Thursday, April 15, 2010

The Role of Posture in Pain

I've discussed before how important your posture is to preventing and treating pain. Posture is how you hold your body up against gravity. It's the picture of your body in space, sitting in the chair, standing up or lying down. It is how you move your body to get from one place to another. Posture is dynamic.*

Most of my clients' physical therapy goals are simple. First and foremost, they want to get rid of pain. They also want to be able to get back to doing everything they did before the onset of pain, injury or surgery.

How we go about doing this is the interesting question. It varies with each patient with whom I have the privilege to work. In physical therapy, the overarching principle is to bring the body back into balance, with itself and within the gravitational field, the constant force within which we all live. We seek to strengthen weaknesses, to relax tense muscles and to open tight areas of the body.

Since the body is a dynamic structure, it is changing all the time. It changes with activity and even with our thoughts, especially the habitual ones.

Learning how to move with ease is a challenge, mostly because of inefficient habits. It usually is not the case that we stand, walk or sit with too little muscular effort, but with too much effort. We habitually hold tension in our muscles, partly in reaction to stress, but also in reaction to gravity pulling on body parts that are out of alignment with gravity. It really is a mind-body thing. Muscles that should be working may become weak and out of balance because of habitual patterns and chronic tension. Chronically tense muscles typically become tight, thereby creating muscle imbalances in a joint or even an entire area of the body.

Finding the weak areas in the movement chain is the therapist's job. There can be some surprising discoveries along the way. Everybody has a unique posture and a unique walk, as individual as her fingerprints. She also expresses varying degrees of composite, predictable movement patterns -- forward head and rounded shoulders with compressed breathing, for example.

Because we sit at chairs, desks and in front of computers all day, we might develop neck, back, shoulder or forearm pain. When the back of our necks and trunks are slumped forward, those muscles become overstretched and weak. The muscles may develop too much tension in them in their chronic effort to hold the head and trunk up from falling over and into gravity. We might develop shoulder impingement problems because of slouching forward at the desk. Our forearms may become sore and painful because of working on the computer. (Did you know that we see more cases of tennis elbow (aka lateral epicondylitis) from overuse of the mouse and keyboard, combined with poor ergonomics, than we ever have from people playing tennis?)

Besides poor posture, things that contribute to dynamic functional weaknesses are too little exercise, the wrong kind of exercise, fatigue and stress. In New York, most of us walk quite a bit, so footwear is important. (This could be the topic for another blog.) Walking on hard concrete, rather than loamy soil, may keep us pointed in the right direction, in a beeline for work and home, but this moving in 2-dimensions on concrete, may create weaknesses in our core muscles, especially the pelvic stabilizing muscles of the gluteus medius and minimii.

What are the core muscles? Are they only the abdominal muscles? Or, does the core also include the lateral and posterior hip muscles? Answer: yes, the core includes the abdominal as well as the surrounding hip musculature.

Did you know that your flat and fallen arches might be the primary cause of your neck pain?  Or your knee pain? Your hip and back pain? The weakness in your core? Or that your shoes, slightly worn down on their outer edges, may be causing your knee or hip pain? Did you know that either having the heels of your shoes fixed or buying a new pair of shoes can immediately give you relief? Sometimes the fix to your problem actually may be that simple!

There are many ways to improve your alignment, but standing up straight with your shoulders back may not be one of them. Learning Mountain and Tree poses in Yoga are wonderful tools to breathe in upright alignment. Ideokinesis is a wonderful tool for learning alignment. Ballet and other dance forms are excellent ways to learn about developing strong posture. Tai chi not only improves balance and posture, but teaches you how to move from your center (your core), as well.

*For purposes of this blog, I will alternately and interchangeably use the words posture and alignment, which essentially mean the same thing.