Posture and Pain: How strong is the link?

large kyphosis but no back pain!!

large kyphosis but no back pain!!


When I was in PT school, we had a whole unit dedicated to the evaluation, assessment, and treatment of “postural dysfunctions”. Likely enemies included excessive kyphosis (rounded upper back), leg length difference, muscle imbalances/tightness from side to side, elevated or depressed shoulder girdles, tight psoas, winging scapula, forward neck posture, and the ever popular “anterior tilted pelvis”.

Like many who came before me, I started my career thinking the above stated had huge implications for pain and spent a substantial amount of time giving corrective exercises and pointing out the many “flaws” my patient had. I then started to notice a number of clients without the obvious structural flaws but they still had pain, now what and who do I blame?

A critical review of the literature and years of clinical experience can often make you question your foundational beliefs and lead to a paradigm shift in the way you practice. A bit wiser and grayer now, I realize that static postural differences are factors but not something to get overly excited about. As Aaron Rodgers of the Packers told the legion of fans as they started to panic at the beginning of the season, just
R-E-L-A-X. So your neck has lost its normal curve (you don’t need a $100 pillow), your right shoulder is a bit higher than the left, and one foot drops in a bit more than the other: not a big deal in the big picture. I have treated numerous patients that many would say have “good posture” and, unfortunately, they have chronic back or neck pain. And likewise, many patients who have significant postural challenges that have no pain in that area.

Meet “Claire” ( I used “Claire” because I was accused by my daughter of always using “Mary” for a fictional name so I switched it up, thanks Hope) who presented to my clinic with a significant thoracic kyphosis but NO appreciable back pain. But how is that possible? There is strong evidence in the literature that structural evaluations have little to no direct effect on pain. But what is an issue is “postural strain”. How long are you sitting at your computer to read this long winded post that is way too long and what kind of position is your neck in? How about lifting those Christmas boxes from the attic? The common denominator is movement. This is where we should be putting our efforts with manual therapy, exercises, and corrective movements.

Learning to avoid postural straining positions and learning to move in a safer, more efficient manner would serve us all much better than worrying about an “out of place pelvis” or a “crooked back”.  Check back in for a video on the “hip hinge” to help save your lower back, until then, be safe and happy,