"If you get your back cracked,
you'll always need it cracked."
Oh, man. I hear this all the time.
"Sitting at a desk all day will give you bad posture."
We need to get away from the notion
that there's one good or one bad posture.
"Massages will remove knots in your back."
First of all, the misconception is
that you have knots there to begin with.
Hi, my name's Dr. Tom Walters.
I'm a physical therapist based in Santa Barbara, California,
and I specialize in the treatment
of patients with general orthopedic pain and injuries.
And I am Dr. David Song, and I am a chiropractor
based in Toronto, Ontario,
and the patients that I mostly see are weightlifters
and other people who are experiencing issues
with their daily activities.
And today we'll be debunking myths
about posture and back pain.
Song: Myths people hear growing up.
"Good posture means standing or sitting up straight."
So, this is a myth that comes up a lot in the clinic.
There's this really ideal, good posture.
Tuck your chin in, pull your shoulders back.
The current pain science, injury, rehab evidence
just doesn't support that thinking.
There isn't really a bad posture.
If you were going to label a posture as bad,
maybe it would just be that posture that
you're in for too long.
And you get anyone to do anything
for eight hours, and chances are
it's not going to be comfortable by the end of it.
So, slouching in itself is not really the problem.
It's why you're doing it for so long,
or not even that --
it's about not doing anything else, really.
Walters: There's actually some really interesting research
where they actually put people in slouching
and show that in the low back
it actually improved nutrient and fluid delivery.
So we just have to keep moving.
"Stretching will give you good posture."
Oh, man. I don't think anyone
has ever achieved good posture through stretching.
By all means, do it.
It's better than just sitting there doing nothing.
Posture is not really determined
by how tight your muscles are.
There are a lot of other aspects that go into posture.
For sure. Genetics are a part of it.
The activities that you're involved in,
especially during development.
Your actual skeleton will change
depending on what activities
you expose it to in your teenage years.
Like, one that we talk about a lot are baseball pitchers.
You know, if they start at a young age,
their actual upper bone, their humerus bone
in their arm will actually twist
because of the stresses they're putting on it.
We might have mobility-type work or interventions,
and stretching could be a part of that.
And the only way you can permanently
really probably change your posture
is to be consciously aware of it all the time
and hold that new position.
But doing that all the time is probably going to
create other problems for you.
So just be dynamic.
Song: "A stiff mattress is better for your back."
Walters: There's always questions about
pillows and mattresses.
I mean, you can understand, we spend a lot of time sleeping.
A stiff mattress might be great for some people
but horrible for other people.
The best way you can gauge if something is good for you
is if it's comfortable.
This goes with shoes, mattresses,
pillows, all those things.
So you really have to think of your own body
almost as an experiment and test things
and see where you're most comfortable
and what's best for your body.
Myths from the internet.
This one should be a real doozy.
Song: "Massages will remove knots in your back."
First of all, the misconception is
that you have knots there to begin with.
There's not some balled-up muscle that we can MRI and see.
We have a bunch of muscles that are just long and skinny,
and if you rub on them like this, they feel like a lump.
Don't worry about it. It's just a muscle in your body.
Song: So, massages can help to loosen up a tight muscle.
It can influence how that muscle feels
and how that muscle perceives, you know,
digital pressure applied to it.
But will it get rid of the knot?
Well, I mean, the knot wasn't there to begin with, so.
"Body braces will fix your posture."
Dave, I'll let you go first.
Song: They do have their place. Don't get me wrong.
They can help assist you in a position
that you need to hold,
much like a crutch would assist you standing up
to not weight-bear on that broken foot.
And so it can help
to deload some of the muscles while you wear it.
They can temporarily improve your posture
while you're wearing them,
but will you get any permanent changes
is a totally different story.
Walters: We need those things sometimes medically
to let something heal,
but anytime you have something passive holding your body,
it means your neuromuscular system isn't doing it
and it doesn't need to anymore.
Those muscles that would have held you back
that are now being held by something else
will quickly atrophy and decondition.
So even if that brace gave you some relief,
we might say, OK, yeah, maybe use it temporarily
in certain times of the day or activities,
but it's only for short windows.
It's not a permanent solution,
because it's going to create all kinds
of other negative physical body side effects.
Song: You want to be able to
condition the body up and strengthen it,
as opposed to rely on some external influence.
Walters: "MRIs and X-rays can always
diagnose your back problem."
Oh, man.
I need to buy myself an MRI, if that's the case.
MRIs and X-rays are often overutilized
for diagnosing back problems.
A lot of the research shows that
a structural issue with MRIs or X-rays
and whether or not that person has a disability or pain,
that correlation is pretty low.
Likewise, you can have someone experiencing a lot of pain,
a lot of issues, and then you get an MRI
and it's completely clean.
It just looks like a healthy spine.
When we look at the spine and spine pain,
we don't recommend MRIs until the person's done,
like, a six-week course of rehab.
Because they've actually found
that when people get those images,
if there is something there,
it can create fear and anxiety.
And they've actually shown that outcomes
in terms of recovery are poorer
when somebody sees their MRI.
Often a patient will be like,
"Hey, I have this MRI report."
And I'm like, "Hold up.
Let me see everything else about you first."
But I don't want to let that MRI
determine everything else about you,
because it's just one aspect about what you're experiencing.
Myths we hear the most.
"Sitting at a desk all day will give you bad posture."
We need to get away from the notion
that there's one good or one bad posture
and just really realize
that the research doesn't support that.
Really the best thing you can do,
from a posture standpoint, is just move often.
Change postural positions often.
In the past, they've done studies where
they got a bunch of people riding this recumbent bicycle
while doing their desk work.
And it turns out that after eight hours of doing that,
their back was killing them,
because they're just doing the same thing
for eight hours straight.
Whether or not you're sitting, moving, biking,
standing, even the treadmill desk, guess what?
You're walking for eight hours a day,
and it might end up hurting your back a little bit.
Your nervous system is pretty good
about knowing when you need to change posture.
So you just try to take breaks every 30 minutes,
every hour or something, get up and walk around.
Just changing those stresses is going to change
how your nervous system perceives your physical body.
It's going to change blood flow.
It's going to change nutrient delivery to tissues.
And it's just implementing the right stresses
at the right time.
"If you get your back cracked,
you'll always need it cracked."
Oh, man.
This, I hear this all the time.
I think the idea that
you need to get your back cracked once it's cracked
is rooted in the idea that the cracking itself
is shifting your bones into place,
and that if you don't get it cracked again
it'll shift out of place,
and then you need to get it cracked back into place.
That in itself is kind of untrue.
What we know now is that those cracks,
what we call are cavitations,
is just gas bubbles being released out of the joint.
Spinal manipulation is just about
introducing movement back into those joints.
It's literally no different than cracking your knuckle
and then not needing to crack that knuckle ever again.
It's the same mechanism.
All it is, is to open up a small window of time
where you can move, like, pain-free
or move with a little bit more ease
and then reinforce that type of movement on your own.
But to sum it all up, no, you don't have to
get your back cracked to infinity and beyond.
"Resting is the best remedy for back pain."
The problem is that we see that when people
are mobilized or rested for too long,
they just decondition and atrophy.
And in some cases, it can make the pain system
sort of ramp up and be more sensitized
if they rest too long.
Rest is very important when it's needed.
Like, if you just sprained your ankle,
I'm not going to get you weight-bearing on that same day.
But the goal is to eventually get back to
what you were doing pre-injury
or even better than that.
Rest in itself won't get you there.
Rest is not rehab.
This is why when you have surgery,
they don't let you stay in the hospital
and sleep there for multiple nights anymore.
You're pretty much in and out,
and you're starting rehab right away.
And the best way to approach that type of thing
is to just slowly level up your body.
I think a lot of people go from 0 to 100
way too quickly, way too often.
"Your body needs to be symmetrical."
Another doozy.
This is one that comes up a lot,
especially on social media.
The truth of the matter is asymmetry is normal.
There's lots of examples of that in the body.
Approximately 90% of people, for example,
have a difference in their leg length.
We write with one hand, right? Versus the other.
We have a dominant leg.
One leg's dominant over the other.
Our body adapts to those things.
So asymmetry is just a normal part of life.
Oftentimes I think people are really quick
to write off that their back pain
is because of their scoliosis.
That might be an attributing factor,
but I would be very cautious to say,
100%, it's because of the structural thing.
It's really case-by-case dependent.
"If you feel pain, it always means something is damaged."
Such an important one to clear up here.
Pain is a signal.
At its most basic level,
your body is saying, "I don't like that."
But it doesn't necessarily mean any structure is damaged.
Like, the most easy way to think about it
is if I just take my hand here
and I just pinch it, that hurts.
If I look at my skin, nothing's damaged.
This has been a really hot topic
in the last 15 years in rehab
and in the pain-science research.
I think it's really important
for people who are in pain to know
that pain does not necessarily equate to tissue damage.
Sometimes it does.
If you sprain your ankle,
that pain is probably associated with tissue damage.
But there are so many other cases
where there's not a good correlation
between pain and actual tissue damage.
This is why we have a biopsychosocial model now.
The bio has to do with tissue,
but the psychosocial are these other complex elements.
Song: And so this is why it's really important to address
all these other aspects and to understand
when you need to collaborate
with another healthcare professional
in order to increase the outcome of your patient.
Walters: We all are going to experience pain at some point.
I mean, if you look at low-back pains,
there's an 80% lifetime prevalence,
which means 80% of us are going to have back pain
at some point in our life.
When people understand pain,
they have better outcomes
and they're less likely to have
chronic pain conditions develop.
Song: And so it's really important to know that
what matters more than anything else is, like,
what is your movement diet looking like?
Like, what are you doing on the daily,
and how's that contributing
to all the things that you're feeling?