Features September 2005 Issue

Arthritis Or Poor Posture: Which Comes First?

Improve your strength and flexibility to improve your posture—and alleviate back pain in the bargain.

Jack is 55 and has osteoarthritis in both knees. Helen is 60 and has rheumatoid arthritis in her knees, back, and hips. Pat is 65 and has been diagnosed with ankylosing spondylitis, arthritis of the spine. All three have something in common—poor posture. With Jack, it’s a limp; with Helen and Pat, it’s a hunched-over, stiff-looking back. Which came first, the bad posture or the arthritis?

“Generally, poor posture is a result of arthritis,” says John Carey, M.D., clinical associate in the department of rheumatic and immunologic disease at The Cleveland Clinic. “Many chronic forms of arthritis can lead to deformities and disabilities that predispose patients to poor posture. However, there is no evidence that poor posture leads to inflammatory arthritis.”

Condition-specific posture
Certain conditions, such as Pat’s ankylosing spondylitis, Reiter’s syndrome, and certain cases of psoriatic arthritis, primarily affect the skeletal system and often result in poor posture. By their nature, these conditions can cause rigidity of the spine, deformities in the upper part of the spinal column, and loss of the normal curve in the lumbar (lower back) area. All of these processes can lead to the deterioration of posture.

“Jack’s osteoarthritis,” explains Dr. Carey, “is more controversial. For a long time, we’ve known that joint injuries can lead to poor posture, but it is difficult to determine whether the joint injury or poor posture came first.” There is some evidence that people who suffer knee injuries were predisposed to osteoarthritis (OA) because the joint suffers “postural instability.” Others argue that it is only after such injuries that the joint suffers postural instability. There is also research that associates conditions like bow-leggedness and knock-knees with a predisposition to OA. “What is almost certainly true,” says Dr. Carey, “is that poor posture may well hasten the progression of the disease.”

Poor posture in itself can also result in pain and disability, especially during activities such as walking. An abnormal gait and bad posture can lead to other painful conditions such as bursitis, tendonitis, and muscle spasms. And bad posture can cause some people to fall and fracture a bone if they have a combination of osteoporosis and arthritis.

Multidisciplinary approach
Regardless of which comes first—arthritis or poor posture—both can set off a chain of events that makes the person susceptible to a long list of potential health problems. But Jack, Helen, and Pat don’t have to passively wait for all of those unhealthy events to unfold. “A multidisciplinary approach to the problem usually works best. We can prescribe medications (nonsteroidal anti-inflammatory and disease-modifying antirheumatic drugs) and, in extreme cases, perform corrective surgery. Physical therapy for muscle conditioning, balance training, and range-of-motion exercises are essential.”

Simple exercises (see sidebar) to increase lower-back and abdominal strength, flexibility, and range of motion can also improve posture and alleviate lower-back pain. Braces, shoe inserts, and other assistive devices can improve posture and daily function, as well as limit disability, although Dr. Carey urges his patients to avoid over-reliance on such devices because they can lead to muscle weakness and loss of function.