Transcript

[00:00] Tim Beames (TB): Hello, and welcome to the Pain Podcast. I’m Tim Beames, joined today by Bart van Buchem. Today, we’re diving into another common myth – the one about posture and pain, specifically, whether there really is such a thing as "bad" posture. Bart, do you often have patients coming in who believe their pain is due to "bad" posture?

[00:45] Bart van Buchem (BvB): Yes, all the time. Many people believe it’s due to their posture, a notion that's deeply ingrained, especially here in the Netherlands. It often shocks them to hear otherwise. When I ask where they got that idea, they’ll say things like, "My mum always told me," or, "My teacher used to correct me." It’s fascinating how these ideas stick with us.

[02:05] TB: I thought you were going to mention your kids! Watching children and their natural positions gives so much insight. They find the most interesting ways to sit or lie around – it’s like a study in how varied our postures can be.

[02:30] BvB: Absolutely! Kids will find the most curious ways to use a chair, for instance. And if they fall or feel uncomfortable, they adjust naturally over time. It’s an exploration.

[03:05] TB: Yes, and it reminds us that there’s value in letting them explore. I find myself torn between telling my kids to sit up straight and thinking they should be free to move as they like. Ultimately, I lean toward letting them have that freedom.

[03:35] BvB: Exactly – it’s called "motor abundance" or "variability," the idea of having freedom to move in different ways. Personally, I need to remind myself to get up and move after long periods in front of the computer. I realised early on in physiotherapy training that variety in movement is key, and it’s something I consciously work on.

[04:45] TB: Yes, and it feels different as I get older. I definitely feel less resilient sitting for long periods.

[05:00] BvB: Absolutely. There are days when I can sit for ages without issue, but other days, 10 minutes is too much. It all comes back to freedom and variety. Sitting still for too long can feel like stagnation.

[06:15] TB: True, and often, people apologise about their posture when they see us, saying things like, "I know my posture’s bad." It’s interesting how they assume physios are always assessing posture.

[06:45] TB: It’s common for people to blame themselves and think they have "bad" posture, but who’s to say what’s "good" or "bad"? Perhaps it’s just what we find pleasing to the eye.

[07:30] BvB: That’s a good point. The idea of "good posture" may have historical roots in how we view confidence or strength. But it’s not necessarily about health.

[08:45] TB: Right, and marketing messages like "sitting is the new smoking" play on these perceptions. It reminds me of when my dentist told me to floss more. Just being told doesn’t always motivate change.

[09:30] BvB: I also find that when people are in pain, their posture can change as an expression of how they’re feeling, almost like a non-verbal cue. So, posture might reflect a person's experience more than anything.

[10:30] TB: Yes, instead of focusing solely on upright, "good" posture, we might benefit from creating an environment where people feel at ease and able to move freely.

[11:00] BvB: Yes, definitely. It’s also common to see images on social media of young, healthy people demonstrating "good" and "bad" posture, which isn’t representative of the real issues people in pain face.

[12:15] TB: And for those in pain, exploring what feels comfortable is more important than adhering to some ideal of "perfect" posture. Sometimes, that might mean using supportive tools like cushions.

[13:30] TB: Exactly. I sometimes work with people who struggle to sit for long periods due to pain. In these cases, it’s helpful to explore ways they can adjust, rather than saying their pain is solely due to "bad posture."

[15:15] BvB: Right, and there’s also the matter of sleep positions. People have so many ideas about the "right" way to sleep, but it’s really about finding what works best for them.

[16:25] TB: Yes, we’re often told to buy certain pillows or mattresses to "fix" our sleep posture. For those in pain, experimentation is important – finding what feels comfortable rather than adhering to rigid rules.

[19:10] BvB: Indeed, many of my patients have tried every possible device. The truth is, no single device can be a cure-all. People often start with hope but soon realise it’s not a magic fix.

[21:00] BvB: Posture that worked fine before may change with pain, which can alter how you move and feel. Seeing a shift in physical expression is common in recovery, and being open to variations is key.

[22:40] BvB: The power of words is significant here. We have an upcoming session with Professor Andrea Evers from Leiden University on placebo and nocebo effects, exploring how language can shape experiences of pain.

[23:25] TB: Yes, let’s finish on some positive language. I sometimes tell people, "Your next position is your best position." It’s about encouraging freedom rather than perfection.

[26:00] TB: To sum up, posture doesn’t have to be "good" or "bad." For some, pain affects posture, but the goal should be exploring movements and finding comfort. Variety and experimentation are valuable.

[29:10] TB: Thank you for joining us. If you enjoyed this episode, please share and subscribe. And if you’re interested in gaining confidence in treating pain, visit lovephysiotherapy.com for resources, including our session with Professor Andrea Evers on nocebo language. Thanks for listening, and we’ll see you in a few weeks.