An attitude" (dictionary.com), "Posture is arrested movement" (Bobath). By itself it is a word which is often used in contexts other than human position with qualifications such as defensive, poor, bad, aggressive, happy.

What distinguishes it from position is the inclusion of the mental element, particularly mood or emotion, as an ingredient; i.e. posture is a "position with attitude", so to speak.

We always have a posture of some kind or another, even if the mental intention behind it is subconscious. And, of course, it is well documented that body language plays a large part in communication.

Our bones hold us up, our joints link our bones, our muscles move the bones around the joints and our nerves facilitate control of the whole. The key to good posture is correct joint alignment; however, muscle activity, balance and nerves are all part of the picture.

Joint alignment

"Joints" are not just the obvious ones such as those on the arms or legs, but the term applies to any links between bones including the spine, shoulders and hips and weight-bearing joints in the feet. There are about 230 mobile and semi-mobile joints in the body.

Our bodies evolved for certain purposes and our joints move in particular ways to fulfil those purposes most efficiently. When alignment is "correct" (that is, in the evolved position) our body is in balance and our muscles and joints are working with least effort.

This actually applies to movement as well as static posture. Professional athletes go to great lengths to understand this, for then their bodies are not just in balance but achieving maximum output as well. If our joints are used differently from their "designed" position, we say they are out of alignment or mal-aligned. One of the effects of using joints out of alignment is at least discomfort, which can manifest as pain and eventually become injury.

The degree of mal-alignment matters; a very slight amount and the effect is not immediately serious. A greater degree and we know about it instantly. If a joint is mal-aligned and under stress, something gives and a break or a tear ensues. "Something gives" can mean quickly or over a period of time if the stress is lower level but repetitive, hence repetitive strain injury (RSI). This can occur anywhere in the body.

Mal-alignment leads to muscle imbalance. Muscles adapt; for instance, an arm in plaster cannot be stretched immediately when the plaster comes off. The same effect happens when a joint is held in the wrong position over a period of time, which is why some people have round backs or slumped shoulders.

Muscle activity

For this discussion, there are two kinds of skeletal muscle in the body, each with their own function. The first kind, postural or "slow twitch" muscle, is for holding us in the "correct" position; these muscles are short and in the deepest layers, especially along the spine. The other kind, movement or "fast twitch" muscles, are for moving us, lie over several joints and are closer to the surface than slow twitch muscles. We need both in varying degrees to perform properly.

(The other kinds of muscle are cardiac - the heart - and smooth muscles, which function automatically, running the digestive tract etc.)

Even postural muscles will not hold positions for any length of time if they are not used regularly, a good reason in itself for sedentary workers to take exercise and understand alignment.

The phrase "muscle tone" in physiotherapy refers to the amount of fibres in the muscle "firing" at any one time. Even at rest, some fibres are firing and the muscle is "ready to go". Only when a body is dead is there no muscle tone. The amount of muscle tone in a posture is largely a function of the amount of support being provided. At an extreme, a person lying on their back has a wide support base, so minimum muscle tone. At the other extreme, a person standing on tiptoes on one leg has a very narrow base and so needs maximum muscle tone in perfect alignment.

The muscles are, of course, governed by the brain: lift an empty box that you believe to be full, and it shoots up into the air as your brain orders too many muscle fibres to fire for the task.

Balance

A contributory factor to holding a posture is balance. Balance can be used in two ways when talking about posture. It can mean the balance of opposing forces; for instance, are the muscles holding the shoulders back strong enough in comparison with those pulling the shoulders forward? If not, then a round back is likely to happen. Secondly, it can mean balance in the sense that if it is not right, the person falls over.

A person with good muscle balance will be able to hold an unstable position for longer because they recruit the postural muscles in the correct alignment and their movement muscles are less involved. A person with poor balance will move a lot and have to use the movement muscles to try to get back to balance. These muscles will get tired quickly and the correct posture will be lost.

Nerves

We control our movement through our nerves. Messages are passed in both directions between the brain to and from the extremities, the muscles and the joints. If this passage of information is disturbed, we cannot have proper movement. Nerves are physical entities and just as subject to maltreatment as bones and muscle; they can be affected by blows, by stretching, by pressure, by twisting. They pass between muscles, along bones and joints on paths developed, like the rest of the system, during evolution. So again it follows that if alignment is not right, the nerves may be affected.

What happens if posture is poor?

In each of the areas of joints, muscles and nerves there can be effects of mal-alignment. These ill effects may start out as very slight and they may remain at a very low level but, if the cause does not disappear, they will get worse and may become intolerable.

Mal-aligned joints and ligaments may just feel uncomfortable, may ache, or hurt. Shearing forces in the spine may affect the discs, putting pressure on the nerves that fan out from the spine.

Muscles will suffer through lack of circulation, which may manifest itself as discomfort, ache or pain as well as lack of performance, getting tired quickly. The body's healing process is impeded when blood-flow and cellular exchange are restricted.

Pain may arise when nerves are stretched or inflamed by mal-alignment. Again, the range of symptoms may be from discomfort, through tingling, pins and needles, hot or cold feeling or numbness to pain. A characteristic of nerve damage is that sometimes the symptom is not in the place where the damage is being caused. For instance, a nerve being damaged in the lower back may cause tingling in the thigh or pain around the ankle.

The effects of these symptoms will carry across to whatever the individual is doing. If you are in pain or discomfort, concentration and attention to the task in hand will be disturbed. A sportsman cannot perform properly when suffering even slightly; the office worker is no different.

If concentration and attention are reduced, tasks will take longer, mistakes will be made and will need to be rectified, the quality of work will be lower.

Why do we have poor posture?

There are two sides to this, physical and mental.

Physically, the short answer, going right back to fundamentals, is that we are hunter-gatherers, with our roots on the savannah, evolved to spend our days wandering in search of berries or pursuit of prey and we are no longer doing what we evolved to do. We are emphatically not designed to spend our day sitting on our bottoms staring fixedly at a screen or a road, or for any of the other activities of our modern life that are so far from our origins.

Mentally, we have unnatural pressures that bear on us all the time. No doubt the link between posture and attitude derives from relationships within our hunter-gatherer community (authority, submission, joy, sadness and so on) but today life is complicated by the sheer variety and duration of circumstances and information that affect us. Thus a person with an oversized mortgage, an unpleasant commute and an unhappy job will tend to have a worn-out demeanour with the posture to show it: rounded shoulders and wrongly curved spine.

What to do about discomfort and pain

There are three main steps:

take control
listen to the body
take action.

Take control

Mind and body are closely linked. In many instances we are, without realising it, in control of the conditions that are giving rise to pain and are therefore in a position to get rid of it. Once we understand this and consciously take control, we can achieve quite remarkable advances and be very much happier.

It is as much a mental as a physical approach. We know a happy person when we see one; we talk of "a spring in their step, head up, chest out." We know instinctively what such a posture means.

Our brain controls our posture through the nerves. Our mind can control our brain. One way of implementing that control is to alter our posture positively. Try walking with a spring in your step, add in a little skip, your head up and chest out; you will probably feel a lift and may well have a smile on your face at the same time. That is the first step. Think positively about improving your physical posture.

There is no reason for anyone to be in "victim mode", feeling that the world has it in for them, that there is nothing they can do. As many practitioners will tell you, if you cannot bring such a person to believe that they can do something for themselves and get them to exercise some initiative, you cannot begin to change their pain. But once they have decided they wish to change, the results can be remarkable. When people understand why and how to take control, their health improves.

Listen to the body

The second step is listen to the body.

Why do people "grin and bear it"? Because they are not listening. Discomfort and pain are telling you something. In particular, with musculo-skeletal matters, they are telling you that something is not right, something is out of alignment, or something is moving in an incorrect way. Analyse the feeling, look for the root cause and seek ways of changing.

Pain is subjective. There are many cases of people with quite severe injuries that they hardly notice, whilst other people with injuries in the same area but to a lesser degree may be in agony. It is noticeable that when a person is concentrating, they may even temporarily put themselves in the position of not feeling pain. Indeed, it can take a very long time for the body to "get through" to the mind and make the point that something is not right. Unfortunately, all this time the damage is getting worse. So it is worth treating the messages of discomfort and pain positively, by listening to them.

"Where pain, no gain"

The phrase "No pain, no gain" is the enemy of musculoskeletal comfort. It derives from an intensive training regime which believes that it is only when the muscles are in a particular kind of pain that they are getting stronger. It does not apply at all to normal life. There is no merit whatsoever in working through pain and hoping it will go away. Pain is a warning signal from the body and it is our job to do the detective work to discover the cause of the warning and do something about it.

Take action

The third step is taking action. There is nothing to be gained from inaction, from grinning and bearing it.

Responsibilities

In an organisation, both employer and employee have their responsibilities. The employer has a duty of care, the employee has a duty to comply with the employer's health and safety policies, and these should include a requirement to report. No employee should ever feel constrained from reporting pain and discomfort; as part of the duty of care, this should always be taken seriously, even where the manager suspects that the employee is making trouble or being frivolous.

Generally speaking, people are sensible when it comes to pain, and if they realise that something will be done, they will not exploit goodwill.

Prevention

We cannot leave this without mentioning prevention which is, of course, the best action. Not the lazy form of prevention, expecting ergonomic equipment on its own to solve the problem; anyone can habitually slump in even the best chair in the world.

The individual will be better at prevention if they have some knowledge, preferably from training, possibly after treatment. The absolutely best preventative action, though, is that which the individual takes. The logic is clear; if taught how, one can sit and work on anything.

The individual will know what hurts and, with knowledge, will know what to do in order to avoid that pain.

Immediate action if too late for prevention

If it is too late, the action depends on the intensity of pain.

In particular, it is essential that if a person has tingling, pins or needles, numbness or discomfort in the fingers, wrists and/or hands, ask for expert medical opinion to be sought immediately.

It is not enough to rely on the opinion of someone who does not have medical training. Even some GPs do not yet recognise the importance of immediate intervention. The best contact is a member of the Association of Chartered Physiotherapists in Occupational Health and Ergonomics (ACPOHE), and all the better if they are ready to come into the workplace.

With this kind of symptom, early intervention is essential. The longer they are allowed to develop, the more difficult it is to get rid of them. There are very clear figures about the relationship between early rehabilitation and return to work; those principles apply even if the employee has not been absent.

Further, the cause is not always obvious, and some detective work may be necessary.

If the pain is not intense, time to find a simpler solution can be taken. Many people do play around with their equipment, layout and habits and find that a change removes the pain. Unwittingly, they have achieved the right result. However, if in the course of making alterations symptoms get worse, they should be treated as needing immediate medical advice.

Long term

We have all met the person who is never comfortable, however much time and money is spent on adjustment and furniture.

In the longer term, such a person may need more information and training about their posture.

To change posture is a more mental than physical challenge. We all have our own posture ingrained in our brains as being "correct". However, in cases in which posture is in fact incorrect, the brain needs to be re-programmed by training to accept the correct messages; constant reminders and repetitions in the early stages are required.

This need not be particularly time consuming. Complete postural re-education for people who have problems should, with weekly one-hour professional help sessions, take no more than 4-6 weeks; the effects can last a lifetime.

The irretrievable

Sometimes a person cannot be helped even by postural re-education. This may be because they have a physical impairment or psycho-social condition that require a different approach.

Have we helped you?

Please let us know whether this article has been of interest and/or help, and what more information you would like to see.