"MIKE AND CO: And I would say, too, I feel like our treatment style here, our philosophy here is, we turn on muscles. I don’t know what the heck that means. I don’t know what the neurophysiology or the neuromuscular components of what turning on muscle is. But I always use this example with patients. It’s probably good to share here just analogy-wise. When you sit in your chair all day, your core doesn’t need to do anything. The chair is keeping me from falling to the floor. If I were to stand up, I have to use my core to engage a little bit. But I’m just sitting here, my core’s completely turned off because the chair is helping me stabilize so I don’t collapse into a pile of bones"
MY RESPONSE: See, you guys are inconsistent. Sitting is easy on the spine. You just said it. Why are you blaming it?
"MIKE AND CO: The second I stand up, if I’ve been doing that all day, you rock back on your static stabilizer, your back stabilizer, because your core is still off. I don’t know what that means. But again, it still is just not active."
MY RESPONSE: Just standing up doesn’t require a lot of muscle activity for anyone. If you put 32kg on your back it requires 1-4% of max activity to stabilize your spine. Even standing is easy.
"MIKE AND CO: And then you just start exercising, you start doing some of the drills we do, some of the rhythmic stabilizations for the core, just like a generic strength and conditioning program. And all of a sudden they go throughout life, and they use their core more during their daily life. We see that in here. So I guess maybe the real summary of this isn’t that posture doesn’t cause pain, but all the associated deficits, or associated consequences of having poor posture all day, and not having movement mirrorability, not ever doing any strength training, not working on your mobility, not trying to reverse your posture throughout the day, the consequences of that are probably gonna be what limits it."
MY RESPONSE: WAIT. STOP. Back up. You guys keep adding in “poor posture” where you don’t need it FOR YOUR ARGUMENT. You haven’t made the case that the posture is the problem. It is everything else that you are talking about which I think is bang on!
"MIKE AND CO: But again, your body adapts to the stress applied or not applied. We always talk about the stress that’s applied, and then we build more resilient tissue by applying load. But remember, your body also will go in the other direction if you never apply load. That’s fine if you never apply load. But if you just sit, and you want to be the best sitter in the world, then you should probably sit more."
MY BRILLIANT RESPONSE: There you go. Sitting posture is not the issue. Blame everything else but sitting posture.
"MIKE AND CO: That depends on how we’re defining applying the load. Just siting for eight hours in this awful postural position might be enough load to break down the tissue that hasn’t had load applied to it, so to speak."
MY RESPONSE: What? You guys did it again. Come on! You just said sitting took no muscular effort. Now its going to break down the spine because of some “awful” position. Again, replace the “awful” position in your argument with an “upright” neutral position. Do you think that will be better? No way.
"MIKE AND CO: Is going down, it’s more sensitive to issues. But somebody else brought up another point too. I just thought it was interesting, but again, it’s the whole pain science comes from the fear mongering thing. You don’t want to make the patients afraid. I’m like, afraid? Is that the right word? I don’t think anybody’s quivering in bed, like scared of the dark that they can’t move. I think, look, we’re creating awareness and caution. Not fear. I don’t know who Nobody’s like that. Like telling people to work on their posture, like, how can that be a bad thing? I don’t think anybody is belaboring it that it’s evil to sit in bad posture. But there are so many good benefits of getting out of that position, of reversing your posture, having variability in your movements and stuff."
MY RESPONSE: You wrote "I don’t know who describes it like, “oh don’t sit like that, it’s gonna break right now.” - What? You just did in this whole piece. You keep talking about “terrible and awful” posture that “might be enough to break down the tissue”.
Regardless, there are more relevant points why its wrong to blame posture and those points have little to do with "pain science". Really, its the biomechanics that often challenge the biomechanics:
1. The research does not support posture as problem. Sitting is not related to more low back pain
2. There is nothing wrong with slouching. It feels good. It can actually be a symptom modifier.
3. If we focus on posture we are focusing on the wrong things. You guys have already said this but the alternative is not worry about posture but address all the things in someone’s life that could be sensitizing them. (Not being active, not engaging in hobbies, no sound training principles and worrying about their goddamn posture J
4. Sure, variability is fine. And a part of variability is just telling people to sit however feels good. This means all positions are welcome even the “awful and terrible” ones.
Here is my take on when posture matters:
2. Symptom modification – if it hurts try something else
In summary, it seems that there is more concern about the things we aren’t doing when we sit rather than the actual posture associated with sitting. Lets just focus on those things.