Be Weary of The Posture Police


Be Weary of The Posture Police

My last post undermined the “best practice” of many practitioners and created quite a stir among the “Posture Police.”

It's too bad that Michael Johnson didn't have all these weekend certified, corrective exercise gurus to "fix" his "…

Posted by Fred Duncan on Wednesday, February 14, 2018


Have you ever been inside a chiropractic or “functional” PT echo chamber? It’s loud, full of confirmation bias and anecdotes, and allergic to evidence.

Since you will try to take my words and twist them, here are my main points:

1.) Pain is exceptionally complex, we are still learning and I recommend you check out Greg Lehman and Paul Ingraham’s work.

2.) There is no clearly defined “perfect posture” and there’s mounting evidence against it (read below), so it’s misleading to propagate this idea. Check out Todd Hargrove’s work for more.

3.) “Leg length discrepancy” in regards to pain is outdated, sloppy, wrong, and used mainly as a sales/scare tactic.

4.) Its ok to admit that you may not know everything. Questioning these ideas are what propels our professions forward.

Lastly, for those who can only think in black and white, I am not saying that analyzing posture is utterly useless, I’m simply trying to provide a well-rounded view.

Overall, let’s stop putting limitations on people by labeling them as faulty or dysfunctional, which creates a an eventual nocebo effect.

Ready, set, read…

  • “It appears that muscle endurance and weakness are associated with LBP and that structural factors such as the size of the lumbar lordosis, pelvic tilt, leg length discrepancy, and the length of abdominal, hamstring, and iliopsoas muscles are NOT associated with the occurrence of LBP.”

Source: Relationship between mechanical factors and incidence of low back pain. Nourbakhsh MR, et al. J Orthop Sports Phys Ther. 2002.


  • “Seventy percent of healthy professional and collegiate hockey players had abnormal hip and pelvis MRIs (magnetic resonance imaging), even though they had no symptoms of injury, according to a new study. The study’s surprising findings could serve as a warning for surgeons to not depend excessively on imaging when diagnosing patients.”

Source: American Orthopaedic Society for Sports Medicine. (2010, March 17). New study finds 70 percent of able-bodied hockey players have abnormal hip and pelvis MRIs. ScienceDaily. 


  • “This study did not show an association between text neck and neck pain in 18-21-year-old young adults. The findings challenge the belief that neck posture during mobile phone texting is associated to the growing prevalence of neck pain.”

Source: Text neck and neck pain in 18-21-year-old young adults. Damasceno GM, et al. Eur Spine J. 2018.


  • “The presence of such structural abnormalities in the patient with neck pain must be considered coincidental, i.e. not necessarily indicative of the cause of pain.”

Source: The association between cervical spine curvature and neck pain D. Grob, H. Frauenfelder, and A. F. Mannion.


  • “Tight hamstring- or psoas muscles could not be shown to correlate to current back pain or to the incidence of back pain during the follow-up period.”

Source: Tightness of hamstring- and psoas major muscles. A prospective study of back pain in young men during their military service. Hellsing AL. Ups J Med Sci. 1988.


  • “Evidence from epidemiological studies does not support an association between sagittal spinal curves and health including spinal pain.”

Source: Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health.
Christensen ST, et al. J Manipulative Physiol Ther. 2008 Nov-Dec.


  • “Three parameters of postural asymmetry were examined from the posture picture measurements: elevation of one shoulder, elevation of one hip, and deviation of the spine from the midline of the body. None of these parameters nor the physical education department evaluations was associated with a subsequent report of low-back pain, mid-back pain, or neck pain.”

Source: An epidemiologic study of the relationship between postural asymmetry in the teen years and subsequent back and neck pain. Dieck GS, et al. Spine (Phila Pa 1976). 1985.


  • “In a case-control study, in which a specially designed questionnaire and a “locating jig” were used to investigate the association between difference in lower limb length and other disproportion at or around the sacroiliac joints and the existence of chronic low back pain, no association was found. Chronic back pain is thus unlikely to be part of the short-leg syndrome.”

Source: Does unequal leg length cause back pain? A case-control study. Grundy PF, et al. Lancet. 1984.


  • “Leg-length inequality was measured … 53 had never had any low-back problem, but they had considerable variation in leg-length inequality. This group of symptom-free individuals did not differ from a group of 78 persons who had disabling low-back pain (LBP) during the previous 12 months. The results from this study make an association between mild leg-length inequality and LBP questionable.”

Source: Leg-length inequality in people of working age. The association between mild inequality and low-back pain is questionable. Soukka A, et al. Spine (Phila Pa 1976). 1991


  • “On MRI examination of the lumbar spine, many people without back pain have disk bulges or protrusions but not extrusions. Given the high prevalence of these findings and of back pain, the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental.”

Source: Magnetic resonance imaging of the lumbar spine in people without back pain. Jensen MC, et al. N Engl J Med. 1994.


  • “Thoracic kyphosis may not be an important contributor to the development of shoulder pain. While there is evidence that reducing thoracic kyphosis facilitates greater shoulder ROM, this is based on single-session studies whose long-term clinical relevance is unclear.”

Source: Is thoracic spine posture associated with shoulder pain, range of motion and function? A systematic review.
Barrett E, et al. Man Ther. 2016.


  • “No supportive evidence is found for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention. Regardless of popular appeal this leaves the subluxation construct in the realm of unsupported speculation. This lack of supportive evidence suggests the subluxation construct has no valid clinical applicability.”

Source: An epidemiological examination of the subluxation construct using Hill’s criteria of causation Timothy A Mirtz, Lon Morgan, Lawrence H Wyatt and Leon Greene. Chiropractic & Osteopathy 2009


  • “Two experienced doctors of chiropractic assessed 43 participants for LLI, one using a prone and the other a supine method. Supine and prone measures exhibited slight agreement for the full data set, but no agreement when both examiners were confident.This study found that supine and prone assessments for leg length inequality were not in agreement. Positioning the patient in the prone position may increase, decrease, reverse, or offset the observed LLI that is seen in the supine position.”

Source: Cooperstein R, Lucente M. Comparison of supine and prone methods of leg length inequality assessment. J Chiropr Med. 2017


  • “81% of asymptomatic people had bulging disks while 56% had annular tears. Annular tears and focal disk protrusions on MR images … are frequently found in an asymptomatic population.”

Source: Annular tears and disk herniation: prevalence and contrast enhancement on MR images in the absence of low back pain or sciatica. Stadnik TW, et al. Radiology. 1998.


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