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When Body Alignment Matters: Function v. Chronic Pain

Chronic pain is the leading cause of disability in the United States, with an annual cost estimated to be about $100 billion. These costs are associated with healthcare expenses, lost income, and lost productivity. A majority of adults experience acute pain at least once in their lives with about 28% later developing chronic pain.

With the nation’s growing opioid epidemic, there's been considerable emphasis on understanding the sources of chronic pain. Many mistakenly believe that tissue damage is directly correlated with a person’s risk of developing chronic pain. Statements from medical professionals to their patients which include “Your MRI shows that you have the spine of an 80 year old and you can expect to be in pain for the rest of your life” or “just avoid stairs or squatting entirely if your knees are hurting” just further exacerbate the myths surrounding chronic pain.

There is much confusion regarding body alignment, movement, and pain even within the medical community. Many of those with chronic back, neck, or knee pain have been told by at least one medical professional that this is the result of “wear and tear” or poor posture. As a physical therapist, I work with people who experience chronic pain with near perfect body alignment, and others without any pain but very poor alignment and body mechanics. So what gives?

Risk Factors for Chronic Pain

Research shows that up to 27% of adults age 30–50 years show a disc herniation with imaging but do not have symptoms. Only about 10% of those with disc herniation have significant symptoms after 6 weeks. This is just one example of the many studies that now show tissue damage does not directly correlate with developing chronic pain.

Psychosocial factors have more predictive power in identifying those who will go on to develop chronic low back pain than physical factors. What research has found is that factors such as anxiety, depression, stress level, occupation, gender, and low socioeconomic status correlate with future risk of chronic pain. Women are more likely than men to experience chronic low back pain at some point in their lives. Those with low socioeconomic status are both more likely to develop chronic pain and to have a prolonged course of care with worse outcomes.

When Body Alignment and Mechanics Do Matter

So... with all that being said, is there a time that body alignment does matter?

Yes, in fact!

Although chronic pain is more complicated than poor alignment or mechanics, there is a time and place where mechanics do matter. Poor body mechanics and tight muscles increase friction within the joints leading to arthritic damage over time. However, as we discussed above arthritis does not automatically lead to chronic pain.

In terms of the function of your body, alignment becomes very important. If you experience pelvic floor dysfunction, bunions, kyphosis, or osteoporosis your alignment does matter.

Muscle has an ideal length and position at which it functions. How we move and position our body parts relative to each other determines how they function. For example, keeping the ribs aligned vertically over a neutrally positioned pelvis allows the muscles of the abdomen and pelvic floor to work together, preventing incontinence or even organ prolapse. Likewise to prevent osteoporosis, our bones need to be in a position in which they are bearing our body weight. If you walk with your torso leaning forward, your hips are not technically bearing your body weight, weakening the bone and predisposing you for future fracture risk.

If you want your body to function at its highest capacity, body mechanics and alignment do matter.

By developing an understanding of the factors surrounding chronic pain, body alignment, and function we can start to discuss solutions for prevention and management of chronic pain.


  1. Delitto et al. Low back pain: clinical practice guidelines linked to the internal classification of functioning, disability, and health from the orthopaedic section of the American Physical Therapy AssociationJ Orthop Sports Phys Ther Apr 2012; 42(4): A1–57.
  2. Jordon et al. Herniated lumbar discBMJ Clin Evid 2009.
  3. McGreevey et al. Preventing chronic pain following acute pain: risk factors, preventive strategies, and their efficacyEur J Pain Suppl 2011 Nov 11; 5(2): 365–375.

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