Inside Out is What Matters (Tuck Me In Book 14)

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If posturology research was better quality, we might actually learn something from it. But most of it must be chucked or, at best, taken with a huge grain of salt.

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This is obvious from a simple observation: there are a lot of people with nice posture who are in terrible pain, and also many people with lousy posture but no pain. The most stereotypical poor posture of them all — a hunched upper back, with the shoulders rolled forward — is widely assumed to be a cause of shoulder and back pain … but the assumption is almost certainly wrong. This has been studied to death for a posture problem. According the collective results of ten different experiments it is almost certainly not a cause of shoulder pain.

Hunchers are not wrecking their shoulders and backs. More exotically, I had a truly scoliotic patient, an elderly woman with a blatant S-curve in her spine that she has had since she was a child. Despite this obvious major source of postural stress, she suffered nothing worse than annoying back stiffness in her whole life.

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Another much younger woman, but with extreme scoliosis, was also amazingly pain-free. Probably not their posture. There are many better-documented stories like this, like the case of a serious traumatic cervical dislocation reported in New England Journal of Medicine in , notable for being mostly asymptomatic: just torticollis and stiffness, but no pain, weakness, or altered sensation. In general, the story is the same for the low back — the other posture hot zone. I once sat at a bar with my wife and spent about twenty minutes leaning to my right while we ate and talked, an awkward position that got uncomfortable fast.

People with less vulnerability to body pain, especially younger people, do not relate well to that kind of story. They may be inclined to underestimate the severity of the pain, dismiss the timing as a coincidence, or to call it a problem with vulnerability rather than a postural problem. And they may be right! More on this soon. The existence of this kind of situation was shown in a large, interesting study of triggers for back pain — what were people doing when they were struck by an episode of acute back pain, basically.

By far the two biggest risk factors both had something to do with temporary awkward postures:. Everyone will be happy to hear that sexual intercourse was not a common back pain trigger, though I imagine it depends on how you do it. Some examples of postural stresses :. But sometimes you are the source of postural stress. There is some overlap between poor posture and postural stress, of course. What if someone is stubbornly unaware of an easily avoidable postural stress? Is that a posture problem? Or is it just cluelessness about ergonomics? I recall a case of a man with truly awful chronic upper back pain and a nasty computer workstation.

I remember my amazement as he described it to me. He was barely aware of it being a problem — I had to tease him about it, it was so absurd — but once the problem was pointed out, he made several easy improvements … and that was the end of his problem. Another good example: the fiddle player who developed terrible pain in his shoulder.

It was only after carefully quizzing him that I discovered he was practicing the fiddle for hours every day with his shoulder intensely hunched up, as fiddlers do. If he stopped playing, the pain would fade away over a few days. If he resumed, it would flare back up. And what a terrible dilemma: a clear postural stress required by a beloved activity!

That guy loved playing the fiddle. Ergonomics is the science of arranging or designing things for efficient use, specifically to avoid postural stress. Unfortunately, ergonomics is usually interpreted unimaginatively, with the result that most people think that ergonomics is just about choosing office chairs and changing the tilt on your keyboard. We live in a gravity field that never quits: day in, day out, it pulls us unwaveringly towards the center of the earth. If we are chronically a little bit crooked, some muscle somewhere is going to have to work more than its fair share to keep us upright.

Try this yourself: see how long you can stand leaning a few degrees to one side. Exaggerated imbalance gets uncomfortable fast. And subtle imbalance presumably gets uncomfortable slowly, for at least some people.

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And the discomfort often outlasts the stress. But there is one good method of inducing trigger point pain: awkward postures. Trigger points seem to be closely associated with a wide variety of other common pain problems. This surprisingly ordinary condition may even be the source many of the non-arthritic aches and pains suffered by the human race, especially low back pain. Lots of people live in gravity! Everyone but these lucky people.

And many people frequently have awkward postures, but never have pain problems. So why me? Why so many others? And is poor posture really the problem, or are some people just excessively vulnerable?

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On the other hand, more vulnerable people, people who get pain from trivial postural stress — people like me — do not have a posture problem so much as we have a pain problem. A vulnerability. It's possible, but I prefer this story: vulnerability increases with age, and we start to notice that postural challenges we once coped with easily are starting to get tricky. And almost everyone gets there eventually.

It is the most ubiquitous of many causes of vulnerability to chronic pain all of which seem more likely to cause trouble than posture. All tissues wear out when the stress on them exceeds their capacity to heal and adapt. Degenerative arthritis is a universal human condition — everybody develops it eventually, to some degree.

It seems like a super reasonable guess that tissues wear out unevenly when they are loaded unevenly — just like shoes wear out unevenly in proportion to how uneven your gait is. Plenty of research does confirm a logical connection between posture and arthritis. That is, the crookedness probably caused the arthritic pain, as opposed to arthritis just making them walk crookedly.

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Arthritis itself is often surprisingly painless. And yet, in fact, degeneration of that patellar cartilage can be painless. I could go back and forth with the research all day, but the messiness of the evidence is the answer.


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Poor posture can get us into an emotional rut. I promised not to spend too much time on it, but it does get a section. But this double-edged sword might cut the other way, too: posture may, to a modest extent, actually create and reinforce emotional states. Emotions, posture, and pain sensitivity probably do all influence each other to some degree. Most self-limiting behaviours have both postural effects and causes. The classic example is depression: a depressed person will adopt a distinctively depressed posture, which can be quite obvious to everyone around them.

And, conversely, sad people who adopt happy postures and expressions will feel a little better. The blending with physicality is interesting, but the emotional dimensions of posture are interesting all by themselves.

It can both express emotional hangups and actually cause and reinforce them. Posture can be a self-limiting behaviour, something that actually keeps you in a poor state of mind. When we leave poor posture unchallenged, we also fail to leave our emotional comfort zone, which is generally necessary for personal growth.

See Pain Relief from Personal Growth: Treating tough pain problems with the pursuit of emotional intelligence, life balance, and peacefulness. Popular thinking about posture is dominated by the ideas of straightness and alignment. It permeates even guru-level rhetoric about posture. They are gods of the gaps. We are the only species on planet Earth that routinely stands upright, and there are many reasons to believe that our erectness is a biological compromise of questionable value and comfort. Scientists are not sure why we ever stood up in the first place, and there is no evidence today that standing up especially straight is necessarily the way to go … or has any survival benefit … or, if it does, that it will necessarily be comfortable ….

Consider your spine.


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It is essentially the same spine owned by every mammal in the world. And nearly all of those mammals carry their spine horizontally. So where did we ever get the idea that we should stack our vertebrae one on top of the other? There is no obvious sign that our anatomy has significantly or effectively adapted to the upright position. For instance, the connective tissues of our abdomen are still similar to those of the quadrupeds: they are generally suited to holding our guts suspended below our horizontal lumbar spines, not for holding them like a sack tied to a vertical pole.

Much more discussion of this idea can be found in the article Natural Imperfection. Good posture is not necessarily about straightness! And yet it is essentially the only widely used definition, even by people with supposedly very sophisticated opinions about posture. I am just pointing out — again, in yet another way — the uncertainties associated with any idea about posture, even this most basic and universal one. There is good reason to doubt anyone who claims to know that good posture is a matter of being well-aligned.

So here are a couple almost philosophical suggestions. Keeping active, frequently changing our posture, and experimenting with new ways of moving through the world are probably good responses to the uncertainties of posture. Most people lead overly sedentary lives — 6—8 hours per day of inactivity, an hour more per day in than 45 — and are also overly consistent in their limited physical activity; that is, even people active at work are often active in only one way, and they need variety in their movement.

More movement — not any particular position, but more positions — is definitely a safe bet and a good start on a good posture.