We need to talk about...Posture

Scott and David discuss two main topics in this conversation. The first is about the US debt ceiling and its potential impact on the US economy. Scott explains that the US government has a limit on how much money it can borrow, and if they reach that limit, they may not be able to pay the salaries of public workers or fund government programs. This could have negative implications for the US economy and potentially affect other countries as well. The second topic is about posture and its relationship to pain. Scott explains that there is no definitive link between bad posture and pain. Studies have shown that there is no correlation between forward head posture and neck pain. Instead, other variables like age, weight, gender, and fear of movement (kinesiophobia) have been found to have a stronger correlation with pain. Hi Scott. Hello David. Happy Thursday. Happy Thursday to you too. How's your day been? Yeah, good thank you mate. How's yours? I mean, I can't complain. It's been, it's been quite, quite long. Yeah. But, yeah, we made it. We just realised we were sitting really fucking close to the mic. I lied. Basically sucking off the mic. It sounds to be a fine thing. Scott, tell me your finance hacks of the week. Go, bosh. So, I thought this was really interesting, okay. And I've only learnt about it for the last couple of weeks. Have you ever heard of the US debt ceiling, David? No, but I sadly think I'm about to. You are. You very much are. So, imagine our government, I'm going to put this into kind of being more relatable. Imagine, if you think about the way our government pays for stuff. So, public workers, like your healthcare, all this kind of stuff is paid via, I mean, via taxes, goes to government, they then dish them out into like sorts of areas, right? Taxes actually don't cover all of their spend. So, what you've probably heard of is the government borrow money and then dish it out. Basically, what's happening in the US at the moment is they have been doing the same thing just as every other country. But the US has this weird debt ceiling, which basically means that they're going to get to a certain level, they can't borrow any more money without getting it through their government by agreeing, basically, a parliament. And what that has, the implications of that is essentially, it could mean that they can't pay the salaries of public workers, like military staff, they can't pay Medicare, they can't pay anything you can think of that the government funds, they potentially aren't going to be able to pay, which means that they essentially will be defaulting, which I don't think has happened before. It's default, I mean. So, it just means that... It's a bullshit puzzle. Yeah, I know. It means that, like, if you were going to, if I lent you some money, right, and then you're paying me back in instalments, if you miss one of your instalments, you've defaulted, okay? So, if the government can't pay, they've defaulted. And that basically knocks confidence for everybody, because everyone's like, oh, this guy, he can't pay. He's like, we don't want to do business with him anymore. So, it's really interesting, because, well, the implications of it is potentially it can have a real negative impact on the US economy. The US economy is basically a, it's like the starting point, it's like the domino. If the US kind of goes down, it tends to have a contagion effect for every other country. And in a high interest rate environment that we're all in at the moment, it could basically fuck us a bit more. I have got a second fact as well. It's not really a fact, it's more just like a little tip. A tip? A tip. A tip's great. And I don't know if you know, and I'm sure you do know this about me, David, but I love the tip. No. I love bank accounts and credit cards, okay? Because I'm a massive loser. I can vouch for that. This week, I got myself a new credit card, didn't I? Okay. Shall I tell you why? Because you love them. Because I love them. It's this new brand called Yonder. I don't know if you've heard about it, but basically, it's this, it's a company that's like specifically designed this credit card for Londoners. You pay £15 a month, which is kind of steep, but what you get for it is you get free worldwide travel insurance, which I thought was pretty good. And then you get, every time you pay for something, you get points, similar to like an Amex or something like that. You get points, and then you save them up, and the points go to their like restaurants or events or activities that they partnered with. But the points are pretty generous, so you can, I think it worked out if like, if you spent £1,000 or something, you get like 30 quid worth of stuff. So if you go out to dinner a lot, which I feel like a lot of people don't do, you can go to different restaurants, you basically pay as you normally would. And then just in your app, you just be like, you swipe it, and you're like, yeah, I want to put my points to that, and you basically get free dinner. Free dinner. Yeah, and to join up, you get a free, you get one month for free, so you don't pay £15 the first month, and you get a £50 voucher to spend at one of their restaurants. So at the weekend, I went out to dinner and got a free Sunday roast, and it was lovely. You love your, the epitome of a bloke who loves free shit. I have just thought, the reason I started smiling then is I, I would like to seek professional help, sponsored by Yonder. So if you are interested and want to be our first sponsor, give us a call. Give us a call, or maybe an email, that sounds better. Yeah, so I've now added my... We're not sponsored by them. Or anyone. Yeah, added to my credit card collection. I've now got three, and that's on top of all my current accounts, which I've got about 10. Okay, so someone's doing well. Just because I love them. No, I think nine of them don't have any money in them. I just like to have them. So yeah, into the question of the week. I've got really bad posture, David, and I've been struggling with this. I've, I've had a bad back, I've had a bad neck over the last week, and pretty much for the last, like, three years. It's to the point where it's actually made me, like, not be able to turn my head on One Direction. Turn your head on One Direction. When they come on the TV. In One Direction, David, you know what I said. And from speaking to other people, I feel as though that it's a very common problem, especially for office workers. You're sitting at a desk all day, you're kind of hunched over. So yeah, I want to get into it. Nice. So you're saying we need to talk about posture. We need to talk about posture. Nice. So the problem with a lot of this stuff is there's a lot of non-definitive answers without a skirt around issues. And the first thing I'm going to do is throw back this question. Is it going to be DP related? Not quite. Define bad posture. Okay. So when I'm thinking of bad posture, I'm thinking of sitting in a chair. Head kind of forward. Shoulders up. Okay. So looking a bit like, I don't know if you ever saw the Theresa May lookalike thing. You need to Google it. I'm getting this up. Yeah. A couple of years before, there was... Sorry, you keep talking. There was this... Theresa May. Maybe it was like a government research thing or something where they basically modelled how they thought people were going to look in like 50 years time or something like that. I can't remember. Okay. Maybe I have seen it. And when it came out, everyone was like, oh my God, that's Theresa May. Yeah. Okay. Which is kind of offensive. Yeah, yeah, yeah. But yeah. Okay. Yeah. Fine. No, I have seen it. So that's the vibe that I'm getting. Okay. Okay. So that typical rounded forward shoulders, chin poke type posture. Yeah, yeah. And that, so I like this question and I hate this question because this topic is definitely something physios will understand. There's kind of certain things you hear really frequently. And this is why I wanted to address this first thing is people come in and they go, oh, I know, I know I've got bad posture. Before, you know, they're coming to talk to you about their shoulder or something and they go, I know I've got bad posture. So the first thing to address, I guess, is definitively and with the evidence, there's nothing linking posture and pain. There's no gold standard definitive of what good posture is and what bad posture is. Right? So there's loads of research studies out there. Essentially, the research shows that there's no definitive link between pain and posture. So if we look, for example, at your question where you're talking about that forward head posture, the Theresa May model, let's call that, it's called in the literature, forward head position. Okay. And loads of studies have looked at forward head position and neck pain and whether there's a correlation. And some have shown that there is a correlation, some haven't. And if you basically put all of those studies together in what's called a meta-analysis, it's kind of synthesis of all the information out there. So meta-analysis is that when you've got lots of analyses smashed together, basically. It's a conclusion of... Yeah, that's a good way of putting it. Loads of studies pulled into one huge study, really. And they evaluate the different research and how good the research is. And basically, the conclusion from those big studies is we can't say that there's any link between a forward head posture and neck pain. So it's not that bad posture that leads to neck pain. And actually, there are other variables that turn up in those kind of analyses that more strongly correlate between those variables and neck pain than posture does. Cool. So that makes a lot of sense to me. But what are examples of those variables? So there's a load of them. You could look at age, weight, gender, how active somebody is. But two that I think when we're discussing this question are quite interesting are number one, kinesiophobia. So that's... What the fuck is that? Exactly. Now, kinesiophobia is essentially fear of movement. So when somebody's quite fearful about being in a certain position, that makes sense. So some people think that it's, again, related to posture. They think that a position is bad and therefore they become fearful of it. And somebody being fearful of movement or, for example, come away from neck pain, bending their back to pick objects up off the floor, that fear of movement and people who are more fearful of different movements often have more pain. That blows my mind. I know, right? I can't picture it. But I mean, I don't want to... Yeah, I feel bad for those people that are scared of moving around. But I think that's the thing a lot of social media does these days. And another correlating factor is like stress. So I think social media and potentially some physios or some practitioners make people scared of certain movements. Okay, like what? Well, actually, let's have this conversation. Some people, you might not even realise this, but subconsciously you're a little bit fearful of the slumped posture, right? Yeah. You're fearful of Theresa May. I'm very scared of it. And actually, you know, that's why I want to reiterate that that position isn't necessarily on its own bad. And people are very scared about, you know, with lower back pain, bending to pick things off the floor. And this could probably be a whole nother podcast on its own. But just I think my massive point, and I might have to be stopped from dropping the sea bomb here, but cool, cool, cool. Cool practitioners who, you know, send out videos saying try this one thing to fix your posture because your posture is causing neck pain could actually be inadvertently increasing fear of movement, increasing people's stress of movement. And there is that correlation between stress and pain. And also people when they're stressed or in a bad posture, and they might be drawing the wrong two things together and go, oh, it's my posture that causes my pain. But actually, is there more of a causal link, more of a correlation between stress rather than posture, and the stress is linked to the posture. So there's basically lots of different variables at play. And it's not just those two things is what you're trying to say, right? Yeah, definitely makes a tonne of sense, actually. So pain and posture aren't the same thing. I think we've very much concluded that. But that doesn't change the fact that I'm still worried about becoming Theresa May. My current destination is her, and I want to change it. I want to be looking chest out. I want to look cool. I want to, yeah, how do we change it? Yeah, that's a good question. So yeah, although there's not that link between pain and posture, people maybe aesthetically will want to change the position that they're in, in resting, and they don't want to look like Theresa May. I'm really sorry, Theresa, if you're listening, which I'm sure you are. I'm sorry, because we're digging into you. But yeah, stop thinking of a posture as good or bad. And a really nice phrase that's kind of out there in the literature, and I don't know who it's attributed from initially. Let's hope it's not someone really dodgy from the BBC in the 70s or something. But the idea of the next posture being the best posture. So if you're in any position for too long, your body will adapt to that position. So certain muscles will lengthen, other muscles will shorten. So for me, I sit at desk like eight, nine hours a day, and I can feel myself hunching over, but what is happening? Yeah, so we've got to think certain changes are happening at different joints. Think about it sitting for a long time, your hip flexors are shortening all the time. So imagine you're sitting, those muscles are getting shortened. The middle of the back, the thoracic spine is becoming flexed. So hunch forward, and your neck will poke forward. And so coming back to that phrase of the best posture is the next posture. The way to fix that posture and that adaptive shortening, the way the body adapts to constantly almost being in that position, is to do the opposite movement. So at the hip, instead of it being flexed, you want to extend the hip. So that might be the stretch that you do at PE at school, which is pulling your heel back to your bum. A standing desk might be great. For your middle of your back, think about extension. So rather than flexion and being forward, if you've got a low chair, which we're actually sitting on now, if you were to lean back over there, or even spending a bit of time with a towel or a foam roller and allowing your back to go over there, arms behind your head to open your chest up, rather than always being forward, you're suddenly giving your body a stretch in the other direction. Yeah, that makes sense. And you kind of start, it takes time, but start to reverse that adaptation, you're adapting the body back into other ways. Yeah. And would you advise, I've seen those, just when I've been, I'll probably get Facebook ads because I've been searching how to improve my posture, but would you advise those things that you wear that kind of pull your shoulders back and give you that ideal posture look or not? It's a good question. I personally would say, if you're going to use them, use them sparingly. It might be good to act as a bit of a prompt and to keep you there, and it is going to stop that shortening of the muscles, but we also want to be, A, build a good habit and think about regular, frequent, active movement rather than lots of passive stuff. Actually, I was told about this years ago, that it wouldn't get past ethics committees these days, but some physio gave this, instead of it being a brace that pulls you back, every time somebody hunched forward, their strap was pulled, and then it gave them an electric shock. Ah, yes. So for me, that's actually more useful because it's more of just a reminder of like, okay, I'm going to sit back now. I'm going to do my stretch in the other direction. Shall we move on to the pain part and try and get into that a little bit? Because I know from what you're saying, what I understand is that it's not necessarily related to the specific posture, but for a lot of people, myself included, pain is there, and it's going to be different for everybody. I do get that, but I guess it's like, where does making a generic neck pain, because I feel as though that's the most common one that people seem to get, where do you reckon that comes from and how can you prevent it or improve on it? It's a tough one, I know. Pain. Pain is a really complex phenomenon, right? Like really, really complex. And so to put it down to the blame posture, I think the problem is in this world, lots of nonsense out there of like, fix your neck pain because of your bad posture. Yeah, yeah. And I actually think it's more worrying because people get scared about certain postures. I can't be in this posture, and this is going to be one of the biggest problems, I guess, with the podcast. People like defensive answers, but unfortunately, the human body is not like a machine. It's not like a car, where you go, I don't fucking know all about cars, so this is going to be a really poor analogy. If we can get a car expert on to help me, not jot it down, write it down, we're going to get a car expert on to improve the analogy. But if your reverse converter and a little screw is out of alignment, you know, there's a simple, it's this and therefore replacing, and it will hopefully make the car work again. Unfortunately, pain isn't one of those where I go, I'm tight in this muscle, if I stretch it, it's going to be fine. But if it was that simple, I would be out of a job really quickly, in terms of like, you know, pain is such a complex thing. And I think the takeaways I would like to promote from this are, unfortunately, it's never a simple question of do this thing, and you're going to be pain-free, unfortunately. Certainly that thing you've taken away of there's no right posture. I can hammer that, if I can hammer that one thing, there's no right or wrong posture, and actually worrying that you're in the wrong posture, and being concerned about being, is probably more likely to cause you pain than the posture itself. Nice. So have you got any other tips or tricks that people can look out for regarding posture? So I think, again, we've covered a lot about there not being a good one or a bad one, but not comparing yourself potentially to others, but comparing yourself to yourself. So... Okay. So like... Explain yourself. A term I like is, so often in the physio world, like what's called asymmetries. Yeah. So that's... That helps too, doesn't it? Well... Asymmetry, are you talking about how things aren't the same if you put a... If I looked at you and looked all the way half down your body, and one side's going to be different than the other? Is that what you're on about? Yeah. So like, it's not symmetrical. Yeah. So it's asymmetrical. Yeah. So if I'm getting neck pain generally, blaming posture would be a bit of a jump unless I went, you know, it's on my left side, and my computer screen's on my left side, and my neck's always turned to the left. And I actually then look at the range... And this is what physio will do. The best tool that we can compare to is the same person, right? Yeah. So I will look at you, how far can you turn your neck to the left? And then how far can you turn the neck to the right? Try what? That's interesting because my range of motion, I'm sure this is very similar for a lot of people, it's very different depending on what side. I can't remember which is my good side and my bad side, but I have a good side and a bad side, which is really interesting. And I think rather than saying I've got a bad posture, that's a more relevant thing to look out for. I'm weaker or tighter on this side, and that's the side that I've got pain. And therefore, that might be the thing I need to focus on. Rather than going my back is more hunched than Serena Mae, but actually I've got left neck pain, and I'm tighter in that way. And then you can start, and as physio we will always explore this is why you end up having a really long chat often, and I don't really get hands-on. I don't normally get, you know, I don't get into the objective assessment it's called, like looking at length of muscles and stuff as soon as the conversation starts. Some health professionals will just start prodding and poking, but I actually try and find out the story of like, often someone will go, I've got neck pain on this side, and then we try and unpick something. Like a treasure hunt. A little bit, and that's why I love my job, it's problem solving. Okay, what do you do for work? I work at a desk. And often you ask a question, they kind of look at you like, shut up, that's not relevant. Okay, you work at a desk, is your computer on one side? Oh yeah, it's on the left. Yeah, okay. And sometimes you see that, that's when I love my job, sometimes when someone just goes, oh, I see what you said there, left side of neck pain, and eight hours of my day, my neck turns to the left. Yeah. And then when I get into my objective assessments, that's the kind of subjective facts, and I'll screen all the other stuff, but the objective stuff, I then go, look at your left rotation, your left rotation is quite good, because you're always looking that way, but right rotation is naff. And that might be enough, and then that can often be the most simple thing to go, try changing the position of your chair or your computer. And see how it goes, yeah. And see how it goes. And it might not be that simple, because I am really guilty of this, and I've tried to get better at it, and I continue to try and get better at it. I do, as humans, we love storytelling, right? Everything is, everything's a story. Exactly. Like, you know, marketing, money, you know, everything is storytelling. And patients engage really well if they can see the story. If I go, okay, you've got left-sided neck pain, you turn your head this way all eight hours a day, and you're tired through there. But we do have to sometimes be careful of not getting carried away. Again, coming back to that car thing of, it isn't just because X thing is necessary, we've got to look at all the other options. And anchoring it a bit too much, and forgetting that there could be other. Yeah, yeah. Overlooking more complex stuff. You know, often, you know, if you hear who's it's a horse, right? Not a zebra. Okay. So, common stuff's common. Yeah. But we don't want to get so engrossed in a story that we bias ourselves to believe in it. Yeah, no, I like that. It's like the law of averages, isn't it? Where a six-foot man drowned in a three-foot river. No, that was wrong. Was I so wrong? Sorry, what? I mean, if you fell over, you could drown in how much water? On average, the six-foot man drowned in the average three-foot of water in the river. I butchered that so hard. Can we go again on that? We can cut that out. I want to know what you're on about. The six-foot man walked into the river, which was on average three-foot tall, or three-foot deep. And he drowned? And he drowned. Which man? Just a man. Okay. Because on average, the river's three-foot deep, but averages are terrible, is what I'm trying to say. Got you. So, some of the river could be nine-foot? Yeah, yeah. Sure. Yeah, extremes. And on that note... I'm joking. Anything else taking your fancy around this question? No, I think you've answered very eloquently, I may say. I think it's definitely educated me in the world of posture. So, yeah. Any final addition you'd like to add? Final addition, and it's a little story. It's a little story that you know about. Story time. Story time. Look out for big changes, sudden changes. So, whether that's in load, for example, if someone starts running loads and they get knee pain, why has your knee pain started? Well, you start running a lot. Posture the same, though. So, our old housemate, Josh, six-foot six, six-foot more, maybe? Tall, tall man. He's really tall. He was really tall. And now he eats. He drowned in three-foot water. On average. He started getting quite bad neck and back pain during lockdown. Do you remember his lockdown working position, Scott? Because I can picture it, really. So, he had an ironing board as a desk. And then, what was his chair? It was his bed. So, he was sitting on a soft bed. Six-foot six man. A low bed, by the way. Yeah, let's explain the bed a bit more. It's not just your normal bed, either. It's not a normal bed. Tell me about the bed. The bed is made using wooden pallets and two mattresses. Yeah. For extra comfort. Yeah. So, it's like the princess of a pig. Yeah. And he sits on the edge of this bed at an ironing board. It's an unsupported sitting. No backrest. For like eight hours a day. Eight hours a day with an ironing board as his desk with his little laptop on it. And then, obviously, he got neck and back pain. I wonder why. Huge change to his load, right? That's what it is. It's a huge change to his position in loading. And they're the type of things, rather than I've got good posture or bad posture, they're the things that I would ask people to look out for. Yeah. Massive changes in your general position and the positions you're in in your day-to-day life. You sit on a fucking plane for nine hours. I'm going to be in tour. I'm going to be in that. Yeah. Is there one thing that I do on one side more than another a lot? Or are there differences between my sides because I need to make them more equal? And then maybe the muscles on the front of my body are a lot tighter than the muscles on the back of my body. It's not a side difference, but maybe it's a front and back difference. Like tight hamstrings, longer quads, for example. Okay. So they'll be my take-homes. I think we're good. Yeah. No, I think that wraps it up nicely. Time-out time, Scott? Yeah. No, thank you for that, David. That was very insightful. I feel as though I've learned something, I think. I don't know if you have. Well, I know that now posture is not a thing. It is a thing. It's not a real word. It's real, but it's not. There's no one-size-fits-all. It could be a change in something. We don't really know. I think that's kind of what I've learned from that. That summarizes everything. Good. Yeah. I'm going to just say to all the listeners, if you do have any other questions, and questions for next week as well, please send them in. But other than that... And we'll be doing a... It'll be a finance-focused one next week. Yes. It'll be my turn to answer a question that one of you listeners has put in. Bye. But for now, goodbye. Goodbye. Oh, shit. Use the disclaimer. Oh, disclaimer. Oh, yes. So, remember, although I am a qualified physio, if you are in any pain, and you are worried about your pain and things, then my best advice would be not Googling it, necessarily, and seeking professional help, actually. Nice. Oh, and just one more thing. Our guests at the end of every episode, we ask them to write down a question for the next guest. So, if you have any questions, please feel free to ask them in the Q&A section. And if you have any questions, please feel free to ask them in the Q&A section. And if you have any questions, please feel free to ask them in the Q&A section. And if you have any questions, please feel free to ask them in the Q&A section. And if you have any questions, please feel free to ask them in the Q&A section. And if you have any questions, please feel free to ask them in the Q&A section. And if you have any questions, please feel free to ask them in the Q&A section.