Despite a lack of substantial evidence to support it, there is a continued assumption that pain (particularly lower back pain) is caused by ‘poor posture’ and specific or repetitive occupational movements (1-2).
Yet, ‘ergonomic’ assessments are still in favour in workplaces around the world, with ‘ergonomic office equipment’ an ever growing corner of the office furniture market. It is also true to say that a number of biomechanical variables are a considered a high priority in assessments in clinical and exercise settings when trying to establish a cause for pain or injury particularly joint range of motion (angle) and muscle tone (also referred to as ‘activation’, which is a whole other can of worms for me to cover in another blog post!).
Although there is insufficient evidence to show that these variables can predict pain or reduce injury risk, assumptions of causality are often linked to a client’s performance in assessment of them. Output from these assessments (i.e.: range of motion test) are often simplified – frequently categorised as either being ‘good’ or ‘bad’ in some way or other. What’s more… despite inadequate evidence to show that changing these variables can improve pain or reduce injury risk, or agreement on their potential mechanistic role in pain, we may still present our clients with physical interventions, such as manual therapy and exercises. In many cases, we may often explain to the client that they need to improve the quality of the movement or tissues in order to mediate their pain or injury risk.
We are dealing with people after all. People are complex, which means that the solution might not be simple.
It’s not a matter of whether or not manual therapy helps reduce pain, or whether exercise reduces risk of injury. We know these things work in some specific scenarios and this is supported by a growing evidence base. The main issue here is that the explanation we give our clients is focused so much on the ‘quality of movement’ (i.e.: range of motion, force production, symmetry) that we forget to look at other factors that could be contributing to their pain experience. While we can’t rule out the possibility of mechanical issues being involved somehow in the pain and injury experience of our clients, it is really impossible to reduce the cause of their experience down to one or two mechanical variables. So, it is our responsibility to ‘cast our net wide’ – to collect as much information from our client about their life as we can. We must consider all the factors that contribute towards pain: history of injury, beliefs about pain and injury, mental health, including stress, sleep, nutrition… the list is endless! The ‘Biopsychosocial’ model supports this and so should we! We are dealing with people after all. People are complex, which means that the solution might not be simple.
Many of these assumptions are not caused by any one particular person or group of people. This is more of a systemic issue caused by misinformation or outdated training and education in the therapy and exercise professions. However, perhaps one of the more morally ambiguous terms given to exercise prescription for the purpose of managing pain is ‘corrective exercise’ to encourage changes in posture. The main issue being that the use of the term ‘corrective’ implies that something is ‘incorrect’ in the first place. But as we can see from the research reviews, there is little in the way of evidence to support this approach. Even though the intention may be good, we should also note the psychological impact of identifying someone’s posture as ‘faulty’ can be negative, and might even have an adverse effect on pain – particularly if they believe their posture and pain are linked, but they do not observe postural changes in response to the exercises prescribed.
Move Well Workshop: ‘An Introduction to Biomechanics’
If you’ve read through everything above and you’re still with me…. nice one! 🙂 It’s fair to say that if as many people felt as motivated as we do to bust common (and harmful!) myths and misconceptions such as ‘good’ vs ‘bad’ posture, we certainly would have much more effective and tailored interventions to help people manage their pain. While we are here and talking about biomechanics, if you’d like to learn more about it (i.e.: what it is, where it comes from and how we can use it well in clinic and exercise settings) then you might like to book a spot on the next Move Well Workshop: ‘An Introduction to Biomechanics’. You can find out when the next online ‘pay-what-you-can’ workshop will be just HERE.
Any questions or thoughts please drop me an email: firstname.lastname@example.org
- Roffey, D.M., Wai, E.K., Bishop, P., Kwon, B.K. and Dagenais, S., 2010. Causal assessment of awkward occupational postures and low back pain: results of a systematic review. The Spine Journal, 10(1), pp.89-99.
- Swain, C.T., Pan, F., Owen, P.J., Schmidt, H. and Belavy, D.L., 2020. No consensus on causality of spine postures or physical exposure and low back pain: a systematic review of systematic reviews. Journal of biomechanics, 102, p.109312.