Actually, It’s OK to Slouch

One of the latest and surprising findings in the field of physical therapy is that slouching is not as bad as we think it is. Certain researchers have gone so far as to say that the conventional fear mongering regarding poor posture can actually be more harmful than slouching itself.  Undoing over a century’s worth of public health messaging about the evils of poor posture—let alone the custom of elders telling youngsters to “sit up straight”—will be a monumental task.

I know because I’ve spent the better part of a decade researching the so-called "poor posture epidemic" of the 20th century, studying the myriad ways in which posture panic has become part of the fabric of our everyday lives. What I’ve found is that some of our most cherished beliefs about posture health are unexamined remnants of cultural and political concerns from the past.  

At the turn of the century, the idea that poor posture posed a serious population-wide health threat became entrenched in American public and popular health culture, thanks in part to the then-burgeoning fields of evolutionary medicine and paleoanthropology. Applying the theories of Charles Darwin to medical practice, early posture advocates such as Jessie H. Bancroft, R. Tait McKenzie, and Eliza M. Mosher—founders of the American Posture League –began to argue that without proper preventative health treatment, bipedalism might actually be an inherent weakness to human functioning, causing organ prolapses and other musculoskeletal problems not found among quadrupedal non-human animals.

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The first study to report on the extent of the problem—the 1917  “Harvard Slouch” study – found that 80% of Americans had bad posture. This spurred further nationwide studies at universities, workplaces, and within the military for much of the twentieth century, all of which came to a similar conclusion. Along the way, industrialists learned that the poor posture epidemic was good for business, leading to new, lucrative markets in ergonomic chairs, back braces, shoes, and fitness regimes, such as yoga and Pilates.

By the mid 20th century, poor posture came to be seen as the culprit for rising rates of low back pain, even though little hard evidence existed to prove such claims of causality. President John F. Kennedy, who had repeated back surgeries and chronic pain, hired his own personal posture guru, Hans Kraus, a man who would go on to create one of the most well-known posture and fitness tests administered to hundreds of thousands public school children throughout the Cold War. It was in this cultural and political context of containment that uprightness became a symbol of patriotism, heterosexual propriety, and individualist strength, all virtues believed to be needed in order to defeat the threat of communism.

And yet even after the Cold War came to an end, the belief in the causality between poor posture and future ill health remained largely unquestioned .

Today, epidemiologists estimate that approximately 568.4 million cases of disabling low back pain exist worldwide, with the highest prevalence seen in the United States, with Denmark and Switzerland following close behind. The causes appear to be many, from low socioeconomic status and biomechanical strain to poor diet and psychosocial stress. In the U.S., spending on low back pain exceeds that of hundreds of other health conditions (including diabetes), with an estimated $134.5 billion dollars devoted to the condition in 2016.

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Similar to a century ago, today’s evolutionary biologists continue to puzzle over human upright posture. Italian evolutionist, Telmo Pievani tells us that “the transition to bipedalism generated negative consequences in almost every part of the body.” Of course, one might reasonably wonder why, evolutionarily speaking, such an imperfection would be passed down from generation to generation. Wouldn’t natural selection weed out this kind of physical weakness?

According to Harvard paleoanthropologist Daniel Lieberman, conditions of poor posture, back pain, and obesity belong to a group of diseases which he calls “mismatch diseases,” maladies that arise due to novel environmental conditions for which the human body is poorly adapted. Lieberman, similar to evolutionists before him, blame industrialization for back pain. He contends that “from the body’s perspective, many developed nations have recently made too much progress. For the first time in human history,” he continues, “a larger number of people face excesses rather than shortages of food. Two out of three Americans are overweight or obese.” Obesity is not the only concern. “Depending on where you live and what you do,” Lieberman warns in his book, The Story of the Human Body, “your chances of getting low back pain are between 60–90 percent.”

In order to solve this (evolutionarily speaking) new problem of industrialized peoples, certain therapeutic body workers and self-designated ethnophysiologists have looked to indigenous populations who exhibit “primal posture.” One of the most prominent North American adherents to this approach is Esther Gokhale. Raised in India by European parents and later educated at Harvard and Princeton in biochemistry, Gokhale today is known as the “posture guru” of Silicon Valley, where she treats corporate heads of Google, Facebook, and other prominent online personalities, such as conservative journalist Matt Drudge. Gokhale developed an interest in human posture at a young age. With a tendency to exoticize, Gokhale recalls of her childhood in India, “I remember listening to my Dutch mother marvel at how gracefully our Indian maid went about her duties and how easily the laborers in the street carried their burdens.” Later in life, she documented the spinal health of indigenous peoples in Burkina Faso and Ecuador, photographing potters, basket makers, weavers, and head-carriers whom she admired for their ideal postures. Thereafter, she undertook training with Noëlle Perez, founder of the Aplomb method in Paris and one of the first Europeans to study under the Indian yoga master, B.K.S. Iyengar.

Largely devoid (at least at the outset) of breathing and meditative practices, Iyengar developed arguably the most biomedically friendly systems of yoga to come out of modern India, especially with its emphasis on biomechanical alignment and symmetry. When Perez opened her own Iyengar-inspired studio in Paris in the 1970s, she undertook doctoral studies in ethnophysiology at the École des Hautes Études en Sciences Sociales and researched nonindustrialized peoples of sub-Saharan Africa, where she claimed to have found bodies in what she called natural “aplomb.” Gokhale followed in Perez’s footsteps, and today contends that “most known risk factors [for back pain] can be mitigated by good posture.”

Gokhale’s insistence on the virtues of paleo posture align well with the 21^st-century fitness industry, an enterprise known for creating slogans such as “sitting is the new smoking” and encouraging products that promote “primitive” eating and living. As in the early years of the poor posture epidemic, the evolutionary approach to understanding human posture—and now, by extension, low back pain—is good for the commercial marketplace. According to market analysts, posture correction technologies are expected to grow approximately 5.7 percent over the next five years, especially with rising demands due to the COVID-19 pandemic, with more at-home workers complaining of back pain.

On the face of it, posture improvement campaigns may seem rather innocuous. What is the harm, after all, of engaging in posture exercise programs? Of buying chairs, shoes, and devices that help to encourage it?

On an individual level, it is entirely possible that an enhanced sense of wellness can come from taking up yoga or purchasing an ergonomic chair. But when looking at the long history of posture improvement campaigns from an historical and structural standpoint, it becomes evident how value-laden they are, and how they can perpetuate sexism, ableism, and racism.

For example, scholars have, for some time, been aware of how, under the systems of slavery and colonialism, white men of science frequently assumed that Black and other non-white peoples could not feel pain, or if they did, it was felt less acutely compared to whites. Knowing this, one cannot help but wonder if the same bias has informed the work of today’s paleoanthropologists and ethnophysiologists, experts who observe so-called hunter-gatherers in Africa and deem such lifestyles to be pain free.

The social stakes of slouching are also higher for the politically marginalized.  In recent years, researchers have found that, even today, prosecutors cite poor posture as a reason to deny African American men jury selection. In his autobiography about growing up in South Africa, comedian and political commentator Trevor Noah succinctly addresses the extra vigilance required of Black men and their posture in a white supremist society. “For centuries,” he writes, “colored people were told: Blacks are monkeys. Don’t swing from the trees like them. Learn to walk upright like the white man.”               

Over the last century, health—and especially preventive health—has become increasingly commercialized: a product to be bought and sold, with the responsibility placed on individual consumers, making it a good that only those with a certain income can afford, rather than an ensured right for all. Those who cannot participate in the market are viewed as leading mismanaged lives, and when they sustain an injury that leads to permanent physical disability, are blamed for their condition. As long as posture surveillance is believed prevent low back pain, many posture and back health wellness programs are liable to create even greater health inequalities rather than mitigate them.

A recent study published by physical therapists working in Qatar, Australia, Ireland, and the United Kingdom speaks to the urgent need of the profession to dispel the medicalized myth that poor posture leads to bad health. “People come in different shapes and sizes,” they write, “with natural variation in spinal curvatures.”

In short, there is no single, correct posture. Nor does posture correction necessarily ensure future health. Maybe it’s ok to slouch from time to time, after all.

Excerpted from SLOUCH: POSTURE PANIC IN MODERN AMERICA © 2024 by Beth Linker. Reprinted by permission of Princeton University Press.