The Clinical Coach: Postural Syndromes in the Digital Age

, when was the last time you had to explain posture to a patient?

Mine was just a few days ago.

It seems there’s no end to the idea of “bad posture.”

Did you know that “good posture” was derived from the military back in the seventeenth and eighteenth century?

Back then it wasn’t even a part of the pain conversation.

No, it concerned social status, and in a very rudimentary way started to make its way into health and illness.

There was even an event in time called the ‘Posture Wars’ in the 1950’s that was linked to discipline and etiquette for young boys and girls in Ivy League schools.

Learning about posture has been quite fascinating, and sad at the same time.

For over 100 years, posture has been used as a marketing tool to sell services, products and more.

It’s 2025 and it is still a topic that is discussed in every household.

Posture in 2025

Over the last couple of years, new publications on the topic of posture and pain have been published.

Many demonstrating a very weak link between what we know as “bad” posture and [low back] pain.

So why do we keep pushing the idea that one must improve their posture?

Think of any movie.

Powerful, strong and independent characters have always possessed a “strong” posture. Even in movies, and TV shows the strength of a character is usually portrayed by their postures.

The more confident the person, the more they’ll display a “strong” posture.
Shoulders back, chin tall, and a relaxed lower body. They are standing out.

The more unconfident the person, the more they’ll display a “weak” posture.
Slouched shoulders, tucked chin, rounded forward and swayed lower body. They are hiding.

Patient’s concerned with posture and parents of young kids will usually bring the topic one way or another, specially if the patient has complained about back pain in the past.

“Doc, what do you think about her posture?”

“Tell him about your posture when you are watching TV?”

“Tell him about your back pain a month ago.”

“Do I have text neck?”

Addressing the posture conversation

Wether or not you believe posture is linked to pain.

I am on the 70/30 boat; 70% of the time posture is not linked to pain, while 30% of the time time posture may be linked to pain.

Usually here’s where I insert “prolonged static posture.”

It has been my experienced that prolonged static posture (active or passive) will lead to pain when the tissue fatigues and becomes hypersensitive to the strain.

I usually do this little exercise with all my patients who are concerned about “proper” posture.

1. I’ll have them squeeze their shoulder blades for a few minutes as if they were in “proper” posture. Usually around 3-5 minutes. It’s usually enough to get some discomfort around the rhomboid area.

2. I’ll have them relax and move their shoulders and back until the discomfort is gone.

By now they get the idea that maintaining a static posture for long periods of time is what causes most postural pain.

Dealing with Text Neck

In my opinion it’s the dumbest syndrome there is out there.

We love to blame something.

What’s so different from reading a book, newspaper or looking down at your phone?

Other than the times these were popular?

The only thing that has really changed, the amount of time we spend doing it.

The solution?

Have your patients move more.

Yes. It’s that simple.

• Brueggers Exercises

• McKenzie Cervical Spine Mobility

• Double Chin Exercises

These are all great drills to get your patient to move their neck more.

Do Your Due Diligence

Assess the cervical spine.

Maybe they do need some dry needling, a little bit of ART and joint manipulation before their rehab.

Or maybe they actually need an x-ray before you deliver your treatment.

Every patient is unique.

Make sure you take the time to understand them.

Until our next issue!

In health and strength,

P.S. If you have questions or comments, feel free to respond to this email. I reply to all emails personally.

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