Musculoskeletal problems and the cost to the economy
In this article we put 'poor posture' in the spotlight and explore its economic consequences, as well as the role that Pilates teachers play in correcting spinal alignment and in teaching good postural habits.
According to the Office of National Statistics, a total of 131 million days were lost because of sickness absence in the UK during 2011, and the greatest number of days lost were for musculoskeletal problems, which accounted for more than a quarter of sickness absence (34.4 million days). People taking days off work due to having a ‘bad back’ are common and its costing the economy millions of pounds each year. EEF chief medical adviser professor Sayeed Khan said: "The gains in tackling short-term absence have now been largely exhausted and, if we are now to make serious inroads into tackling long-term conditions, we need a renewed approach from Government, companies and other bodies."
Each year one third of the adult population is affected by lower back pain. It is the second biggest reason for sick days and costs the UK £38.4 billion per annum. Of those suffering back pain, approximately 20% will consult their GP. Although most cases are not serious and will resolve themselves spontaneously within a few weeks, it is estimated that total yearly healthcare cost of lower back pain is around £12.3 billion.
Lower back pain is the leading cause of disability in the world with 80% of the population having an episode of back pain at one point in their lifetime  and 35% suffering from it at any one time.
Between 15% and 45% of the population will develop chronic back pain, which is pain persisting for more than three months. For those people, back pain can have an adverse effect on their quality of life and social relationships.
As Pilates teachers, we are very adept at assisting clients back to good health if they are referred to our class suffering with a bad back. We understand the absolute benefits of improving musculoskeletal strength and throughout each of our classes, we teach exercises that will help our clients to improve and create good posture for themselves – but what exactly does good posture mean?
Posture is the position in which you hold your body upright against gravity while standing, sitting or lying down. Good posture involves training the mind and body to stand, sit, lie and perform everyday life activities such as walking, bending down and exercising in positions where the least amount of strain and stress is placed on supporting structures, muscles and ligaments.
Good or ideal posture not only offers aesthetic benefits but also optimal musculoskeletal function. Due to the specific and often limited movement patterns employed by many of our clients as a result of modern living, postural faults can lead to pain and discomfort or even disability.
A well designed exercise programme can help to play an important part in our clients’ lives by addressing postural faults and providing both strengthening exercises and stretches such as those in used in Pilates.
In a group exercise class we can only rely on visual assessment of our clients and this may not necessarily give a true picture of the specific problem, so if in doubt it is advisable to do a one-to-one assessment of the client and to give them specific exercises and stretches to do at home. We will consider general posture types and how we can incorporate Pilates exercises into our classes to address the more common problems that you may come across.
What is ‘poor’ posture?
Poor posture is where your bones are not aligned properly and muscles, joints and ligaments take more stress than nature intended. Poor posture can result in aches and pains, which usually can be traced back to poor postural habits. According to the AAOS (American Academy of Orthopaedic Surgeons) it can result in a ‘faulty relationship of various parts of the body which produces increased strain on the supporting structures and in which there is less efficient balance of the body over its base of support’.
It seems achieving poor posture is easy but achieving good posture is difficult especially for certain people. It is important to realise that clients will have learnt their postural faults over many years and to start with you will need to help them re-align through ‘hands on’ corrections until the client can do this for themselves. This means that they will have moved into the motor stage and can automatically correct themselves through better body awareness and proprioception.
The spine is a curved column of vertebral bodies that act as a support for about half the weight of the body with the other half supported by the muscles. The flexibility of the spine allows the body to rotate, flex forward and flex laterally.
The cervical spine (neck – C1-C7) has 7 vertebral bodies. These vertebrae are the smallest in the spinal column.
The thoracic spine (upper and middle back – T1 – T12) has 12 vertebral bodies. This level has very little motion because the vertebrae are attached to the ribs and sternum (breastbone). As there is little motion in this level of the spine it is not usually a site of chronic pain.
The lumbar spine (lower back – L1-L5) has 5 vertebral
bodies. This level extends from the lower thoracic spine to the sacrum (bottom of the spine). The vertebral bodies are stacked on top of each other with a disc in between each pair. These vertebrae are the largest in the spinal column.
The sacrum is a fusion of 5 sacral vertebrae (fusion occurs from late teens to early twenties).
The coccyx or ‘tailbone’ is a fusion of 4 coccygeal vertebrae.
Each vertebra has a bony arch that is positioned so that the space enclosed forms, in effect, a tube: this is the vertebral canal which protects the spinal cord. Between each pair of vertebrae is a disc that has a tough outer core with a jelly-like substance inside. Its primary function is to act as a shock absorber.
Poor posture can lead to increased stress on soft tissue. (ligaments, discs, muscles), biomechanical compensation, adaptive shortening, weakness and instability, immobility and muscle and joint tension, all of which can cause muscle imbalance.
Muscle imbalance is due to changes in muscle length: this means that the agonist muscle becomes significantly stronger than its antagonist, or that one becomes significantly shortened or stretched. If the muscles on one side of a joint are tight and the opposing muscles are stretched the joint will be pulled out of alignment toward the tight muscle.
Regular physical activity with special attention to strengthening the core muscles (along with neighbouring muscle groups) and stretching of the tight muscles can reduce muscular imbalance and general backache through poor alignment for most people.
As Pilates teachers, we talk about ‘neutral alignment’ and ‘neutral spine’ as being a definition of ‘ideal’ posture. Neutral or natural spine is defined as the position in which the spinal vertebrae and pelvis are aligned and maintained with the least amount of stress placed on the supportive tissues (discs, ligaments, joint surfaces and other soft tissues).
When viewing the posture in a standing position, a ‘plumb line’ is used to assess the posture in this position. This is a vertical line that shows the line of gravity and provides a line of reference that can show any abnormalities in the alignment.
Plumb line points during side viewing in neutral or ideal alignment:
- Ear lobes
- Bodies of cervical vertebrae
- Shoulder joint – tip of shoulder blades
- Bodies of the lumbar vertebrae
- Slightly posterior of hip joint (through greater trochanter of femur)
- Slightly anterior of centre of knee joint
- Slightly anterior of lateral malleolus (outside ankle bone)
You’ll find out in more detail about specific spine shapes when you attend the Pilates Improver course. You’ll learn key features to recognise in your clients and this will help you to establish their posture type. Having established this, you’ll learn which specific Pilates exercises are required to help improve posture and create better alignment.
 NICE, (2012) Low back pain; early management of persistent non-specific low back pain. Available at: http://publications.nice.org.uk/low-back-pain-cg88. (Accessed 28 November 2012). Back to top
 Whitehurst, DGT., Stirling, B., Lewis, M., Hill, J., Hay, E.M. (2012)Exposing the cost-utility of stratified primary care management for low back pain compared with current best practice within risk-defined subgroups. Annals of the rheumatic diseases. Back to top