Posture & Back Pain – Does it Matter?

How many of us have heard this statement and wondered why? Posture has long been associated with notions of health and well-being. Before posture was blamed for causing poor health and physical pain – it had a different role altogether. Posture is originally a French word that has its origin in classical Latin ‘Positura’ – referred to the “the relative disposition of the various parts of something; esp. the position and carriage of the limbs or the body as a whole, often as indicating a particular quality, feeling, etc.; an attitude, a pose” (5).

The first idealised notions of good posture arise from 16th century military journals describing “a particular position of a weapon, or a method of wielding it, in drill or battle” (5). The ideal or rest position comes to be “standing at attention” with a more or less rigid spine, tucked-in chin and feet clearly positioned under the head, back upright but yet not rigidly aligned with the rest of the body. The development and representation of military drill formation became the fertile ground for the idealised erect standing position in our culture today (5).

Idealised military notions of posture then found their way into civilian life in the 18th and 19th centuries with the Leipzig anatomist Christian Wilhelm Braune and his student Otto Fischer dropping the plumb line along the now acceptable rigid posture of “standing at attention,” bringing the study of military posture into the medical literature (5). A century later we see the first instances of ‘functional exercises’ focused on improving posture. During the reign of the last Emperor of Germany, Kaiser Wilhelm II, American body culturist Elizabeth Marguerite de Varel Mensendieck (c.1866–1959) was hired to improve the posture of his courtiers (5). Elizabeth describes her ideal posture:  

“When the human animal stands properly erect, an imaginary line should cut the nose, chin, breastbone and crotch. Another imaginary line should drop from the mastoid, in front of the shoulder joint, through the elbow and little finger (palm turned to the rear), side of knee and ankle. This is achieved by standing with feet together, shoulders held back, abdomen tucked in, buttocks clenched” (5)

Fast forward to the 20th century and ideal notions of posture had now spread wide into the popular culture through efforts of organisations like the American Posture League – see the picture below (5).

During this time, functional definitions of posture came to dominate the debate around posture, at least within medicine, although little attention is given to its origin. The Posture Committee of American Academy of Orthopaedic Surgeons in 1947 defined posture as “the relative arrangement of the parts of the body,” making a distinction between good posture: “the state of muscular and skeletal balance which protects the supporting structures of the body against injury or progressive deformity irrespective of the attitude in which these structures are working or resting” and poor posture as “a faulty relationship of the various parts of the body which produce increased strain on the supporting structures and in which there is less efficient balance of the body over its base of support.” (pg 72 – excerpt from “Stand Up Straight”: Notes Toward a History of Posture 5).

As science has taken more and more of a role in human’s quest for knowledge, we have found little evidence to support these long-held notions between posture and pain/dysfunction, particularly low back pain (2). Whilst low back pain remains a very common and costly musculoskeletal disorder, it is a complex symptom with a multitude of causal factors (1,7). And yet, through hundreds of years of socio-cultural conditioning and well-intentioned attempts at medicalising good posture – we see it commonly blamed as a primary source for peoples back pain. Low back pain is still often ascribed to relatively “normal” variations and asymmetries in peoples posture by health practitioners, despite the lack of strong evidence to support such a claim (2).

The reality of back pain is far more complex. We now realise that low back pain arises through a complex interaction of people’s biological, psychological and social circumstances (2). Meaning that a person’s experience of back pain is not well understood solely as a result of a degenerative spine or disc bulge, but more by a combination of stressors, be they physical, psychological or social (1). And the more these stressors create a perception of danger to the body (consciously or unconsciously) – the more likely we are to experience pain (4).