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Welcome to Season 5 and Episode 76 of the Movement Logic podcast! In this second episode in our Posture Panic series, Laurel and Sarah take a deep dive into the currently available research around posture to debunk some of the long held beliefs around posture, pain prevention, muscle activation, and more.

You will learn:

  • Does good posture keep you pain free?
  • Is Text Neck or Tech Neck really a thing we need to worry about?
  • Do we need to spend so much time finding a “neutral spine”?
  • Do you need to keep your shoulders “back and down” at all times?
  • Does a flexed spine automatically lead to a disc herniation?
  • What the actual predictors of pain and injury are (spoiler: it’s not your posture)
  • Why we hate @postureguymike’s fearmongering pseudoscience approach to “strength” for seniors

And more!

References:

Slouch: Posture Panic in Modern America

Modifying patterns of movement in people with low back pain -does it help?

No consensus on causality of spine postures or physical exposure and low back pain

Association Between Text Neck and Neck Pain in Adults

Posture and time spent using a smartphone are not correlated with neck pain and disability in young adults

Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults?

Can we reduce the effort of maintaining a neutral sitting posture?

Exploring lumbar and lower limb kinematics and kinetics for evidence that lifting technique is associated with LBP

Evidence for an inherited predisposition to lumbar disc disease

The Twin Spine Study: contributions to a changing view of disc degeneration

Why Sitting Posture is Mostly Irrelevant to Future Pain

Effects of sex differences on scapular motion during arm elevation

In vivo 3-dimensional analysis of scapular kinematics: comparison of dominant and nondominant shoulders

Scapular Dyskinesis Is Not an Isolated Risk Factor for Shoulder Injury in Athletes

Sign up here to take our free Strength Class on September 19th 8:30am PT/11:30am ET

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Transcript

Introduction to Movement Logic Podcast

00:00:02
Speaker
Welcome to the Movement Logic podcast with yoga teacher and strength coach Laurel Beaversdorf and physical therapist, Dr. Sarah Court. With over 30 years combined experience in the yoga, movement, and physical therapy worlds, we believe in strong opinions loosely held, which means we're not hyping outdated movement concepts. Instead, we're here with up-to-date and cutting-edge tools, evidence, and ideas to help you as a mover and a teacher.
00:00:36
Speaker
Welcome to the

New Merchandise Announcement

00:00:37
Speaker
Movement Logic Podcast. I'm Sarah Court, and I'm here with my co-host, Laurel Beaversdorf. Laurel, do we have something new and exciting to share with our listeners? Yes, we do. Merch! We got merch. We got t-shirts, two styles. One that says, hashtag bulky girl summer, and another that says, women belong strong.
00:01:00
Speaker
The t-shirts are in white and royal blue. There are tanks in white, muscle tanks in black, asphalt slub, and black slub. I don't know what the slugs are. I don't know. That's just what they called it. I think it's sort of like that heathered look. Okay. Does that make sense? like It's not like a solid color. It's got like a little Slubbiness. I have no idea. It's a little slubby. Yeah. It's a little slubby. Yeah, we're very excited. We've been trying to make merch happen for a while. And for whatever reason, it's just been ah a big challenge getting it. It's always seemed like the not most important thing on our list so it gets shoved to the bottom. Yes. Remember when we were recording an episode and we kept coming up with t-shirt ideas that were ridiculous, that we were likely never going to act on? And then we would just say to the air, assistant, can you write that idea down? And we of course had no assistant. and We still don't have an assistant. But yeah, I'm super excited that we finally made this t-shirt thing happen.

Merchandise Purchase Information

00:02:00
Speaker
All these t-shirts are available at www.movementlogitutorials.com slash shop, or you can just click the link in the show notes.
00:02:10
Speaker
Yes, it's very exciting. I've actually been wearing my bulky girl summer t shirt when I go on hikes, and I got a lot of like thumbs up and like, yeah, and like like a lot of women giving me sort of like a knowing look, it's very fun. So that's a really fun one to wear out in the wild. I know I wore mine at the YMCA in Huntsville, and I got a bunch of inquisitive looks that kind of had a little sparkle in the eye, a little, little grin in the eyes. And I was like, all right, Alabama, okay.
00:02:35
Speaker
yeah So you could also get a women belong strong for your partner. And in particular, if your partner is male, get that man around town wearing a t shirt that says women belong strong so he can be a real ally. Or if you're at a Meekins, you might like a hashtag bulky girl summer t shirt. That's true. You could get either of those t shirts.
00:02:57
Speaker
Depending on the comfort level of the man in question, you know, if you want to support us or you just, you know, you need some t-shirts, you need some shirts to work out in, go grab yourself a shirt.

Success Stories from 'Lift for Longevity'

00:03:08
Speaker
Okay. So then also some other really exciting news that I have just been like boasting about to literally anyone who will listen. So we, as you probably know, we have our bone density course, Lift for Longevity. We ran it starting last October for six months.
00:03:23
Speaker
And we had some women in the group who already had an osteoporosis diagnosis. Just a reminder, it is not illegal to lift heavy weights with osteoporosis. And what we are thrilled to learn is that in that six months, she got another DEXA scan which measures your bone density.
00:03:44
Speaker
after doing the six months, and she has reversed her osteoporosis diagnosis. She has increased... That is amazing. It's amazing. She has increased her bone density above the line to where it's no longer considered osteoporosis without using medication. It's just, it is so thrilling. It's thrilling on so many levels. it It's thrilling because our work, our program is based on research loosely. It follows a similar pattern to the lift more trial in terms of the amount of time that people are lifting and and all that kind of stuff and as well, including things like impact training. And so in my mind, I was like, well,
00:04:24
Speaker
this should just have the same effect. This should be able to do the same thing that that trial did, but you know you never know until it's done. Right. And so the really exciting thing for me as well is, apart from the fact that it worked, is that she didn't have to take any medications because the medications are kind of problematic. Yeah, that is awesome. And I look forward to hearing more details of how She was able to accomplish this because while it, you know, obviously she signed up for our course and underwent our programming and learned from us. She's the one who put in the work. She's the one who did the training. She's the one who applied all of the knowledge from Strength ah Training 101. And she, you know, was in the live classes regularly and also asking lots of questions. So bravo. Yes. her. That is an incredible, incredible accomplishment. And I'm sure she's enjoying other fringe benefits.
00:05:29
Speaker
ah So awesome. So good. All right.

Posture Panic Series: Cultural and Scientific Perspectives

00:05:33
Speaker
So today's episode is part two of our three part series that we are doing on posture panic.
00:05:41
Speaker
And so in episode 73, Posture Panic Part 1, we discussed the history of posture from a cultural, moral, and even religious viewpoint. And we drew from Beth Linker's book, Slouch, Posture Panic in Modern America, which we also highly recommended love.
00:06:00
Speaker
And as a side note, Beth has graciously agreed to come on the pod for our third Posture Panic episode that's coming later on in the season. We're very excited about that. Yeah, she's a yoga teacher, so we're going to talk yoga, physical therapy, ah being a scholar of posture. Yeah, it's going to be so cool. Very exciting. So in today's episode,
00:06:21
Speaker
We're not going to get down with the science of yesteryear, but we're here for the science of today and whether it supports a lot of the myths that are bandied about on social media in yoga classes, in Pilates classes, by physical therapists, kairos, trainers, and on and on. Is there research that shows conclusively that quote-unquote good posture is better for you than quote-unquote bad posture?
00:06:48
Speaker
That's our main thrust today. Does good posture save us from arthritis? Sorry, I'm laughing because when I wrote those notes, I meant to write disc bulges, but instead I wrote disc bugles. It just kind of really entertained me in the moment, so I left it, and I'm just now reading it again right now and and thinking about how I thought it was really funny. But the the real question is, does good posture save us from arthritis, disc bugles, or disc bulges, stenosis, and all the associated pain that would come with it?
00:07:20
Speaker
Or are we just you know consciously or not still carrying around those kind of moral associations that we talked about in part one that we take to be fact? Do better people have better posture? right do we Do we just wield this moral take around like a disembodied skeleton and just whacking people over the head with it? Let's find out. So for this episode, I took a pretty deep dive into the posture research. I had some help with this and I want to acknowledge a couple of people.
00:07:51
Speaker
The first person is Adam Meekins, aka the sports physio, who posts a ton of research to his Instagram page, which made the initial searching for me, which is the part that takes so much time, a lot shorter. So thank you for your service, Adam Meekins, from your two favorite Americans, because that's what he called us, and we're keeping it. We're keeping it.
00:08:11
Speaker
I also want to thank Naomi Schwartz. ah She reached out to me after listening to an earlier episode when I talked about all the various tricks I have employed in an attempt to access research papers that are behind paywalls. Typically, I i lean on various people that I know who are associated with a university because that's kind of the easiest way to do it.
00:08:32
Speaker
And you know I can't lie, sometimes it's the PT student who comes into the clinic to do their rotation for 12 weeks. And I'm like, oh, could you just do me a favor and find these 15 papers? But it's it's a very kind of catch-as-catch-can situation because I'm not affiliated with any sort of academic institution at the moment.
00:08:48
Speaker
So Naomi heard this and she emailed me and said, listen, I have access anytime you need a paper, just let me know. So I have used, but not abused, hopefully, her offer. So a big thank you to Naomi as well, who is the associate director of quantitative science at Biomer and Pharmaceutical.
00:09:07
Speaker
And so she's helped me with getting the full versions of some of the papers we discuss today. She's an epistemologist. Is that what it's called? Epistemologist? Yes. ah No, an epidemiologist. There we go. that I get confused. What's epistemology? She certainly deals in epistemology, the study of how we know what we know, because I think anyone in science is really dealing in epistemology to some extent. because So much of science is skepticism, right? And questioning what is true and not true based on the evidence. But yeah, epidemiology, which is the study of, I guess, disease. Epidemics? in the Yeah, right. Epidemics. Hey. Disease

Debunking Posture Myths: Is Good Posture Necessary?

00:09:48
Speaker
contagion in the populations. Sure. That sounds right. So the way we're going to get into the this potentially really overwhelming task of you know finding all the research out there about posture
00:09:59
Speaker
is we're just gonna take it posture myth by posture myth. So we're gonna name the myth and then Laurel and I will talk about the research or lack thereof around each myth and then what that ultimately means for teachers and their students. All right, so let's get into it. So a myth number one, good posture will keep you pain-free, right? I think we've all heard that. If you sit up straight, that's better for you than if you slouch. But in reality, nothing really keeps you pain-free.
00:10:28
Speaker
You know, I talked about this a little bit in our last episode, McGill We Go Again, about how much his focus is on avoiding pain at all costs. But I can't name a single person who has never experienced pain in their body. And I would think that pretty much everyone has had some sort of musculoskeletal injury that brought on pain, whether it's something, you know, small, like rolling your ankle.
00:10:51
Speaker
or a ski accident where you crash into a tree, or you get rear-ended while driving and you have whiplash. I just started getting really dramatic with my examples. This is totally unrelated, but Laurel, do you remember when I said that my favorite injury is a pneumothorax? I do, yes. I had a new patient who had like a prior history of having had one, and I had to sit on my hands not to to be like, that's my favorite injury, because I'd try to appear slightly normal.
00:11:16
Speaker
I try when I'm first meeting my patients. People skills. People skills. That's right. um The other thing that I flashed on is that quote from the Princess Bride, which is, life is pain, Highness. Anyone who says differently is selling something. Okay. So, but let's say, let's say we're taking this myth as fact, right? Okay. So the fact myth is good posture will keep you pain free. So then it must follow.
00:11:38
Speaker
that bad posture will create pain in your body, right? So we're setting up this neat little binary, you know, because that's how sensation works, right? It's really black and white. Good posture equals no pain, bad posture equals pain.
00:11:51
Speaker
So Laurel, when you think of something we would call bad posture, what are some like specific descriptors or fear-mongered positions that have been given like actual names that come to mind? Yeah, I'll start from the top. Tech neck or text neck, forward head position. Neck hump or Dowager's hump, which is even worse because a Dowager is a widow with a title or property derived from her late husband. and That's very weird. Very strange. name That's Dowager's hump. Yeah. Mm-hmm. Rounded shoulders. Slouching, right, which tends to kind of take place through the whole spine or slumping. Then we've got our anteriorly tilted pelvis. We also have things like knock, knead, or flat feet. ah So yeah, there's so many different ways to have bad posture all throughout the body.
00:12:49
Speaker
I think most mostly when people talk about bad posture online, I find an inordinate amount of focus placed for women, especially on the the neck hump, hyperkyphosis, that rounded back position. And also on in the in the yoga community, it's a lot about pelvis, in anterior tilted pelvis and things like that, so poor or overly tucked pelvis, a posteriorly tilted pelvis.
00:13:14
Speaker
If we're still, you know, working within this idea of like good posture equals no pain, bad posture equals pain, it follows that if I'm not living in good posture, I need to correct my posture so that I remove any possibility of getting back pain or injuring myself. This is the scenario that has been set up by this theory. Good posture keeps you pain free, right? Okay, so Laurel,
00:13:38
Speaker
What does the research say? to All right, so our first study, this was a 2012 systematic review by Laird et al entitled, modifying patterns of movement in people with low back pain. Does it help a systematic review? So I'll just read the study quote. Quote, the available evidence on muscle activity pattern changes following therapeutic and interventions indicates little difference in outcomes between a general exercise program and specific interventions that aim to change the activity of trunk muscles such as transversus abdominis and lumbar multivitus. That same evidence suggests that improved pain or activity limitation are consistently unrelated to changes in the activity
00:14:26
Speaker
of specific muscles. So we're talking about patterns of movement as a a way of working with posture. And it seems as though a general exercise program performs about as well as specific interventions aimed specifically at targeting isolated trunk muscles like the transversus abdominis and the lumbar multivitis. Improved pain or activity limitation are consistently unrelated to changes in the activity of specific muscles. So like even if you do change the activity of the particular muscle, that doesn't seem to have a relationship to pain improvements or you know improvements to activity limitation.
00:15:09
Speaker
Right. So in other words, you can modify muscle activity, you're not necessarily going to change pain or activity limitation. And so why, why focus on the muscle activity, if you could just do a general exercise program that might be a hell of a lot more fun than like, let's do this exercise for your, you know, one single muscle of your trunk or two single muscles of your trunk. well so If we extrapolate it a little bit, it's like, okay, if i if I'm going to have better posture, if I'm going to go from my slouch posture to my sitting up straight posture, it just follows that I'm going to have to have different muscle activity in order to do that. all this What this study is showing is that you can make any muscles you want stronger. It's not going to make your back pain go away. It's not going to make your back pain go away, and it's also potentially not going to change your posture.
00:16:03
Speaker
And even if it did change your posture, how would you measure that? is so Is Big Brother going to follow you around with a camera all day and like average out the averages of all of your resting postures when you're not consciously thinking about it and then go, your posture improved? Because posture is dynamic and context dependent. So the problem with trying to improve posture is we it's not testable.
00:16:25
Speaker
in in in a real world context. It might be testable with very expensive lab equipment in this hyper-specific instance where we've basically reduced movement down to like one task or one position. But in reality, even if you were able to show that posture change because of muscle activity,
00:16:50
Speaker
One, it seems as though that's not really going to change your pain experience. And two, does that even have any carryover or relevance in the real world when you step outside of the lab and now have no means by which to actually know what your posture is in any given moment? Posture is dynamic and context dependent. right like I'm going to have different posture sitting in different chairs, sitting in different contexts.
00:17:19
Speaker
talking to different people, engaging in different types of conversations, right? Okay, and then, so what else does this mean? You can literally do any type of exercise to strengthen your trunk.
00:17:31
Speaker
None is better than any other. A general exercise program was able to have the same effect as specific interventions that aim to change activity of specific trunk muscles. And it didn't even say a general exercise program for trunk muscles. It just said a general exercise program because a lot of the exercises you do in strength training that are maybe lower body or upper body exercises have carry over to being core exercises as well, though maybe If you want a really, really strong core, you might target that area specifically with a specifically um demanding exercise on the core. But squats are still going to a large extent, make your core stronger. Deadlifts are going to make your core stronger. Overhead presses are going to make your core stronger. Rows are going to make your core stronger. And those are all upper and lower body exercises.
00:18:18
Speaker
yeah And then another thing we can take away from this is that strengthening muscles could give me better posture, but that may or may not improve my pain.

Exercise vs. Specific Muscle Focus

00:18:27
Speaker
Okay, so the third thing is that, so say you strengthen muscles, okay? This could give me better posture. All right, but it's not necessarily going to eliminate my pain, and it's also not necessarily going to allow me to do things I couldn't do before because of my pain. Now, it also might,
00:18:48
Speaker
make me have less pain. But is it because I targeted these specific muscles that I have less pain or is it because I was just exercising something, right? I think some exercises often are always better than none. So if I choose transversus abdominis exercises and lumbar, multifidi exercises to do and nothing else, at least I'm doing some exercise. But again, the study showed that a general exercise program performed about as well as these specific interventions. And my point is that if it's actually not about targeting muscles or changing posture, but rather just about exercising, why don't we just choose a form of exercise that's like more engaging, less boring, more connected to what we personally want to be able to do. Like we don't have to just do transversus abdominis exercises unless we want to, right? yeah
00:19:35
Speaker
ah right There's so many other ways to exercise that could potentially help us feel better, not because of specific muscles being targeted, not because of posture correction, but because exercise in general right creates changes in our body that tend to yield positive outcomes in health, including musculoskeletal pain.
00:19:56
Speaker
yeah And I think especially in the rehab world, there's just so much focus on the transversus and so much focus on the mitulfidos, right? These what are considered smaller postural muscles that like we have to get these working and that's going to make your posture, but that's going to take your pain away. and it's just not supported in the research. That's what's interesting, and although it's still used constantly all over the place. And it's not to say, I mean, I teach plenty of people how to engage their lower abdominal muscles. um I mean, it's really all of them, but what they're feeling that a lot of the time is new is that they have abdominal muscles below their belly button. Like a lot of people just have never really sort of paid attention to any of that.
00:20:36
Speaker
But I often am using that as a way like I have a patient right now, severe acute disc herniation, pressing on a nerve, and I'm teaching him how to move with a tensioned core so that he doesn't just re-aggravate it over and over again, right? Not because he has to do that for the rest of his life, and that's the only safe way to move, but that's the way he can move with the least amount of pain at the moment.
00:20:58
Speaker
you know So it has its place sometimes, but that in itself, like those exercises by themselves aren't going to change what's going on at that disc level, right? You need steroid injections. That's what changed it. I'm really glad you found this study because it it speaks to movement quality, which we hear a lot of people have opinions about.
00:21:21
Speaker
and you know like to create this binary way of seeing movement as being high quality or low quality. But again, there are no standards by which to measure this, and there is no consistent way to evaluate this. So it's like we end up just kind of spouting off our opinions about what we find, I think, to be aesthetically pleasing or unpleasing. And here's where I want to say that aesthetics, which is what we're talking about when we're talking about movement quality. And when we're talking about posture is we're really talking about what it looks like while it's happening. These are separate from capacity. Like how strong are the bones? How strong are the muscles? How strong are the ligaments? How strong are the tendons? This is separate from function. What is this person able to do? The woman who took, I believe, fourth place in the marathon in the Olympics when she runs, her knees knock in
00:22:12
Speaker
extremely noticeably to the point where like most people who have something to say about movement quality would look at this one and be like, Oh my gosh, that is a knee injury just waiting to happen. Well, this woman obviously probably runs more than a hundred miles on a weekly basis because she's an Olympian who, you know, got fourth place in the marathon. Her knees are just fine and they function.
00:22:36
Speaker
extremely well on an elite level. like Very few people's knees function as well as this woman's. Let's be honest, she got fourth place in the marathon. okay And then aesthetics are also separate from sensitivity. You can't look at someone's posture like knocking knees and running and and know what their those knees feel like. right So we can change aesthetics and make all of those things worse or better. We could change things to, you know, look better, but make capacity, function and sensitivity worse, right? If I decide I want to fix my posture, so I'm going to stop doing strength training and focus on posture correcting forms of
00:23:15
Speaker
movement, like the Alexander technique, or yoga, right, or Pilates, my capacity is going to decrease, my strength will decrease, my bone strength will decrease. That's, that's just probably what's going to happen because atrophy is taking place all the time unless we do something to counteract it, right. And those exercises take place at a much lower resistance level.
00:23:36
Speaker
I can make the movement prettier and I can make the posture prettier, but I might decrease my functionality. right If I start messing with this Olympian's running style, if I start changing her gait, she's probably not going to be as fast. ah she might get in She actually might obtain an injury because of that, because she has not adapted to that pattern of running.
00:23:55
Speaker
Right, right. And I can change the aesthetics and I know you, Sarah and I have experienced with this and talked to any ballet dancer who's like but aesthetically beautiful in their body, we can change the aesthetics of a movement and make pain worse. Right? Yes, we have to uncouple this idea that what it looks like tells us anything about capacity tells us anything about function and tells us anything about sensitivity. I think this is what research is is showing us. Here's an analogy and I know I don't like analogies that try to equate the human body with like a thing, an inanimate object. But we had a leaky shower. We got it replaced. As a result, our bathroom looks much better with our new shower in it because we got new tiling, right? It's like pretty and not scummy and beautiful, right? And our shower also works better. But we could have installed an ugly ass shower that
00:24:46
Speaker
worked great because now it doesn't leak but the tiles don't match or maybe we got the tiles secondhand from like a garbage dump and we were just like okay let's just patch this shit up and make sure it doesn't leak and the shower functions better but it looks worse right?
00:25:01
Speaker
the The thing about aesthetics is that it really doesn't tell you how so how well something works. right And so I'm going to be referencing the shower analogy potentially a couple of more times. you can You can think of my pretty shower that doesn't leak. And you can also think of potentially my ugly shower that doesn't leak and go, well, I'd rather have the pretty shower that doesn't leak, sure. But just because a shower is pretty doesn't mean it doesn't leak. right And just because it's ugly doesn't mean it leaks. Same with posture.
00:25:32
Speaker
That's right. All right. Well, there goes that theory. ah Correcting my bad posture will get rid of my pain. What about Laura? What about if I just have good posture and I don't have pain? Surely staying in good posture forever and ever will keep me pain and injury free.
00:25:49
Speaker
No, as it turns out.

Spinal Posture and Low Back Pain: Myth or Fact?

00:25:51
Speaker
So this is a study, this is maybe my favorite study of all the ones that I found. It's a 2020 systematic review by Swain et al, and it's called no consensus on causality of spine postures or physical exposure and low back pain, a systematic review of systematic reviews. This is like the motherload. This is a systematic review, meaning they look at all the current research, of 41 previous systematic reviews, right? It's like the inception of systematic reviews. 41. That is what's known as a fuck-ton of research, in case you did not know. And here's the best quote from it, I think. Both positive and null associations between spine posture
00:26:42
Speaker
prolonged standing, sitting, bending, and twisting. Awkward postures, which I kind of loved. I'm like, what's an awkward posture? yeah Whole body vibration, which they just as an aside, they test that for people saying that they get back pain because they work with like a drill. And components of heavy physical work were reported.
00:27:01
Speaker
Despite the availability of many reviews, 41 to be exact, there is no consensus regarding causality of physical exposure to low back pain. Association has been documented but does not provide a causal explanation for low back pain. right So this is that correlation not equaling causation situation.
00:27:26
Speaker
Right? Or as Laurel would put it, ugly showers sometimes leak, but not always. Some of them work great. Some good looking showers work great. Other times they leak. So this phrase causality of physical exposure to low back pain means there's no relationship between any one specific position, movement,
00:27:48
Speaker
series of movements, et etc., where there is undoubtedly, unequivocally a direct link between that specific position or movement and low back pain. and We're going to bring this up later as well. and In case you missed this, this is a systematic review of 41 systematic reviews, people, which in themselves each took all the available evidence to see if there was any relationship between posture and pain. so This is a resounding no. like this is the This is the study, I think, that really got people's attention where they, if they're willing to hear it, if it's not causing just massive cognitive dissonance, that posture and pain, there's no causality link between them. And it's hard, I can feel even in myself a little bit like, but surely there is, but no, there's not, there's not. But Laurel, okay, come on, surely.
00:28:37
Speaker
Tech neck is a thing, or text neck, depending on who you're talking to. I mean, we named it has a name. We named it. it looks It looks ugly from aesthetic standpoint. Everyone seems worried about it. There's been reports on the news about it. That's got to be a thing, right? What is what does the research say?

Debunking 'Text Neck' Myth

00:28:54
Speaker
Well, it shows that there is no evidence neck flexion increases risk of neck pain. Oh, god damn it. So there's a 2021 observational cross-sectional study by Korea et al entitled Association Between Text Neck and Neck Pain in Adults. 582 volunteers answered questions about smartphone use, neck pain, and other markers.
00:29:19
Speaker
Neck flexion was measured in each. The study quote is that text neck was not associated with a prevalence of neck pain, neck pain frequency, or maximum neck pain intensity. ah There's also a 2021 cross-sectional study by Bertotsi et al entitled Posture and Time Spent Using a Smartphone.
00:29:44
Speaker
are not correlated with neck pain and disability in young adults across sectional study. This was a study of med students and their neck pain and the study quote is that quote, no significant correlations were observed between the number of hours spent and posture while using a smartphone and neck pain and neck disability index. The neck disability index is one of many like self-reporting questionnaires that exist in the PT world that's used just it's used as a ah standard. So it's basically saying things like, how does your neck feel when you put a shirt on? When do you feel neck pain? When don't you feel neck pain?
00:30:23
Speaker
but do you have pain when you're doing this, right? It's just, and it's sort of like, you know, it's one of those always, sometimes, often, never, or, you know, that kind of thing. So it's a standardized questionnaire that's used a lot in research. I got you. Okay, this is continuing the study quote, while half of young medical students reported neck pain, the use of smartphones was not correlated with neck pain and disability.
00:30:44
Speaker
While we wait for future prospective studies, there is no reason to recommend a change in smartphone use habits among young adults in the meantime. And then I also have this study that I've referenced in a couple episodes, actually. Is neck posture subgroup in late adolescence a risk factor for persistent neck pain in young adults?
00:31:08
Speaker
All right, so they're looking at the neck posture of young adults. This is a prospective study. The purpose of this was to determine whether that forward head posture, um if you have membership to that subgroup in late adolescence, if this is a risk factor for persistent neck pain. There were 688 participants checking at 17 years old and then a follow-up checkup at 22 years old. And the conclusion is that after taking into account persistent neck pain at 17 years. Sitting neck posture at 17 was not a risk factor for persistent neck pain at 22 years of age in males.
00:31:48
Speaker
Whereas in females, more relaxed postures, slumped thorax, forward head, and intermediate postures were protective of neck pain compared with upright posture. So what does this mean? It means that females in late adolescence who sat in slumped thorax slash forward head or intermediate posture, right bad posture,
00:32:14
Speaker
rather than upright, sitting posture, good posture, had a lower risk of persistent neck pain as a young adult. So the practice of generic public health messages to sit up straight to prevent neck pain needs rethinking.
00:32:34
Speaker
I'm just thinking about while you were talking, I was thinking about this probably 10 years ago at this point, when I was still teaching yoga, I was teaching yoga tune up. And then there was all of this like how to hold your phone in a good position for your neck stuff going on. And I remember specifically Kelly Starrett talking about how he only let his kids use a phone if they were up against a wall and they had their head back against the wall and holding the phone up. Do you remember this or this kind of yeah stuff? Absolutely. i'm I'm just thinking back to it and like slowly shaking my head. Yeah. I mean, can we talk about these stupid fucking images on the internet of people like bent over their phone and there's like red thunderbolts coming out of the back of their neck like their head is about to fall off? and There's literally an infographic showing someone standing with their head progressively forward, forward, forward, forward, forward, and then the last images of their head literally falling off their neck.
00:33:33
Speaker
And like many years ago, maybe like seven or eight years ago, I actually shared it on social media to promote some like text neck class I was teaching. And of course, it was yeah it was a very sensational image and it did very well on social media. But now I look at these and I'm just like, oh, so cringe. And I think about like sharing that. I was like, oh, so cringe. But there's this idea that The more you crane your neck forward, right? Zero degrees, 15, 30, 45, 60 degrees, that your head starts to weigh, like it goes from weighing maybe 10 pounds to like 60 pounds or something with your head craned 60 degrees forward. And so these infographics you should know are really, really misleading because they apply Newtonian physics to the body. And that's a mistake.
00:34:18
Speaker
Because Newtonian physics is based on hard, rigid structures like, say, a crane and the body is not hard and rigid rigid, it's soft for the most part. And so in these diagrams, the head is shown as getting heavier and heavier and heavier as the head tilts forward, supposedly putting this extreme strain on your neck. um But that really, really oversimplifies the way our our body works, our body made up of many, many soft tissues works.
00:34:45
Speaker
um First of all, we're not a static structure. We're not a crane. And our neck and every other body part are made of soft tissues which are viscoelastic, right? So these are muscles, tendons, and ligaments. They're soft. They're flexible. They become more flexible when they're warm.
00:35:01
Speaker
And they are elastic, right? And they're adaptive as well, right? They're alive on lycra crane. So these tissues are all distributing force also dynamically in multi-directional ways, right? This is kind of the concept of tensegrity, right?
00:35:17
Speaker
across the body in this web-like web-like way. So it's not just a simple case of adding pounds with every degree of tilt. Because you're first of all, your muscles and tissues are constantly adapting to loads. right So they're theoretically, if your head is getting heavier as it's craned forward, your neck is also getting stronger to be able to manage that because that's how adaptation works.
00:35:38
Speaker
right in response to what you do with your body, your body becomes more capable. But additionally, all of those tissues in that multi-directionality viscoelastic soft tissue property are spreading out the way that your entire body is managing the weight of your head. It's not all just falling onto your neck. Your back body is is being given some of that load to varying extents and additionally it's just the math doesn't math here because again this is newtonian physics physics applied to the body so next time you see those neck infographics right just know that that's inaccurate it's nocebic it's meant to scare you it's meant to make you feel like your neck is fragile and that your neck is not strong enough to hold your head up and also know that it's just a
00:36:33
Speaker
It's a marketing ploy, right? It's just a way to grab your attention and scare you and be like, I've got to focus on my neck posture. And you know of course, this person is probably trying to sell you a way to do that, right? Sure. All right. So I think we've we've busted this myth pretty well, this idea that you know keeping good posture, whether it's in your whole spine or just your neck, will keep you out of pain.

The Impact of Posture Anxiety on Pain

00:36:54
Speaker
And then the flip of that argument that changing your posture from bad to good will relieve your current pain.
00:37:01
Speaker
And I also just want to say, before we talk about what this means for movement professionals, I do want to say, when we say it's not supported by research, that doesn't mean that there's one person or a few people or someone in your life that it actually might help them with their pain. It just means you can't take a paintbrush and say, it's going to help everybody. Right. And that's true of most things, right? Everything, there's is's a lot of, it depends in, in all.
00:37:29
Speaker
movement and exercise and rehab and all of that stuff. So I think sometimes when people get shirty about it, they're like you know they'll reach out and they're like, I've seen X number of people get better with better posture. And it's like, okay.
00:37:44
Speaker
But does everybody get better with better posture? that's That's where the no is, right? So maybe there's a percentage that that do. And ah that's the other thing as well. as I'm not saying stop teaching posture at all, but you should definitely stop saying that posture is going to create pain. Like bad posture is going to give you pain. That's what a load of horseshit is. And it's contributing it's contributing to a narrative that actually does make people's pain worse. So while yeah presumably trying to help people,
00:38:13
Speaker
by warning them about their problematic posture. You are in actuality making their pain potentially worse. You're contributing to their hypervigilance and neuroticism around their posture. First, that's not a very productive way to be spending your mental energy, frankly. And second, they start to develop these beliefs about their body that are really hard to deprogram, right? It's really hard. Someone who's been told that their neck is at risk and fragile and vulnerable. These are all the words that are used for the neck, right?
00:38:44
Speaker
is then going to be very difficult to talk down from that and say like, Hey, listen, it's okay to strengthen your neck. It's okay to put load on your neck. It's okay to do these, you know, activities will actually make your neck even stronger than it already is and always has been. No, they think their neck is inherently fragile. It's a hard belt on ring.
00:39:06
Speaker
Yes. the The sort of short answer, I think, is you don't have to police everybody's posture. And in fact, you shouldn't. Okay, so but you might say to yourself, fine, I won't police people's posture anymore. I won't keep saying things that associate posture with pain. But people still come to me and say they want to improve their posture, right? I mean, I'm sure people come to you as well, Laurel.
00:39:32
Speaker
Okay, so if someone comes to you and says they want to improve their posture, what you can do then is just drill down a little bit, find out why. Are they having pain? Are they in one shape all day long and it doesn't feel good? Do they feel weak? right Those are all things that you can work on. But think about it, like if you correct someone out of one position to now be in a you know newer, better position,
00:39:58
Speaker
you're probably just swapping out one problem for a different problem, right? It's like when when standing desks, remember those? When those first became all the rage and everyone was like suddenly, oh, sitting is the new smoking and everyone's standing up all the time now. Standing for eight hours of your day is just going to create different problems for you because bodies like to move, they like to change shape. And so really the best thing that you can do for someone who is you know looking to improve their posture is to teach them a lot of different kinds of ways to sit or to stand.
00:40:29
Speaker
that will build strength in a variety of positions, build tolerance, right resilience in a variety of positions. That's a much healthier goal than saying, okay, well, instead of what you're currently doing, just do this, but only do this for your whole day. Laura, can you tell me more about this idea about like what does it do for people to get more options, posture options in their life?

Encouraging Posture Modification Over Correction

00:40:55
Speaker
Yeah, absolutely. So instead of thinking about it in terms of posture correction, think of it in terms of posture modification. I think if we just change that word correction to modification, now we're talking about changing posture, we're not talking about moving it from wrong to right. Okay. And and we've suddenly entered into a much more nuanced and interesting world of discovery, because there are a number of reasons why modifying posture might be extremely beneficial for a student or a patient or whoever you're working with, right? So number one is it's going to introduce load variety to their body, right? Because if you stand differently, if you sit differently, if you do a yoga pose differently, you're going to be loading your body differently. And that in and of itself has benefit, right? Varieties despise life. I know it's kind of cliche, but it's true when it comes to ah feeling good. A lot of times um movement
00:41:47
Speaker
done repetitively without variation or postures held repetitively without variation are are basically like a recipe for not feeling great over time. right So variety is really just a way to change those patterns, break free of those habits, and like introduce some fresh new input to the body, to the brain. Number two is resilience, as Sarah mentioned, right which is that we're going to be able to tolerate a wider variety of loads, a wider variety of positions, adaptability. right we're going to start to stimulate our body in these different ways that are going to cause our body to change in response to those those simulations. And then, of course, if you have pain in a particular alignment or posture, being able to know where you are and then make a different choice is really, really valuable because maybe a different way of doing the movement or a different way of sitting or standing is going to actually decrease your pain. And that's a good thing. And then finally, skill acquisition, right?
00:42:44
Speaker
It is a fact that, for example, if you want to do something like gymnastics-oriented or calisthenics-oriented or ah play a sport ah you know and and develop skill in a particular sporting movement, and the list goes on and on, yes,
00:43:02
Speaker
position matters for sure. Like if I'm going to deadlift the most amount of weight possible for me, there's going to be a narrower set of ways that I position myself to be able to do that. Like not anything is going to get me there, but you know, I think it's just really fun then to think about posture modification as just another tool that we have in our toolbox and we can continue to use all of our abilities to see students, intuit how they move, intuit what they might benefit from, listen to them, have a conversation, understand what their struggles and their goals are, and then use our skills of being able to teach alignment, to teach posture, which many yoga teachers, Pilates teachers are actually really, really good at.
00:43:50
Speaker
The thing that might be challenging is breaking out of this default mode or like pre-recorded voice in our head, always wanting to direct students towards the same cookie cutter posture because we've really internalized that that's the safe, best way to be. That's hard. That deprogram is hard and I speak from experience that it's hard. It's hard to kind of let the movement look a little messy, right?
00:44:17
Speaker
it's hard to let the student kind of not get it exactly how you would like them to get it. And and it's you know also sometimes confusing to hear that that's working just fine for them. Thank you very much. And you don't actually need to go in and correct that. And it's and it's also hard to take up posture that maybe someone is struggling with that you feel is ideal, right? You've aligned them correctly or whatever, and they're like, this doesn't work for me, and then go,
00:44:46
Speaker
Yeah. Okay, I guess it's actually okay if you, you know, don't, whatever it is, have a neutral pelvis then in this but particular pose. Sure, let your pelvis anteriorly tilt a little bit or posteriorly tilt or whatever feels better. It might be hard in the beginning, but if you can let go of this idea that you're correcting posture, and if you can step outside of the word world of binary right round thinking and enter into the much more colorful fun and play for world of posture modifications,
00:45:11
Speaker
ah then it's going to you're going to get practiced at at being able to view it through that lens and have fun actually have fun with posture. right Stop trying to save people from themselves and start to introduce people to themselves. Amen. okay so Then if posture is not going to be my predictor of future injury, Laurel, what are some actual injury predictors?

Key Predictors of Injury

00:45:36
Speaker
Yeah, the biggest one is history of injury.
00:45:38
Speaker
right So if you have sprained your ankle, you're more likely to sprain it again. If you've torn your ACL, you're more likely to tear your ACL, right? So there's history of injury. And so that's not anything you can know about until you talk to the student and find out, right? There's also training load and load management, which is probably not a term any yoga teacher hears in their yoga teacher training.
00:46:02
Speaker
um And I'm not sure a Pilates teacher hears it in their Pilates training either. There is such a thing as acute versus chronic workload, right? So if your chronic workload is that you walk three days a week and you do gentle yoga three days a week, but then you go to a fast-paced Vinyasa flow class where the teacher's having you do a different pose um on every breath and you engage in attempting 80 different chaturangas, suddenly your acute workload is much, much higher than your chronic workload. Or if you go on vacation and suddenly start hiking 20 miles a day or 15 miles a day or whatever it is, suddenly your acute workload has vastly exceeded your chronic workload. In other words, you're probably not prepared. And this is the next predictor of injury preparedness, right?
00:46:51
Speaker
Have you done too much too soon? Were you prepared for the amount of exercise that you you know had had to do in a particular day based on what you've been doing the past couple of weeks, months, or years even? And so this is where, like as yoga teachers, we should just stop pretending that it's OK for a beginner to step into a vinyasa flow class and try to do 80 chaturangas.
00:47:17
Speaker
because there's a really good chance that as a beginner to yoga, they especially if they're women and they don't strength train, they're not doing a whole lot of stuff with their upper body. They're not doing a whole lot of upper body pushing that is involving body weight, almost, you know, half of your body weight at least. So, you know, workload management means being able to teach a class that has options outside of just doing Chaturanga every single time.
00:47:42
Speaker
and so that you can ah manage that acute workload that your students are going to be experiencing in that particular class so that they're not doing suddenly too much in this in this first class they're taking with you. And this goes for strength training. This goes for Pilates, right? Obviously, we want to.
00:47:55
Speaker
try to meet students where we think they might be. We can't know everything about them and what they've been doing, but we can take a guess that if they're a beginner, they probably haven't been doing a ton of chaturangas. And if they're women who haven't strength training, they probably don't have a high level of upper body strength, right? We can just kind of assume that, I think. The other thing that can be a predictor of of injury is recovery, right? So if you are someone who actually goes a little too hard and doesn't let your body rest, and he doesn't let your body recover from your workouts, like your strength training,
00:48:24
Speaker
um and running and doing lots of yoga and you're never taking day off or you're just doing um more than your body is accustomed to having to adapt to and it's not getting enough recovery time. You could probably end up with an injury. I could definitely tell you lots of times when that happens to me. I was not letting myself recover enough from running.
00:48:43
Speaker
And I ended up with a calf strain. Yeah, that's how it works. There's also things that are maybe a little bit more subtle, like is psychological factors, right? Where someone's coming into a situation where they're a little bit fearful or anxious, like we can all, if we're If we've done yoga, we can remember like the first time we were introduced to doing handstands, right where you're suddenly like, holy shit, wait, what? I'm going to be kicking upside down, huh? Or like an arm balance. You're like, I'm going to do a face plan into the floor, for sure. These emotions can actually increase injury risk. I think maybe because you're just not as focused on what you're doing, you're just in your head a little bit too much, and that's going to cause you to like maybe slip up and make some mistakes or make some poor choices. But also, a lot of times, this fear and anxiety might be coming from
00:49:25
Speaker
some narratives, some unhealthy healthyy narratives that we have about our body. Like we think our body is fragile or incapable of handling the demands of particular exercise we're doing. If the exercise is actually appropriate amount of exercise, but we're still fearful and anxious about it. Like say, for example, if you start strength training and your coach is like, okay, let's, let's work on deadlifts. You're immediately like, oh my God, deadlifts. I've heard that those are absolutely the worst thing you can do for your back. And I'm going to herniate my disc. Like you now actually are more likely to hurt yourself in the deadlift.
00:49:53
Speaker
because you're entered into that fearful, anxious state. And this is why we just go on and on and on about how it's really important how you talk about students' bodies, how you talk about their capacity, how you talk about movement, because if you're instilling fear, you're basically setting them up for pain. You're setting them up for injury. Right. So the other last one, too, I'll mention, which are things that we can't necessarily change about ourselves, which is genetics. Right. There's definitely a genetic component to injury. There's also age. You're more likely to get injured as you get older.
00:50:24
Speaker
hormonal factors play a role, and then underlying health issues. oh and one And one more is environmental factors. So i consider like what kind of equipment you're using. you know Is the equipment safe? right Or also, like what kind of um turf or what kind of ah surface are you practicing? Running on a sidewalk, I learned this in my run club. Running on a sidewalk is much harder surface to run on than running on the road. And that's why so many runners run on the road.
00:50:51
Speaker
You're like, why don't you run on the sidewalk? It's like they're running on the road a lot of them because asphalt is soft. And cement is hard. Yeah, I learned that. I was like, that makes so much sense. And now I can actually feel that now. Maybe it's just because I've been like, ah it's been suggested to me and now I believe it. But I feel like I can feel that the sidewalk is harder than the road. So what what you're saying is they're not running in the road to piss me off. No, they're not. They might be running in the road because the pedestrians are pissing them off. I could see that being the thing. It's definitely a thing in New York City. I could see it being the thing in LA. But sometimes, like in Alabama, there's never anyone's on the sidewalk, right? The sidewalks are free and clear.
00:51:29
Speaker
but The runners are on the road because the asphalt is softer. Yeah, and then and then weather, of course, right? like You're more likely to get injured if the pavement is slippery or if the turf is wet. So these these are all predictors of injury, and like not one of them mentions posture, not one of them mentions movement quality.
00:51:49
Speaker
Not one of them mentions muscle fucking imbalances. If I hear that phrase, muscle imbalances one more time, I don't know what to do. Thank you for that for that comprehensive list of things that actually might injure you, none of which are posture. Okay, our next myth is that neutral spine is a specific place And it's important that you and your students find it. Well, what's the

Rethinking Neutral Spine Position

00:52:16
Speaker
reality? First of all, if we want to consider it as an idea, if we're like, okay, let's let's talk about this idea of neutral, it's definitely not a single place. It's possibly more like a neighborhood or a zone. If we're thinking about neutral as like the middle space between one end of our range of motion and the other end of our range of motion in our spine, right?
00:52:39
Speaker
Is it possible to identify what a singular neutral spine space is for anyone in phone and everyone? Well, we talked about this in our Alignment Dogma episode number 54 about spinal alignment.
00:52:53
Speaker
and One of the things is that nobody can decide what a neutral spine is anyway, like what parameters make up a neutral spine. Do you remember I was going through all those descriptions and like one person said this and somebody else said this and some people said, tuck your pelvis. The other say people said, think about your, I don't know, butthole. And it just was so ridiculous.
00:53:10
Speaker
And the reason why nobody can come to an agreement on what a neutral spine is, is because everybody is freaking different. You ding-dongs. I don't know how many more times we're going to have to say everyone is freaking different. Stop trying to make this one you know space exist for every human body. It's not possible.
00:53:31
Speaker
yeah Okay. So what does the research say? Well, there was a study done, yeah I'm cackling because I thought this was very funny. There was a study done that actually suggested it can be more painful to be in a quote unquote good posture, right? In that neutral spine posture. So this is a 2012 pilot study by O'Sullivan et al entitled, can we reduce the effort of maintaining a neutral sitting posture, a pilot study.
00:53:57
Speaker
And this was a randomized control trial of sitting without back support and sitting with back support in this one specific kind of a chair. I got the feeling that this study was done by the people who invented the chair. It seemed like that kind of a stuff, like let's find some research evidence that we can use to promote our chair. But anyway, so they had people sitting without, without the back support and then sitting with the back support and then testing what muscles were turning on in each case.
00:54:22
Speaker
And so here's the quote from the study. Neutral sitting postures are commonly advocated in the management of low back pain. Yet, maintaining these postures may require high levels of paraspinal muscle activation. In this study, pain-free participants could maintain a neutral lumbar spot, lumber? Lots of, lots of wood. In this study, pain-free participants could maintain a neutral lumbar spine sitting posture with less activation of lumbar muscles, but not the other paraspinal muscles.
00:54:56
Speaker
when sitting on a dynamic forward inclined chair compared to sitting on a standard chair with a flat seat pan. So what the hell does that mean? Well, it means that sitting in a chair with a neutral spine, with your quote unquote neutral spine without any back support, can make your muscles have to work really hard. And that that in itself might end up making it painful or uncomfortable or fatiguing. So it's not an automatic fix that it's going to make your back feel better if you sit with a neutral spine. So what does this mean if I'm a movement professional? Well, what this means is there is no automatic place for your spine that is, you know, A, neutral, whatever that means. B, definitely pain free for everyone. C, easy. And D, that everyone can propriocept well.
00:55:44
Speaker
Right? But with that said, I do think it's valuable to get people to move their spine around and find what feels like the middle in a general sense, but without micromanaging it and without making outsized claims about its value. Like, this is where you should try to be at all times, or this is the only safe place for your spine to be. i This is something that I do in the clinic. I'll have my patients, let's say we're working on a hands and knees position, I'll have them,
00:56:12
Speaker
go through you know sort of a cat cow and then find where roughly the middle is. and then i'm not What I see a lot of other people doing, what I'm not saying go doing is going in and posteriorly tilting their pelvis like another two degrees and making their ribs go in a hair you know because that's actually the right place. No, it's a zone. right and so getting them to feel roughly where the middle is, that's a great thing to do. But trying to get them to then get themselves into this very like so tiny, tiny specific detailed thing every single time is just a way to make them spend more money and have to come back to you because that's a very hard thing to do unless you're a professional dancer, basically. you know I mean, I've been told, Pilates trainers have told me that I had a posterior pelvic tilt.
00:57:02
Speaker
And Laurel, I know you probably don't spend a ton of time staring at my butt, but you may have spent some time, we've spent some time together, and I think you might agree with me that I really do tend to be more anteriorly tilted.
00:57:13
Speaker
but so But so Simone Biles. Exactly. No, I'm not saying there's anything wrong with that. But when I when i questioned it, because we also know that anteriorly tilted pelvises do not equal but pain or problem or anything. But when I questioned them saying that I have a posterior pelvic tilt, what they said was, at the top of my sacrum, by my spine, I'm anteriorly tilted. But at the tailbone end, I'm posteriorly tilted.
00:57:38
Speaker
And I was like, all right, well, how do you want me to fix that? Because I can't break my sacrum into two pieces and move each end independently of the other. Like, what the fuck? Well, we see so much. I was like, what? We see so much micromanaging. Can I just break in here with like what's turning out to be one of the mantras of 2024 for me?
00:58:00
Speaker
Yes. You're focusing on the wrong thing. yeah right But we see this, we see so much micromanaging of these like tiny elements of position that don't ultimately matter for the patients or the clients or the students' function. right I had a patient come in recently who had been going to another PT, but had stopped seeing that PT because they were telling her to avoid anything but really gentle movements and the patient could feel that like over the weeks she was just getting weaker and not getting better. And so at one point I i had her get down on the ground to do like a dead bug and they told me that the other PT wouldn't let them do dead bugs because when they did it they had a rib flare.
00:58:44
Speaker
And I was like, oh boy. Well, so I said, okay, well, let's let's just try it and see what happens, right? And can I tell you that her ribs maybe maybe shifted a quarter or a half of an inch in that rib flare direction, maybe, and that was it. So I was like, you know what? I think this is totally fine. And I think you can do dead bugs.
00:59:09
Speaker
That's okay. But my second thought was about this other PT like, all right, fine. You think your patient has this tiny rib flare and that matters. Why aren't you working on it instead of telling them to avoid anything strenuous, right? It just was like, it makes no sense. Laurel, have you ever been posture shamed or micromanaged into a neutral spine? Oh my God. So wait, you're just making me think of an email I got once from somebody who signed up for my virtual studio and didn't latch on to what was in there and wrote me this angry email. And her email was something along the lines of like- Didn't start with blessings.
00:59:51
Speaker
No, it did not start with blessings. It started with something along lines of like, I couldn't find any classes that I can take because, you know, she, I guess just really needed one-on-one sessions to be honest with you, given like the litany of things going on in her body. And I was like, well, you signed up for an online membership. Like, it's probably not your best bet in terms of your movement education. But then she was like, your feet are weak. You have weak feet.
01:00:24
Speaker
she Based on what? Did she have evidence? She took some of the my prerecorded classes and like was watching my feet, apparently, and like the yoga poses. huh And so when I think about my feet, like I have very high arches, and I have a little bit of this tendency to supinate. I've never had any problems with my feet. like My feet have been a non-issue for me. I don't worry about it, right? And and so she thought, based on based on my foot posture, that my feet were weak. And I was like, listen, lady.
01:00:54
Speaker
I guarantee you my feet are about 150 times stronger than your feet. But I didn't say that. No. I was like, okay, sorry, it didn't work out for you. And, you know, professional and cordial. But I'm like, wow, you think my feet are weak? um Interesting. ah So also, like, what who?
01:01:14
Speaker
Nobody asked you lady. Nobody asked. That's the thing too about, yeah aren't you just like asking for a refund basically? Where are you going on about Laurel's feet? People who are really focused on posture correction do also so tend to have this sense of entitlement in terms of like what they feel they're entitled to be able to say about another person's body, all in the name of quote, helping them. Yeah. So it was actually a very passive aggressive, like violent Wait, wait a minute. ways of fear stealing from her You're saying a yoga person yeah um saying a yoga person got passive aggressive in an email? Yeah, I know it's hard for us to believe Sarah. We've never encountered any of that ever. I've never encountered an email with massive amounts of vitriol in it that ended with the phrase blessings. I've never encountered that. Who would do such a thing?
01:02:08
Speaker
Anyway, back to what we were talking about. Okay, so I've been, I've been micromanaged for sure. And um I definitely was given the impression maybe not through micromanaging or shaming or anything like that, but like that I was constantly should be striving for neutral at all times in, in the yoga poses, especially, and eventually just found that to be a really painful and also kind of uninspiring and boring way to approach movement.
01:02:33
Speaker
And like I said, anything done repetitively without variation will probably eventually lead to discomfort, which is exactly what happened. I started to have a lot of pain in my body from my yoga practice because I was just doing things repetitively and constantly trying to fit my body, right my then my round body into the square peg of like neutral. right And then also there's this other element that I think we should touch on, which is when you are being evaluated right for your posture,
01:02:59
Speaker
you are in a sense performing your embodiment for someone else. And that is exhausting. And in my opinion, has whispers of fascism as well.
01:03:13
Speaker
This is like, big brother is watching. We're watching you. Where is your head in this moment? Is it on top of your spine? ah Sit up straight. Where's the natural curve of your lower back? ah The fact is that neutral is just another position, a zone, as you said, a zone of positions to be in a neighborhood. And you know believe it or not, we can even overdo neutral But first, let me back up. First, we'd have to agree on what the fuck neutral even is. Because we're really shit at assessing it. And we don't have the lab equipment to assess it accurately. So good luck. Good luck, agreeing on what neutral is. And then good luck on um being in neutral all the time. People are pretty shit at eyeballing
01:04:02
Speaker
another person's neutrality and really, really bad at predicting how good their capacity, their function, and their pain sensitivity is based on whatever it is they think they're seeing. Oh, and my mantra for this year is twofold. You're focusing on the wrong thing, and you often don't know what you think you know. Nice. I like that. I like that second one. All right, so here's here's a doozy. You might want to sit down for this. Oh, you are sitting down. Okay.
01:04:30
Speaker
All right, flex. Flecked. but it Flecked. fleed Genuflecting. He's bad for. Do you know one time I had a patient and I had to work with him on his genuflecting because that was he was a um ah seminar, seminary, something, something religious. He had to like do a lot of genuflecting and he had a heart like his hip was bothering him. So we literally practiced like kneeling before God. yeah Oh, he's a genuflecting. I was confused as like the definition of that word is actually it's to kneel.
01:04:59
Speaker
Yes. Okay. But you do genuflection in in the Catholic Church, you do it a lot. Right, right. I was like constantly kneeling and yeah. For some reason, I thought it was just like talking with your hands like I'm genuflecting. Oh, ah no, I was like totally confused about what that word meant. Genuflecting is doesn't it sound like it's like, inflecting? Yeah, or genuinely. And it's like, I feel like I've heard like people who talk with their hands or more. I don't know. Trustworthy.
01:05:26
Speaker
So it's sort of like you're your andbinding ah you're combining gesturing. What was the other thing? You're combining gesturing. And flexing. Flexing. Flexuring.
01:05:38
Speaker
Oh gosh. Knee flexing. Okay. Genu knee flexing. Oh, Genu is Latin for knee. Oh shit, it is. There you go. Genu flexing. I mean reflecting, flexing. Well, flexion, flexing is flexion. So knee flexion. Okay. Boom. We got it. Boom. Nailed it. Myth busted.
01:06:00
Speaker
Okay, so here's the actual myth. but so Wow, we really went on a tangent. Yeah. Okay.

Genetics and Disc Herniations

01:06:06
Speaker
Flexed spinal posture causes disc herniations, especially under load. That's a myth. I just want to reiterate. Hey, everybody. That is a myth. She just said myth. Myth.
01:06:20
Speaker
So more recent research has shown that as Laura was talking about earlier, even when to the naked eye, a spine looks neutral, there is often flexion going on at the vertebral level. So we're not very good at telling if a spine is straight or not straight, straight first of all. But apart from that, let's look into the research around loading with a visibly flexed spine.
01:06:43
Speaker
And what does the research say? Well, there's two studies that we're looking at this. One is the one that we, my inception one that I love so much that we talked about earlier, the 2020 systematic review of systematic reviews by Swain et al. And so when I got into the part of this, I i you know tried to read it And it's it's really very, reading systematic reviews is an incredibly dizzying activity because it's saying things like three studies, measured this and found this. Four studies looked at this and found this. Two other studies did that. And you're just kind of like, oh my God. when i So I got into the part of the study that really drilled down into the different spinal postures, right? The flexion or the movement or the vibration. And it was just an array of studies that all contradicted each other.
01:07:29
Speaker
and were varying levels of quality. And the quality means how good is this piece of research and how and and as then how seriously should we take the findings based on how good the research is, right? ah There were questions around publication bias, which I thought was interesting. There were questions around how it's basically impossible to know if all of these studies that they were reviewing, whether they're categorizing flexion or even pain the same way. And then ultimately here's what they said about spine flexion and low back pain. The findings from systematic reviews were inconsistent. The evidence for a dose response relationship is limited and temporality is conflicting. So it basically is saying we cannot find any consistent evidence to prove any aspect of this one way or another.
01:08:25
Speaker
And as a reminder, that was a systematic review of 41 systematic reviews, also known as a fucked up evidence. Yeah. Okay. So then there was another, uh, systematic review with meta analysis by Sarah Cini et al. And it was called.
01:08:41
Speaker
to flex or not to flex. I want to say also I always enjoy when somebody puts a slightly funny title in their title of their research. There were so many studies. I don't know why I was looking up information about urination, but there were so many studies.
01:08:56
Speaker
about urination. I think I was like looking at some pelvic floor stuff and it was it they would have titles like, you're in trouble, colon. Pelvic floor, you know, continents or whatever, it just made me laugh a lot. But anyway, so here's to flex or not to flex. Is there a relationship between lumbar spine flexion during lifting and low back pain? A systematic review with meta analysis.
01:09:21
Speaker
So this was a review of current literature and it showed a few things. and And what I thought was interesting about it is it was looking at people who already had low back pain and people who didn't have low back pain. And it showed that people who already had low back pain tend to flex their spine six degrees less when picking up something heavy, as opposed to those who don't have low back pain. So that's kind of interesting. You you kind of automatically don't let your spine flex when you're having pain already. What that speaks to specifically, you know, it could be a number of reasons why you do it. I do see a lot of people in the clinic when they come in with low back pain who are afraid to let their spine flex because of their pain. But quite often the pain they're having is because they're holding on for your dear life in, you know, more of extended position. And like the second those muscles actually get a chance to lengthen a little bit, it feels a hell of a lot better. But that's just my anecdotal
01:10:21
Speaker
That's not research. Most studies, nine out of 11 studies reported no significant between group differences in lumbar flexion during lifting, meaning some people had lumbar flexion, some people didn't have lumbar flexion, they lifted. It didn't seem to make, there was no significant meaningful difference between those groups.
01:10:42
Speaker
So if it's not that flexing my spine repeatedly is pushing my disc out and making it call hit a nerve and cause me horrible pain, then what is? Well, here's what's really interesting. The leading cause of a herniated disc is genetics, not posture.
01:11:03
Speaker
I thought this was fascinating. so There's a 2011 study by Patel et al. called Evidence for an Inherited Predisposition to Lumbar Disc Disease. so They're looking at not just herniated disc, but disc degeneration, things like that. They took data from one million. so I'm going to go ahead and say this is a really good study because it involves one million people.
01:11:23
Speaker
one million Utah residents for some reason. And so they went into their medical charts, they looked for the codes for disc herniations, disc degeneration, and then they cross referenced those people with genealogical information and found a very strong relationship between the two, right? So all these people who are having disc disease a lot of them were related to each other and not just like, you know, father, son, or, you know, Holy Spirit or the Holy Spirit. Thank you.
01:12:03
Speaker
but also like uncle three times removed. or like it was it was There was a lot of hereditary infinite evidence. And then ah there was a twin study, I love twin studies, ah from 2009 by Bati et al. And it it was called the Twin Spine Study, contributions to a changing view of disc degeneration. And it followed sets of twins from Canada, Finland, and the US s starting in 1991. And this was a like long-form study.
01:12:30
Speaker
And it looked at things like their lifestyle, their occupation, their the heritability, right the genetics, and other factors. They did find that smoking was a contributing factor to smaller disc size, which I always think is fascinating, like how many things get fucked up in your body from smoking. oh yeah But anyway, this was their conclusion. And this is a quote. The once commonly held view that disc degeneration is primarily a result of aging and, quote, wear and tear from mechanical insults and injuries was not supported by this series of studies. Instead, disc degeneration appears to be determined in great part by genetic influences. Although environmental factors also play a role, it is not primarily through routine physical loading exposures, e.g., heavy versus light physical demands,
01:13:20
Speaker
as once suspected. Mic drop. Bam. Yeah, that's ah that's a big mic drop. So I

Active Movement vs. Posture Correction

01:13:26
Speaker
was reading some of Greg Layman's blog posts in preparation for this episode. And this is a little bit more related to your ah paper that you found about the relationship between lumbar spine flexion during lifting and low back pain. He is a blog titled Why Sitting Posture?
01:13:44
Speaker
is mostly irrelevant to future pain. Now, obviously not deadlifting or lifting, but this idea that we need to have a certain upright posture while we're sitting. And he made this really good point about how nociception basically catalyzes movement. So nociception is this afferent feedback that goes to your brain from certain neurons telling your brain that something noxious is happening. It's very unspecific, but it's like, hey, brain, you might want to like pay attention to what's happening down here in the lower back region or whatever. So nociception, just input to the brain basically something noxious is happening. It basically catalyzes movement. It's what causes you to move in a different way. If you if you have this nociceptive experience, which we're not always ah we're not aware of. right we're We're aware of the perception of pain.
01:14:34
Speaker
right which is when the brain actually outputs pain, but no deception is not something we're aware of. um But it it is what's causing you to, for example, change positions while seated. okay So you might not even realize as you're working at your desk, you're trying to sit up straight because you've been told that that's going to be healthier for your lower back. But eventually, as you get caught up in your work, you you start to slouch. right This has happened to all of us. right We start to slouch because, well, why? right Why would our bodies naturally start to slouch when we're not paying attention?
01:15:04
Speaker
possible that it's because the no-ceception that we're experiencing from sitting up straight is causing that change in position to want to happen, right? Our our brain's like, okay, we got we got to do something that's more comfortable here. um And if if slouching were really that bad, why would that be the position that our body would kind of default toward?
01:15:26
Speaker
wouldn't our body, you know via this process of no deception, be catalyzed to move in a different position, to a different position? like Shouldn't it be the opposite based on the narrative around slouching? like Shouldn't it be that like as soon as our body starts to feel us slouching, right we sit up straight? Or maybe that does happen, but for the most part, it tends to be that people try to sit up straight and then end up slouching.
01:15:52
Speaker
And he gave this example of ending up with ulcers, right? Like the reason we don't all end up with ulcers on our ass from sitting at our desk is because of this nociceptive experience that we're experiencing all the time underneath our awareness, right? Which is that we, as soon as we start to feel like a little bit of discomfort, we shift our seating position, our sitting position, right? Well, that doesn't happen.
01:16:17
Speaker
with bedridden patients who've been immobilized for some particular reason. And so they need to be turned, right? If they're not turned, they'll develop ulcers because they are not able to respond to the nociceptive input. I just found this really fascinating, kind of more sciencey, pain sciencey take on like why we don't need to be so concerned about sitting upright when we're sitting in a chair because basically our bodies are really, really smart and knowing when it's time to change position.
01:16:46
Speaker
And maybe we should ask ourselves why the more comfortable position that our bodies naturally put us in without us even being aware of is it tends to be for a lot of folks, not everybody, but it tends to be for a lot of folks that we end up slouching, right? I just think that we could stop demonizing slouching as this dangerous place to be because it's obviously not if that's where our body is sending us as relief from whatever other position we were forced to get into.
01:17:16
Speaker
um So I thought that was really cool. And then also, um sitting up straight is just more effortful, as you noted. And when we get we slouch, we get relief from that. But it's also the case that if we sit for too much time in whatever position, we just feel like shit. I think it's the case that if we don't move enough during the day,
01:17:37
Speaker
It doesn't matter how we're sitting, what chair we're using, what ergonomic equipment or furniture we're using. We're going to feel not as good as we would have had we moved more. And this is because maybe the real cause of our pain isn't posture but sedentarism, which we talked about a lot in Posture Part 1. And because Beth Linker talked a lot about it in her book, Posture Panic. So then the question becomes, does posture correction fix sedentarism?
01:18:05
Speaker
And it does not fix sedentarism directly. Exercise fixes sedentarism directly. Of course, posture modification can play a role in making exercise more tolerable for folks, but posture correction does nothing to fix sedentarism. Another point Lehman makes is that we can't be both pro-loading and then anti-forward head position. Because, oh no, now we have to support a 60 pound head. Because if we think loading is good, then why is it now bad?
01:18:41
Speaker
right And I made this point a little bit earlier, but wouldn't a 60-pound head just serve our necks in their ability to be stronger? So you know like again, which is it? Is load good or bad? A lot of people say that inefficient posture, which they mean is bad posture. right They have actually no way of measuring the efficiency of anyone's posture. like To do that, you would have to be able to somehow know how the body is metabolizing.
01:19:07
Speaker
a posture. and know It's completely impossible to happen in folks. You don't have any idea what is more or less efficient for someone, right? But a lot of people insist that oh slouching is inefficient, or standing with the posterior anteriorly tucked pelvis is or a forward head posture is is is inefficient. And it's like, well, is is that the problem that we're like in pain because of all the inefficiencies of our posture? Or is it that we're in pain because we don't have the capacity and the resulting function from that capacity to handle being on planet Earth, right? Walking around, having to hold ourselves up and hold up whatever else we're trying to hold up. So so of course, tweaking our posture,
01:19:59
Speaker
Posture correction, even posture modification without accompanying sufficient amounts of exercise are not going to be the best way to improve our capacity. to be able to manage loads, to go from a decondition to a conditioned state, to go from a weak state to a strong state. And so posture modification kind of misses the point. Again, I will say it, you are focusing on the wrong thing, posture correction.

Movement Variability Over Uniformity

01:20:22
Speaker
Instead, let's get people moving, let's keep people exercising and let's use our ability to modify posture, tweak alignment, however, whatever language you use for it to help people make exercise more tolerable, more enjoyable.
01:20:38
Speaker
And then layman also makes the point that it's not that sitting is too much load for the spine, right? Everyone's like slouching is so inefficient and therefore too much load for your spine or forward head position is too much load for your neck. And that's why you have pain. No, it's not that sitting is too much load for the spine. It's actually that sitting is too restful for the spine. Sitting is too restful. I loved that. So, okay, what does this mean for movement professionals?
01:21:08
Speaker
I think we can just stop correcting people's posture, which is a form of gatekeeping. You're basically like, welcome to my opinion. Do you have your ticket to entry? ah My opinion is that your posture should look a certain way. And your ticket to entry to being acceptable according to me or safe according to me or whatever other qualifying words we use to let people know what we prefer their posture to be, is that you adopt this particular way of holding yourself or that you adopt this particular alignment. um I think we can just stop warning people gatekeeping movement and making it seem like their poor posture eliminates them, disqualifies them from participating. So basically just get people moving. If they need posture modification, give it to them.
01:22:00
Speaker
You will have to teach posture. You will probably have to teach alignment. You will have to teach form and technique because you have to teach people where to put their body in space to be able to do a movement. But you don't need to be overly rigid about what it needs to look like. And you don't need everyone to look the same.
01:22:15
Speaker
There's a ton of possible variation that you'll see between people and it's fine to usher them toward roughly the same shape for efficiency

Natural Movement vs. Rigid Posture

01:22:23
Speaker
purposes, right? like Or just, you know, this is how you do a deadlift and this is not how you do a deadlift kind of a thing. Like you're doing a squat, this is the deadlift. But it's truly okay if despite doing that, right, ushering people toward the general position they need to be in, that their spine runs a little bit.
01:22:40
Speaker
that their butt winks a little bit, that their knees come in a little bit. It's truly okay, unless it's not, and they'll let you know. And then you use your tools of posture posture modification. You should also not assume that someone's back hurts and deadlifting because there's a little bit of flexion. Or don't assume that the woman who took fourth place in the marathon in the Olympics, her knee running is causing her knee pain.
01:23:03
Speaker
clearly she is doing just fine. She might have a little leap pain though, because elite athletes tend to tend to walk around with some pain. That's the price of entry to being ah an elite athlete for a lot of them. But don't just assume that based on what someone's body looks like aesthetically, right? Don't assume that a pretty shower doesn't leak. Don't assume that an ugly shower leaks, right? Don't assume based on what someone's body looks like aesthetically, what their capacity is, what their function is, what their performance is, and what their pain tolerance is for that particular position you're observing and the position that you would like them to be in. Maybe consider ways to reduce range of motion if it's necessary to help them be able to perform the movement with a position that is helping them experience the exercise and with less pain or less discomfort. Maybe decrease their rating of perceived exertion in the exercise, like don't have them go to ah you know two reps in reserve, let them go to three or four reps in reserve, decrease load if it's necessary.
01:24:01
Speaker
decrease the amount of reps and sets they're doing if necessary. If it's a yoga pose, change the pose out completely for another pose or modify the pose significantly. Maybe instead of doing chaturangas, they just hold a plank for five seconds, right? Oh, and then also remember about load.
01:24:18
Speaker
management, right? So have a conversation with the person and find out what else they've been doing. Because if I had a penny for every time someone went, yeah, you know what, this deadlifting is hurting my back. And then like five minutes later in the session, they also mentioned that yesterday they went on a 20 mile hike or packed up their entire apartment into a moving truck.
01:24:36
Speaker
I would be rich. okay Because again, people often have it in their mind that a certain particular exercise or their posture is bad. Therefore, this is why they have pain. But then when you start talking to them, you realize, oh, you're under quite a bit of stress at work. Or, oh, you're actually doing a lot of physical activity that you don't You normally do, right? So this is this is all under the umbrella of load management, including psychological including psychological load management

Shoulders Back Myth: Origins and Reality

01:25:02
Speaker
sometime, right? I guess my the takeaway here, advice from our professionals is you can stop worrying so much about people all needing to look the same, but you can use alignment, you can use posture to help everyone
01:25:18
Speaker
have a better experience of movement and exercise for sure. Nice. Okay, here's our last myth. Shoulders, back, and down at all times. Oh, ouch. My shoulders, my neck, everything hurts just thinking about that. ah Yeah. yeah So the reality of this, and this is another one we talked about in our alignment dogma series when we did it about the shoulders, shoulders back and down. So we're talking about retraction, depression of the scapula, basically just to roll on the same page. It's this aesthetic ideal that that started with ballet, made its way through Pilates into yoga. And now it's something that Genpop
01:25:59
Speaker
thinks they need to do at all times for good posture. But the reality is there's a huge variety in the shape of people's rib cages, for example. So somebody's going to get a winging scapula. Oh, no. If they've got a little more flattened thoracic spine and flattened rib cages, there's literally nothing you can do about it or should try to do about it. And something else, Laurel, you you may remember this.
01:26:25
Speaker
When we were both in the yoga tune-up community, this would have been about like 10 years ago now, I remember this huge argument ah between the crossfitters who were doing yoga tune-up and the yogis who were doing yoga tune-up about whether or not the upper trap should be involved in the overhead arm position. Do you remember this?

Cognitive Dissonance in Alignment Theories

01:26:46
Speaker
And the crossfitters were saying, yes, of course, because that's how upward rotation of the scapula works. yeah And the yogis were like, we're experiencing massive cognitive dissonance right now because we're trying to get out of this singular alignment argument that has been drilled into us by the yoga community. So we want to agree with you, but it is so hard to think this is okay because we were brainwashed. So we're going to say, sure, maybe in loaded positions, but not unloaded positions, which is
01:27:13
Speaker
Kaka made me, it makes no sense, but I remember feeling this cognitive dissonance myself and not really knowing who was right and what I should believe. Do you remember this? I absolutely do. In fact, I wrote i wrote an entire article about it with someone else. That's right, you did. Yeah, it no me it was hot topic. Yeah. so I see a fair number of people in the clinic who have neck and shoulder pain and who are suffering, in part because they are trying to stretch, stretch, stretch their upper trap and their levator scapula.
01:27:43
Speaker
and someone at some point gave them or they saw it on the internet somewhere that stretch where you sit on your hand and then pull your neck the other way for their upper trap or their levator scap is not helping because a lot of the time what people need especially people who've been spending so much time focusing on their shoulders staying back and down is to actually allow their upper trap to contract.

Strengthening Upper Trapezius for Overhead Movements

01:28:05
Speaker
It's not the devil, but yoga and Pilates teachers make it seem like it is. And as often as not, what people need is a stronger upper trapezius that assists in all their overhead positions, which means they also need a stronger neck because the upper trapezius attaches to the cervical spine all the way up to your cranium, right? so it's not more stretching that's going to get you out of pain. It's not shoving your shoulder blades down your back so far that you end up with you know just this incredibly overly yanked down position right that doesn't does you know good. so ah There are a couple of studies that I found, they're talking about scapular movement. and One of them was actually, I thought this was interesting, they're looking at the differences between male and female scapular kinematics,
01:28:54
Speaker
And what they found was that the upward rotation angle of the scapula was significantly greater in males. The internal rotation angle was significantly, significantly greater in females, and none of these people were having shoulder or neck pain, right? This is just where they ended up. And that also makes me think about how so much research is done on men and then assumed that women are just like smaller men. So then you know all these markers or ideas of like how much should your scapula upwardly rotate that we've been taught as just kind of across the board factual turns out
01:29:34
Speaker
It's different if you're a man or a woman, but we're all out here trying to shove everybody's scapulas into the same place, apparently for no for no good reason. And then there was another study that looked at the kinematic differences between a you know dominant arm and non-dominant arm.
01:29:50
Speaker
ah this the two scapulas and they found that the dominant scapula were 10 degrees more downwardly rotated at rest and 4 degrees more upwardly rotated during elevation on average compared to the non-dominant scapula. The quote from that study is Scapular motion was not the same between dominant and non-dominant arms in healthy subjects. The dominant scapula was rotated further downward at rest and reached greater upward rotation with abduction. These differences should be considered in clinical assessment of shoulder pathology.
01:30:25
Speaker
And again, none of these people are having either neck or shoulder pain. This one's my favorite.

Reconsidering Scapular Dyskinesis

01:30:32
Speaker
There's a 2021 paper by Hogan et al that says, scapular dyskinesis is not an isolated risk factor for shoulder injury in athletes, a systematic review and meta-analysis. So this was a review of other studies. So seven studies were eligible for inclusion resulting in 212 shoulder injuries observed across 923 athletes.
01:30:54
Speaker
Scapular dyskinesis was present in 46% of participants, and these athletes had an injury rate of 25%. So that means the presence of scapular dyskinesis displayed a trend to increase the risk of shoulder injury, but it was not statistically significant. So scapular dyskinesis was not significantly associated with the development of shoulder injury,
01:31:23
Speaker
in athletes. who What does this mean for movement professionals? Well, maybe stop stretching their upper traps and levator scaps and their neck as a solution to their neck pain because nine times out of ten is not the answer. When they raise their arms up in sun salutation or a crescent pose or any other time you're reaching your arms up, stop telling them to pull their shoulders down because it's messing up their natural scapular movement.
01:31:50
Speaker
of upward rotation. Also, you should definitely stop micromanaging their winging scapula because it's not a problem. I remember an old yoga teacher of mine i had gotten married and she was showing us pictures of her wedding and she was in this really pretty strapless dress and she pointed out that her shoulder blades stayed like, you know, were on her back. They weren't waiting the entire time. I remember thinking, wow, I wonder if I could do that.
01:32:15
Speaker
you know And, you know, sure, for your wedding photos in a beautiful dress, yes, aesthetically, it looks really nice, but it's not illegal if they're not. This is not a requirement for healthy shoulder movement. It's also not a requirement that your two scapula do the same thing as each other. And neither one of those things is an indicator that you're going to have pain.
01:32:34
Speaker
So let's all stop telling people to pull their shoulders back and down because it's probably actually causing them more problems than it's helping.

Critique of Pseudoscientific Posture Advice

01:32:42
Speaker
Alright, now Laurel, there are a whole ton of people out there who spend a lot of their time using pseudoscience scare tactics around posture. There's one in particular that we're finding especially offensive at the moment in no small part because he has one million followers on Instagram.
01:32:59
Speaker
Can you tell us about this ding dong, what he's saying, what he's pushing, and why it's bullshit? Yeah, before I tell you about Posture Guy Mike, just keep in mind that all of the people who are using these pseudoscience scare tactics around posture, are all of them are ignoring the biomechanical research that shows a poor correlation between posture and pain. They're all overlooking the fact that um neck pain involves more than just physical loading on the spine and neck and so does every other type of joint pain. They're all disregarding the body's ability to adapt to pretty much any type of loading. They're all neglecting the fact that humans, for example, in the example of forward head posture, that humans have always bent their necks in daily activities from the beginning of time. Like, how do you think we created the spearheads
01:33:54
Speaker
to be able to kill our prey. We did it with a lot of chipping away at rock, right? Do you do you really think they were holding the rock up eye level and chipping away at the rock to make a spearhead? No, their heads were forward. Scholars, craftspeople, chess players for centuries and centuries have been sitting there doing whatever it is they do for many hours a day with their head forward. This is not a new development with the invention of the iPhone.
01:34:23
Speaker
And all of them ignore the fact that there are a lot of sporting activities that involve significant neck loading, like F1 racers, which we've posted about on Instagram, wrestlers, that these sports involve significant neck loading. And they are actually helpful for the strength and resilience of the athletes neck And the same can be said about any joint. So I kind of just pulled the neck out as an example. But these are the types of things that get ignored with pseudoscientific scare tactics around posture. So there's this guy in posture guy, Mike, who sells a posture enhancement program for seniors who are women. And they are basically gentle, corrective exercises or stretches to improve what he says is their strength.
01:35:10
Speaker
But he's not teaching strike training. And to prevent them from getting, and he'll typically point down to a picture of an older woman with a dowager's hump or a neck hump or a hyperkiphotic spine. So here are some examples of his posts. He'll post three exercises for posture to avoid looking like

Posture Guy Mike's Advice Scrutinized

01:35:30
Speaker
this woman. And he'll point down, for example, to an older woman who's slouching in a chair. And these exercises would be things like shoulder rotations, lying prone and holding a towel and flossing your shoulders, right? Putting the towel behind your head and then bringing it in front of your head. Down dog, right? At the wall, if you're standing with your hands on the wall, doing down dog at the wall. These are the three exercises that he says you should do to avoid having hyperkyphosis, to avoid having a a slumpy spine. One of his posts says, get rid of neck hump, okay? And it's six exercises. he By the way, if you go through his grid, he keeps prescribing the same six or so exercises for like every problem. And the problems he focuses on a lot are forward head posture, hyperkyphosis. Every third video pretty much is something about fixing this particular posture problem. And it's an exercise. And then he'll say, do this 25 times every day.
01:36:25
Speaker
And it's always do this 25 times a day to avoid forward head posture, to avoid neck hump. He has dozens of videos like this. If I did every exercise he recommends 25 times a day, every day, I would not have time to feed myself, which would be a good thing because I also wouldn't have time to go to the bathroom.
01:36:50
Speaker
that But some exercises he recommends to fix rounded shoulders include one where he's leaning into the wall with his head pressing into a block and then flossing a towel behind his head. Do this 25 times a day. Or he'll be in like some Superman variation with his forearm sliding up and down. Do this 25 times a day. Or you'll be holding a towel behind your back and like lifting it up behind you to extend your shoulders.
01:37:15
Speaker
do that 25 times a day. And I don't know. I was going to ask you, Sarah, is like a PT thing? Like, do you do you tell your patients to do something 25 times every day? but Fucking never. Like, where did you get that number 25? Anyway, so he eitherre here this this is the one um that really kind of made me crazy, is fix your forward head posture with this heel wedge. Click the link in my bio. I have an affiliate code to sell you this heel wedge.
01:37:40
Speaker
and you're going to supposed to stand with your toes facing uphill with your back against the wall, your head pressing into the wall, and this is going to fix your forward head

Questioning Heel Wedge Logic for Posture Correction

01:37:47
Speaker
posture. This this heel wedge, by the way, is basically a slant board that people but try to sell online all the time. and you know You can do squats on it, or you can stretch your calves. I'm trying to i'm just trying to work through in my head like how how you could what how you would try to put those ideas together is the idea that if you're if you're going into more i mean this doesn't make any sense but if you're going into more dorsiflexion in your ankles right like increased from from a neutral like flat foot position then
01:38:20
Speaker
Is that creating more pull up your calf muscles and your hamstrings and your glutes and your back and your neck? It all starts in the feet. Is that going to just yank my head back because I'm now pulling on it like a string? I don't know. I don't know. We got to make posture, Mike, make sense.
01:38:39
Speaker
Oh, God. Big time. Yeah. He'll also teach the same exercise that F1 racers do. There's a lot of chin tucking, by the way, in his videos. Lots of chin tucking. But he won't put any weight on the head, so it's unloaded. It's just the weight of your head, and it's a lot of chin tucking over a table. Do that 25 times a day. Oh, God. Here's the thing. If people actually tried to do all of this in earnest, they were like, I want to fix my posture.
01:39:03
Speaker
And they saw no progress. He could simply say, just do it for longer. Keep going. Right. Do more. But then if they quit because they saw no progress, he could just simply say, well, you didn't do it long enough. And that's why it didn't work. Because there's no way to know you're making progress with this. Like I said, there's no way to measure improvements to posture. If you're trying to know what your resting posture is,
01:39:25
Speaker
throughout the day, like just the way you are standing when you're not thinking about it. that's that By the way, that's a different posture than the one that you adopt when you are thinking about it and being neurotic about it and being hypervigilant about it or performing it for someone, which hopefully you're not doing all day long,

Flaws in Posture Program Claims

01:39:40
Speaker
right? Hopefully that is not where your mind is all day long.
01:39:44
Speaker
So how are we going to know that you've improved your posture? There's no way to know. Unlike strength training, where there is objective proof that you're getting stronger, you know it's working. And if it's not working, you should probably hire a different coach, right? You should hire a coach maybe because you don't maybe know how to build strength, right? Get an expert to help you. There's no way to know if this is working or not working. So it's so easy for him to just be like, do this 25 times every day. Keep going.
01:40:14
Speaker
to fix your posture. I'm sure people mostly feel better after doing these exercises though and that's where this gets tricky because there's actually nothing wrong with the movements he's teaching. I've taught a lot of them myself. It's how he's selling them that is actually, in my opinion, a really big problem. I know that this guy, posture guy, Mike, he believes for sure he believes in muscle imbalances, the idea that muscles can be locked short and locked long. And the muscles that are locked long are weak and the muscles that are locked short are overly active. And this is Vladimir Yanda's work that we've talked about a lot on this podcast that is a outdated ah scientific theory that has been replaced by more up to date science. But he seems to think it's like he thinks the spine is like a set of teeth. And his exercises are the braces.
01:41:00
Speaker
you know You just wear them for, I don't know, forever, 25 times a day until you're all straightened out. Or or maybe it's the spine is like clay. you You just have to pull on some parts to lengthen them and push on other parts to shorten them, and voila, you have a straight spine. Yeah, that's what you're doing with your feet on that slant board, is you're just pulling on your neck from your feet.
01:41:20
Speaker
Yeah, yeah. The thing is, as I said, like you know people are going to feel better after these exercises. And that's where we get that confirmation bias, where we're like, OK, I did this thing. I feel better. It must have achieved the goal that I originally did it for. I have bad posture. I want to fix my posture. I do posture guy my mics exercises 25 times a day. And I feel better. Therefore, that must mean my posture is fixed. Because again, we have no objective way to measure whether posture has improved because we can't even decide what good posture is, right? Like, I guess a lot of people think it's neutral, but we can't agree what that is. And there's no way to measure your posture. There's no way to do it. And also, it makes me think about this, like some of the other research that says like,
01:42:07
Speaker
Any kind of general exercise is fine to do to help your back pain better. So there's a strong chance they're feeling better because they're just doing something. Yeah. Like literally anything. Yes, exactly. Any amount of exercise is better than none. And exercise is a proven way to help us feel better. And oftentimes when we feel better, we think we look better too. Definitely. So he he loves these before and after picks.
01:42:33
Speaker
It's like what people use for weight loss, but I think it's hilarious because he uses them for posture, which is amazing because he'll do a before and after pick of someone slouching in the before and then after they're standing upright as if, right, in the course of three months using his 25 times a day. His patented 25 times a day model. Their posture has been permanently altered.

Humor in Posture Improvement Claims

01:42:59
Speaker
But I could slouch in one second and then stand up straight the next. I can also take a picture of my head rotated to the left, my eyebrows lifted unevenly, and my tongue hanging out of my mouth. And you could take a picture of that. And then another one a second later of me smiling to camera. And you could slap the word before on the first picture and after on the second picture. And voila, now you have a face fixing program. Hashtag face coach. Do these exercises 25 times A day. Eyebrow lifts 25 times a day. Neck rotations 25 times a day. Tongue sticky outies and innies 25 times a day. Think of all the things we could fix like this.

Critique of Fear-Based Posture Marketing

01:43:36
Speaker
Before picture of my elbow bent. After picture of my elbow straight. Elbow straightener program. Hashtag elbow coach. It's funny, okay? It's funny haha. But it also makes me want to cry because then here's something that is really not funny at all. And in fact, it enrages me.
01:43:54
Speaker
So you're lifting weights, you herniated disc, and now can barely get out of bed. Why does that happen and how can you prevent it? When you bring a crooked body similar to the one in red above, to any event, including lifting weights, you're building on top of an unstable foundation, cementing and compounding your postural misalignments. This could lead to herniated discs.
01:44:17
Speaker
poor posture and a number of other different issues. You can simply prevent this from happening by starting your day out doing gentle corrective exercises and stretches to bring your body back into alignment similar to the photo above in green. So that now when you go to the gym or simply go about your life, you're building on top of a solid aligned foundation.
01:44:40
Speaker
So here we have this video where he's just implied that this image of a woman with crooked posture and he's got like the dots from like the joints, then they're crooked and the knees are coming in and the shoulders are uneven, right? He's got this older woman. She's clearly an older woman. With crooked posture, he's implying that this woman with crooked posture or anyone with crooked posture like this woman could one day get up and go to the gym and lift their weights and then the next morning wake up with back pain because they just herniated a disc because they lifted weights with their crooked posture and what they should have done
01:45:17
Speaker
is instead of going and lifting weights with that crooked posture, they should have instead done gentle corrective exercises every day, 25 times a day to first fix their posture. Okay, so again, we have another example of someone, a younger white dude, no less.
01:45:36
Speaker
telling older women not to strength train and rather to stick to light resistance activities all in the name of changing their appearance. Careful you don't get a Dowager's hump. Did I mention that he shills $150 AI shoes that track your balance so you don't fall? But don't strength train.
01:45:55
Speaker
Here's my affiliate code for some shoes and a slant board. Stand against the wall, tuck your chin, rotate your shoulders 25 times a day, fix your posture. Spoiler, none of these things are gonna change anyone's posture. And then after you do all of this stuff until kingdom come or hell freezes over, then you can strength train. In the meantime, while you're doing these dozens of exercises 25 times a day wearing expensive shoes and standing facing uphill in your own home and you are not engaging, in the research-supported activity that will prolong your life and stave off chronic diseases for the benefit of you, your family, and everyone else who loves you and needs you. And if you suggested to this guy that his audience should strength train, he probably believes they're too old for that. But actually, you know why he has the audience he does? Because they believe they're too old for that.
01:46:46
Speaker
thanks in part to people and messages like the one espoused by Posture Guy Mike who have led them toward that conclusion and who have used it for their own profit.

Unethical Posture Marketing Tactics

01:46:58
Speaker
Yeah, it's it's deeply unethical and it's deeply unforgivable. it It reminds me of, you know, people scamming older people out of money. Like the Nigerian prince has money for you kind of emails, right? It's just playing into people's fears and not really giving them a solution because you don't give a shit? Ultimately, I don't know. I don't know. i mean I always wonder with people like this, is it malicious? Is it just from being uneducated? Do they not bother to do any research? Have they just hit on a good thing? And so why would they change it? I don't know. But anyway, maybe our next make somebody make sense is going to be make posture guy Mike make sense. Cause you know, we like punching up.
01:47:52
Speaker
All right, everyone. Well, I hope that you have enjoyed this episode and maybe learned some new things and hopefully not experienced too much cognitive dissonance if the information within really doesn't gel with what you previously thought or believed. But ultimately, here's the thing.

Movement Variety Over Perfect Posture

01:48:10
Speaker
All of this is good news because you can stop worrying about your students being in good posture or bad posture and instead start instilling in them the love of movement.
01:48:22
Speaker
of variety of finding strength and just being in your body in a number of ways which ultimately is going to be much better for them so you don't have to work as hard and they're going to have a better time right because we've said this before but we'll say it again the biggest issue for the vast majority of people is not whether or not their posture is exactly in the right place at all times. It's the fact that they're not doing enough exercise. So why don't we stop fear mongering these invented problems and let's start encouraging people to move their bodies more and in more ways. It's just, it's wild to me when I think about how many people are afraid of hurting themselves have been made to feel afraid of hurting themselves.

Embracing Body Diversity and Functionality

01:49:04
Speaker
It's a phenomenal marketing tool because now they need you to fix them, right? They need you to tell them what to do, but it's so deeply unethical when the research shows otherwise. And we need more people out there yelling it to the rooftops that your body is a wonderland and it's time to reclaim it.
01:49:22
Speaker
All right, everyone, check out our show notes for links to all the references we mentioned in this podcast. And finally, if you liked this episode, it helps us out tremendously if you subscribe and rate and review it on Apple podcasts or wherever, wherever you listen to your podcasts. And then the last thing I need to tell you is you need to get on the wait list. What wait list you ask? Oh, it's the only available wait list for our bone density course that starts in October, which is just around the corner at this point. Get on the wait list. You'll get the only discount for the course that's available. It's exciting. We're getting we're getting geared up. ready to Ready to rock and roll one more time. All right. Should we try to see you in a fortnight? All right. See you in in a fortnight.