The idea that bad posture can cause various pains throughout the body is not a new one.
This is also the case in relation to shoulder and mid back pain. We have been told our mothers, teachers and now at work to sit up and not slouch or slump.
It is true that more desk-based occupations and more sedentary past-times involve a slumped upper spine, rounded shoulders and poking chin. This is sometimes referred to as upper cross posture.
How can bad posture cause shoulder and mid pack pain?
Using in an upper cross posture, the following are examples of some contributing consequences:
– the facet joints of the thoracic spine to become stiff
– the downward compression of the ribs can result in similar stiffness of the costa-vertebral joints
– An increased gap between the shoulder blades causes the muscles (between the spine and inside of the shoulder blades) to lengthen and ache because they are working so hard
– Rounded shoulders can result in reducing the blood flow to the shoulder complex due to the limited space created. his can cause pain through the compression of the shoulder structures or associated inflammation
– Slumping causes neck and the cervical spine having to extend to compensate for bad posture. This can lead to compressed joints in the cervical spine and overactive muscles in the neck which can refer pain to the mid back.
What is the evidence relating to posture and pain?
The interesting thing is that there is very little evidence to show that bad posture causes mid back pain.
– Teenagers with postural asymmetry and excessive thoracic kyphosis were no more likely to develop back pain.
– People who work in occupations involving frequent awkward postures do not have higher levels of back pain.
– There is no association between measurements of neck curvature and neck pain.
How can this be?
Here a few valid reasons:
1. Tissues adapt to stress over time. When your muscles, tendons, joints and ligaments are exposed to a particular stress, i.e. slump posture, they adapt and become more resilient to cope with this stress.
2. Tissue damage does not always equal pain. Many studies consistently show that a lot of people with evidence of tissue damage on investigations such as MRI, eg. bulging discs, rotator cuff tears and knee degeneration do not have pain. Equally so, imaging of the thoracic spine and shoulders where individuals have pain have shown no pathology.
3. We all move differently. Although there are more common postures, there are an awful lot of natural variations, the size and shape of peoples’ bones and the frequency of the tasks they do can change what is the most efficient posture for someone.
So what then?
Having said all this, posture is still important. While our body can adapt to low stresses, i.e. sitting relatively slumped for longer periods, it is not good at tolerating high loads even for short periods, without good dynamic posture (posture through movement). For example, when lifting something heavy it is important to have good lifting posture and alignment.
Posture is not a singular notion, there are many postures and varying your postures is best. This shares the load around your tissues. Even small variations work a treat so keep shifting around. On a more vain note, some postures are more aesthetic than others. If you are frequently in a slumped posture you can lose the awareness of how a more open, upright posture feels in order to reproduce. You can also literally lose the physical ability to get into and retain an attractive and confident looking posture.
What should I do?
Work on retaining all your movements. Although you may primarily need to sit at a desk most of the day or bend over laying tiles, it is important to maintain your ability to have the range of motion and functional strength in the postures necessary to reach overhead, rotate to look behind and press weight overhead.
At MyPhysioSA we can help identify any movement or strength deficits that you may have and that may be contributing to your pain or loss of ability to do a function or more importantly, how to improve them.
Are there any aids that can help?
The PostureMedic Back is useful in the early stages of making you posture-aware; a fundamental component of the discussion above. It is convenient in that you can vary the amount of time you use it by just taking it off and refitting it easily later. You can use it if you want to learn a more aesthetic posture or just when you are doing some heavy lifting.
If you would like to know more about PostureMedic back brace or have your posture assessed, book an appointment with any of our physiotherapists.
Anthony Sheridan myPhysioSA Associate Physiotherapist