Myth busting about posture, core stability and lifting

Introduction

This leaflet is aimed at those living with chronic pain and discusses the common myths about posture, lifting and core muscles.

Posture

The term ‘posture’ describes the position of the body during any physical movement. A given posture is maintained by the combined actions of the muscles and ligaments which support and stabilise the body.

Posture can be affected by many different factors such as:-

• Pain
• Habits
• Mood
• Energy levels/fatigue
• Work
• Environmental factors

People are often advised by others, including health care professionals, to sit or stand up straight to avoid back or other joint pain. When clinicians look at the research though, there is no clear evidence to prove that bad posture CAUSES back or other joint pain.

There is no such thing as 'perfect' posture

However it seems clear that once you have pain, your posture can affect your pain. When dealing with pain, people commonly report that sitting and standing for long periods, as well as bending, twisting and stooping can increase their pain. Overall, the evidence shows that there is no ‘perfect’ posture for sitting or standing; it is the time spent in a posture that is key.

This increase in pain, for example while sitting, is not because you are damaging your spine. It is mainly related to a slow stretch or stiffening of sensitised, sore muscles and other soft tissues in the painful area.

‘Helpful posture’

Pain is one of the main reasons why people change and adapt their posture in the first instance. During acute pain, this change (such as a limp or standing with less pressure through a leg) is often helpful in the short-term to help reduce pain during the healing process. However, when the pain persists after the tissues have healed, we often find that the change in posture is now no longer helpful.

In fact, the change itself places stress on other structures, leading to muscle tightness in other areas of the body. Changing your posture can be difficult. When you have adopted a certain posture as a result of pain, you may find that when you first try to change it, it may be difficult and uncomfortable. Use the principles of ‘little and often’ to re-learn a more natural, relaxed posture.

Our spine and body were designed to move in all directions, and movement helps to keep the tissues in our backs healthy. The key point to remember when doing anything for a period of time, is that there is no single ‘perfect or correct’ posture.

Instead try and move regularly, and explore different, relaxed postures. As part of your pacing, you might want to swap between different postures for the same task.

Standing posture

If you want to strengthen the muscles that help you with standing, you could try practising the ‘tai chi’ standing posture:

• Place your feet hip width apart and stand with ‘soft knees’ (knee joints slightly unlocked).
• Now imagine your feet as footprints in the sand; concentrate on spreading your weight through the whole foot (and equally on both sides) so that the footprint is equally deep throughout. Remember to keep your knees soft
• Now lengthen through your spine as if someone is suspending you by a string from the top of your head.
• Remain tall but relax your back and trunk muscles. You may feel that this is quite hard work for your leg muscles.
• Keep your breathing relaxed.

When standing for any length of time, try to keep moving and using your muscles to keep your joints relaxed. Adopting the above posture or shifting from leg to leg at times may also help.

Sitting posture

Sitting comfortably can be a bit tricky when living with chronic pain. You may have adapted how you sit over a long period of time to try and take the pressure off painful structures. However, over time people find that their sitting tolerance gets shorter and shorter. As mentioned before, there is no ‘perfect posture’; it is more about for how long you are sitting. Some people find that certain types of chairs suit them better and help make it more comfortable to sit.

Try sitting right back in the chair. It helps to have your feet supported flat on the floor. Try using the back of the chair to support your back so that your back and trunk muscles are relaxed – don’t be the chair! Sitting too upright and tense and without back support for any length of time can be uncomfortable.

Remember to get up and move regularly, even if you just stand up and do a couple of stretches. If you are doing something that is absorbing, try and set a timer to remind you to move!

Sleeping posture

Having difficulty sleeping when you are in pain is a common problem, and the topic is addressed in a separate session of the programme. Trying to keep your joints and back in a relaxed posture in bed is difficult because we automatically move in our sleep.

Core muscles

Our ‘core” muscles are the deep abdominal and back muscles that form an inner ‘corset’ around our backs. For many years, physiotherapists, doctors and trainers believed that back pain is caused by weak core muscles.

Common assumptions:

• There are a group of “core” muscles more important than others for stabilisation of the spine
• Weak abdominal muscles lead to back pain
• Strengthening abdominal or trunk muscles reduces back pain
• There is a unique group of core muscles that work independently of other trunk muscles
• A strong core will prevent injury
• There is a relationship between stability and back pain

Long-term research has shown that these assumptions are not true. In fact, we find that people living with chronic pain often hold their core muscles tense all the time, which in time can increase the tension and pain in the back.

Have you noticed that you hold your breath when getting up from a chair, or bending over? This is a clue that you may be bracing your core in an unhelpful way. Another clue that your core may be overactive, is to check whether doing Pilates or core exercises make your pain worse. If this is the case, you may need to relearn to reduce the over activity in your core muscles, to make movements less painful.

Research shows that Pilates or core exercises are no better for people with back pain than any other form of exercise. If you enjoy Pilates, and it helps you feel better, then carry on. However, the good news is, for people who do not like Pilates, or who find it makes their pain worse – it is not the only way!

The facts:

1. Very little trunk muscle contraction is needed to stabilise the spine.
2. Deliberate core contraction reduces spinal movement and increases spinal compression by 45%.
3. Repeated studies have found no association between trunk musculature size and lower back pain (LBP).
4. You cannot isolate the “core” muscles in exercise.
5. You get a similar amount of trunk “core” muscle contraction in all types of exercise.

Lifting

We are often taught ‘correct’ lifting techniques at work. Certain professions, like nursing, have reported higher incidents of back pain; this was thought to be because of the lifting involved. When looking at the research, however, there is no evidence that lifting ‘correctly’ prevents back pain or injuries. A review of 27 studies showed that the biggest protective factor for preventing injuries or back pain, was regular exercise rather than being taught correct lifting techniques or having special equipment.

Clearly we all have different strength and capabilities, so we need to use our common sense. Doing repetitive activities or lifting, runs the risk of causing a pain flare-up. Pacing such activities by taking regular breaks and minimising the work load (e.g. the height at which you are working or how far you are reaching) will help reduce the chance of pain or injuries. Ask for help when moving larger or bulkier objects.

When lifting anything, use the posture that feels most comfortable for you.

Take home messages

☑ There is no “best” posture, but change it regularly.

☑ Use common sense on lifting & moving.

☑ Keep your “core” relaxed on movements.