Episode 14 of the Help! I’m Hypermobile Podcast Transcript

Episode Title: Posture and Hypermobility: Why What You Think You Know About Posture is Probably Wrong

Date released: 09/05/2024

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TRANSCRIPT

Hey, I’m Hypermobile and if you’re listening to this, I’m guessing you might be too! Hi, my name is Alex and I’m your Hypermobile host and today we are talking all about posture. Now, posture is a hot topic. I cannot tell you how often I see it, see social media content where people are talking about posture, maybe some people who shouldn’t be talking about posture.

I cannot tell you how many times my patients ask me about posture, and it’s something which I used to be really confused by, because there’s a lot of, quite frankly, very, uh, conflicting and confusing information out there so in today’s episode, my aim is that you leave here more informed. And less confused about what you need to know about posture than you did before you started listening to this episode.

Now before we go any further, please note that the information in this episode is in no way, shape, or form medical advice. You have a uniquely hypermobile body, a uniquely hypermobile medical history, and that is something which you need to go speak to your medical doctor for. But from an informational perspective, I think the information here is really, really going to help people

understand things better because at the end of the day, one of the hardest things about being in a hypermobile body is just quite frankly, how confusing it can all be. As well, I do want to note that we have some really cool things going on. There’s a workshop, which is going to be happening in London in late July, early August.

We’re still finalizing the dates for that. There are a couple of other things that are always going on. We have the The Discord community, Hypermobility HQ with my HQ crew, it is a private membership community for the scientifically minded hypermobile person to share thoughts, feelings, and ideas on what it’s like to really live in a hypermobile body.

And of course, we have my newsletter. It goes out monthly. We missed last month, but that’s okay. We’re getting back, back in the saddle, or back on the wagon, back on track. And uh, be sure to sign up for that, because I do put a lot of time into it, and there is some pretty useful information in there. And I can promise you that you will not be spammed, because I can barely get these emails out, given how busy my schedule has been.

So if you’re not on my email list already, be sure to scroll down and read through the show notes. The link will be right at the top of that, because it might be really important with the way that social media changes over time that we’re able to stay connected and it’s a direct contact line from me to you.

Now, let’s get into today’s episode. Posture is one of those words that people say without even thinking about what it means, without defining their terms. For those of you who don’t know me, I’m a UK registered osteopath, so I’m a musculoskeletal specialist. I did a four year degree in osteopathy in the UK, but prior to that, I did a four year degree in English literature in Canada at the University of Western Ontario, now called Western University.

But posture and defining terms here is really, really important because if we don’t know what we’re saying, how can we even make any sense? So posture literally refers to the position of a, well, it can refer to posture of anything, you know, cats can have posture, right? But in the context of today’s episode, we’re talking about human posture.

So it refers to the position of the human body, including the limbs and the, the appendages. Okay. So we’re looking at the position of, of the physical you. And how that is oriented. Unfortunately, there’s, this idea that posture simply refers to static posture. So I’m sitting right now. That’s a static posture.

If I was standing, that would also be a static posture. But at any point in time, if, if you’re walking, listening to this episode, if we just freeze you. We capture you on film, we freeze that frame, we’re going to see you in a position and that’s going to be a posture. And there are things that we can, you know, maybe pick up from that posture, information we can use.

You know, that’s a big part of gait analysis is literally watching people walk or in my work that I used to do more so with athletes, although I still do some of it, watching people move. So posture is, as much as it can be an isolated instance of someone’s body position, it can be, I’m, I’m in every posture right now as I talk with my hands, because that’s something I’ve.

Always done. Anyways, it’s a word though that we need to think about in the context of history and culture as well. So there’s more to it than just like, you know, this kind of very simplified and very reductionist idea that we have of good posture upright, bad posture slouching. So our idea of a posture has changed.

throughout time, and I’m going to take you on a little bit of a magical history tour briefly in a moment. Um, but as well, posture and the idea of what constitutes a good or bad posture depends on, on which culture you’re in and which, you know, group of people you’re, you’re with. The posture that someone has at a dining room table in North America is probably going to be different than the posture that someone has when they’re eating a meal in Japan, right?

So there, there can be differences in how we approach things. The posture, going back to that analogy of someone using the toilet in a, you know, a place where they have a porcelain throne, shall we say Is going to differ greatly from me, if I’m on a wilderness survival course in the wilderness, it’s gunna be different in that context So let’s, let’s dive on in, let’s, let’s get to it because the history here is fascinating. So if we go all the way back to ancient Greece. So, 2000 or so years ago. We have these people, you might have heard of them, Aristotle and Plato, and they like to look at the world around them and write down a lot of thoughts about it in brief.

And one thing that they did write on was posture in people and they noticed that people were very upright. We are a biped species, you know, we walk on two legs and there are a few animals that kind of do that, but we do it in a very pronounced, a very obvious way. And they looked at animals which tend to walk on all fours or kind of like slither on the ground or move, you know, in different ways where they’re kind of more horizontal.

So they looked at humans and they looked at the animals and I, I suspect as well that they were probably thinking at this time of the Greek pantheon of gods, which, you know, we have represented as humans, Zeus and Hera and Aphrodite. They’re, they’re all people, you know, they now thought to be imaginary people, but There’s this idea that being upright, because we are people and the gods are people, it brings us closer to divinity.

It’s less animalistic. It’s reflective of intelligence and some sort of elevation. So we have this inherent idea, which is really influenced by the religion at the time, that upright is good and to be anything other than upright is inferior. As well, it’s important to note that people at the time, of course, had illnesses.

Like, it’s, when you think about what it was like to be unwell prior to now, and even now, it’s not great for, you know, the vast majority of people worldwide. And it, you know, it’s not great for a lot of people, quite frankly. But when you think of what it’s like to have illness in ancient Greece, it was bad, bad times.

And there were a lot of illnesses happening. which would cause people to end up in a very, um, hunched over or slouched or that classically like bad posture position. So people would look at like their neighbor or whatever who was, you know, walking in a very hunched over manner, probably, you know, possibly because of their untreated illness of some kind.

And they would think, potentially. Oh that person is ill because they’ve done something bad, because we didn’t understand viruses or bacteria or other mechanisms of illness back then. So they would say, oh my neighbor, they are a bad person and this is why they have bad posture, and their bad posture is reflective of them being bad.

So anyone with bad posture is bad. And of course we can appreciate from our, from our, You know, current perspective that this doesn’t make sense. But back then again that way of thinking really reinforced this idea that bad posture was bad. From even just like a moral perspective it was something which was very, very negative.

Now there are kinds of, there are different ways of looking at posture throughout history. There’s written texts that you can look at, there’s how it’s portrayed in art. And if you’re a posture expert listening to this episode and you’d like to come on the show, I’d love to find a way for that to happen.

So please do reach out to me, because it would be really cool to talk about posture throughout history and how it’s reflected, and from the pictures, the paintings of the Romans lounging, having someone drop grapes into their mouths to perhaps the Victorians with their fainting couches or people in Indian art sitting cross legged, right?

Like, there are all these different portrayals of the human body and position and. I would love to talk about that. But anyways, when we get to the 1500s and 1600s, we have this idea of, um, good posture and bad posture continuing, and that’s really reflected in a word which crops up at the time, which is upstanding.

So if someone’s an upstanding individual. We can pretend I’m upstanding. They are someone who’s like, honorable. They have very, very good morals. They are, it’s something to aspire to. It’s a positive thing. If you’re an upstanding individual, you are an exemplary human being. And for me, it was so interesting to see this word crop up around the 1500s, 1600s.

And when you break it down, you get, Up. Upright, right? And standing. So there’s this idea, again, that standing up is good. As well, we start to see posture talked about more. We have the advent of the modern military and the development of military drill formation in more of the, the modern sense that we have today.

And again, I’m not an expert in military stuff, so I hope I’m getting this all right. But we start to see the idea of a standardized posture really come into the public eye. consciousness of, you know, what is a good posture. And of course, from that military perspective, if we think of that upright standing good posture, the military upright posture is almost that and a bit extra.

It’s like that chest a little bit up. It’s everything in neutral. It’s that replicable posture, which really, for me, as someone who’s not in the military is It’s symbolic of that idea of uniformity and moving as a unit and erasure of the individual. So it’s interesting, again, to see the language start to change as we start to have certain aspects of society change and evolve, which reflect our understanding and how we view posture at that time.

In 1741, we have the publication of Orthopedia by Nicholas Andry and Nicholas Andry, he comes up with this idea of the Andry tree, which has to be one of like the cooler, I don’t know, eponymous words you can come up with from a healthcare perspective. So I don’t know if there’s anyone listening to this who also dreamed of having a, I don’t know, a body part or a cell or something named after them.

Orfanides, like who wouldn’t want it? to put that on something, but, um, when it comes to the, the Andry tree, the idea that Nicholas had was that like, uh, trees, humans grow up first. So we have the little baby, which is kind of like the seed that makes the tree. And then the baby starts to get taller and grow up like literally as in vertical.

And then as that, human that, you know, that, that teenager, and then that adult is, they start to age and their health declines and they, you know, become less well. We see that, that downward slope, that, that hunch, that roundedness, that bad posture. So his idea, really did start to even, further cement the idea of good posture and bad posture.

So his text really started to cement the idea of good posture and bad posture with that tree analogy, which people seem to be big fans of. As we get into the 1800s, we have the advent of what we consider to be modern physiotherapy, and it happens in Sweden, and it’s important to note that the guy who founded that, he had a big appreciation for posture, and he, in his, um, how he conceptualized physiotherapy kind of working, he was thinking of military contributions, that idea of a military posture, as well as gymnastics, and this really feeds into what is present to this day, this, um, Passion for posture, shall we say, amongst musculoskeletal professionals and this idea of good posture and bad posture.

It’s important to note as well that around this time we had ballet really taking off and when it comes to groups of people who, have thoughts about posture and whose whole craft is built around posture, Ballerinas , any type of ballet dancer. Like this is an individual who has had to spend a lot of time dedicated to making sure that they’re able to present certain postures in a way which is consistent with the demands of their, their craft.

So with ballet, again, I’m not an expert in ballet. They kicked me out for being too tall when I was four, which is only the type of thing that could happen back in the nineties. But. Anyways, um, when it comes to posture with ballet, there are different positions and different movements. And like the military, you have a corps and the ballet dancers who end up being in the corps in particular, they have to all be moving as one, a beautiful corps.

I don’t know if you’ve seen Swan Lake. I’ve been lucky and gotten to see the ballet a few times, but it moves as a, as a unit. And again, it comes down to that, like the, sum of the parts is what, what is it? The sum of the parts is greater than it. It adds up and makes more. Okay, we don’t want these, like, we don’t want people sticking out in a ballet corps, just like we don’t want people sticking out in a military unit.

We want everyone to be moving as one. And that really starts to become very prevalent with the just the explosion of ballet as an art form in Europe around this time. If we continue into the 20th century, and I promise we’re almost done this history tour, but isn’t it interesting how our ideas of things get shaped through our existence over time?

But in 1967, we have a professor of public health, Professor John Keeve, and he talks about how there’s really no evidence for our fixation on good posture because, uh, as you can see, it’s, it’s been something we’ve been thinking about for a long time and, and people thought that this, if we have a good posture, we have good health, but he looks at the research that we really only start to get in the 20th century, we really only started to get this, the standardized studies that we’re so used to today, the randomized clinical trials, um, the systematic reviews, all, all of these studies that we’re so used to.

Okay. They don’t exist prior to the 20th century. So he starts to be able to look at this research, and he says a quote which sums up my views on posture, which we’re going to get to in a second, as well as some of my favorite tips. But he says, and I’m going to have to read this quote because it’s hard for me to memorize all this stuff when talking to camera.

“There are no scientific facts to substantiate the benefits of this, postural, aesthetic ideal. Yet a great deal of attention is devoted to correcting faulty posture.” And this is a quotation which really, summarizes exactly how I feel when I look at the research. It’s strange how there’s this whole fixation on posture and everyone has bad posture and everyone must feel bad about it and everyone must try to have good posture and spend money on devices and money on treatment and whatever for their bad posture so that they can perhaps be good if they work hard enough.

For me it’s very strange that there’s this pressure and this fixation really by the public as a whole but especially also the the manual therapy industry, osteopathy, chiropractic, physiotherapy, whatever, Because it doesn’t really make sense when you look at the research. We’ll get to the research in a, a minute, but in terms of industries around posture, we of course have the, the modern industry of which I’m a part of these musculoskeletal healthcare professionals, manual therapists, whatever you want to call them.

But you also have a whole product based industry. So in, the Victorian era, and even a little bit before we start to see these corsets with steel boning in them to really force people into a very. upright posture. We also see a metal placed into collars of men’s shirts, which is wild. And it was there so that heaven forbid their chin droops.

You want that metal there to like be keeping it up, right? Cause it’s not gonna be comfy if you let your chin drop down and it’s steel within that collar. So we have these industries develop and the gadgets that are out there. A few weeks ago I was on my commute home from clinic and I was, I was listening to some posture podcast to get some ideas for this episode and see what’s been talked about and what hasn’t.

And I heard this person talking about this magical device which is going to cure everyone’s bad posture and people have to get it because everyone needs it. And I looked it up and it was like 400 pounds for a pair of basic like orthotics, which quite frankly aren’t going to help many people, if anyone.

It’s ridiculous, the predatory nature of the industry around posture in particular. So when it comes to any aspect of anything to do with posture, proceed with caution. Because the best way to make money, in my opinion, is to make people feel really bad about themselves. Just, and look, it’s what the beauty industry does, it’s what a lot of the fitness industry does, and again, I’m not saying every beauty company or every fitness company is bad, that’s objectively very not true.

But it’s a very, effective strategy to make people feel really bad and insecure about something, so you can then sell them a solution. And we see that play out with posture. all the time. Now, when it comes to posture, it’s such a complex and like charged topic. I have to confess, this is my third time filming this episode because I got really stressed about it.

So for the rest of this episode, or for quite frankly for any episode you listen to where I’m, I’m here talking to you, I want you to pretend like we’re just like hanging out at a, I don’t know, a nice bar or a coffee shop just talking about real issues around posture and my professional and personal thoughts on them. But this is, as I said earlier, this is not medical advice.

These are my thoughts on posture in general, but they are as direct and as candid and Hopefully as useful as I can possibly make them for you, so that you can then go on, of course, to speak with your qualified health care provider and see if perhaps they help you, I don’t know, think of some things differently, or maybe just even understand your body differently.

But let’s start with thinking about posture as a whole. So we’ve talked about what posture is, it’s a body position. Posture does not have to be like a standing posture, although it’s certainly one posture that someone can have. Posture is reduced into this binary good posture and bad posture and that does a disservice to all of the complex and beautiful ways that the human body can be positioned.

Now it’s also important to think though about Is there even anything that is a good posture? Does the concept of a good posture even exist? Like, this is a type of thought experiment I want you to go on, okay? So, what is a good posture? For me, a good posture is going to be one that serves that person and the needs of their body.

It’s going to be one that doesn’t contribute to injury in that person. It’s going to be one in which they feel comfortable. Maybe they feel happy in it, even, because we’ll talk about posture can affect mood in a second. Now, When it comes to posture, there’s a quote that I’ve, um, I first came across it on social media, but there’s this idea of the next position is the best position.

And I think at the end of the day, that’s a really good takeaway from this episode, if you’re looking for just something to remember. By changing positions and changing postures regularly, you avoid the thing that I think makes Well, that I know can make any posture injurious to people, which is being in one position for an extended period of time.

If you stand up with that, like, perfect, which by the way, doesn’t exist, but that perfect upright posture, and you’re doing that for eight hours, you’re probably going to be pretty uncomfortable at the end of that. If you can even make it that long, which I know I couldn’t, if you sit slouched for eight hours, again, you will probably be uncomfortable, right, at some point around there.

So it’s important to think about posture. And the risk of almost overdosing on a certain type of posture, which may be all right in moderation, but which may start to injure people if they do it for too long. And what is too long is going to depend on the person. Now going back to analogies for posture, cause you know, I love analogies.

Posture can be thought of almost like vitamins. So every single person needs some vitamin A. If you don’t have vitamin A, bad things are going to happen to you. But if you only have vitamin A and you don’t have anything else, that’s going to be a big problem. You’re going to potentially overdose on vitamin A and be deficient in all of your other vitamins.

So if we take that analogy and apply it to posture, Yeah, being able to have like a relatively upright posture is beneficial. It’s a good thing if it’s possible for someone to have an upright posture. But if that’s the only position you’re ever in, you’re going to have too much of that upright posture and you’re going to be deficient in all of the other beautiful ways that your body can move.

What we want to do is achieve a variety of postures. We want to find multiple postures in which someone can comfortably position themselves. And we want to make sure that we are avoiding the postures, which might be particularly injurious to that person. So we’ll talk more about that in a second, depending on your body and what injuries you have going on.

We want to make sure that we, enjoy and really indulge in more of those beneficial postures, which, which you feel comfy in and which you, which you just find feel good. If something feels good, it often is good. At least that’s how I approach a lot of the work that I do. Now, a question I get asked all the time is, will fixing my posture fix my pain?

And this is typically coming from someone who’s been told by other manual therapists that the reason that they’re in pain is their fault. They’re the bad one. It’s patient blaming, obviously, but they’re being told, you know, you have neck pain because you were bad and you had bad posture and it’s your fault.

And by the way, I just have to say that’s such an easy way to find excuses for not actually helping patients with their neck pain is by saying it’s their fault. So it gives you a really good out if you’re a manual therapist and it’s kind of messed up. I think how people do that

question one, will fixing my posture fix my pain? And this is the kind of question I get asked all the time from patients in particular who’ve been told by other manual therapists prior to seeing me that it’s their fault that they’re in pain, that they have neck pain because their posture is bad and they should be forcing their shoulders back and cranking their, you know, their head up or and that that’s going to fix their pain.

I’ve never seen that happen. Now, theoretically, could it happen? Perhaps, but I can certainly say professionally and anecdotally that I’ve, I’ve never seen a case where fixing a patient’s posture in isolation was what fixed their injury and fixed their pain. I think it’s also a very, common way to simply do patient blaming.

So if you are, if we have the example of a manual therapist who, for example, is not able to fix their patient’s pain or improve their symptoms or provide care, which is beneficial to that patient, It’s a lot easier to blame the patient and say, hey, this is actually your fault, instead of saying, you know what, I’ve reached the limits of my professional expertise, I’m sorry that I can’t help you further, but I’m going to try and find someone who can, or I’m going to try and help you, you know, find some other option, and I’m sorry I can’t be of more assistance.

I have to say that is my thought on why that happens so often, but it does certainly happen. Now going back to the question, will fixing my posture fix my pain? We already know, hopefully by now, that there’s no such thing as truly good or inherently good or inherently bad posture. So the idea of fixing and finding that perfect posture becomes quite fantastical, quite frankly.

But we can certainly look at someone’s postures and body positions throughout the day and try and think, okay, are these positions that they’re putting their body in, are they serving this individual or are they injuring them perhaps? So let’s think of the example of an office worker and they’re sitting in their chair all day and they’re really, really slouched.

Is that a good position to be in for eight hours or 10 hours during the day? No, it’s not. It might be an excellent position for one hour or for half an hour, but it’s not going to be a good position to be in for an extended period of time. Not because it’s an inherently bad position, but because it’s simply almost, think of it like a repetitive strain injury.

The volume is too great and it exceeds the ability of those tissues to cope with that stress placed on them by that one position without rest. If you want studies and research, by the way, please go check out my website. It’s hypermobilityhq. com. I will put a study on there which really illustrates what I mean when I talk about this.

But when we look at studies of medical imaging, I believe they used MRI in the study I’m referencing, and they’re looking at people’s spines. They find that there is less stress placed on the disc, that the force transference is reduced when you have someone actually sitting in a slouched posture, because it just allows the erector spinae muscles and some of the soft tissue to take some of that load instead of having everything go through the spine if they were to sit perfectly upright all day long.

So again, if that office worker was to try and say, you know, I’m going to sit upright, bolt straight for eight hours a day, and that’s going to fix my low back pain. I would be very surprised if that happened. And often I find that patients actually get worse after they take that approach and try that. So again, will fixing my posture fix my pain?

Back to that question. I’m going to say it’s unlikely, but it’s certainly something that’s good to think about. And I would think about it more from the perspective of, are the postures that I’m in potentially challenging my tissues too much that they’re injuring me? And can I find a greater variety that’s going to cause less stress on my body and just allow me to kind of, challenge different tissues at different points throughout the day so I don’t challenge anything too much.

As the Greeks like to say, everything in moderation. That is how I sum up my answer to that question. The next question. I have a lordosis, is that bad? I get asked this question again a remarkable amount of times, by patients who see me in clinic. I also sometimes get messaged about it, but anyways. A lord people get told having a lordosis is bad, what?

I don’t know if this is a fault of the physiotherapist or osteopath or chiropractor or medical doctor or whatever. I don’t know if this is a fault of the health care provider that they’re seeing or if this is the fault of the patient perhaps misunderstanding things, but everyone has a lordosis. In fact, you have two, hopefully.

Most people are going to have a curve in their low back. That is your lumbar lordosis. And that just means that it is a curve that is concave. It literally just rounds the spine. in, okay? It’s the, it’s the curve of low back. You also have a bit of a curve in your neck again, um, and that is a bit of a lordosis.

We don’t want a neck that’s jutting out like that. We don’t want that kypho lordotic posture that we, we see in people who are perhaps, if you think of like a really, really like, old person who’s like hunched over and they’re trying to keep their neck up. Like that’s when we start to see a kind of hunchback kypholordotic posture, right?

But we do all have a, or not we all do, but most of us should have a lordosis in our cervical spine, in the neck that produces just a gentle curve. And I’ll explain why in a second, okay? And guess what? We all should have a kyphosis. So a kyphosis refers to a convex curvature. So it’s just that little bit of a rounding in the thoracic spine.

If you had a perfectly straight thoracic spine, that’s actually like not ideal. You want a tiny bit of a kyphosis there. And the reason for this, and I was going to get a model for this episode, maybe I’ll do it for a Tik Tok or Reel one day, but if you have a stick of spaghetti and you put pressure on it, Actually, hang on.

I’m just gonna get a stick of spaghetti. A few moments later. We didn’t have a stick of spaghetti, but we have a rice noodle. This rice noodle is pretty straight. There’s no curves in it. But if we take it and we put pressure from the top and the bottom, even just a minimal amount, it’s gonna go like that.

It snapped. It did not cope well with that pressure. If the rice noodle had lordosis a kyphosis and then a lordosis, so it makes like a little S shape, that’s going to help it cope with that loading, that pressure of being upright, the force of your weight plus gravity pulling on you. That is going to cope better. And we would, we know based on studies, I’m sure they’re out there, check my blog post, I’ll try and put all the good stuff in there.

But we know that that’s going to tolerate the force of being upright. better than a straight up and down line. And actually, the patients I see who have the worst low back pain are the ones with the very, very straight spines. They are the ones with the reduced lordosis. Of course, the people who have, what some people will call like a swayback posture or so on, or they have a really, you excessive, they have a hyper lordosis in their lumbar spine, an excessive curvature, so kind of tummy out and kind of bum sticking out.

Those people certainly will have more low back pain potentially, not always again, but some of them will have more pain than like the a person with an average spine. But the spine which I would want to not have the most would be a reduced lordosis in the lumbar spine, a very, very straight spine.

That’s the type of spine where I see the most problematic cases in the patient population that I work with. So if you’re someone with a hyper lordosis and you’ve been made to feel really self conscious about it, there are other types of spinal anatomy, which I think are more problematic.

And I say that because I’m someone who has been told repeatedly that I have too much curvature in my low back and I find ways to make it work for me. So there might be solutions out there for you. Now, in terms of other problematic spinal anatomies, we do see as, as well, things like a scoliosis. And I’m going to save that for another episode because that’s a whole topic of its own.

But a scoliosis refers to abnormal curvature of the spine. They can occur in different planes. So you can have a scoliosis, which affects the spine forward and backwards, side to side, or in a rotational aspect. We’re going to save that for another time, but of course, a scoliosis certainly does complicate things.

And these are patients who require a specific care. They require a diagnosis and they require, a little bit more management than a patient with like an anatomically relatively normal spine. Although I do want to stress, we’re all a little bit weird. We all have a little bit of abnormal stuff going on to some extent.

One of my eyebrows is higher than the other. One of my legs is longer than the other. Like we we’re not pixels on a screen. Like we are, we are people and building human bodies is complicated as is maintaining them now. One other thing I want to say going back to, um, posture is it’s important to think about the person and how they’re positioned and I meant to mention this earlier, but I completely forgot.

Did I tell you I get stressed making these? Anyways, we need to think about posture and, disability. and posture and mobility aids and so on. So again, this idea that upright is good and anything other than upright is bad, I think it’s very, very ableist. I think that it really hurts people who can’t perhaps achieve that upright posture.

And it doesn’t take into account people who, for example, are, you know, wheelchair users, in some respect, or people who rely on, different types. of aides where they’re using like, rollators, for example, or a cane. These are people where they need to work with health care providers who are going to help them have the best positioning of their body possible for usage of the mobility aid, which they need and benefit from to move around.

So we always want to look at posture in the context of that individual patient and all of the ways in which they’re positioning their body throughout the day to do what they need to do with their hypermobile body. The next question that I get a lot is, okay, you’ve told me how I don’t need to like fixate on good posture versus bad posture, but I want good posture.

Anyways, I say good in quotation marks. Again, I want that upright straight posture. I just want it so I can like have it for photographs or feel comfortable. What can I do? How can I achieve that? And again, I don’t think it’s a bad thing to want that. I think it’s important that people who are able to have that upright standing posture, a really good version of that, I think can certainly be beneficial for people to have it.

It is beneficial, quite frankly, if it’s something that you can obtain. I just don’t think you should live in it 24 7. Now, the first thing I would say is that it’s important to get injuries addressed. So when you stand up, and I do this with patients all the time in clinic, I’m like, I’d like you to try standing up really, really straight and tell me what you feel.

And you know what, as much as precise orthopedic assessment is important, it’s important to be scientific. It’s important to, you know, be, um, as strict with these things as you can be, as objective as you can be. I do find it sometimes helpful to ask patients like, what’s your body saying to you? Like, just like, what’s, what’s going on?

Because it can be hard to feel things and you will probably definitely understand that if you’re someone who’s hypermobile. But I’ll say, what’s your body saying to you? What are you feeling? And very often the issues which patients, report noticing They’ll often come from kind of the interscapular region.

Interscapular region is one of my favorite medical terms ever, anatomy terms. You know that place between your shoulder blades? That is your interscapular region. So very often I’ll have patients say, you know, it feels like my shoulders aren’t quite settled. And this goes back to a viral TikTok I did back in the day, uh, where I talked about my shoulders feeling homeless.

And this is, in these types of patients, I’ll very often see the shoulder blades slightly forward. They’ll be, protracted, so they’ll have kind of that rounded posture. These are people who will be told to try and, like, force their shoulder blades in. But these are patients who will see me and say, like, I’ve been trying to force them back.

I’ve been doing all of these exercises, and I’m just not making any progress. In these patients, I will very often look at the musculature and the tissue and the nerves between their shoulder blades, so the dorsal scapular nerve, I’ll look at the spinal accessory nerve, I’ll look at the scapulothoracic joint and how that shoulder blade is sitting in the muscle and connective tissue in which it is embedded.

I look at the rhomboid muscles and so on because I want to see like what’s going on, in the place where they’re feeling pain, which is a pretty reasonable place to start for a lot of the issues that hypermobile people present with. What I tend to notice is that these patients very often, even if they have hypermobile scapulothoracic joints So the hypermobile scapulothoracic joints will be people whose shoulder blades are winging, but it’s also really important to note there are people who will report feeling like their shoulder blades are almost glued on their back and they almost like can’t move.

So they might even have hypermobile glenohumeral joints. So that’s the shoulder joint out. I’m pointing to it on the video if you’re watching this, but if you’re not watching this, it’s there. what people think of as the shoulder joint. It’s what you would call your shoulder. Um, but anyways, they kind of even have hypermobile glenohumeral joints, but hypomobile, so less than ideal mobility, scapulothoracic joints.

And in those patients, those patients that have that really, really, stiff tissue in their intrascapular region, what I will want to do is work with them on trying to improve or positively affect that tissue quality on trying to build muscle and, uh, tissue which as a whole is more functional to allow that shoulder blade just to settle nicely in that kind of down and in position.

And if you just do a little experiment, if you’re someone who is able to get your shoulder blade a bit down and in, You will feel that when you do that and you’re standing, it’s very easy to just have your arm by your side. It feels kind of light. It’s just hanging out. But if your shoulder blade is forward, if it’s in that protracted position, you will notice very quickly that your arm feels heavy.

So finding ways for people to get their shoulder blades down and in, if it’s possible for them is a great place to start. And that’s a whole complicated thing. I’ll, I’ll get into it more in another episode, but I hope that gives you just an idea of one place I would look. I’m also going to be looking at their feet.

So very often people who are hypermobile have abnormal foot anatomy. Again, everyone’s quirky, but hypermobile people are often a bit quirkier. And there are a couple of different types of foot anatomy presentations, which I’ll see. One of them is a fore foot varus. Another one is a flexible flat foot.

But regardless. Thanks. These are people who will very often have feet where their arches are kind of collapsing. So when you look at them lying down on a table, they do have an arch in their foot. When you assess them, you see it’s not a true pes planus. It’s not a true flex. Sorry, it’s not a true flat foot.

But when you look at them carefully, you’ll see actually they have a flexible flat foot, which is commonly mistaken for a pes planus, or they have a forefoot varus. or both But anyways, what you want to do with these patients often is work with them directly or work with someone who is able to help them find an insole, which is just going to lift the ground up to them.

So we stop that collapse because when that arch collapses, that knee will cave in and that starts to put tension on the hips. And we kind of get a downstream effect or an upstream effect, perhaps I should say, if we’re looking at the knock on consequences of that. But thinking of foot anatomy here is also important because if your feet aren’t in the right position, you’re kind of in trouble from the start.

That being said, I, I can’t think of a single time where I’ve come across a patient who’s been really happy that they’ve like spent a lot of money on orthotics. I think that it’s really important to start with basic interventions. I think it’s important, you know, if you can find someone who’s going to make you perfect orthotics by all means to do that.

But a lot of these corrections are more straightforward and I think more accessible than they’re presented by the healthcare and medical industries to be quite frankly. So ideally your healthcare provider will be working with you because it’s a relatively straightforward issue addressing a flexible flatfoot or a forefoot virus, but that’s just my opinion as a UK registered osteopath.

We also want to be thinking about gaze and where your eyes are going, and this kind of ties in really nicely to a holistic appreciation of life in a hypermobile body. So hypermobile people, they are often a little bit clumsier, this goes back to issues with proprioception and a few other things, you know, of course there’s a correlation with ADHD and neurodivergence and other stuff going on, but we want to really think about where you’re looking.

If you go for a walk and you look down and you have someone film you, you’ll notice that there are probably knock on consequences to your posture. You’re probably looking a lot more slouched than if you go for a walk and have your eyes level looking straight out in front of you. Your eyes determine where the rest of your body goes, and your body will do everything it can to protect that horizontal sight line.

Being able to see is very important for function, obviously. Sight is a very important sense that we have, or that most of us have as humans. So your body will do any compensation necessary to try to be able to have you see the world in front of you as much as possible. So this is why, again, if we think of that kind of the stereotypical, like, little old lady or grandpa or whatever, who’s really, really slouched over, They will then get that extension in their neck.

They’ll get that kypho lordotic, that excessive kypho lordotic posture in their thoracic and, uh, cervical or so their mid back and neck because their body’s trying to keep them able to look at the world around them. They’re trying to keep that gaze up. So think where your gaze is. When you’ve done all of those things, when you’ve had the injuries treated, when we’ve had any anatomical abnormalities in the feet addressed, when we’ve thought about things like gaze, we then get onto, of course, things like pelvic floor.

Which can certainly affect your posture, having tension and appropriate tension, not too much tension, because a lot of hypermobile people have issues with that certainly, but having appropriate tone there in the muscles, having an awareness, and also when it comes to breath again, having good breathing mechanics, or just having even good enough breathing mechanics, that can make a big difference as well.

And my final tip is to think about the actual biomechanic beauty of movement in particular. Because if you’re a hypermobile person, any opportunity you have to dose your body with good movement, with good mechanical stimulus, is beneficial. So I’m going to use a little story time here. So back when I was about 20, I was told that when I walk, I look like I’m carrying two suitcases.

And I had to think and I was like, you know what? I looked at some videos of me walking. I was like, that’s correct. Cause basically my, my shoulders, my, my upper body was not moving at all. All of my movement was stopping kind of around my low back. And I’m one of those people who had the shoulder blades glued on the back problem.

I had a lot of neck pain and a lot of kind of mid back pain. And one thing that helped me, it didn’t fix everything, but one thing that helped me, and this is easier, of course, when you live in an area where. Maybe you don’t have too many people watching you walk or you just don’t care. That’ll work too, but I would try and walk and really just feel and appreciate the rotation that was, that was going up my spine.

So I would try and walk and make sure my shoulder blades were moving and I was getting a little bit of a rotation. up that mid back as I was walking and my shoulder blades were moving as I swung my arms and that movement wasn’t stopping at my glenohumeral joint, so my shoulder proper or my low back.

So trying to just allow that like diffusion of movement from every step that I was taking. And I know that sounds very like woo-woo or whatever, but just feeling that for me really helped. And I think All of my clinical work with patients and everything I’ve done with myself, it’s all about fighting for those 1 percent improvements.

So I do think that that, uh, was one of those little positive changes, which made a difference. And it’s something which I think of to this day. And of course, I had to be very conscious initially when I was doing it. I had to think, Don’t look like you’re holding suitcases when you walk. Walk like a normal person.

Like, that’s what I was thinking. Like, just try and look normal when you walk, which is so weird. And that’s not really the best line of thinking, but it eventually evolved to try and feel that really juicy little bit of diffuse rotation of your spine and gentle movement of your shoulder blades as you walk.

And that went on to become my normal. And I have to say it’s really weird to go throughout a decade, a bit more than a decade, but to have that experience of being someone who was being, you know, not just being told, but who objectively, if you look at photos of me in my late teens and stuff, I didn’t have, um, I didn’t look comfortable in my body.

You know, I don’t like the whole good and bad thing, you know that by now, but I didn’t, um, I wasn’t able to sit in ways which just looked comfortable and felt comfortable to me. There were these abnormalities in my movement, which weren’t serving me. So now to be someone in my 30s, which is able to sit in positions, which I feel serve me and feel comfortable and they do, you know, they do.

They do look good and photograph well. There’s a reason why artists like to have people in that very upright posture because it just, it has a certain aesthetic look to it, uh, right? But anyways, it’s been an interesting experience just to see and appreciate how changeable that can be and how it can go from being a really conscious thing to a, an unconscious, thing.

It’s anyways, it’s just a personal note for me. And that kind of wraps up to my, my final tip. This isn’t a question. This is a, this is a tip. So we’re finishing up our coffee or our drink or whatever. The bar is closing. I want to give you the best advice I can because I don’t know if we’re going to meet again.

I hope we meet again. I hope you’re back for next episode. But um, don’t think about posture in terms of good or bad. Think about what serves you and what doesn’t serve you. So be selfish. I think more people need to think about what serves them in different aspects of their life. And posture is no exception to this.

So I want you to think about what feels comfy, what feels good, what makes me feel powerful, what makes me feel capable. Going back to, , posture and what serves you, I’m just gonna give you a few examples of postures that have served me. So right now I’ve been sitting cross legged a lot of this episode.

I switched because I started, I started to get uncomfortable in that position. So that’s why I switched. I’m going to grab another pillow actually, because that would make me comfy right now. If you’re a hypermobile person, you might notice that postural aids serve you. You don’t have to do it all alone.

You might notice that, wearing a corset or a stomacher serves you. There are a lot of people in my online communities who like, um, different types of supportive undergarments ranging from shapewear to corsetry. Use that. It gives you a little, little brace, little support. Think again of propping things up.

I’m literally propping, like, my body up on pillows right now. Why? Because it feels comfy. And I enjoy it. That’s why I’m doing that, okay? You will probably never see me record an episode ever in that upright good posture position. I don’t like the feeling of my legs being below my hips. It causes blood pooling and feels uncomfortable, so I avoid that like the plague.

Other postures which serve me? Leaning on things. If you’ve seen me in clinic, I, I’m like a little, like, avoiding standing upright ninja. Like, I can do it. I do it for photos. I do it when it serves me. But I’m leaning against the wall as much as possible, because I’m I’m tired sometimes. As well, one posture, one body position which comes to mind, which really served me at a time when I really needed it, was back in my early 20s.

I had the worst neck pain. This was the thing which, really sucked the most for me, was this horrible intense neck pain. neck pain and these, tension type headaches with migrainous characteristics that were of a disabling intensity in the sense that I could not leave the house for days at a time when they would happen.

They were awful. I would just lie in bed with a pillow on my face for days waiting for them to stop because they sucked that much, couldn’t eat because of the nausea, eye pain, tooth pain. It was, horrible. Worst thing ever. I hated them. They suck. If you have them, I’m so sorry. They are the worst. But one of the positions which really helped me, and again, it’s not going to be appropriate for everyone, it’s not going to be appropriate for people perhaps with serious eye issues in particular, so please go talk with your medical doctors.

Please go do that before you ever do anything that you hear me talk about on the show. But, I had a treatment table at the time, because I was doing my osteopathy degree, so I had a treatment table in my home, and I would have these headaches, and I would just go lie, like, tummy on the table, face in the face hole, face down.

I’d put the iPad on the floor, I think I had a footstool to bring it up slightly closer, and I would just lie there, and like, just watch a TV show and that position really took tension off my neck and having that position as an option helped. So again, I wouldn’t stay there for eight hours, but I might go watch a TV show for like half an hour or an hour there.

And it just felt like it gave my neck musculature and nerves a break from whatever was causing them injury at the time. So that’s an example of kind of a creative or weird posture. Which I found, which served me, I haven’t done it in years, but it’s pretty darn comfy. And, uh, it’s something which you certainly might want to consider and speak with your medical doctor about, of course.

And as well the whole cross legged thing, so I mentioned sitting cross legged earlier, I do it all the time, I like to make people comfy in my clinic room, so if patients want to sit cross legged, I don’t mind, you sit in a way that’s comfortable. But, do not sit cross legged for hours on hours. That will injure you.

Do not do what I did and go for like 20 years only sitting with your legs crossed one way. Everyone’s kind of going to have like a preference one way or the other because of variations in mobility in their hip joints or whatnot. So switch sides and do it evenly. Find ways to enhance that position.

Put pillows under your knees and so on. See if you can have a supported posture. See if you can find a position that’s what I call true rest. So that just means having enough stuff to prop you up that you can really just go floppy and you’re supported, which feels so luxurious and so restful. I have some content on it on my TikTok, maybe on my Instagram, but go check that out.

Maybe I’ll do a blog post on it one day on my website. But finding positions of supported rest where you can actually rest, of course, is also key. But again, it all comes back to that last tip, which is find where what serves you. Ask yourself, is this helping me? If you’re one of those people where they claim that standing perfectly upright and sitting bolt upright, their entire waking existence, if that serves you and you’re comfortable doing that, then by all means do that.

But at the end of the day, be critical. Be thoughtful, be curious, and I hope that through doing these things, you will find ways to position your body that work for you, whether you’re someone who, you know, stands on your own or someone who uses mobility aids. It’s all about finding what works for that person, for that individual, and I hope I hope that as we’re wrapping up today’s episode, you have felt my passion for posture and that it has inspired you to think more about your own hypermobile body and how you are going to position it throughout your day.

Take care. Thank you for being here. Be sure to sign up for my email newsletter list. Seriously, it’s how we keep in touch with each other. Lots of exciting things coming up and I’ll see you next time. Bye.

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