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Standing Posture and Pain – What’s the Link?

May is “National Correct Posture Month” and its purpose is to shed light on the importance of the posture of the human body. Another goal is to increase awareness regarding the strategies people can follow to improve their posture. Bad posture will have a great impact on quality of life. It can also lead to certain painful health conditions such as persistent upper and lower extremity and back pain.

The Dangers of Sitting Posture:

Sitting has been called “the new smoking” when it comes to the wide-ranging health problems it can trigger. In fact, one in four American adults sits for more than eight hours a day, according to federal research from investigators at the Centers for Disease Control and Prevention (CDC).1 Some figures indicate that the average American sits 7.7 hours per day. Research has linked sitting for long periods of time with a number of health concerns. They include obesity, increased blood pressure, high blood sugar, excess body fat around the waist and elevated LDL and reduced HDL cholesterol levels.

Too much sitting overall and prolonged periods of sitting also seem to increase the risk of death from cardiovascular disease and cancer. Researchers analyzed 13 studies of sitting time and activity levels. They found that those who sat for more than eight hours a day with no physical activity had a risk of dying similar to that posed by obesity and smoking.2

We healthcare providers have spent many hours in our clinical practices teaching patients how to mix in a realistic, healthy amount of standing during their day to combat the long hours of sitting. So many people lose track of time and stay seated for hours on end. They have every intention of getting up to move around, but they just don’t do it. The key to correcting issues causes by excessive sitting starts with addressing their posture.

What is Proper Posture?

When we stand up, our goal should be to have an erect or upright posture. In a perfect world, perfect standing posture is where the ankles, knees, hips and shoulders are level with each other and parallel to the ground. In both the front view of the spine and the side view, the ankles, knees, hips and shoulders are all stacked up vertically, one on top of the other. The images in Figure 1 show what perfect standing posture should look like. Next, we’ll discuss how proper posture is essential to optimal health.

Standing Posture and Pain – What’s the Link?
Figure 1

The Benefits of Standing:

Standing is beneficial for people because standing exercises muscles in the abdomen, buttocks and legs that are necessary to keep them upright for an extended period. Standing also burns about 50 more calories per hour than sitting. Some of the benefits of standing are:

  1. Reducing the risk of weight gain and obesity3
  2. Lowering the risk of heart disease4
  3. Helping lower the risk of Type 2 diabetes and other metabolic diseases5
  4. Lowering long-term mortality risk
  5. Helping reduce the risk of cancer
  6. Reducing chronic back pain6,7 
  7. Increasing energy levels and elevating mood8
  8. Boosting productivity while working
  9. Standing while working helps build muscle tone, posture and balance

Standing posture gained popularity during the coronavirus pandemic when many people worked from home. In the beginning, people thought that they’d return to their corporate workplace in just a few weeks. But as remote work continued, the ergonomic insufficiencies of their new work environments became evident. Standing workstations started to become popular, and with them came a whole new set of issues caused by standing that people now need to overcome.

Pitfalls of Standing:In my practice of over 26 years, I have observed that practically every patient has some degree of dysfunction and instability of the foot’s three arches. This is critical information because it sets the stage for a patient’s standing posture. Understanding that flat feet are pervasive among human beings across the planet helps you identify it. Looking at the effects of excessive pronation by using the “Crooked Person” and lateral posture diagram below helps you to understand and explain it to patients. We begin with the feet, the foundation of the body. 

The “Crooked Person” (Figure 2) illustrates how the left foot excessively pronates more than the right foot. Following the effects of foot pronation upwards from the feet and ankles all the way to the neck helps show how the standing posture of the body can be negatively affected by flat feet. 

Standing Posture and Pain – What’s the Link?Figure 2Standing Posture and Pain – What’s the Link?Figure 3

Among my patients, I routinely observe a flatter medial arch that drops one or both feet towards the floor (Figure 3). I have seen a “knock-kneed appearance” because of too much internal tibia and femur rotation. I have observed that the inferior tipped pelvis leans toward the more pronated foot (now one hip is higher than the other). This then leads to a lateral curvature of the lumbar spine towards the flatter foot with a resultant slight curvature of the T-spine to the opposite side, throwing the shoulder height off in the body’s attempt to keep the head level. 

Remember that most patients you encounter have no clue about the presence of the three arches of the foot and how their function affects the entire body. The feet themselves don’t hurt and they are accustomed to being told by other healthcare providers that pain in other areas of their body, like their lower back, is due to them “getting older”. You have a lot of power to help them understand the true source of their issues and give them action steps for pain relief.

Action steps 

As chiropractors, we address pain throughout the body by identifying the root cause and providing proactive solutions, rather than masking pain through opioids and shots. For the most effective treatments, I suggest making the following steps part of every patient’s care:

  1. Perform regular chiropractic adjustments Postural stresses created by both excessive foot pronation (and supination) create misalignments and subluxations throughout the extremities and the spine. Find and address them using the “Crooked Person” as a model for patterns you can look for and incorporate these actions into your ongoing adjustments. Other chiropractors who don’t check the feet may miss these patterns … but you won’t. This elevates the quality of your care.
  2. Prescribe custom, three-arch, flexible orthotics Support the three arches properly and the effects of the “Crooked Person” and the lateral pronation diagram can be greatly reduced. I tell my patients that “with these custom orthotics, we are going to level you up and support your body from toes to nose”. 
  3. Encourage sedentary workers to vary their positions Experts suggest that for a 30 minute time period, a person should sit for 20 minutes, stand for 8 minutes and then move around for 2 minutes. This is a good rule of thumb for our patients as well. You can come up with your own time parameters, but there should be a mix of sitting and standing. Even with proper orthotics in their shoes, we don’t want patients standing more than 30-45 minutes because the body gets too stressed and fatigued. Mix it up!
  4. Recommend exercises that range from stretching, strengthening and cardiovascular The suggestions we make for our patients are as individual as they are and are based on their needs. Someone might want to get back to doing yoga while someone else just needs to begin walking at their lunch break again. Use your clinical knowledge based on their daily activity demands to get the perfect exercise program for that patient. 

Through your non-invasive care, you can help prevent patients from turning to dangerous pain medications like opioids. 

The opioid epidemic continues to worsen at epic proportions. The latest updated statistics from the National Safety Council quote the odds of dying from an accidental opioid drug overdose at 1 in 58. If you Contrast that with the odds of dying from a motor vehicle crash, 1 in 93, and falls, 1 in 989, the opioid odds are shocking. As chiropractors, we offer drugless solutions to the cause of patient health problems. Treating the effects of excessively flat feet to help mitigate chronic pain is one such opportunity. 

Using the healthy standing posture has critical links to the feet and the three arches. We are always saying that “when the foot hits the ground, everything changes”. That is very apparent when looking at the effects the feet have on standing posture. By incorporating these crucial steps into your treatment plan, you can be the health care practitioner who supports your patient’s posture and body from the ground up, for improved overall wellness. 

In the U.S., you are more likely to die from an accidental opioid overdose than a motor-vehicle crash.*

*National Safety Council

Dr. Kevin M. Wong, DC is a graduate of the University of California, Davis, and a 1996 Summa Cum Laude graduate of Palmer College of Chiropractic West. He has been in practice for over 25 years and is the owner of Orinda Chiropractic & Laser Center in Orinda, CA.

As a member of Foot Levelers Speakers Bureau since 2004, Dr. Wong travels the country speaking on extremity and spinal adjusting. See upcoming events with Dr. Wong and other Foot Levelers speakers at footlevelers.com/seminars. Check out his monthly blogs with proven practice tips to help you achieve optimal patient outcomes.

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