Does having "good posture" really matter?
March 13, 2015 10:20 AM   Subscribe

Health-conscious people are haunted by the idea that they “should” correct their posture, and many fight a chronic, uncertain and tedious battle against crookedness. But is it necessary? After working as a massage therapist for many years, I became confident that poor posture is a “real” thing. I think it is sometimes a factor in chronic pain, mostly later in life, and probably can also be improved in some cases with a little effort. But it’s not a straightforward business, this posture stuff! There aren’t many “easy wins” for people here. And there’s plenty of potential to waste time and money — or even get hurt. Delving deeper into the topic as a journalist, studying the scientific literature and learning more from countless readers and experts, I have developed many reasonable doubts about posture’s importance.
posted by sciatrix (40 comments total) 52 users marked this as a favorite
 
If good posture is defined as proper form in moving from physical position to physical position (squatting, sitting, standing) combined with knowledge and implementation of proper ergonomics then I can't imagine anyone disagreeing that form is important. You're doing single-rep body weight exercise.

If good posture is 'don't slouch,' meh.

(after briefly RTFA, the author actually does a very good job of defining terms and making a clear and nuanced case for their position)

position, get it?
posted by leotrotsky at 10:51 AM on March 13, 2015 [1 favorite]


If poor posture contributes to the formation of knots in tired muscles — which is far from proven, but it’s a reasonable theory — then this might be the chief risk of poor posture, and it might be a good idea to try to improve it.

This is very much my experience. When I'm spending a lot of time slumping in chairs or on couches, I get a lot of trigger points, and often that pain can lead me to overcompensate, which creates more pain, etc etc.

I don't know that posture is the issue exactly, but certain weak muscles are definitely part of the story whether it's described as "imbalance" or not. When I'm in good backpacking shape, I walk, sit, and stand differently; as my core muscles and quads strengthen, my hips rotate back, my gluteus muscles start to engage when I walk, and my hips stay stable with activity. When I'm in winter desk work shape, my core and quads get super weak, my posture becomes lordotic, my gluteus muscles don't help me walk anymore so my calves & hamstrings have to do all the work, and my hips feel less stable with activity. Similar story in my upper body.

Either way, I get tons of trigger points in my legs and neck when I'm working at my desk all the time, no matter how I'm sitting. In my experience it's the sitting itself that creates the problem, not the way I sit.
posted by dialetheia at 10:52 AM on March 13, 2015 [3 favorites]


Every single picture I've seen of 110+ year olds shows them with poor posture. It is so irritating. What is wrong with their generation?
posted by srboisvert at 10:58 AM on March 13, 2015 [28 favorites]


I have a big chest, and will always struggle with posture. But I'll take the big chest.
posted by Melismata at 11:01 AM on March 13, 2015 [1 favorite]


But I'll take the big chest.

Everywhere you go.
posted by yoink at 11:04 AM on March 13, 2015 [6 favorites]


Having my posture corrected was like one of those "I didn't know leaves where separate things until I got glasses" moments. It was like I was a full two inches taller.
posted by The Whelk at 11:09 AM on March 13, 2015 [5 favorites]


Having my posture corrected was like one of those "I didn't know leaves where separate things until I got glasses" moments. It was like I was a full two inches taller.

Being tall means having shitty posture if you ever want anyone to make eye contact with you while standing.

Or dance cheek to cheek. Or sit at that toy furniture that everyone else might call a table or a desk.
posted by Pogo_Fuzzybutt at 11:13 AM on March 13, 2015 [9 favorites]


"After working as a massage therapist for many years, I became confident that poor posture is a “real” thing"

Thanks doctor!
posted by MisantropicPainforest at 11:15 AM on March 13, 2015 [5 favorites]


The idea of posture itself - as a static position - is culturally coded out of things like "how soldiers should stand at attention" and "how children should sit at their desks to receive instruction." Posture is about movement, and based on the comments here I don't think folks are reading the article or absorbing the message.

Thanks for the FPP, sciatrix. This is motivation to get working on my FPP on how pain works and maybe debunking trigger points while I'm at it.

Thanks doctor!

A lot of the stuff he talks about in the article is promoted by massage therapists and chiropractors, so he's taking the piss a bit. A lot of doctors disserve their patients as well by not being up on current science and promote the same BS, and that's a whole other conversation.
posted by MillMan at 11:21 AM on March 13, 2015 [11 favorites]


maybe debunking trigger points while I'm at it.

Interesting take - the linked site has a whole section on trigger points, and whether it's a "trigger point" or a "muscle knot" or even if it's really a nerve issue disguised as a muscle issue, many people have direct experience with the instant benefits of myofascial release. I'd love to hear your argument if you feel like expanding on this.
posted by dialetheia at 11:29 AM on March 13, 2015


Being tall means having shitty posture if you ever want anyone to make eye contact with you while standing. Or dance cheek to cheek.

Alternatively, you can take my approach and bring other people up to your level. My hugs generally result in people's feet leaving the ground.

I also once dated someone a full foot shorter than me and when we slow danced, he would sometimes stand on my feet to keep level.
posted by C'est la D.C. at 11:31 AM on March 13, 2015 [1 favorite]


Looks like the same author also has an article covering standard trigger point doubts, for anyone else interested in that aspect of the posture question. Sounds like the science is just not at all settled yet and there hasn't been enough work done to find a mechanism for the phenomenon with any scientific certainty, but that tons of people apply that theory to their pain management and have great results.
posted by dialetheia at 11:34 AM on March 13, 2015 [1 favorite]


I also once dated someone a full foot shorter than me and when we slow danced, he would sometimes stand on my feet to keep level.

Your feet are twelve inches high?
posted by srboisvert at 11:34 AM on March 13, 2015 [1 favorite]


Maybe they were the same height, but dialetheia refused to take off her awesome platform shoes. Because why would you? :)
posted by Strange Interlude at 11:38 AM on March 13, 2015 [1 favorite]


Shoes were definitely a factor. Not enough to make our heights the same, but enough so he could rest his head on my shoulder, rather than having it buried in my chest.
posted by C'est la D.C. at 11:43 AM on March 13, 2015 [2 favorites]


Thanks, doctor!

I know that reading the article is strictly optional (if not unfashionable) these days on Metafilter, but are we really at the point where we don't even read the full FPP itself?

Working with a massage therapist made him confident that good posture was a thing, but "delving deeper into the topic as a journalist, studying the scientific literature and learning more from countless readers and experts, I have developed many reasonable doubts about posture’s importance."
posted by Ian A.T. at 11:44 AM on March 13, 2015 [6 favorites]


This really is one of those situations where it's worth it to read the article, guys--I had a rough time trying to pick out a good, summarizing hook, because the article talks about so many things and takes a really even-handed approach to the main question. I promise it's even engagingly written. I apologize if I haven't framed it well--this may have been one of those times where I should have just written my own summary instead of ganking a sample of the text--but there's a lot more flow in the first few paragraphs of the whole thing.

I also recommend reading the footnotes, which often have interesting commentary on the assorted peer-reviewed studies the author is citing.
posted by sciatrix at 11:50 AM on March 13, 2015 [3 favorites]


This is motivation to get working on my FPP on how pain works

Also, I would read the hell out of this. I know just a little bit about how pain and the perception of touch more generally work from an undergrad class I took on sensation and perception, and I'd love to know more. It's an incredibly interesting, complicated topic.
posted by sciatrix at 11:52 AM on March 13, 2015 [1 favorite]


...but dialetheia refused to take off her awesome platform shoes. Because why would you? :)

To play the built in gameboy, presumably.
posted by justsomebodythatyouusedtoknow at 12:07 PM on March 13, 2015 [1 favorite]


What a wonderfully written article about a subjet I've never really thought about. (Apart from being told by my parents that my posture should be better.) Thanks!
posted by Braeburn at 12:16 PM on March 13, 2015 [3 favorites]


Being tall means having shitty posture if you ever want anyone to make eye contact with you while standing.

Or dance cheek to cheek. Or sit at that toy furniture that everyone else might call a table or a desk.


Or when driving, to see traffic lights when you're first or second in line.
posted by Foosnark at 12:44 PM on March 13, 2015 [3 favorites]


Now I'm being forced to imagine that these are C'est la D.C.'s dancing shoes.

Interesting read - I've always felt like the lecture on proper posture was much more cultural than physical, but I never bothered to look into it.
posted by fermezporte at 1:00 PM on March 13, 2015 [2 favorites]


The person who changed my views on posture is Lederman. His 2010 article The fall of the postural-structural-biomechanical model in manual and physical therapies makes a good argument for why "poor posture" is likely not the cause of someone's low back pain. Also from Lederman, and related: The myth of core stability.
posted by blub at 1:02 PM on March 13, 2015 [8 favorites]


I apologize if I haven't framed it well

I don't think it's you, it's the author. The piece is pretty great but the title and framing are off; framing something like this in terms of a yes-or-no question just encourages discussion about that shallow question while eliding all the interesting distinctions ("does it matter" in what way? to whom? in what circumstances? etc). The more interesting questions that he actually tries to answer are, what is posture, how does it impact muscle pain, what interventions lead to better outcomes, etc. Titling it "does posture correction matter?" as if he's going to reach some universal yes/no conclusion is silly.

I will say that for an article that only accepts evidence from scientific studies, he's a bit cavalier with certain points when building his argument, and I wasn't convinced by some of his points. He asserts that "the 'problem' of poor posture is generally minor and self-limiting" with almost no evidence aside from the claim that people don't want to feel pain and will keep themselves in shape for the activities they want to do. That's a pretty big claim, and a key part of his argument, with no evidence aside from motivated self-interest logic. I also thought the piece was a lot more rigorous before I started clicking through the footnotes, many of which are just little anecdotes not citations.

Other parts of his argument are totally just semantic issues, like where he wants to define the maladaptive body position of typing at a desk as "postural strain" instead of "poor posture". He goes on to describe a classic case of what most of us would call "poor posture" even though it was simply induced by working at a poorly set-up desk, and indicates that improving this guy's body position improved his pain immensely, but dismisses that as "hard to think of as a posture case" just because it was a problem with the built environment that caused the strain. To me, that's purely semantic - the guy had issues with his body position that were causing him pain, which is how most of us would colloquially define poor posture. Really a lot of his argument seems to boil down to this: "Much 'poor posture' is just awkwardly coping with a postural strain" which just raises the question of "postural strain" instead of posture and additionally introduces the question of the "awkwardness" of the response.

I also wish he'd moved the bits about "posture is not about straightness" to the beginning; by waiting until halfway through the article to differentiate adaptive body position from culturally-defined "good posture" he muddies the waters of his earlier points a bit.

Finally, I think more needs to be done in studies about these topics to separate sedentary people from people who exercise regularly and are in decent shape. In a perfect world, this article would include sections about posture's importance for different populations (elderly people, sedentary people, generally fit people, etc). I worry how many of these studies don't seem to consider any threshold responses where the effect varies with physical fitness up to a certain point, after which it no longer matters; e.g. sure, once you've reached a baseline level of physical fitness, stretching probably doesn't help, but if you barely ever leave your chair, as is the case for so many of us now, 15 minutes of yoga or whatever might really help to compensate for that general lack of physical activity and dynamic stretching, so telling that person "stretching doesn't matter" just because it didn't help a bunch of fit people is silly (not that the author does this here, exactly, but it happens a lot in exercise science writing).

He buries that lede with this line: "In general, goals for postural fitness are almost indistinguishable from general fitness." I don't think anyone would really disagree with that; if you're fit and you have the strength to stabilize your body while doing mild exercise, posture probably doesn't make a big difference in your overall health or anything. But if you're sedentary and constantly subjecting yourself to lifestyle-based "postural strains", and you're fairly weak so you're highly vulnerable to those strains, then developing your strength to minimize your vulnerability and adjusting your body positioning as you build the strength to hold yourself so as to minimize postural strain could all potentially help a lot with muscle pain.

It doesn't help to tell that person "no, postural correction doesn't matter" if they think that means they don't have to pay attention to how they hold their body, but what you actually mean is that they should reduce their vulnerability and exposure to postural strain (which colloquially means improving posture for most people).
posted by dialetheia at 1:13 PM on March 13, 2015 [5 favorites]


The person who changed my views on posture is Lederman. His 2010 article The fall of the postural-structural-biomechanical model in manual and physical therapies makes a good argument for why "poor posture" is likely not the cause of someone's low back pain. Also from Lederman, and related: The myth of core stability.
posted by blub at 1:02 PM on March 13 [2 favorites −] Favorite added! [!]


I personally am receiving physical therapy right now premised on the biomechanical model: bad hip (1/3 normal range of motion) led to low back injury is the short version of the story. It is working, so there's that.

It's also interesting because it totally contradicts the stuff coming out of the Prague School, Stuart McGill (see Why Everybody Needs Core Training), Craig Liebenson et al who are the go-to guys for rehabbing the best of the best in terms of strength athletes.

Also, it does grind me gears when people say "core" when most of the time when we say "core" we are in fact talking about abs, so there's that. But I get why people, especially professionals, do it.

Lots to think about, thanks for the comment.
posted by mrbigmuscles at 1:38 PM on March 13, 2015 [1 favorite]


Whatever else, men and women that keep their heads up appear more confident, dignified, attractive, and industrious, which I'm sure is socially rewarded. It's a narrow view of 'posture', but it accounts for much of the folk wisdom.
posted by dgaicun at 1:42 PM on March 13, 2015


rest his head on my shoulder, rather than having it buried in my chest

Did you ask him which option he preferred?
posted by PixelPiper at 1:52 PM on March 13, 2015 [2 favorites]


Whatever else, men and women that keep their heads up appear more confident, dignified, attractive, and industrious, which I'm sure is socially rewarded. It's a narrow view of 'posture', but it accounts for much of the folk wisdom.

Quoting from the OP:

Most people are at least dimly aware that sexual uptightness is a Puritan thing,[] Few people know that the Puritans also gave us the idea that rigid posture implies moral righteousness and strength of character. Postural laziness is a great moral failing in the Puritanical world view, which still pollutes the cultural DNA of modern civilization to a shocking degree. People still exaggerate the value of “good posture” for this reason, mostly unconsciously.
posted by Abehammerb Lincoln at 2:04 PM on March 13, 2015 [2 favorites]


the go-to guys for rehabbing the best of the best in terms of strength athletes.

Interestingly the people who work on top athletes often have a pretty terrible background in science. I think a lot of it comes out of the impenetrable culture of "no pain no gain" which science has already passed by in terms of manual therapy. There was some discussion on a PT board I poke around on talking about how stunning it was that Tiger Woods, who has had back pain issues for a while now, was talking about how "my sacrum was out, and my PT put it back in." That's old school chiropractic talk off a model that is over a century out of date. And Tiger Woods, who can get access to effectively anyone in medicine - gets that.

To dial it back a bit, science trickles down at a slow pace. What neuroscience has learned over the past three to four decades has only partial penetration in medicine, much less physical therapy, much less massage and chiropractic. In my studies since becoming a massage therapist I've come across the following that are relevant to me:
  • Humans are better thought of under the biopsychosocial model than the biomechanical model (the subject of blub's link above).
  • The nervous system drives all musculature without exception. When I am working on someone and their musculature softens, this happens at the behest of their nervous system, not because I tenderized it.
  • Pain is an output of the brain, not an input. It is not a measure of injury, but a motivational stimulus. It is highly contextual and based on personal emotional history.
I could go on. The above points are incompatible with most manual therapy as it is practiced today.
posted by MillMan at 2:08 PM on March 13, 2015 [11 favorites]


Having my posture corrected was like one of those "I didn't know leaves where separate things until I got glasses" moments. It was like I was a full two inches taller.

You and Jonathan Pryce:
Which book changed your life?
The one the teacher put under my head during the Alexander technique sessions at Rada. I grew an inch and a half.
posted by homunculus at 2:35 PM on March 13, 2015 [2 favorites]


Interestingly the people who work on top athletes often have a pretty terrible background in science. I think a lot of it comes out of the impenetrable culture of "no pain no gain" which science has already passed by in terms of manual therapy.

No doubt generally true. Probably not relevant to McGill, who are working scientists in addition to a leading practitioner (I am skeptical of your suggestion that the go-to back rehab guy for athletes all over the world who make a living axially loading their spine, might not know what he's doing). Not to mention the Prague school which is literally run by two scientists. I mean I know what you're getting at but this wasn't really responsive to anything I said.

And anyhow, I'm of the opinion that science often lags behind practitioners in most fields but particularly in strength and conditioning, and relatedly in nutrition and rehab.

"my sacrum was out, and my PT put it back in." That's old school chiropractic talk off a model that is over a century out of date . . . When I am working on someone and their musculature softens, this happens at the behest of their nervous system, not because I tenderized it.

Well your patient would no doubt say "MillMan worked out my knots." False, and in the same way as the Tiger Woods quote, right? It was their brain that did it. I'm sure you'd agree that just because your patient mischaracterized your methods, does not mean your methods are unsound.

Pain is an output of the brain, not an input.

Vision is also an output of the brain, but it's the result of an input. Like pain, or more properly nociception, which is absolutely a response to input. Sure, there are cases where someone is in pain and there's no obvious physical stimulus (often in chronic pain patients and people with failed back syndrome) but pain from things like gunshot wounds, broken limbs and disc herniations is the result of an input, or do you disagree?

Don't get me wrong, I think the BPS model does have value. As a PI attorney I've seen it all - from people claiming to be in pain a year after a muscle strain, to guys whose spine MRIs show a back that look like a grenade went off in it who had very little pain. There is clearly a psychological and social component to this stuff.

But it seems to me that BPS folks seem to throw the baby out with the bathwater, and are wildly overstating their position, in saying that the biomechanical model is "over." And often just the way you did, with a link to the wiki article and little more in terms of argument. It is very trendy on internet discussion forums but I don't see that it's caught on among people whose careers depend on preventing injury and returning to their sport as soon as possible when they do get injured. So I remain unconvinced.

All that being said, I'd be interested to see case studies of athletes who were rehabilitated through psychological counseling and/or an improvement in socio-economic status (and because it's the internet: this is genuine and not sarcasm)
posted by mrbigmuscles at 3:28 PM on March 13, 2015 [2 favorites]


Also, here is a response (TW: PDF) to Dr. Lederman from Dr. McGill and others in the subsequent issue of the same journal that blub linked to above.

A concluding remark: Extending Dr Lederman’s logic, and dismissive word choice - In response, “Is this not obvious”? Dr Lederman chose to write about the “unfortunate” oversights of others who have dedicated themselves to performing difficult work and holding it up for peer review. Errors in misrepresenting cited work followed by criticism is not forgivable. Credibility of those who choose to dismiss others within academic debate requires evidence of their own contributions to the scientific literature
posted by mrbigmuscles at 6:00 PM on March 13, 2015


I personally know someone who contracted a hiatus hernia from poor posture while working for many years with her head bowed down while seated at a work bench. Posture is a common cause of this type of hernia, and in her case treatment required surgery.
posted by krinklyfig at 9:32 PM on March 13, 2015 [1 favorite]


Sure, there are cases where someone is in pain and there's no obvious physical stimulus (often in chronic pain patients and people with failed back syndrome) but pain from things like gunshot wounds, broken limbs and disc herniations is the result of an input, or do you disagree?

Yeah, I disagree. The TED talk I linked to goes over the basics. Nociception is one of a number of inputs the brain uses when deciding what it is going to output pain wise. The brain can and will ignore nociception when it decides its person is not under threat, and it will create pain without nociception when it decides its person is under threat. Nociception is not a pain signal, it's a nerve impulse. Creating the sensation of pain requires across the board processing within the brain which nociception has nothing to do with.

Well your patient would no doubt say "MillMan worked out my knots." False, and in the same way as the Tiger Woods quote, right? It was their brain that did it. I'm sure you'd agree that just because your patient mischaracterized your methods, does not mean your methods are unsound.

It's unlikely that Tiger's PT is up on current neuroscience, but I would be elated to be proven wrong. PT in the United States and Canada is very mired in the biomechanical model. Hell, they're into acupuncture of all things (they call it "dry needling").

Per my own interactions with clients - the context of where I work means that bringing this stuff up is usually unhelpful, because they are not there for a science lesson, and the gap between the Cartesian world we grew up in and what we've learned from modern neuroscience is too broad a conceptual gap to work through on a massage table. This is sometimes unfortunate. I'd say once a month I get into a good conversation about it with a client.

As to McGill, the biomechanical model, and appeals to important people -

Science is provisional. The biomechanical model, while being the basis for treatment for a long time, has never been verified in the sense that you're going to use it to find causality. Trigger points, upper crossed syndrome, core strengthening - many of the things mentioned in the original link of this post fall into this category. Someone came up with an idea and never verified it, but they sure built memes and careers out of them. Most human concepts are unverified. The BPS model is an attempt to integrate what we've learned from neuroscience, as I've stated. It's the next step. It will be superseded eventually as well.

McGill may do good work. Do we know he does good work? How do his patients fare versus control groups? Can we verify his work gets the patients better, or did they get better through the natural healing process? This is a big question in PT in general.

The stats on the efficacy of any and all manual therapy is dismal. It's as bad as anything in the social sciences or economics. For massage, about the best we have is that it correlates with reduced depression. This is part of why the BPS model has slow uptake - it's not just ego and institutional inertia holding it back. I don't think it correlates with better outcomes. What it does do, though, is cut through a lot of nonsense expensive treatments and sets up boundaries that can help with preventing people from getting worse.

All that being said, I'd be interested to see case studies of athletes who were rehabilitated through psychological counseling and/or an improvement in socio-economic status (and because it's the internet: this is genuine and not sarcasm)

Sarcasm tag not required. I was watching a presentation (not publicly available online) in which a PT I respect said, with knowledge of the BPS model, that "probably half the reason my patients get better is because I'm wearing a tie." He wasn't joking. Here is where ego comes in. If it turns out that manual therapy doesn't have better outcomes than placebo, which it generally doesn't, are folks like those who treat Tiger Woods going to buy in? Or any PT whose job depends on assigning people core strengthening exercises? Of course not.

I'm skipping over a lot of stuff here - if I do a FPP on pain a lot of good stuff will get thrown in there. How PT at it's most effective is a form of social grooming and cultural deprogramming, why animals don't have chronic pain the way we do...
posted by MillMan at 10:48 PM on March 13, 2015 [2 favorites]


From the FPP:
Sitting for hours with your knees tucked sharply under your chair is a classic example, and it’s a real hazard to kneecaps — avoidable and entirely caused by a lack of awareness of how knees work.
I... I don't know about you guys but I don't have hinges in the middles of my thighs so I can't for love or money visualize how anyone can sit like that at all, let alone "for hours." Help me out? Am I misunderstanding the word "under?" Are they taking about chairs with extremely short seats sloping forward?
posted by seyirci at 5:20 AM on March 14, 2015 [2 favorites]


Yeah, I disagree . . . The brain can and will ignore nociception when it decides its person is not under threat

Well, me too. A guy who just got shot in the chest and has chest pain is experiencing pain because of an input (a bullet). We've all seen Saving Private Ryan and know that dudes were running around with missing arms, not feeling pain - at first! But eventually, it starts to hurt. And I'm pretty confident that a dude whose arm was recently violently separated from his body, is going to feel pain, and probably pretty close to where the separation occurred.

I don't want to misstate your position but if you think physical injury is never an input that is relevant to someone's pain, that's simply wrong. This is what I meant by babies and bathwater. After all, the brain outputs vision also, sometimes even without any input (e.g. hallucinations). Therefore vision is not the result of an input?

I also disagree that animals don't suffer from chronic pain. Any vet or person who has owned animals for long enough has had them treated for chronic pain at some point. And if that is the position of BPS folks then I feel bad for their pets.

As to McGill, the biomechanical model, and appeals to important people. . . Someone came up with an idea and never verified it,

McGill is one of the people who is verifying it. I "appealed" to him because he's a working scientist (and yes, a prominent one) who is in the process of verifying it empirically through both laboratory work and clinical practice at this very moment.

"probably half the reason my patients get better is because I'm wearing a tie."

I think there's a little hide the ball going on here. Not all pain is the same and not all PTs are the same. I've personally deposed plenty of garbage PTs, they are a dime a dozen. Now, a person with "non-specific low back pain", sure, they're probably just going to PT for the attention. I once had a "disabled" client whose treatment consisted of her neurosurgeon trying to convince her that her spine was in fact structurally sound. There was no physical reason for her disability, she used a cane she didn't need, etc. It was all psychological. So I get it.

But I don't believe that a powerlifter who just herniated three discs squatting 700lbs will have his sciatica relieved by the presence of a necktie. The mechanical stuff matters - maybe it is not everything, but it matters. After all, disc herniations can cause paralysis if they're severe enough. That's why you can't talk somebody out of cauda equina syndrome, no matter how fancy your tie is.
posted by mrbigmuscles at 6:36 AM on March 14, 2015


I don't want to misstate your position but if you think physical injury is never an input that is relevant to someone's pain, that's simply wrong.

Nociception is one input that the brain uses to decide if it is going to create pain for the person, as I have already stated. Injury may or may not cause nociception - hopefully it does, but it doesn't always. I'm not sure what else to tell you. The current best model of pain is the neuromatrix model of pain which is worth reading.

But I don't believe that a powerlifter who just herniated three discs squatting 700lbs will have his sciatica relieved by the presence of a necktie. The mechanical stuff matters - maybe it is not everything, but it matters.

The B in biopsychosocial stands for...bio. Of course it matters. Cauda equina syndrome usually requires medical intervention, not talk therapy. When someone presents with pain, the bio questions need to be answered first. Is this person injured? Does this person require medical intervention? Once those are clear, you move on. Was this person injured, is now healed, but the pain states are persisting? This one wouldn't be asked under the biomechanical model, and that's where it runs into trouble. PTs under that model continue looking for mechanical injury or other mechanical "shortcomings" (core strength and such) when the issue is neurological, and the techniques for backing that down look a bit different than usual PT. One example is graded motor imagery (youtube video for the lay public).

Then you get into the other psycho-social questions. What's going on at home and at work, etc? Per my quote about the tie, this book is a good look at the doctor-patient relationship. Louis Gifford is another PT who talked about this stuff a lot in his blog and in his books.
posted by MillMan at 9:32 AM on March 14, 2015


Thanks for this fabulous trip through the links on posture & ergonomics & mind & pain perception. This article about handling pain by the same author was particularly helpful.

My takeaway: it's time to stop sitting with the computer and start moving my body in the garden. Good for the body & the spirit!
posted by heidiola at 11:59 AM on March 14, 2015 [1 favorite]


Yeah I really liked this article too, enough to check out the rest of the site. The parts I'm familiar with are the same as the treatment my physiotherapist gave me for a shoulder problem, which healed really well. And the ebooks here have had input from Dr Steve Novella, the QuackWatch guy, so I feel like I can trust the advice.

I like his take on the fuzzy or half-arsed science behind some treatments: it's a bit crap, but luckily science isn't over yet so we can still improve our knowledge.
posted by harriet vane at 12:15 AM on March 15, 2015 [1 favorite]


I adore his Perfect Spot massage series too. It's a great resource for learning self-treatment techniques.
posted by dialetheia at 12:14 PM on March 15, 2015


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