Can’t Stop, Won’t Stop – Posture and Pain


The emergence of pain science as a reliable, researched intervention has significantly improved physical therapists’ understanding of symptoms.  Practitioners across the world are now armed with insightful literature, schematics, and even video.  This new found knowledge has changed examination, assessment, and treatment with the promise of reducing symptoms with education and simple movement.

Recently, the idea of posture and pain was the subject of an interesting debate.  In the pain science community it has become vogue to denounce former anecdotal treatment in favor of cognitive behavior training.  As a therapist who routinely uses pain education I will not question the validity of pain science or its impact, but I do question the willingness to discredit other interventions due to semantics.  While posture may not “cause” pain, it certainly can influence pain, and should not be dismissed.  For example, I have a tendency to sit  with my leg tucked underneath me and after a period of time I sense lateral knee pain.  I realize that the nociceptors are transmitting an input to the brain that is in turn posting an output of “Hey, this needs to be addressed.”  When I move my knee I occasionally have a “pop” which I assume is my fibular head, and then my brain stops the threat message and my pain resolves.  Now, you can call the output of pain a result of misalignment, posture, my memory of past experience or just needing to move, but you can not deny the contribution of sitting on my sense of pain.

Now, I am not promoting going backwards and blaming everything on static posture, but another can of worms to open is if there truly is a “static” posture.  During sitting or standing, there are muscles firing to maintain balance, keep the horizon, etc. so “static” posture may be an inaccurate term.  In addition, for clients who are strapped to a desk all day and in the “flow” they may not notice the subtle messages from the brain alerting them to the presence of nociception.  So, I say do not pin everything on posture, but do not dismiss it either.