The 'Myth' of Good Posture — REALLY?!

A recent Guardian article and BBC program (13:30–20:30 minutes) discussed the “myth of good posture,” and two main takeaways from these pieces were that comfort trumps posture and that good posture includes an S-shaped spine. We’d like to respond.

Our culture is confused about posture. When you have back pain you want to navigate to the best solution quickly. What you don’t want is to get lost in a landscape of incomplete and conflicting information, poor advice, bias, and historical baggage.

Over time, experience and good research will generally clarify matters. A good example of this is the sweeping change in the advice given to people recovering from heart disease. Back in the 1930s, the standard advice following a heart attack was 6 weeks of lying bedrest. Not surprisingly, heart function and general health deteriorated rapidly. By the 1950s there was a study demonstrating that chair rest brought better results, and in 1968 the first study showed that rehabilitative exercise was hugely beneficial [1]. The American Heart Association now recommends an extensive cardiac rehab and exercise program wherever possible.

Of course it takes serious studies and evidence for authorities to change their view and for health advice to change. We currently need a root and branch reappraisal of postural health in our culture, and a good start would be by debunking two of the most common posture myths.

Any debate about posture could involve consideration of what we do with every part of the body — now that’s a 227-page book called 8 Steps to a Pain-Free Back that I’ve already written! For this feature, let’s just narrow down the argument to the shape of the spine.

Myth #1: Comfort matters, posture doesn’t

Some prominent voices in this debate say that any style of sitting is fine so long as it is comfortable, claiming that the concept of good posture itself is a myth. Typically, comfortable sitting is equated with slouching because it is the only way people know to be both relaxed and comfortable. You can stay like that for hours. But what happens when it’s over months, years, and decades?

Feeling no immediate pain does not mean that there is no damage occurring. Much back pain is the result of long-term degeneration that remains apparently “problem-free” for years. If you advocate slumped sitting, you are disregarding the uneven loading of discs and bones and the overstretching of spinal ligaments that comes with a C-shaped spine.

Hunching compresses the spinal discs, causing degeneration and related problems.

In our culture, it is not unusual to have disc degeneration, osteoarthritis, and stenosis by middle age, and so these things have come to be seen as somewhat inevitable, or even “normal.”

It is interesting that the exponents of slouched sitting would rarely advocate this spinal shape for standing or walking. But observation of posture shows that when the pelvis is habitually tucked, as in slumped sitting, the tissues adjust to this position, making it both habitual and more likely to carrying over into standing, walking, and bending. Typically the C-shaped spine will be found alongside over-tight hamstrings, tight psoas muscles, and weak core muscles.

To claim that there is no correlation between a slumped posture and back pain flies in the face of research findings and common sense.

Myth #2: The S-spine produces the best posture

The second myth does believe that posture matters, but that the best posture comes when the spine can be described as S-shaped.

A child sitting in a slumped way will often be told to “sit up straight,” which, if the pelvis is already tucked in the slumped C-shape, will necessitate tensing the lumbar area, creating a sway there and a curved upper back. Together, these then produce the familiar S-spine, which is now widely regarded as ideal and the mainstay of good posture. It’s even seen in most medical textbooks and the windows of the high street chiropractors, osteopaths, and physical therapists!

Given that the spine consists of vertebrae and intervertebral discs with essentially parallel upper and lower surfaces, the exaggerated arching of the S-spine will lead to compressed discs, leading to wear and tear, bulging, and even herniation. It places abnormal loads onto the vertebrae, encouraging calcium deposition in compressed places, leading to arthritic development and bone spurs, as well as insufficient calcium deposition in the right places leading to localized osteoporosis. There is also less space in places for nerves and circulation which may be constricted.

One particular piece of research throws some light on this. Unlike other researchers, Jackson & McManus distinguished between curvature in the upper lumbar, and curvature in the lower lumbar areas of the low back. They found that curvature in the upper lumbar — indicative of an S-spine shape — was correlated with increased back pain, while curvature lower down — which indicates a J-spine shape — was not [2].

The drawing on the left shows an S-spine, while the one on the right shows a less curved spine, or J-spine. These drawings appeared in early anatomy textbooks. As the one on the right appeared much earlier than the one on the left, we can see that we used to promote much less curve.

Ironically, as long as this stress-producing architecture is regarded as the norm and by definition, “good posture,” people will indeed be inclined to argue that posture is not relevant in combatting back pain!

To find data that shows genuine back health we have to move beyond the myth of the S-spine. A logical place to look is among populations that have remarkably low rates of back pain. 

In the industrialized world an estimated 80% of the adult population will suffer a serious episode of back pain in their lives [3]. By contrast, the prevalence of back pain in rural south China is only 12–14% and in a mountainous farming community in the Philippines, 7% [4]. Genuine good posture that correlates with being pain-free is found to have a J-spine, characterized by a curve low down in the lumbar at L5/S1 and a relatively flat straight spine above that. We can see this same natural human architecture in our own infant population, many of our athletes, and images of our ancestors.

Babies, many athletes, and our ancestors showed J-spines, which have a curve at L5/S1 and a straight spine above that.

We are hopeful that the power of the argument for the J-spine will soon attract the resources for the full-scale studies it deserves. However, there is already good crowdsourced evidence for the J-spine taught in the Gokhale Method Foundations Course. Healthoutcome.org gives anyone a chance to rate how any given intervention helped their wellbeing. According to the site’s founder, once the number of ratings has reached 80, the findings are statistically significant and reliable. The Gokhale Method is, by a wide margin, the highest-ranking intervention for low back pain on www.healthoutcome.org. This site’s crowdsourced data on lower back pain has been found by Stanford University researchers to correlate with randomized controlled trial (RCT) results [5].

The Gokhale Method has honed an efficient and effective pathway to get from a place of pain and discomfort to where you want to be — pain-free — with the right posture! If you have already enjoyed the benefits of what we teach, or would like to see this viewpoint given wider circulation, then help shape the debate by contacting your national and local media with this article — and of course, feel free to share on your own social media platform.

----------
Sources:
[1] Mampuya, Warner M. “Cardiac Rehabilitation Past, Present and Future: an Overview.”Cardiovascular Diagnosis and Therapy, Mar. 2012, pp. 38–49., doi:10.3978/j.issn.2223-3652.2012.01.02.
[2] Jackson RP, McManus AC. Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size: a prospective controlled clinical study. Spine. 1994;19(14):1611-18.
[3] Lehrich JR, Katz JM, Sheon RP. “Approach to the diagnosis and evaluation of low back pain in adults”; UpToDate.com; April 2006.
[4] Volinn, E. The epidemiology of low back pain in the rest of the world: A review of surveys in low- and middle-income countries. Spine. 1997;22(15):1747-54.
[5] Peleg, Mor, et al. “Is Crowdsourcing Patient-Reported Outcomes the Future of Evidence-Based Medicine? A Case Study of Back Pain.” Artificial Intelligence in Medicine, pp. 245–255., doi:https://doi.org/10.1007/978-3-319-59758-4_27.