When we seek the services of a physical therapist in the hope that they will be able to get rid of a persistent pain, tightness or weakness, chances are that at some point we will receive a ‘postural assessment’. Before long, the conversation turns to the hours we accumulate sitting hunched in front of a computer, or standing hunched over a hospital bed, barber chair or even massage couch. Postural assessments often uncover one leg longer being than the other, one hip higher, a dropped pelvis causing a big arch in the lower back, forward shoulders causing a humped upper back… the list goes on. The temptation is often to blame our pain issue on one of these findings and then set out to do everything we can to ‘correct’ that bad posture, to restore ‘balance’. This could involve paying the therapist for a few sessions to twist, pull and click us back into position, and very often an us performing a series of ‘corrective exercises’ to restore good posture.
The problem with this approach to helping people in pain is there really isn’t much evidence that ‘poor posture’ causes pain, or such a thing as ‘poor posture’ even exists. If having an ‘excessive arch in the lower back’ is a precursor of lower back pain, how do we explain the many, many people who have this posture but are pain free? If ‘forward shoulders’ are responsible for pain between the shoulder blades, how do we explain the large population of pain free people with forward shoulders? Research actually shows fairly conclusively that the relationship between posture and pain is not as clear as we have grown up believing, and spending time trying to ‘correct’ posture via targeted stretching and strengthening may not always be the best way to tackle pain issues.
Research Into Posture and Pain
The ‘shape’ of the lower back is often used as a benchmark for measuring ‘good posture’. An ‘anterior pelvic tilt’, where the front of the pelvis tips forwards and the back hikes up, is often blamed for lower back pain. However, studies on lower back pain show that adults with an increased lower back curve are no more likely to have back pain than others. The same goes for lumbar scoliosis (curve in the spine), hamstring or psoas tightness, pelvic asymmetry or leg length inequality under 2cm; in fact, having one leg longer than the other is more common than having them the same length, with an average leg length difference of 0.5cm.
Now, that is not to say that the above cannot exist at the same time as pain. I have seen many runners with lower back pain who do display an anterior pelvic tilt, and I have seen many who after performing stretches for the hip flexors do see the pain go. But I have also seen runners with similar degrees of anterior pelvic tilt who do not suffer from lower back pain, and runners who despite frequent attempts to stretch their hip flexors do not succeed in eliminating the pain. In other words, just because two things happen at the same time does not mean one causes the other (correlation not causation).
So What Is Causing My Pain?
Good question, and one that science is still far from totally understanding. But it is getting closer. In our article Understanding Pain, we looked at how research by modern neuroscientists such as Lorimer Moseley and David Butler is helping us get closer to understanding the true nature of pain. We now appreciate that pain does not come from a damaged tissue. It comes from the brain. Rather than a pure measure of tissue damage, it is a measure of how much danger the brain perceives we are in, a warning alarm based on sensory input (visual, auditory, olfactory, etc.), emotional input (belief, fear, motivation, etc.) and other factors such as nutrition and respiration. This helps explain why whilst some people with osteoarthritis or bulging discs suffer from pain, others do not. It helps explain how stress, fear, job satisfaction, etc. can make some people experience more pain than others, and how some people experience pain even if they have no structural damage at all.
Blaming poor posture for pain is falling into the trap of believing pain comes from the body. It doesn’t… In fact, there is more evidence to suggest that modified posture may be the result of pain, as opposed to the cause. Imagine you have injured yourself. Nerve endings send information to the brain regarding the nature of the damage. Note: no pain has been triggered yet. The brain interprets this information based on a multitude of other sensory input including what we see/have seen, hear/have heard, believe, fear, etc. The brain’s decision as to ho wmuch pain to outoput (or indeed if it needs to output pain at all) will therefore be different for every individual.'Posture And Pain: Implications For Runners' - at sportinjurymatt.co.uk. #ukrunchat #runchat Click To Tweet
Pain Is Real, But It’s Not The Enemy
It is vital that you do not interpret this description of pain as ‘all in your head’ or ‘imaginary’. No one is saying ignore it and it will go away; the brain’s ability to use pain to defend us from potential danger is on deep, unconscious level that we can’t just ‘turn off’ by concentrating. However, by understanding the many factors that can influence pain output, we can choose far more effective ways of trying to deal with it rather than trying to correct a ‘poor posture’ that may not have anything to do with the situation.
If you are a runner suffering from persistent pain, a very useful question to ask yourself may well be: “Am I doing anything that could be causing my defence system to feel threatened?’ By understanding that overcoming pain is often a question of gradually restoring system thresholds (which have been lowered as part of your system’s natural defence strategy), the way you deal with a pain issue will change significantly. As well as graded exposure to load (yes, you still need to do the exercises you are given), other factors such as current activity level, sleep, nutrition, false beliefs, stress may also become important players in helping you achieve full recovery. Seeing a health professional who is aware of this will help you get far more effective treatment than one trying to turn you into a ‘symmetrical robot’ with ‘perfect posture’. Your nervous system controls almost everything you do with regards to function and sensation. Make sure you involve it in your rehabilitation plan!
Do you have any tips or interesting experiences regarding rehabilitation from injury? Whether you are a therapist or a runner, we would love to hear from you in the Facebook Comments section below!