An anterior pelvic tilt will definitely lead to low back pain. A forward head posture or kyphotic posture will end in shoulder, neck, and upper arm pain. Always be upright when you sit and stand. And I am sure you have read and heard plenty more examples where posture is definitely linked to pain. It’s almost mandatory nowadays for personal trainers and strength coaches to perform a postural analysis as part of their initial assessments. And any deviations will be stretched and strengthened backed to the ‘ideal’ posture.

It’s quite obvious that the belief that certain postures will cause pain is so deep-rooted and wide spread in our society. But, surprising to say the least, there is little scientific evidence to show posture will cause pain. The simple fact that you see thousands of people around with bad posture with no pain and thousands more with ideal posture in a lot of pain just shows there is much more to pain than just posture. I think it’s high time that we take a closer look and see where we all went wrong and what we got right about posture and pain.

Posture Studies

One of the most common postural abnormalities is the forward head posture, and is often cited as a contributing factor in the pathology of subacromial impingement. The posture literature says that such a posture causes an increase in the thoracic kyphotic angle, causing the scapulae to elevate, protract, anteriorly tilt, and become rotated in a downward direction. All of these changes result in the loss of flexion, abduction range, impingement of supraspinatus tendon and the sub deltoid bursa against the acromion process. And hence the dire need to examine and fix posture. However, the evidence to support these ‘theories’ seems to be scant and contradictory.

Wright compared these distinct postural deviations claimed to be involved in impingement syndrome by comparing 60 symptomatic subjects (with pain) and 60 asymptomatic subjects [without pain] and concluded, “posture in asymptomatic and symptomatic people with subacromial impingement syndrome does not follow the set patterns referred extensively in medical, physiotherapy, and osteopathy textbooks and articles. The results suggest that posture may appear faulty, yet the individual maybe flexible and capable of large range of movements.” The author further goes on to point that postural assessment has a very limited role in the clinical decision making process in subjects with impingement syndrome [1].

These findings were supported by other studies, which reported no relationship to exist between forward head posture, forward slouch posture, and the curve of thoracic kyphosis in both symptomatic and asymptomatic people [2][3]. Similarly, no significant relationship was found between standing pelvic tilt and depth of lumbar lordosis in healthy folks [4]. Another study found clinical assessments of thoracic kyphosis and lumbar lordosis not to be in agreement with the radiological assessments [5]. Out of 427 people examined in another study, not even one showed a resting forwards head posture perfectly aligned with the ‘ideal’ posture postulated by Kendall in his seminal posture book [6].

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Simply put, all the above studies show that the structural abnormalities claimed to be associated with certain postures and which seems to be the scientific rationale for correcting posture has very little science. More importantly, these studies hardly justify this raging interest seen among personal trainers and physical therapists in fixing posture to prevent pain.

The studies, which do seem to have seen structural differences between symptomatic and asymptomatic people, are confounded by the question of whether these changes contributed to the pathology or were just the consequence of the pathology or/and pain [7][8][9]. And this seems to be the basic question in all posture studies finding a correlation between pain and posture. Pain-evasive or antalgic postures, movements, and behaviors are often observed in response to pain.

A good question is, if posture has little to do with pain, then what about those work related musculoskeletal disorders (WRMD)? Quite a few studies have found an association between shoulder, neck, back disorders and posture [10][11]. As well, posture is considered to be an independent risk factor for musculoskeletal disorders among computer users [12].