Sometime in 2016, just as opioid use in the U.S. was reaching epidemic proportions and adult obesity rates were hitting 40 percent, the population was being woken up to yet another surging health crisis. “Tech neck” was being diagnosed among more and more people whose default head position had developed into an unsightly forward scoop, acquired through repeatedly craning into their laptops or smartphones — quite possibly to read editorials about how to prevent tech neck through hours and hours of advanced yoga technique.
The condition — which appeared to be a mutation of the earlier “text neck” pandemic and which was yet to evolve into the dreaded “nerd neck” variant — received a lot of attention. According to research by a spinal specialist in New York, tilting the head forward by 45 degrees was adding an extra 37-pound load, on average, to neck muscles supporting the head, and this was alarming since, “Billions of people are using cell phone devices on the planet, essentially in poor posture.” A major chiropractors’ association in the U.K. has suggested that a forward-leaning neck risks early death and “younger people might be knocking time off their lives by using this posture when they text, go online, send emails or play games on phones.”
For the majority of practitioners concerned with musculoskeletal health — to varying degrees osteopaths, chiropractors, personal trainers, manual therapists, yoga instructors and proponents of alternative medicine — posture correction is the obvious first fix for aches and pains affecting the back and trunk. Many also attribute postural causes to a host of more remote ailments, ranging from headaches and breathing difficulties to sciatica and carpal tunnel syndrome.
Beyond the pathology, from parents insisting we sit up straight at the dinner table to sports coaches yelling into serial slouchers’ faces, it’s an almost universally accepted fact that, along with the health benefits, good posture equates to entry-level seemliness for anyone who wants to get on in life. But what if (and you might want to sit down for this) there’s really nothing to correct? What if we’ve been getting all bent out of shape over posture for no reason?
This is the position taken by Eyal Lederman, osteopath, author and senior lecturer at University College London, who says, “There is no scientifically agreed definition of what constitutes a good or bad posture.” Furthermore, summarizing his own study of the literature on the causes of lower-back pain, he argues, “Research in the last several decades has failed to show any relationship between sitting, standing or lifting posture and back pain or any other musculoskeletal condition.”
It’s fair to say that in both conventional medical circles and the wider world of fitness training, Lederman’s arguments strike a pretty controversial chord (he’s also written about why he thinks the related concept of core stability — a foundation stone of the 21st century fitness industry — is a myth, but maybe let’s not go there for now). The received wisdom is that our bodies are poorly designed for the contortions modern life puts them through, and we should focus on posture as a way of compensating for the damage wrought by everyday misalignments and unnatural stresses. What this picture misses, he contends, is our anatomy’s formidable robustness and complex ability to adapt. Judgements about good and bad habits are misleading, he says, because, “Every task requires a unique motor control and specific limb and trunk positions. The idea that we have set postures is an illusion.”
According to Lederman, we have been led astray by the biomechanical model of anatomy which dominates our thinking of bones, backs and bilaterals, and frames the body as an ideally engineered system, “some form of machine not too far from the technological objects around us.” This became the de facto image of how bodies function, he says, “largely because we forgot that humans are mostly a biological entity, with some biomechanical features: A biological system that obeys a completely different set of rules, especially when it comes to health, disease and suffering.”
Backs in the Day: How We Got Obsessed with Standing Tall
If Lederman’s view seems radical, the story of how American culture’s attachment to rigid spines emerged in the first place would tend to back him up. The preoccupation with posture is, in fact, about as old as the Republic itself. An emphasis on striking a manly, upright figure first came to the fore in the mid- to late-18th century, possibly in an effort to set colonial manners apart from the louche aristocracies of Europe, where slouching and draping oneself over furniture was the fashion of the time.
Writing in his diary, a young John Adams — in the 1750s, a self-conscious obsessive when it came to proper conduct and discipline — lambasted a local Massachusetts preacher over a whole rap sheet of postural lapses: “When he stands, He stands, bended, in and out before and behind and to both Right and left… When he walks he heaves away, and swaggs on one side, and steps almost twice as far with one foot, as with the other. When he sitts he sometimes lolls on the arms of his Chair, sometimes on the Table… It is surprizing to me that the Delicacy of his Mind has not corrected these Indecent, as well as ungraceful Instances of Behaviour.”
Meanwhile, the first part of the 19th century saw etiquette manuals, as guidebooks for social climbing, surge in popularity — an early bestseller was 1815’s Lord Chesterfield’s Advice to His Son on Men and Manners, which advised that “awkwardness of carriage is very alienating” — this spread posture dogma among the expanding middle classes. From there, it was propelled into the Victorian era, where it was taken up by an army of energetic doctors intent on medicalizing every facet of life. According to a definitive 1998 paper on posture in The American Historical Review by David Yosifon and Peter Stearns, medics began at this point to hone in on the slumping habits of children in particular, with some focusing on excessive letter writing as the cause of slouching in girls (the 1880s version of text neck), while for boys, “bad posture was registered as yet another effect of masturbation.”
It was also toward the end of this period that posture took on its strange moral quality. Uprightness in both the moral and physical senses was shot through the textbooks used to literally scare school kids straight by the American Posture League after its formation in 1914 (“Posture expresses personality,” clipped one author), and had its ultimate expression in the scientific morality tale of the Strange Case of Dr Jekyll and Mr Hyde, written by Robert Louis Stevenson in the 1880s. At the conclusion of the iconic shapeshifting story, Jekyll contrasts his own upright, professional bearing with the hunched figure of his monstrous alter ego: “Even as good shone upon the countenance of the one, evil was written broadly and plainly on the face of the other. Evil besides… had left on that body an imprint of deformity and decay.”
After decades of vigorous finger-wagging, the national campaign for good posture finally fell apart under its own weight around the middle of the 20th century, according to Yosifon and Stearns, owing to a conspicuous lack of medical evidence in support of its health claims. This wasn’t, however, before a number of Ivy League universities had spent years photographing each year’s intake of students naked for their files, “sometimes at various angles,” in the name of maintaining elite posture standards on campus.
This level of scrutiny had a deep and lasting influence on the population at large. “Many people were exposed to posture training and to doctors’ examinations” in the course of what the authors call America’s “posture wars” — and this, they say, “had real results in terms of anxieties and efforts to live up to standards.”
By the late 1970s, Jekyll and Hyde’s good versus evil silhouettes had transformed into contrasting modern images of success vs inadequacy. Here’s Margot Kidder’s Lois Lane giving Christopher Reeve’s Clark Kent her notes on how he shapes up against his own alter ego in the director’s cut of 1980’s Superman II: “Just look at yourself. What we have here is a potentially aggressive, dynamite guy who could do anything he wants. I mean, it’s not my fault you keep putting yourself down, you know? For starters, look: You slouch all the time… Here, stand up straight… There, that’s better!”
Vertical alignment as a model for success hit its most extreme stride in 2012, in a widely circulated TED talk by social psychologist Amy Cuddy, who prescribed privately practicing triumphant and expansive “power poses” as a way to artificially boost confidence, reduce stress and “significantly change the way your life unfolds” — although the scientific evidence for this was later cast into doubt by one of her research collaborators.
Amid all of this, what’s been handed down to us in the 21st century, for better or worse, is that workshop-manual version of muscles and bones Eyal Lederman hopes to overturn. “Interest in posture was also supplemented by long-standing beliefs in the body as a machine — an argument still being used as late as the 1940s,” conclude the historians Yosifon and Stearns, “which made posture a logical part of mechanistic precision.”
Is Good Posture a Confidence Trick?
Along with etiquette and morality, somewhere along the way, the science of back health also got mixed up with modern preoccupations about body image. “I have very bad posture,” sang Kurt Cobain in 1993, and an entire generation slackened its shoulders and earned its nickname.
“Whether someone is standing correctly or not is often defined by cultural ideals and fads,” affirms Lederman. “It’s largely aesthetic. Traditionally, ‘good posture’ is considered to be a specific alignment of skeletal landmarks in relation to a plumb line. But no one stands like that; not anyone I know.”
However, this is exactly the stance prescribed by more traditional practitioners, partly because from their point-of-view, aesthetics can have a tangible impact on their clients’ quality of life. “Psychologically, posture can affect you and affect how you’re seen by others,” says Mykel Mason, a chiropractor based in Eastbourne in the south of England. “If you have a good posture, often people will view you as more confident and then this gives them a greater confidence in you.” Mason also points out that self-esteem and erect posture are a two-way street: “Especially in the young I find that confidence tends to affect their posture, rather than their posture their confidence, with shyer individuals more likely to round their backs and look down.”
This picture of posture as a reflection of your outlook to life is one shared by Belinda Mello, a New York-based instructor in the Alexander Technique, the posture-centric system of bodily control subscribed to by many performers, including a few cultural A-listers. Mello, like Lederman, emphasizes that “a person’s posture isn’t a fixed position, but a way of moving.” But like Mason, she thinks value judgements like “good” and “poor” can be usefully applied to how you hold yourself. “Think about what poor posture is like to live inside,” says Mello. “It’s like being in a box, and outside the box is freedom of motion, and access to pleasure and excitement.”
In her experience, though, it’s not only about building confidence and providing actors with a physical way in to devising new characters. Being mindful of the poses you adopt in different patterns of movement can lead to concrete improvements in physical health too. She says, “A person will come in for a first Alexander Technique session with a lot of pain in their neck, for instance. And by learning some simple facts about how they can move differently, the pain is quickly alleviated.”
Can We Try to Straighten This Out?
Scientific confirmation for a direct link between poor posture and some of the most common back complaints might be disputed, but it’s perhaps premature to dismiss the hands-on experience of a legion of physical therapists, osteopaths and chiropractors who are sure they see evidence of it all the time. “I always incorporate advice and exercises working on posture in my cases,” says Mason. “In my years in practice, I have seen good improvements with posture correction and this has helped to improve function especially,” he says, citing a clutch of research papers that point toward links between teenage slumping, sedentary work habits and spinal curvature and various aches and pains.
“The complaints that I find are most affected by posture are neck pain and headaches,” he says. “This is normally with a rounded upper back and head going forwards. Rounding in the upper back and shoulders increases the chance of having neck and low back pain; poor upper back posture has been associated with longer pain duration and severity of pain and how much it is affecting your daily life. You’re also more likely to present to a chiropractic clinic with headaches if you have an altered upper-back posture.”
When it comes to treating most common back complaints, Lederman’s view is that a prescription of posture-correction exercises is essentially a clinical sideshow that will have little impact on the likely source of the problem. Instead he recommends a multidimensional, “whole person approach” to treatment which gives as much attention to patients’ genetics, their psychological state and their social and physical environment as to physical factors. “We know that 60 percent of low back pain can be explained by genetic-environmental factors,” he says, adding that, “We can predict low back chronicity and disability from psychological and social factors more than any biomechanical findings.”
But it could be that the reason poor posture’s health implications have been tricky to detect directly is that — like many so bad habits — its corrosive effects are incremental and might take years to accumulate into twinges and torments. Says Mason, “I’d say that just because you don’t have pain doesn’t mean there aren’t any problems. Issues don’t occur overnight. You can have no pain one day and excruciating pain the next, but it’s commonly a build-up over time that has been pushed passed your threshold, leading to the pain.”
And while psychological interventions are a central component of Lederman’s strategy for dealing with chronic back-pain issues, he stops short of saying these conditions are purely psychosomatic. As he explains it, “The experience of pain resides within the central nervous system. It’s therefore modulated by psychological factors, such as anxieties, depression — but also beliefs and attitudes to health, illness, pain, etc.” Psychological treatment that changes a patient’s attitude to pain might not eradicate the discomfort, he suggests, but might “reduce the anxieties about it and therefore influences the level of pain experienced.”
In the end, it boils down to psychology one way or another. If you’re concerned about the creeping impact your day-to-day hunching might be having on your future frame, by all means take that perpendicular approach to life recommended by Mason when he says, “It’s easier to stay healthy than to become healthy, and posture is a big part of health” — though perhaps you might feel its immediate impact more on your self-esteem than on your skeleton.
On the other hand, if concerns about poor posture and your inability to correct it have themselves become a source of anxiety, dejection or depression, you might be better off bending in the opposite direction; unburden yourself from the whole culturally loaded notion of good posture with a shrug, and take comfort in Lederman’s advice: “You can sit, stand or bend in any way you wish; yes, you’re safe to slouch in your chair. Don’t be afraid of your body!”
Just like those slouching Victorian schoolboys weren’t afraid of theirs.