On this episode of the #AskMikeReinold show we talk about one big question – Does Posture Really Influence Pain? To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.
#AskMikeReinold Episode 108: Does Posture Really Influence Pain?
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Transcript
This question is from Ian from North Carolina. I was reading through a recent discussion on one of your posts in Instagram in the influence of posture on pain. There seems to be a lot of theories. What do you guys think?
– What is the influence of posture on pain? We talk about this a lot on Facebook and Instagram the last few weeks ’cause I put a post showing the prevalence of rotary cuff tears are higher in people with poor posture. And there’s definitely not the best methodology in that subject. But it created a bit of a buzz. So I don’t know. Does posture influence pain? Who wants to start? This is a big one, but there’s tons of info. You got it Mike?
– I can start. I’ll let you guys follow up, but I know when I sit at my computer for a long time with bad posture, I don’t feel better. So I feel pretty bad actually after sitting for like four or five hours working on the computer with bad posture. I just don’t feel,
– You feel worse.
– I feel worse. So I don’t know if that means anything.
– So let’s roll off that. What do you guys think? Why does Mike feel worse after sitting at his computer all day? That’s an interesting question. So his poor posture did increase his symptoms, but why?
– I think honestly it depends. I think sitting for a prolonged period of time and not moving probably has a lot of things going on physiologically than just make you feel poor. I know that if I sit and I work in front of a computer for a long period of time, as opposed to standing and engaging with people, I feel better standing and engaging, being more social, moving my body. I bet physiologically there’s a lot of good stuff that goes on with movement. I think the big question is whether or not having a prolonged posture is gonna lead to pain. But I think the thing that we can probably all agree on is that when someone has a pain problem, certain postures will definitely exacerbate that.
– That’s a good point.
– Without a doubt.
– That’s a good point.
– I can say right now, sitting here for awhile, my hip is starting to hurt. It doesn’t feel phenomenal. I wouldn’t say that sitting’s gonna make everyone’s hip hurt though. But it’s definitely related to that individual.
– I think that’s well done. An interesting quote that came up, so Greg Lemond actually had a great quote. I think it’s safe to say Greg doesn’t listen to this podcast so we’re probably safe to chat here, but maybe he will if he reads this title, so what’s up Greg? But Greg put a pretty cool comment. He just said, you know, “loading is life” or something like that. I actually replied. I was like, “yeah, that’s pretty good.” Loading is life, ’cause somebody said it like, “poor posture increases load. It increases load on the tissue.” And he’s like, “well, tissue needs to be loaded.” And I thought that was actually a smart comment, Greg, sorry. But I also thought it was quite short sighted too because that’s him just implying all load is good. And I think that’s interesting. So what I kind of added to the conversation, and I like to just plant these bombs and then step away and let everybody else argue about ’em. But what I added to the conversation was, well, can we say that certain postures, as well as other things, like a type III acromion or something like that, but can certain postures then decrease the capacity of the tissue to handle load before symptoms occur, or partial tearing, or inflammation occurs? So it’s real short sighted to say to just say you need a load. I mean, maybe it’s really like the issue of, are there things like posture, does that make your total capacity to load lower? And I added that to the question. I don’t think anyone’s chirped back at me yet, but I’m sure they will. I don’t know. So based on that, I don’t know, keep the discussion going.
– I think that’s just building upon what we’ve been saying, is you put yourself in a seated position, your lumbar spine is flexed relatively, so that means all the surrounding musculature is trying to hold on in a flexed position. And then you go up, and you’re upright now, you’re extended, and now you’ve gotta do things in that position. Can your tissue respond? In some people yes, in some people no. What’s the stress in their life? What’s going on in other things? I think there’s so many different factors. I think it’s one small piece.
– Yeah.
– I agree with that.
– Semi me, I definitely, ’cause I was interested in this myself because I was just going through posture, I was kinda redoing my shoulder impingement series, which you guys have not checked out, fitnesspainfree.com. Anyway,
– Search for shoulder pain series?
– Yeah.
– Nice, good.
– Initially I had a post about posture. And honestly, I didn’t update it ’cause it’s, the literature, at least when I was doing the review, I think it’s important that if you want to get some answers, you go and look yourself as opposed to just reading everything that’s on social media. Go on, look at the research yourself, and come up with your own idea.
– Social media does not have any answers, I would argue.
– But it was very mixed. I’d say that the majority of what I found did not correlate postures with shoulder pain. But then again, Mike found an article just the other day that had a very strong correlation between postures and shoulder pain, and also with pathology, right?
– Right.
– But I was finding quite a bit that was linking prolonged postures with neck pain and a little bit of lower back pain. So I think it’s kind of like stress, and Dave and I talk about allostatic load, and Lenny just alluded to this. It’s all the influences in your body that are potentially leading to this. Maybe my neck starts hurting because I’ve got a lot of stress going on in my life. I actually have terrible posture. I have terrible load capacity in my neck ’cause I don’t exercise all the time. All these things are going to come together to give you a problem, right?
– Right.
– And maybe if you do an enormous study and look at everyone’s posture in the entire world, and say, “okay, so postures don’t affect that.” It’s like wow, there’s a billion variables that could have led to that person having a problem. There’s no way you can say that the research indicates that it’s not related whatsoever.
– I think it’s a small, small, it’s one piece you can’t ignore. ‘Cause you’ve got to know the majority of people out there are not exercising like these guys. So they’re not out there loading the tissue. They’re not out there doing movement stuff. They are sitting at a desk, and then they go home, and they sit and eat dinner, and then they sit and watch Netflix. So I think those are the people that are out there. So yeah, 80% of people with back pain get better, yes, on their own, but I still think there’s that 20% that we can’t ignore that are not exercising and loading their tissue, and end up seeing us for P.T. So it’s a small, small piece of the puzzle that is pain.
– Lenny, are you a shareholder of Netflix?
– I am actually not a shareholder of Netflix.
– Alright, I was gonna say, “do we have to disclose that?”
– Big regrets that I did not buy Netflix. [Chuckles]
– Alright, so how about this then?
– I think my thought my summarize a lot of it.
– Alright.
– Yeah. I agree with all of what these guys are saying. And what I’ve learned to kind of take from the literature and all that stuff, is one of the biggest buzz words that’s around posture is variability. And I think that that concept has a lot of facets into what we do. Like, the people who come to see us, maybe it’s their first time. We say maybe lay on your stomach for the first time in awhile, and hey, look up everyone once in awhile. Or like, do some exercises to reverse your posture as you say, like dancing. Like, add some more variability to your training. It’s not always about mobility differences. I think people jump to, oh, mobility stiffness causes postural adaptations, which is, now I hurt. That’s not always directly relational. But like, variability training, or doing other exercises for your upper back along with the front of your shoulders. I think those factors are usually what people find the end benefit of. Whether it’s education from us or exercise design, or whether it’s just talking to them about what’s going on. Like, why do you, after eight hours of sitting, do you feel bad ’cause that tissue is sensitive? Versus if you just get up and move around you might feel better. So I don’t know if it’s so much as like, the posture’s the problem or it’s more about your lack of ability to do a bunch of different stuff and not do one thing over and over. It’s probably what sensitizes the tissue.
– Alright, so let’s go off that and let’s combine it with Mike’s comment to an extent here. What if you sit all day, and then you never do anything but sit all day?
– That happens everywhere, you know?
– Are those people in pain? Does it cause pain? Or is the question is, do we sit all day and then go play basketball?
– Right.
– Or do we sit all day and then go do an overhead press with a barbell?
– Right.
– Maybe the issue isn’t that posture creates disuse, which creates muscle imbalances, and tightness issues, and tone, and some muscles that are used to not being on because of compensation and stuff like that. So it’s just, posture creates this cascade of things. And then it’s that we sit for X hours a week. You drive to work, you sit at a desk all day. You drive home, you eat dinner, you watch Netflix, and that’s it. And then on the weekend you try to play ball with your kids and all of a sudden your shoulder hurts. And they say well, it’s because of your posture.
– No. But I think you’re right. That scenario alludes to everything. Like me in gymnastics. They live all day long in anterior tilt, in extension. They train in extension, a lot of them adapt to extension. And then it’s not that that’s bad for them. But that plus a bunch of back handsprings is probably what finally aggravates you. So I don’t know, it’s that posture, it’s the repetitiveness of it, or the, like you said, stacking something on top of that at the height of demand.
– And I would say, too, I feel like our treatment style here, our philosophy here is, we turn on muscles. I don’t know what the heck that means. I don’t know what the neurophysiology or the neuromuscular components of what turning on muscle is. But I always use this example with patients. It’s probably good to share here just analogy-wise. When you sit in your chair all day, your core doesn’t need to do anything. The chair is keeping me from falling to the floor. If I were to stand up, I have to use my core to engage a little bit. But I’m just sitting here, my core’s completely turned off because the chair is helping me stabilize so I don’t collapse into a pile of bones. The second I stand up, if I’ve been doing that all day, you rock back on your static stabilizer, your back stabilizer, because your core is still off. I don’t know what that means. But again, it still is just not active. And then you just start exercising, you start doing some of the drills we do, some of the rhythmic stabilizations for the core, just like a generic strength and conditioning program. And all of a sudden they go throughout life, and they use their core more during their daily life. We see that in here. So I guess maybe the real summary of this isn’t that posture doesn’t cause pain, but all the associated deficits, or associated consequences of having poor posture all day, and not having movement mirrorability, not ever doing any strength training, not working on your mobility, not trying to reverse your posture throughout the day, the consequences of that are probably gonna be what limits it. But again, your body adapts to the stress applied or not applied. We always talk about the stress that’s applied, and then we build more resilient tissue by applying load. But remember, your body also will go in the other direction if you never apply load. That’s fine if you never apply load. But if you just sit, and you want to be the best sitter in the world, then you should probably sit more.
– That depends on how we’re defining applying the load. Just siting for eight hours in this awful postural position might be enough load to break down the tissue that hasn’t had load applied to it, so to speak.
– Yeah, ’cause the threshold,
– Correct.
– Is going down, it’s more sensitive to issues. But somebody else brought up another point too. I just thought it was interesting, but again, it’s the whole pain science comes from the fear mongering thing. You don’t want to make the patients afraid. I’m like, afraid? Is that the right word? I don’t think anybody’s quivering in bed, like scared of the dark that they can’t move. I think, look, we’re creating awareness and caution. Not fear. I don’t know who describes it like, “oh don’t sit like that, it’s gonna break right now.” Nobody’s like that. Like telling people to work on their posture, like, how can that be a bad thing? I don’t think anybody is belaboring it that it’s evil to sit in bad posture. But there are so many good benefits of getting out of that position, of reversing your posture, having variability in your movements and stuff.
– Getting your muscles active.
– Yeah, getting your muscles moving again. And just getting your cardiovascular system, you know what I mean? So I’m gonna just see it in a different, heck, maybe our patient population’s different. But that’s what our patients need here. Well, is there anything else? Is that good? That was a good question.
– It was.
– It was a big question. I don’t think any of us think posture causes a cough attack, right? I don’t think we do that. But certainly, there’s definitely some things that go into it. Maybe some of the results, the end results of poor posture may be it. So I guess maybe we’ll let you guys decide. And I guess we can continue talking online. Interesting question. I don’t know if we’ll ever know the answer, but that’s just kind of our style, right? So awesome. Well thanks guys. Good, big question on that one. We’ll do more episodes on one question so we can elaborate more.
– Depth.
– Some depth on that. Somebody made a comment on YouTube that they are too short, and they should all be like two hours long. I’m like, yeah, I don’t know, we’ve got other things to do.
– As long as we’re gonna work.
– Yeah, that sounds nice.
– I don’t think I wanna listen to me for two hours
– We have to help people heal too. But anyway, good episode. I like it, good stuff. Thanks so much. Head to mikereinold.com, click on that podcast link, you can fill out the form to ask us more questions. Anything related to P.T. fitness business, sports performance, all that stuff in between, please ask. And don’t forget, head to iTunes and Spotify, rate, review, and subscribe to us, and we’ll see you guys on the next episode. Thanks so much.
