A bit stunned
A couple of weeks ago I wrote an article about my experiences with pain, linking issues around posture to my pain experience. I did not expect many people to read it, and have been surprised by the amount of times it has been shared and commented upon on social media.
People have asked me what I did to get out of pain, but before I create any posts along those lines, I’ve written a follow up to my first article to pick up a couple of loose threads.
But first -Who the hell am I to opine about this?!
Aargh! Feeling a bit self-conscious now, but anyways… Having had what can reasonably be described as a ‘crappy time’ with pain, and now helping others on a daily basis to reduce their pain and improve their movement and sense of well-being, I humbly believe that I have things to share that may: be of interest to others; throw up an issue to ponder; lead people to good sources of information to offer an opportunity to re-frame or improve their experiences. I’m not a scientist, academic, expert or even a writer — but I’ve read a few things by people deemed to have some depth of expertise in their field — whether it be psychotherapy, neuroscience, pain or movement, I’m willing to learn and always in pursuit of, well, just being better and doing better. So on that basis and I’m happy to share my experiences if it might create conversations or enable others. So here I am, writing articles that I hope may be helpful or of interest to others in my position, or indeed to those dealing with people in pain.
This thing with posture
Posture is such a difficult area to broach because, really, what does posture actually mean? A presentation of oneself to the world? The way one holds oneself? The way we sit? How we stand? An attitude or an approach to life? The way we move? Biomechanics? Structure? Alignment? Is it involuntary? Is it a choice? Is it to do with beliefs? What is the role of emotions? Is it related to social and cultural expectations? Is it a little of all of these things?
That BS I was talking about
What can you see in the photo? I’m not referring to the hat, nor the human, which happens to be my dear OH, but the object he’s holding behind his back.
We’re in the Victorian school room at Sudbury Hall where he is demonstrating use of the back board or back straightener — designed to improve a child’s posture in the classroom. The device was also used to attain a fashionable figure, as this blog post from the Victoria and Albert Museum explains. These are examples of bullshit about posture. Such beliefs, unconsciously passed down through generations, pervade culture and society.
Messages about posture are all around us
Returning to the photo of the back board, historically in schools and institutions an erect posture has been the posture of showing respect, having a good work ethic as well as a physical demonstration of paying attention. Indeed the very essence of being ‘at attention’ in the military is chin, up, shoulders back, chest out, belly in and heels together. This is a posture that one can find in many professions and walks of life where an individual is in some way presenting themselves with confidence and authority to an audience. What would be the reaction to a newsreader slumped at the desk? A teacher cringing at the side of the whiteboard? Military personnel slouching and bored whilst on parade? Such images would probably not come to mind first if we were to conjure up societal and cultural images of authority, strength, capability and professionalism.
Furthermore, posture is inextricably linked with mood and emotions, as my 6 year old son intuitively understands. When told ‘No’ for whatever reason, he has started rolling his shoulders in, sticking his belly out, collapsing his chest and letting his head slide forward with a look of disappointment, saying the words — I kid you not — “Oh. I just went down a bit.”
I asked him to recreate it for you. Where has he got this from? When I asked him he said he’d just made it up. He seems to be demonstrating a physical manifestation of disappointment, defeat and emotional collapse, which also happens to be a universal phenomenon.
Where can we get clarity about posture?
Moving away from general conceptions about posture, we turn to the health and fitness industry for more clarity. Here it is common to find exhortations about making postural improvements and corrections and moving with precision and alignment. Messages abound about the need for core stability and good technique whilst performing functional tasks, and are often accompanied by suggestions that failure to do so may result in muscle imbalances and back pain. From my fitness industry days I have a selection of books on my shelf. I randomly pick one and look at the rationale for exercise:
“Stabilisation and bracing techniques to enhance core stability should be a prerequisite in exercise programmes at all levels. Poor posture over time can lead to damage of the facet joints and discs.”
There is a supposition that posture is something we need to improve and correct, whether to achieve greater structural integrity, to look better, to be more confident, to protect our spines — and we should be especially concerned about it if we are in pain or wish to avoid future pain and degeneration. It turns out, from a research point of view, that such commonly held contentions about core stability and protecting the back don’t hold up to examination. I suggested some related resources to check out in the last article, but I forgot this one by Eyal Lederman.
Posture and pain — getting to the truth
The title of my previous article was “Bullshit about posture causes pain and suffering.” I gave my article a catchy title to get your attention (because that’s how the brain works!) and suggested within it that unhelpful information about the supposed weaknesses and instability of my body and directions of how to perform exercises and tasks with precision and indeed carry myself, had contributed to my pain. These messages came from a variety of sources, as I seek to outline here, but were then emphasized by various health professionals giving me advice about my lordosis, spinal instability, muscle weaknesses, incorrect pelvis and shoulder placement, and proper techniques for performing routine activities such as lifting, lunging and bending. All this BS about posture converged with other pain modulating factors to create an unremitting fog of uncertainty about how to move, stand, sit and hold myself that persisted for years.
I want to clarify here that modern pain science suggests that posture does not correlate well to pain. These articles and clip on pain science and posture correction, produced by those with expertise in this area examine the topic in more depth:
Does Bad Posture Cause Back Pain? by Todd Hargrove
Perfect Posture Doesn’t Exist by Dr Greg Lehman
Posture Correction: Does it matter?
Posture correction strategies and exercises ... and some reasons not to care or bother.
Your Back Is Not Out of Alignment
In order to spot a physical flaw that needs to be corrected, one must begin by having a reliable measure of whether or…
So what are the causes of pain? As I understand it, danger and threat are the starting point, but the whole experience is modulated by a complex interplay of a range of factors, unique to each individual, such as:
· the meaning of pain to the individual (“I’m a guitarist and my hand is injured! My income and joy in life are threatened!”)
· kinesiophobia -avoidance of movement due to fear of further damage (“It hurts to bend and squat, I won’t do those things”)
·memory and experience (“I’ve been here before and it was truly awful”)
· expectation (“I know somebody who had the same condition as me who is now in a wheelchair”)
· catastrophizing (“I haven’t responded to treatment and I’m getting worse, this will ruin my life.”)
· lack of sleep
· lifestyle factors
·other biological factors
For more information, listen to this no-fuss, 10 minute guide to understanding pain, that also manages to weave in some of the complexities involved.
For more depth, this excellent lecture by science-based writer and teacher, Lars Avemarie, informs on the factors involved in the biopsychosocial experience that is pain.
Making sense of my own pain
Though posture and movement have certainly been part of the picture for me, as I unravel my experience it has become very clear to me that the key driver of my pain experience was fear. I felt like I had lost agency in my own body and simply didn’t know how to be in my body any more. It was agony to sit or stand. And what should I do when walking and bending? Everything hurt no matter what I did.
I was scared because the treatments over the years had not worked. I simply was not getting better. I was scared because I had read about my condition (spondylolisthesis) and seen that slippages are graded on a scale of 1–5. I was on grade 2. I had followed instructions given to me, but since my exercises had not made me better, and actually I felt worse, I must therefore be bound for degeneration (expectation and catastrophizing). I was scared because I didn’t understand how to hold myself, carry myself, sit or use my body safely any more (fear avoidance). I felt disgust at the thought of my spine slipping around (disembodiment). I was concerned about becoming disabled –after all I’d reached the end of the line in terms of treatment and I’d been told to start using a wheelchair (anxiety about the future). My pain, to me, meant I was unable to enjoy my son growing up, I fretted about the future and whether I could continue to work. I was feeling depressed, scared, fearful about movement, fragile, helpless and hopeless, a bad mother, incapable, anxious and couldn’t sleep. This ongoing stress caused my body to stiffen and tense further still. Analyzing this now, with more knowledge about pain mechanisms, it’s so obvious to me how I came to be in chronic pain.
“Being frightened means that you live in a body that is always on guard.” Professor of Psychiatry and author, Bessel van der Kolk.
Consider the options of fight, flight or freeze that go with the stress response. How can you run away from or confront the danger, when that danger is coming from your own body? I think I just froze. Being on guard meant that I couldn’t move well, relax or feel well. Rigidity just became a habit.
How did I get better? By learning about pain, unpicking and understanding the issues I was having and losing the fear, the bracing, the splinting and the rigidity. By finding a different meaning to posture — a way of using my body to the full, and finding flexibility, comfort and safety in my own body. I would say I developed what Psychotherapist Pat Ogden has described a varied ‘movement vocabulary’,
“The more options a person has in their movement vocabulary, the more options they’ll have in response to life’s stresses and thus the more resilient they’ll be.”
I learned to let go, move freely, to be free. I became more resilient in mind and in body.
I am no longer dealing with relentless stress and fears about the safety of my body. There is always going to be stress in life and now I recognize that for me it presents as tension in the body which leads to discomfort. Now I have ways of moving that give my body efficiency, range and bring me back to a more neutral, centred state — not collapsing and not rigid. A body that feels like home, and where the locus of control is back with me. I am free of unhelpful third person impositions of how I should be. The father of Somatic Education, Thomas Hanna’s words are so pertinent for me:
“The basic somatic task during out lifetime is to gain greater and greater control over ourselves, learning to flow with the stress and trauma of life, like a cork floating on top of the waves.”
And after all I’ve said, it may sound weird that in and among what I do to stay feeling well are some ‘core’ exercises. The big difference is that now I’m not doing them for fear of falling apart. I’m doing them because they feel good.
The best advice I can give anyone experiencing issues which seem related to posture, movement and pain is this:
Movement is medicine.
Motion is lotion.
You just can’t go wrong getting strong. (Adam Meakins gets credit for the last one. Thank you, Adam Meakins).