Top 5 Fridays! 5 Reasons Why You Should be Looking at Posture | Modern Manual Therapy Blog

Top 5 Fridays! 5 Reasons Why You Should be Looking at Posture

I understand that research shows slouching does not correlate with pain. However, you are really missing out if you let that flawed logic prevent you from some of the most easy and important education that you can give a patient.

If you saw a morbidly obese patient who had no chest pain, but had high blood pressure, does it make sense not to make some changes? Just because the perception of threat precluded the actual risks to the patient's well being? A PT online once told me that he was slouching as we were chatting and he had no pain... sure... To me, that's like the situation above, it does not mean changes should not be made. It's such an easy and effective educational treatment, if it makes a big difference, why would you not address it? I'm not addressing it if you come in for an ankle sprain, but any shoulder, hip, spinal, HA, TMJ patients are definitely getting some postural education.

Here are 5 Reasons Why You Should Be Looking at Posture

1) It's Easy
  • a patient has HA, radiating UE pain, radiating LE pain, lumbar pain, painful shoulder arc... etc
  • you place them in an optimal sitting position and ask for any changes in their Sx
  • if their pain improves, peripheral complaints centralize, and/or shoulder motion improves, have them slouch again
  • if Sx return and/or shoulder ROM quantity/quality worsens, repeat the corrected posture again
    • you've just educated them on cause and effect
  • this also works great for shoulder MMT, UE or LE DTRs as a pre and post correction tests
  • it is that easy, starting with this during the subjective or immediately afterward brings a sense of importance as opposed to mentioning it during the last 5 minutes of an evaluation
2) Head position affects mandible position
  • Dr. Rocabado proved quite a while ago that cervical protraction caused mandible retraction
  • most TMJ articular discs sublux antero-laterally which can be a result of the mandible being pulled into retraction and inferiorly by the inframandibular tissues and digastrics
  • have a TMJ or HA patient click their teeth together in their normal sitting posture (or corrected) then have them fully flex/protract and extend/retract, they may perceive a slight difference in occulsion which shows head and neck position affect mandible position
3) It affects breathing patterns
  • breathing pattern dysfunction has been correlated with chronic HA, cervical pain, and lumbar pain
  • if you can perform correct diaphragmatic breathing yourself, try it in hooklying or supine and vary your pelvic position from different degrees of anterior and posterior pelvic tilt
  • this changes the length tension and position of the diaphragm 
  • this will in turn either make it easier or more difficult to breath correctly
  • this is also an easy concept to demonstrate to patients who have good body awareness
4) It locks in the improvements for spinal, shoulder, and hip derangements/rapid responders
  • when a patient leaves, feels better, and comes back and says it didn't last AND they were compliant with the HEP, AND they were performing them at the instructed mode, often they were not maintaining correct posture in sitting/standing/lying
  • part of this is also frequent movement to avoid prolonged positions - not just static holds 

5) It can (and should) be practiced anywhere

  • it is a habit like anything else, it requires frequent practice and awareness for true change
  • you don't need equipment
  • it promotes efficient length tension relationships preps for movement
  • it's not just for sitting, there are optimal positions for patients with difficulty sitting, standing, lying
    • other than lying, even optimal posture should not be held statically for very long, frequent movement is key!
Also, see #1 again, it's so easy, I just can't understand why anyone would not choose this as first line education and prevention. As a side note, thanks for everyone who nominated this blog for the Therapydia blog awards! I am honored to be nominated along with the other great PTs out there in social media.


  1. Dr. E,

    How would you describe proper sitting posture? I've learned 4 different ways to sit and these 4 ways are drastically different. I wonder if the issue with sitting isn't about proper posture, but more of prolonged sitting itself???

  2. Hey Rex, since I'm MDT trained, I tend to stick with a McKenzie Lumbar roll and have them sit supported, but still not be static for prolonged periods. I have also used unsupported sitting with one leg forward and the other back hip hinging and sitting slightly forward with the weight shifted to the front leg. I'll shoot a video for this.

  3. I've taken McKenzie A and B years ago and I stopped asking patients to use a lumbar roll as the optimal posture to sit. I also no longer discuss the disc model with patients since there are just too many studies indicating so many other components to pain, mostly based on articles by Lederman ( specifically - "The fall of the postural structural biomechanical model in manual and physical therapies: exemplified by lower back pain" & "The myth of core stability"), Others who put things together for me are Lorimer Moseley and David Butler, Melzack, Shacklock, and etc)

    I do teach patients multiple ways to sit (based on McKenzie, Institute of Physical Art, and the Back School of Atlanta) to promote variability of movement (based on theories of novel movements and Feldenkrais).

    In different paradigms of practice, they have their way of teaching how to sit and feel it is the best method. I'm sure that they all have great outcomes,but how do they really know and I just haven't found articles regarding validity, reliability of posture and its cause and effect on pain...So at the moment, I'm in the belief that we just don't know what "optimal" posture is or if it even exists. I hope I am making sense.


  4. I don't prescribe traditional "core" exercises and most of my postural education comes from MDT first and IPA second. I still go with the lumbar roll first and try other things second because like most of MDT, it's easy. I don't really instruct the disc model either, unless it's easiest for a patient to understand. We don't know what optimal posture is but with all the theories out there, sometimes simple length tension makes the most sense and if you have to be static for a bit, it may as well be the least provocative position.

  5. Dr. E.

    Thanks for the conversation! this can be discussed for a very long time. Length tension relationships and the core are also very interesting topics...


  6. Yes, both separate posts/discussions. Again, mostly I educate and practice HEP as MDT principles but since integrating some SFMA/FMS into my practice if MDT is not working I move on to other ther ex.

  7. Thank you, Dr. E, for these mind-opening facts. I have to admit that I slouch most of the time on my seat at work. After a couple of hours, it would be hard to compose a proper posture because my back aches for some reasons. I got a good article also about prolonged sitting that causes diabetes and heart disease. I have the link in here, what can you say about it?

  8. Recent research is showing people with sedentary jobs actually die sooner than those without. Sitting is the new smoking. I educate my patients that you can sit well, but the only prolonged static position you are supposed to do is lying in bed for sleep.