Does Your Posture Really Matter?

QuestionAnswer / Findings
DOES YOUR FOOT POSTURE MATTER?• NOT on foot pain (1)
• NOT on knee pain (2,3)
• MAYBE on lower back pain in women (4)
DOES YOUR KYPHOSIS MATTER?• NOT on your vertebral bone health (5,6)
• NOT on shoulder and neck pain (7)
• EXCESSIVE kyphosis is associated with lower back pain and more importantly with a negative self image (8–10)
DOES YOUR LUMBAR LORDOSIS MATTER?• The optimal lordotic angle is still unknown and differs greatly between different individuals (11)
• Hyperlordosis provides a greater advantage in lifting (12)
• Hypolordosis and NOT hyperlordosis is correlated with low back pain (13,14), but people with and without low back pain have very similar lordotic angles (15)
• NOT on your lumbar discs’ health (16,17)
• MAYBE associated with Facet Joint Arthritis (but not necessarily pain) (18)
DOES YOUR PELVIC POSTURE MATTER?• NOT on low back pain (19,20)
DOES YOUR SCOLIOSIS MATTER?• ONLY in extreme cases (medically assessed) (21)
DOES YOUR NECK POSTURE MATTER?• ONLY in extreme cases (22) and when the duration of sitting posture was excessive (more than 1 hour long) (23,24)
• “Abnormal” neck posture and neck pain are probably coincidental and are not well associated (25), even after 10 years follow up (26)
• Unlike hyperlordosis, hypolordosis of the neck is correlated with pain (27)

As you can see from the table, static posture is not always associated with pain and injury even after 10 years of follow up (26), which means that if you are trying to correct your or your clients’ posture, you may be wasting your time! 
More importantly, even in the cases where correlation between posture and pain/injury was found, we need to understand that such correlations mostly exist in severe cases of certain postural dysfunction such as severe thoracic hyperkyphosis and scoliosis (8,9,21). 
We should also know that correlation does NOT necessarily mean causality. For example, if we found out that more people eat shawarma at night, and car accident frequency is also higher at night, it doesn’t mean that eating shawarma at night causes more car accidents! 
Another question to consider is who existed first: the chicken or the egg? In some of the studies that found correlation between pain and posture (retrospective cohort studies or cross sectional studies), it wasn’t known whether the static posture induced pain, or the existing pain caused a change in posture as a compensatory pattern. 
These questions need to be answered before we assume that there exists a bad posture, which is an unsolved question itself (28). In the meantime, we need to realize that static posture is not as important as we once thought, unlike some claims by individuals and organizations that may be driven by commercial purposes only. 
In our next awareness article, we’re going to explore how our perception of posture may be a greater source of pain than posture itself. Stay tuned! 
REFERENCES 
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2. de Groot R, Malliaras P, Munteanu S, Payne C, Morrissey D, Maffulli N. Foot posture and patellar tendon pain among adult volleyball players. Clin J Sport Med Off J Can Acad Sport Med. 2012 Mar;22(2):157–9. 
3. Kedroff L, Galea Holmes MN, Amis A, Newham DJ. Effect of patellofemoral pain on foot posture and walking kinematics. Gait Posture. 2019;70:361–9. 
4. Menz HB, Dufour AB, Riskowski JL, Hillstrom HJ, Hannan MT. Foot posture, foot function and low back pain: the Framingham Foot Study. Rheumatol Oxf Engl. 2013 Dec;52(12):2275–82. 
5. Katzman WB, Vittinghoff E, Kado DM, Lane NE, Ensrud KE, Shipp K. Thoracic kyphosis and rate of incident vertebral fractures: the Fracture Intervention Trial. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA. 2016 Mar;27(3):899–903. 
6. Ribom EL, Kindmark A, Ljunggren Ö. Hyperkyphosis and back pain are not associated with prevalent vertebral fractures in women with osteoporosis. Physiother Theory Pract. 2015 Mar;31(3):182–5. 
7. Tsunoda D, Iizuka Y, Iizuka H, Nishinome M, Kobayashi R, Ara T, et al. Associations between neck and shoulder pain (called katakori in Japanese) and sagittal spinal alignment parameters among the general population. J Orthop Sci Off J Jpn Orthop Assoc. 2013 Mar;18(2):216–9. 
8. Petcharaporn M, Pawelek J, Bastrom T, Lonner B, Newton PO. The relationship between thoracic hyperkyphosis and the Scoliosis Research Society outcomes instrument. Spine. 2007 Sep 15;32(20):2226–31. 
9. Bezalel T, Carmeli E, Kalichman L. Scheuermann’s Disease: Radiographic Pathomorphology and Association with Clinical Features. Asian Spine J. 2019 Feb;13(1):86–95. 
10. Villafañe JH, Bissolotti L, Zaina F, Arienti C, Donzelli S, Negrini S. Thoracic hyperkyphosis non invasively measured by general practitioners is associated with chronic low back pain: A cross-sectional study of 1364 subjects. J Bodyw Mov Ther. 2018 Jul;22(3):752–6. 
11. Been E, Kalichman L. Lumbar lordosis. Spine J Off J North Am Spine Soc. 2014 Jan;14(1):87–97. 
12. Pavlova AV, Meakin JR, Cooper K, Barr RJ, Aspden RM. Variation in lifting kinematics related to individual intrinsic lumbar curvature: an investigation in healthy adults. BMJ Open Sport Exerc Med. 2018;4(1):e000374. 
13. Chun S-W, Lim C-Y, Kim K, Hwang J, Chung SG. The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis. Spine J Off J North Am Spine Soc. 2017;17(8):1180–91. 
14. Masaki M, Ikezoe T, Yanase K, Ji X, Umehara J, Aoyama J, et al. Association of Pain History and Current Pain With Sagittal Spinal Alignment and Muscle Stiffness and Muscle Mass of the Back Muscles in Middle-aged and Elderly Women. Clin Spine Surg. 2019 Feb 11; 
15. Laird RA, Gilbert J, Kent P, Keating JL. Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2014 Jul 10;15:229. 
16. Schenk P, Läubli T, Hodler J, Klipstein A. Magnetic resonance imaging of the lumbar spine: findings in female subjects from administrative and nursing professions. Spine. 2006 Nov 1;31(23):2701–6. 
17. Pape JL, Brismée J-M, Sizer PS, Matthijs OC, Browne KL, Dewan BM, et al. Increased spinal height using propped slouched sitting postures: Innovative ways to rehydrate intervertebral discs. Appl Ergon. 2018 Jan;66:9–17. 
18. Jentzsch T, Geiger J, König MA, Werner CML. Hyperlordosis is Associated With Facet Joint Pathology at the Lower Lumbar Spine. Clin Spine Surg. 2017;30(3):129–35. 
19. Levangie PK. The association between static pelvic asymmetry and low back pain. Spine. 1999 Jun 15;24(12):1234–42. 
20. Youdas JW, Garrett TR, Egan KS, Therneau TM. Lumbar lordosis and pelvic inclination in adults with chronic low back pain. Phys Ther. 2000 Mar;80(3):261–75. 
21. Ilharreborde B. Sagittal balance and idiopathic scoliosis: does final sagittal alignment influence outcomes, degeneration rate or failure rate? Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2018;27(Suppl 1):48–58. 
22. Brink Y, Crous LC, Louw QA, Grimmer-Somers K, Schreve K. The association between postural alignment and psychosocial factors to upper quadrant pain in high school students: a prospective study. Man Ther. 2009 Dec;14(6):647–53. 
23. Murphy S, Buckle P, Stubbs D. Classroom posture and self-reported back and neck pain in schoolchildren. Appl Ergon. 2004 Mar;35(2):113–20. 
24. Prins Y, Crous L, Louw QA. A systematic review of posture and psychosocial factors as contributors to upper quadrant musculoskeletal pain in children and adolescents. Physiother Theory Pract. 2008 Aug;24(4):221–42. 
25. Grob D, Frauenfelder H, Mannion AF. The association between cervical spine curvature and neck pain. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2007 May;16(5):669–78. 
26. Okada E, Matsumoto M, Ichihara D, Chiba K, Toyama Y, Fujiwara H, et al. Does the sagittal alignment of the cervical spine have an impact on disk degeneration? Minimum 10-year follow-up of asymptomatic volunteers. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2009 Nov;18(11):1644–51. 
27. Yoon SY, Moon HI, Lee SC, Eun NL, Kim YW. Association between cervical lordotic curvature and cervical muscle cross-sectional area in patients with loss of cervical lordosis. Clin Anat N Y N. 2018 Jul;31(5):710–5. 
28. Claus AP, Hides JA, Moseley GL, Hodges PW. Is ‘ideal’ sitting posture real?: Measurement of spinal curves in four sitting postures. Man Ther. 2009 Aug 1;14(4):404–8.