Physical therapists debunk 11 popular myths about posture and back pain


Following is a transcript of the video.

Dr. Tom Walters: “If you get your back cracked, you’ll always need it cracked.”

Dr. David Song: Oh, man. I hear this all the time.

“Sitting at a desk all day will give you bad posture.”

Walters: We need to get away from the notion that there’s one good or one bad posture.

Song: “Massages will remove knots in your back.” First of all, the misconception is that you have knots there to begin with.

Walters: Hi, my name’s Dr. Tom Walters. I’m a physical therapist based in Santa Barbara, California, and I specialize in the treatment of patients with general orthopedic pain and injuries.

Song: And I am Dr. David Song, and I am a chiropractor based in Toronto, Ontario, and the patients that I mostly see are weightlifters and other people who are experiencing issues with their daily activities.

Walters: And today we’ll be debunking myths about posture and back pain.

Song: Myths people hear growing up. “Good posture means standing or sitting up straight.”

Walters: So, this is a myth that comes up a lot in the clinic. There’s this really ideal, good posture. Tuck your chin in, pull your shoulders back. The current pain science, injury, rehab evidence just doesn’t support that thinking. There isn’t really a bad posture. If you were going to label a posture as bad, maybe it would just be that posture that you’re in for too long.

Song: And you get anyone to do anything for eight hours, and chances are it’s not going to be comfortable by the end of it. So, slouching in itself is not really the problem. It’s why you’re doing it for so long, or not even that – it’s about not doing anything else, really.

Walters: There’s actually some really interesting research where they actually put people in slouching and show that in the low back it actually improved nutrient and fluid delivery. So we just have to keep moving.

“Stretching will give you good posture.”

Song: Oh, man. I don’t think anyone has ever achieved good posture through stretching. By all means, do it. It’s better than just sitting there doing nothing. Posture is not really determined by how tight your muscles are. There are a lot of other aspects that go into posture.

Walters: For sure. Genetics are a part of it. The activities that you’re involved in, especially during development. Your actual skeleton will change depending on what activities you expose it to in your teenage years. Like, one that we talk about a lot are baseball pitchers. You know, if they start at a young age, their actual upper bone, their humerus bone in their arm will actually twist because of the stresses they’re putting on it. We might have mobility-type work or interventions, and stretching could be a part of that. And the only way you can permanently really probably change your posture is to be consciously aware of it all the time and hold that new position. But doing that all the time is probably going to create other problems for you. So just be dynamic.

Song: “A stiff mattress is better for your back.”

Walters: There’s always questions about pillows and mattresses. I mean, you can understand, we spend a lot of time sleeping. A stiff mattress might be great for some people but horrible for other people. The best way you can gauge if something is good for you is if it’s comfortable. This goes with shoes, mattresses, pillows, all those things. So you really have to think of your own body almost as an experiment and test things and see where you’re most comfortable and what’s best for your body.

Myths from the internet. This one should be a real doozy.

Song: “Massages will remove knots in your back.”

First of all, the misconception is that you have knots there to begin with.

Walters: There’s not some balled-up muscle that we can MRI and see. We have a bunch of muscles that are just long and skinny, and if you rub on them like this, they feel like a lump. Don’t worry about it. It’s just a muscle in your body.

Song: So, massages can help to loosen up a tight muscle. It can influence how that muscle feels and how that muscle perceives, you know, digital pressure applied to it. But will it get rid of the knot? Well, I mean, the knot wasn’t there to begin with, so.

Walters: “Body braces will fix your posture.” Dave, I’ll let you go first.

Song: They do have their place. Don’t get me wrong. They can help assist you in a position that you need to hold, much like a crutch would assist you standing up to not weight-bear on that broken foot. And so it can help to deload some of the muscles while you wear it. They can temporarily improve your posture while you’re wearing them, but will you get any permanent changes is a totally different story.

Walters: We need those things sometimes medically to let something heal, but anytime you have something passive holding your body, it means your neuromuscular system isn’t doing it and it doesn’t need to anymore. Those muscles that would have held you back that are now being held by something else will quickly atrophy and decondition. So even if that brace gave you some relief, we might say, OK, yeah, maybe use it temporarily in certain times of the day or activities, but it’s only for short windows. It’s not a permanent solution, because it’s going to create all kinds of other negative physical body side effects.

Song: You want to be able to condition the body up and strengthen it, as opposed to rely on some external influence.

Walters: “MRIs and X-rays can always diagnose your back problem.”

Song: Oh, man. I need to buy myself an MRI, if that’s the case. MRIs and X-rays are often overutilized for diagnosing back problems. A lot of the research shows that a structural issue with MRIs or X-rays and whether or not that person has a disability or pain, that correlation is pretty low. Likewise, you can have someone experiencing a lot of pain, a lot of issues, and then you get an MRI and it’s completely clean. It just looks like a healthy spine.

Walters: When we look at the spine and spine pain, we don’t recommend MRIs until the person’s done, like, a six-week course of rehab. Because they’ve actually found that when people get those images, if there is something there, it can create fear and anxiety. And they’ve actually shown that outcomes in terms of recovery are poorer when somebody sees their MRI.

Song: Often a patient will be like, “Hey, I have this MRI report.” And I’m like, “Hold up. Let me see everything else about you first.” But I don’t want to let that MRI determine everything else about you, because it’s just one aspect about what you’re experiencing.

Myths we hear the most.

“Sitting at a desk all day will give you bad posture.”

Walters: We need to get away from the notion that there’s one good or one bad posture and just really realize that the research doesn’t support that. Really the best thing you can do, from a posture standpoint, is just move often. Change postural positions often.

Song: In the past, they’ve done studies where they got a bunch of people riding this recumbent bicycle while doing their desk work. And it turns out that after eight hours of doing that, their back was killing them, because they’re just doing the same thing for eight hours straight. Whether or not you’re sitting, moving, biking, standing, even the treadmill desk, guess what? You’re walking for eight hours a day, and it might end up hurting your back a little bit.

Walters: Your nervous system is pretty good about knowing when you need to change posture. So you just try to take breaks every 30 minutes, every hour or something, get up and walk around. Just changing those stresses is going to change how your nervous system perceives your physical body. It’s going to change blood flow. It’s going to change nutrient delivery to tissues. And it’s just implementing the right stresses at the right time.

“If you get your back cracked, you’ll always need it cracked.”

Song: Oh, man. This, I hear this all the time. I think the idea that you need to get your back cracked once it’s cracked is rooted in the idea that the cracking itself is shifting your bones into place, and that if you don’t get it cracked again it’ll shift out of place, and then you need to get it cracked back into place. That in itself is kind of untrue. What we know now is that those cracks, what we call are cavitations, is just gas bubbles being released out of the joint. Spinal manipulation is just about introducing movement back into those joints. It’s literally no different than cracking your knuckle and then not needing to crack that knuckle ever again. It’s the same mechanism. All it is, is to open up a small window of time where you can move, like, pain-free or move with a little bit more ease and then reinforce that type of movement on your own. But to sum it all up, no, you don’t have to get your back cracked to infinity and beyond.

“Resting is the best remedy for back pain.”

Walters: The problem is that we see that when people are mobilized or rested for too long, they just decondition and atrophy. And in some cases, it can make the pain system sort of ramp up and be more sensitized if they rest too long.

Song: Rest is very important when it’s needed. Like, if you just sprained your ankle, I’m not going to get you weight-bearing on that same day. But the goal is to eventually get back to what you were doing pre-injury or even better than that. Rest in itself won’t get you there.

Walters: Rest is not rehab. This is why when you have surgery, they don’t let you stay in the hospital and sleep there for multiple nights anymore. You’re pretty much in and out, and you’re starting rehab right away.

Song: And the best way to approach that type of thing is to just slowly level up your body. I think a lot of people go from 0 to 100 way too quickly, way too often.

“Your body needs to be symmetrical.”

Walters: Another doozy. This is one that comes up a lot, especially on social media. The truth of the matter is asymmetry is normal. There’s lots of examples of that in the body. Approximately 90% of people, for example, have a difference in their leg length. We write with one hand, right? Versus the other. We have a dominant leg. One leg’s dominant over the other. Our body adapts to those things. So asymmetry is just a normal part of life.

Song: Oftentimes I think people are really quick to write off that their back pain is because of their scoliosis. That might be an attributing factor, but I would be very cautious to say, 100%, it’s because of the structural thing. It’s really case-by-case dependent.

Walters: “If you feel pain, it always means something is damaged.” Such an important one to clear up here.

Song: Pain is a signal. At its most basic level, your body is saying, “I don’t like that.” But it doesn’t necessarily mean any structure is damaged. Like, the most easy way to think about it is if I just take my hand here and I just pinch it, that hurts. If I look at my skin, nothing’s damaged. This has been a really hot topic in the last 15 years in rehab and in the pain-science research. I think it’s really important for people who are in pain to know that pain does not necessarily equate to tissue damage. Sometimes it does. If you sprain your ankle, that pain is probably associated with tissue damage. But there are so many other cases where there’s not a good correlation between pain and actual tissue damage. This is why we have a biopsychosocial model now. The bio has to do with tissue, but the psychosocial are these other complex elements.

Song: And so this is why it’s really important to address all these other aspects and to understand when you need to collaborate with another healthcare professional in order to increase the outcome of your patient.

Walters: We all are going to experience pain at some point. I mean, if you look at low-back pains, there’s an 80% lifetime prevalence, which means 80% of us are going to have back pain at some point in our life. When people understand pain, they have better outcomes and they’re less likely to have chronic pain conditions develop.

Song: And so it’s really important to know that what matters more than anything else is, like, what is your movement diet looking like? Like, what are you doing on the daily, and how’s that contributing to all the things that you’re feeling?