Episode 18: The Posture Talk, Sit up Straight...or Don't?

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• Joe Gambino
• Joe LaVacca

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Summary

In this episode, Joe Gambino and Joe LaVacca discuss mobility work for individuals with hypermobility and debunk common myths about posture. They emphasize the importance of individualized approaches to mobility work and the need to address soft tissue work and interoception for hypermobile clients. They also challenge the idea of a universally correct posture and highlight the limitations of accurately assessing posture. Lastly, they emphasize that posture is not the sole cause of pain and that changing positions and breaking up long periods of sitting can help alleviate discomfort.

Takeaways

• Individualized approaches to mobility work are important for individuals with hypermobility.
• Soft tissue work and interoception can be beneficial for hypermobile clients.
• There is no universally correct posture, and accurately assessing posture is challenging.
• Posture is not the sole cause of pain, and changing positions and breaking up long periods of sitting can help alleviate discomfort.

Transcript

Joe Gambino (00:00.919)
Welcome back in to the Beyond Pain podcast. I am one of your hosts, Joe Gambino. And I'm here with the now riled up right before our conversation is getting kicked off here, Joe Lavaca. You can find us on Instagram. I am at Joe Gambino DPT and Lavaca at strength in motion underscore PT. So please feel free to reach out to us there. I have a conversation. There's nothing better than at least for me, I'm not going to speak for Joe. You can chime in if you want, but

Connecting with the audience, connecting with people who follow me is one of my favorite things about social in general. So you can just DM me the word podcast or DM Joe the word podcast and we can have a conversation and let it roll wherever it goes. This podcast is also on YouTube at cups of Joe underscore PT on YouTube. Yeah. Yeah.

Joe LaVacca (00:51.31)
Yeah, we probably should just change it to Beyond Pain, right? I mean, so confusing. We have 14 different names.

Joe Gambino (00:59.54)
I guess so, right? well, I mean, it's in the show notes, so we'll make it easy for you to access regardless. And on Instagram, Beyond Pain Podcast, you can find the podcast specifically there. I didn't get it wrong this time. Joe gave me the okay sign that I nailed it. And that's it. Welcome back to the show. I did raw Joe up and you know, and I think now he is primed for a podcast episode.

Joe LaVacca (01:03.66)
Here we go.

Joe LaVacca (01:14.786)
Yeah, nailed it.

Joe LaVacca (01:23.586)
Time to go.

Joe Gambino (01:25.071)
So we're gonna, I got a new segment first Joe, I don't even think I told you about it. You might've seen a little note with nothing, nothing, but it's the question of the day. And I have one of you from one of my clients, Mercedes. So let's jump into it. The question is about mobility work specifically when targeting someone who has hypermobility. So maybe we'll give a little quick overview about how we're.

Joe LaVacca (01:29.656)
Start on the notes.

Joe LaVacca (01:37.838)
Cool.

Joe LaVacca (01:49.41)
Thanks.

Joe Gambino (01:53.941)
looking at mobility, flexibility, stretching for that population specifically.

Joe LaVacca (01:59.65)
Yeah, I like this new segment already. A little Q &A. So let's just welcome that among everyone if they want to drop a question for the podcast and we can always start off answering one or two of them. Interestingly enough, since I was brought a slightly different perspective on this while watching Dan Pope's actual course, Fitness Pain Free, he talked a little bit about hypermobility, certain joints.

It made me sort of reconsider my stance on a couple of ideas. So this also came up in clinic several times for us this week with Avery and I, and we just got done talking about it ourselves. So with hypermobile clients stretching, I would say these fall into the category of any sort of athlete. You're gonna want to do the things that you're really good at and maybe even temporarily relieve or alleviate the sensation, we'll call it pain in this case, that you are maybe struggling with.

So I put myself in a position, I put my body at length, this stretch alleviates something that I don't want to feel, pain, ache, whatever, typically feels good, maybe while I'm doing it, maybe for a couple seconds off of it, but then this whole sort of idea comes back and I feel stiff again, or maybe the pain comes back or the symptom comes back. So what I've started to really think about with hypermobile clients,

is this might be a great time to consider your soft tissue work. This is where think where your foam rolling comes in. I think that when we label things as proprioceptive for the body, interoceptive, these are all these things that people talk about with balance and things like that. There is another term that I like to cue everybody in on and that's interoception. And that's just basically the feeling that's happening inside your body that you're aware of.

So I do think that with hypermobile clients, there may be a miscommunication of what's happening in your body. So like maybe a little default issue with interoception. And I think manual therapy, think foam rolling can really help with that. And then this is where we just had Grayson Strange on. This is where I love end range training for those clients. So bring in that FRC system.

Joe LaVacca (04:20.376)
bringing in very heavy isometrics into positions that we have opportunities to strengthen. So that's what I would say in a quick nutshell there, but what are your thoughts? Have you shifted any of this recently? Have you always stood firm in one way or the other? No stretching, yes stretching, foam rolling or not?

Joe Gambino (04:39.425)
Yeah, so I think, did Mike Stella mention this on the podcast when we had him on? I feel like he might have, and this is where the first time I really thought about manual therapy for that population. So I'm kind of with you on that. I mean, I haven't really tried it with many people. I mean, it would be anecdotal for me to say, but it makes sense as far as that, how that could work. if you have...

experience with it and that's been, helping. mean, then I think that's a valuable something that someone with hypermobility or someone who is overly flexible can kind of dive into to help kind of manage some of those symptoms that kind of pop up. I don't necessarily think that they need to avoid stretching because if they do find that it brings down their symptoms and they do feel good, it just shouldn't be the thing that they default to. know, most people who are hypermobile tend to go towards like the yoga route and like to shred because that's what

feels good and what is easiest for them. And they don't do the strength, the stability and all that other stuff that would kind of balance it out. if I like to, you know, when I have somebody I explained some on the spectrum, you know, people in the middle will have some sort of blend of being mobile with this amount of stability. And that's why you fall in on the, on the center of the spectrum. And then some people are just naturally based on their genetics and their anatomy that they're to fall on one end where they have

way more mobility, that comes at a cost of stability and strength. You have other people on the opposite end of the spectrum, which can have a lot of strength, but sometimes that comes at the expense of being hypo mobile, right? So being less flexible than somebody else, right? So you can have this kind of...

I'm a green and range strengthening. Really it's mobility training that's helping you kind of have better control of your body and also strengthening at the same time. So isometrics and eccentric loading and all that stuff that challenges some of that because

Joe Gambino (06:37.403)
Usually those people with hypermobility will have more passive range than they have active. So can we close that gap and give them as much control over that passive flexibility as possible? And then just general strengths training. I mean, just getting them in and lifting some weights because that's what I mean, honestly, that stuff carries over. I had a client.

Ooh, just yesterday messaged me and she's like, I'm so grateful for all the strength work, what you're doing. She's a Pilates coach. And she's like, we're literally moving locations. I've been carrying all this equipment and stuff up and downstairs. And like, if we didn't do stuff like this, I'd be in a world of hurt. Right? So I think there's a nice carry over to strength training in general that

if you do need to do something physical, your body's gonna be more capable of doing so. So I'll leave it there. We don't need to dive in too much deeper than that because we have an important topic to talk about today, Joe.

Joe LaVacca (07:26.69)
Very important topic. And I think maybe we opened up another topic to do another episode on because there probably is a little bit more to say on it. So stay tuned.

Joe Gambino (07:35.543)
Yes, absolutely think so. Today we're going to be talking about posture, something that pops up. think all the time I get constant questions about it. And whenever I have a conversation with somebody about being a client or they are a client of mine or family member, my posture is always something that pops up here. So I want to kind of do maybe today a little myths episode around posture.

Joe LaVacca (07:55.768)
Yes.

Joe Gambino (08:04.607)
So let's kick it off there. I'll let you do this one from here, Joyboy.

Joe LaVacca (08:09.294)
Totally. Well, you know what I like to do when we talk about very common things in our industry is ask the question, what is posture? And again, I Googled it. There is a definition. is defined. What would be your definition of posture, Joe?

Joe Gambino (08:29.567)
My definition of posture would be the way that you hold yourself. I think you can look at it in two different ways. One, there's a static portion, the way you sit, the way you stand, the way you hold yourself in a singular moment, but it's also your ability to get, you know, it's also dynamic in nature, right? So if you're moving, right, what positions can you get into? What can you maintain? You know, if we're...

I'm going to use a plank as an example, right? Can you maintain postures under load? Can you move through different positions and actually access them? And I think what's maybe more important here is your ability to get in and out of positions as probably the more important scenario than the static picture of how we're sitting.

Joe LaVacca (09:11.384)
Yeah, I like this idea of variability. That's something that we have talked a lot about on the show, having more options for movement. Can you get into a position? Can you get out of a position? That's important. When I went to Google with all these now AI tools and everything that I love reading about and capturing some information, I think they're very helpful. There's actually two definitions that pop up. The AI overview.

says this, posture is the way you hold your body when you're sitting, standing or lying down. No mention of dynamic movement, no mention of how you're holding yourself in different environments, right? Just that, sitting, standing, lying down. I do like this, posture is maintained by your musculoskeletal system. So I want to come back to that when we start talking about how to treat it and train it. Because if it is a musculoskeletal system, then

maybe we don't just need to work on scab retraction. We can think about big picture type stuff. Here's the second definition that popped right up underneath it. And I think this is more from the NIH or the National Institute of Health. The term posture means the position of your body in space. This I like a little bit better as a more broad term. It also indicates the position of body in space that has the purpose of maintaining balance during dynamic movements as well as being still. So,

I think a friendlier definition there, but I agree with what you said. It's a little bit more about how you're holding yourself in an environment and what maybe you're doing in that environment. And I know you wanted to do a three myth or some top myths about posture. And I was reflecting on that a little bit. And these were the ones that came to mind. And I'd love your feedback on them. Number one, with our clients, our family members, people who come to us in pain.

maybe even with other clinicians, there seems to be this idea that there is a universally correct posture. I think that's myth number one. I think myth number two is maybe a self reflection for you and your clinician to do together. I can accurately assess it and you can accurately assess it and we know exactly what we're looking for and we can see all these tiny minute movements of a spine, of a foot, of a knee, of a, you name it. Then,

Joe LaVacca (11:37.602)
The last one, posture is the cause of your pain. And I think these are the most consistent narratives that I see shared by my clients that we end up chatting about. You're virtual, you're all over the place, right? You see people all over the country, right? Is that reflective of people that you see in the digital space as well?

Joe Gambino (12:08.653)
Yeah, I think it is. mean, in essence, right? I think I do think that these are three great myths here. There are constant themes that think people come with in the virtual in person. The themes always kind of remain the same. So let's have it to one because I like this first one here, universally good posture. I do think that there is a ideal.

ish posture may be different for everyone, right? But like the whole idea about posture is a position that there's less strain on the body.

so sitting a certain way, standing a certain way. Sure. There's some merit to it, right? but the reason why I think it's a myth is because it doesn't matter what the postures, if you do it over and over over and over again, for years on end, you're going to have issues. So this idea that I need to have a good posture to feel better. Well, maybe that's the case because if you've been sitting in a chair your whole life from school age to work and everything else, and you have pain because when you sit, have pain.

But sure, maybe changing your posture is going to be a good thing, but it's probably not going to solve your issue because even if you change your posture and change the loading, sitting is probably still going to be problematic for you because sitting is an irritant. So for that person, right, is going to be moving more breaking up the position. So can you sit for a couple hours and stand for a couple hours and then sit for a couple hours and then go take a walk in the middle of your day and constantly moving is going to be probably the better scenario for that person because that

repetitive strain that happens over a long period of time that causes these problems gets broken up and you have some recovery built into your day around it. So I think that's kind of where, you know, it's, it's a myth from that perspective, but we can use that potentially to your advantage. If sitting slouch speeds up the response for pain, then maybe changing the way that you sit can have an impact. again, right, there's only a, I don't think that's going to solve the perspective, the problem. And we're only kind of.

Joe Gambino (14:11.727)
maybe move the needle or push that, know, pain happens at an hour, we change your posture. Maybe you get an extra amount of time. But then there's also like, if you're busy, you're probably just going to default to your normal postures. If you're stressed, you're going to default to a different posture, right? It's not just, well, I'm just going to sit like this because if that was the case, then 100 % of the time people just make the change. You wouldn't have to train it or talk about it, right? Because it's that simple.

Joe LaVacca (14:36.953)
Yeah, you're making a lot of sense there, my friend. The reason why I thought it was a myth was because with posture, the same things as pain influence it. It's your genetics, it's your body composition, it's your environment, it's the psychosocial factors you mentioned. Are you happy at work? Are you engaged at work? Did you just have a fight with your spouse, a fight with your boss? Did you just get a promotion?

How tall are you? How much do you weigh? What kind of chair are you in? Does your computer sit directly in front of you? Is it off to the side? I mean, there are so many different things. And I remember reading about OSHA and workplace setup. And supposedly, the ideal workplace setup or how we have come to known it with your desk and your chair height and all this other stuff.

was really designed for, think, a five foot six or five foot eight human being. So now if you are not five six or five eight, I don't remember exactly what the actual height was. You have to start making adaptations to maybe your workplace environment because I'm not five eight. I'm five 10 and a half, five 11. If you're asking me to put my resume down, I'm six foot, of course. I gotta crack that barrier. But exactly, exactly.

Joe Gambino (15:56.084)
That's the social media stats.

Joe LaVacca (16:00.258)
But you know, I am then going to have to make modifications, which not enough people do. So to go back to your idea of like, well, there might be an ideal posture that eliminates strain. I'm going to challenge that just a little bit, because if I'm slouching or sitting in any position, I can put more strain on one hip, less strain on the other. can lean forward. Yeah, maybe I put a little bit more stretch through the muscles of my thoracic spine.

We're gonna get to that in a minute on what flexion does to muscles of your spine. But if I sit up and I redistribute force, well, yeah, okay, I'm taking off some force in one area, but I'm putting more force or strain in another area. So my body weight didn't change, gravity didn't change. It's just about how I'm dissipating these forces. And...

of the things that I've been reading and what I try to talk to people about is, you know, they'll always show me this, you know, like, I sit very forward. you know, I'm like this all the time. And I tell them, I don't think that you probably start off like that. You know, you're, you're probably getting into this posture a, because you're at work. Maybe you're engaged in what you're doing or you're trying to get things done quickly. Right? So there is efficient ways for you to focus your attention and conserve energy or.

maybe you start slouching and moving around because you have pain and the slumped position actually alleviates some of that pain for you. And now coming out of that position is painful and therefore I think slouching is the thing that's causing my pain. you know, I think there's some things where the forced conversation is always interesting to me because it's just like squatting and

preventing your knees over your toes, right? Well, if you prevent your knees over your toes, you're have strong hips and a strong spine because that's where the loads go. So if you want to sit more erect or tall, well then you probably need a better pelvic floor. You probably need some extra length through certain tissues in the posterior side of your hip. There's so many different things that you have to think about in terms of your opportunities to even sit like that. So that's where I think I was going with that kind of first bullet.

Joe Gambino (18:20.611)
Yeah, I mean, I'm in complete agreement think that the ability for someone to, you know, if you're sitting with perfect posture, such a small portion of things and

you know, again, right, it's not going to be the thing that would make a major change for anybody. Because if it was that simple, nobody would have came from a sitting perspective or standing too long perspective because it's so easy to, you know, I could just say, hey, you know, you're standing there. OK, well, where's the weight on your feet? it's more on your heels. Well, what if you just changed it so that the weights, you know, even with, you know, right in the middle of your foot?

Or like one of the tests that you can do for PTA is you stand on a table behind someone and push on their shoulders and kind of see where they feel stressed. And then you can change it and try it again and see if it redistributes it. All that stuff is easy. You can do that snap of a finger just by coaching somebody. So if that was the solution, well, I think we would have a whole lot more answers and posture wouldn't be this big thing. But I think it's very easy for someone to attach to posture. Someone says, your posture's so bad.

Look at how you're sitting, you're rounded, blah blah blah. then, you know, I mean, there are some people who physically and anatomically cannot get out of flexion. Those people are doomed if that's the case, right? Like they're going to live a life of pain just because they are.

Joe LaVacca (19:35.256)
Great. Great.

Joe Gambino (19:42.125)
know kyphotic in nature, right? Which is not the case. are plenty of people who have kyphosis that have no pain. And there are some people that have pain and there are some people who have sitting with perfect posture and have pain and some people that don't, right? So what is the reason? And I think what we're just trying to say here is that it's more complicated than we think. And it's not as simple as a tweak here or tweak there that's going to make all of your issues go away.

Joe LaVacca (20:06.626)
Amen.

Joe Gambino (20:10.243)
Perfect, we got it. Let's move to number two. Can we accurately assess it? And I kind of like this one, Joe, because I think the idea that us as PT's or your doctor or your chiropractor or your trainer that's gonna sit here and say, you know, this is neutral spine and this is perfect posture and just eyeballing it. I mean, you can maybe have an idea, right? But unless you're using some sort of...

I think really what we're trying to say here is like if you and I were both looking at somebody and we're gonna and we were You know, I put you in a different room and I said to this person. this is perfect posture This is how you supposed to sit this is you know, if I'm looking at your Shoulders and I find this higher than the other and then I go into another room and you come out and you do the same exact assessment There's a good chance you can be telling them something different because inter radar reliability or the the testing between two practitioners

Joe LaVacca (21:01.688)
For sure.

Joe Gambino (21:07.073)
is not very strong when it comes to this. So the fact that anybody can be like super confidence, right? That this is what they're seeing and then tell that to the person, I think is not fair to the patient or the client that's sitting in front of them.

Joe LaVacca (21:24.97)
And I think too many people, like you said, just eyeball it. It's you looking at your coworker or when you're working with your provider, it is something just totally random of like you pushing down on their shoulders. Well, shouldn't we be pushing down on their head? Should we push down on their shoulders first? we push down simultaneously? Then we would have to do it sitting, standing, staggered stance, walking, all these different types of things. And I think what's interesting is

If you wanted to try to assess this at home, or if your provider has told you, have forward head posture and you're just eyeballing it, there is sort of a range that you'd want to look for. And it's just looking at your ear, the back of your neck where that kind of like, you know, nice vertebrae really sticks out, and then your shoulder. So it's that sort of line there. If that line is, or that angle is smaller than 50 degrees, right? So your head's really forward, that angle becomes a little smaller.

that would be sort of a representation of your forward head posture. Now here's the funny thing, even if you did that with your spouse and you're looking at your ear line and your neck line and everything else and you were like, my God, honey, you have forward head posture. Here's the thing, it hasn't been correlated to people with neck pain. And even if it were, how far away from 50 degrees would we need to interject? Do you interject at 45?

Should we work twice as hard at 42 that we would at 44? Yeah, exactly. But that's the thing. It's like, excuse me, when does it actually matter? And I've seen people throw studies or reference studies around on social media where when you click on them, the differences in people's forward head posture when they've actually assessed it was less than five degrees.

Joe Gambino (22:55.503)
It's 39 .921.

Joe LaVacca (23:20.788)
And this was what was correlated to pain. So, I mean, I don't know, five degrees, less than five degrees. mean, so that would mean all my neck pain is basically a result of me doing from this to that. That's it. I mean, and that's not barely detectable by the human eye. So this is where I would really challenge this idea that we can even reliably assess it. So that's where, you know, when we start to kind of risk it back into this, you know, think about it with this idea of pain.

I don't think your posture is a risk of you developing pain, but I do think it can be sensitive. I do think it can be a symptom of your experience. And maybe that's what brings us to our last point here, that posture causes everything. And I cannot see that because I don't think that that's what everything I've read or every encounter I've had kind of supports.

because so many people sit in different chairs and have different body types and some don't have pain and some do, but we all seem to share this. We love straight lines. We love artwork that's symmetrical. We love buildings that are tall and erect and you know, that look pleasing. And that's sort of what a sitting up posture looks like, right? I mean, if you were watching models run down the runway, you know, they're not moping down the runway, you know, like this, you know.

Joe Gambino (24:44.486)
You

Joe LaVacca (24:44.75)
They're up tall, they're proud. You're not watching like Aaron Judge hit his 300th home run and be like, I really wish I would have hit it sooner. No, he's tall, he's erect, he's proud. mean, there are all these things that we model ourselves after and then think that that one moment in time is how we should look at all moments every time. So I think it's better for me to kind of think about almost like a car dashboard analogy for clients who have pain with sitting or standing.

It's like, look, you're driving along, everything is fine, until it's not. Your check engine light comes on, your gas light comes on, maybe a tire pressure light comes on. But what happens? You see something and then you do something that triggers a behavior. Hey, I need to pull over, I need to check my air pressure. Hey, I need to make sure I stop at the next gas station because I need to refuel. I need to schedule that trip with the mechanic because you know what, there was a couple of knocks or things that I heard prior to that light going off.

And then I say this to them, well, if you feel something, you change something. Sit more forward in your chair, sit more back, raise the chair up, march in place, spin around in a circle. If you have a band, I don't know, do some bicep curls. Do anything that's just gonna change your system and the state of your system, even if it's for 30 or 60 seconds, and then go back to just working. Because guess what? The more comfortable you are sitting without worrying about your head up tall,

The sooner you get out, the sooner you get to happy hour, the sooner you get to your weekend. And to me, that's my trade off. I'm okay with that.

Joe Gambino (26:17.869)
Yeah, no, I like that. it's funny because, you know, I mean, going back to point one, right, with with moving more, you know, many people I've had tell me like, you know, sitting bothers me after after an entire day of working. So I got a standing desk. So now I stand all day. And then they have

pain because they're standing all day, right? Again, right? comes back to breaking things up and taking a break. And once you start to feel something, it should be your cue, right? To change your, your positions. And I think one of the big takeaways about point three here about posture, not being causative of pain, really nothing is causative of pain, right? It's always whatever you're doing is exceeding whatever your body's capacity for stress is at that time.

So if your body is, know, whether it's squatting is painful, whether it's sitting for a long period of time, whether it's waking up in the morning, right? It's well, all that's telling you is that the stress that you're placing in your body for that period of the day, it's kind of, it's just exceeding your tolerance. So what we need to do is improve your tolerance to take in those stresses. need to, and then as we're doing that, and we're trying to build up more robust body, right? That can tolerate more stress. How can we in the short term?

not allow those long -term low force stresses from sitting or lying or standing, how can we just break it up so that you have let those tissues recover? And I think that's perfect. Like, hey, you're sitting a certain way and you start to notice some issues. If you sit up taller, if you lean forward, if you, I don't know, sit on a stability ball, set up an actual chair, if know anything that's gonna change the way that you're being loaded so that those tissues that were feeling discomfort just have some recovery.

Joe LaVacca (28:05.848)
All right.

Joe Gambino (28:08.471)
Love it. let's show we, you want to rehash things for the listeners to wrap it up, Joe?

Joe LaVacca (28:15.256)
Yeah, I think big takeaways. Don't get too focused on any one thing in rehab. I think this is across the board. So if it's your posture, if it's your mobility, if it's one particular joint range of motion, a stretch of this, don't get too hung up on one thing because you are part of a much bigger system. And I think changing the variables within that system are much more complex than you just sitting upright or finding a stretch that works for you. If your provider

thinks that posture really is important in terms of your pain and your function. They're probably a little bit dated in their ways of thinking. They're probably a very heavy, mechanically oriented, which is fine. But if you're not getting results, then maybe try to find someone else in your network or in your system that can actually give you a different perspective on this. And then if it hurts to sit for 30 minutes, like my man Joe just said, just get up.

Just get up and move around a little bit. Take some action, reset, play with that chair, and then continue about your day. Get your work done as fast as you can so you can get the heck out of that office as quickly as possible.

Joe Gambino (29:28.129)
Love it. You know what, Joe? When we record our next episode, I'm going to stand. Okay, I'm going to raise my desk here and I'm going to stand for the next episode. It'll be the first episode I stand for. So sit tight. All right, guys. Well, that's today's episode. Joe, I love you. Listeners, we love you. And if you made it this far in the episode, extra love for you as well.

Joe LaVacca (29:32.876)
Ooh!

Joe LaVacca (29:39.203)
There we go.

Joe LaVacca (29:45.166)
I love you.