Patient: “I know I’ve got terrible posture.”
Me: “Okay. What makes it terrible?”
The answer to the question “What makes posture bad?” can usually be summed up in one word: Time.
If you’ve ever seen a Cirque du Soleil show or professional dancers in performance, then you know that the body is capable of amazing things - almost superhuman. And many of these performers do the same movements 6-8 times per week, every week. It is an incredible testament to the fact that our bodies were designed to move - not sit in a chair for 8+ hours a day. So: how long are you holding that posture of yours, and what are you using that posture for?
Posture isn’t just how we sit or stand; posture is how you use your body in your daily activities. Different activities in our lives have different physical requirements - do you have to perform something repetitively? Do you have to lift, hold or carry something (or someone) of a substantial weight? Does your job require you to maintain a position for periods of time, be it sitting or standing? Are you physically active, and does your exercise mode have certain postural requirements? Is your posture slowing down your running times or keeping you from lifting more at the gym? Hint: your posture is totally messing with your back squat...
Don't Move - Hold That Thought
Historically, we physical therapists used a plumb line or body grid as a tool to assess posture. How vertical is this person? Do specific body landmarks line up with this vertical line? Do we see a shift in the body? Ergonomic assessments followed suit, with some more specifics around “ideals”. Elbows should be bent at 90*, hips should be at a 90-110* angle, head should be over the shoulders, with shoulders relaxed. A search for images reveals figures who don’t necessarily follow these rules, primarily with the lumbar spine, pelvis and hips. But the story is consistent - you should relinquish your body to these rules and to the design of your chair. Good luck!
In our work as Functional Manual Therapists, we adopt a slightly different approach via two tenets:
Your body is your responsibility, and
Gravity is your Friend
Away From the Grid
So - we come back to our main question - what makes posture "bad"? As we discussed in an earlier post, things are rarely so clearly "good" or "bad". It's usually the time that we spend in any given position that makes posture dysfunctional. We further complicate the equation when we add in components of load and repetition. This may not seem significant when you're sitting at your desk - thought it might if you were experiencing neck pain or back pain It becomes much more apparent when we move away from more static positions and begin to move. Posture is not just how we sit or stand. Posture is how we dynamically use our bodies.
An effective posture allows for the automatic engagement of core and other joint stabilizers. It also allows for the efficient transfer of load with different activities: walking, running, lifting, carrying, pushing, pulling, jumping, dancing, or whatever your sport, hobby or life requires. When a body has a dysfunctional alignment, the muscular system creates a "holding pattern" with muscles overworking to keep us upright. These holding patterns alter the way we move and interact with gravity.
Consider this: Have you ever played Jenga or played with building blocks? The tower of blocks is nicely aligned and in a state of balance. That is how our bodies should be used - the efficient stacking of our head, spine and pelvis, using our "bony anatomy" to do it's job and hold us up. This is our relationship with gravity. When blocks are taken out of neutral alignment, our muscular system activates to hold the pieces together. Overtime, this leads to strain and compensation.
As a functional manual therapist, we use functional tests to assess alignment by testing the body's relationship to gravity. The patient is then taught how to correct it for themselves and use it in functional situations.
On Your Own
This is where the magic happens: when patients learn about their own bodies, can feel the difference between dysfunctional and efficient alignment and are then able to apply it in their own life and activities. For me, that is the "holy grail" of any treatment session! It's not automatic or a quick fix by any means, but teaching patients and athletes how to use their bodies better is perhaps some of the greatest impact we have as physical therapists.
So - don't just "sit up straight", SIT BETTER!