Regular readers know I spend as much time dispelling myths in my day-to-day practice as I do actually treating the patients. Today I’ve chosen to write about something I think explains the way patients and clinicians think about musculoskeletal pain. That is, the deviation away from the supposed ‘perfect’ posture of our physical shape.
What I mean is the beautifully curved spine, the head at the top of the spine with the chin tucked, shoulders back and toes pointing squarely forwards. I am describing the image we all picture when someone thinks of a good posture.
The fundamental issue I have with this is the lack of research about its importance.
For example, when I was at university during physical examination classes, we were taught to check the heights of a patient’s pelvis. We were told that differences in height could be significant for a patient’s pain. Some chiropractors still insist that this must be ‘corrected’ immediately.
Unfortunately for these posture enthusiasts, a 2023 study of 300 adults found 78% had some form of pelvic asymmetry. This means that it is more normal to be asymmetrical than it is to be symmetrical. Viewing a patient from the front with a noticeably uneven pelvis may mean they look a bit lop sided, but it turns out it is completely normal. This goes entirely against the ‘good posture’ model we’ve been discussing.
In fact, the issue is worse because having one leg longer than the other is a likely cause of pelvic asymmetry and leg length discrepancies are present in around 90% of the population.
Another study from 2019 of 202 women found that over 75% of them had one shoulder higher than the other. This study found no correlation when pain levels were compared to shoulder asymmetry. So, it’s more common than not to have uneven shoulders and it is not related to pain.
Another area I regularly hear chiropractors discuss is that if a patient has too much or too little curvature in their lumbar spine then that could be a cause of their pain.
A study from 2025 of nearly 36,000 test subjects found enormous variations in spinal curvatures, with lots of differences linked to age, gender and race. So, if everybody has different levels of spinal curvatures and it’s due to factors outside of our control, it would be an enormous leap to suggest that it’s linked to pain or is abnormal.
As a final example I will discuss forward head carriage. This is when a person’s head sits slightly in front of their shoulder line when viewed from the side (if you poke your chin forwards you will see what I am describing).
I’ve lost count of the number of times I have heard practitioners blame the position of a patient’s head for their neck pain. A 2019 research paper reviewing lots of other high quality research found no correlation between neck pain and forward head carriage.
Musculoskeletal pain is a complex and unpleasant physical experience, made up of factors from our biology, lifestyle, environment and mental health. It’s impossible to put a patient’s back, neck or shoulder pain down to simple postural asymmetry, it’s a hugely reductionist way of viewing the body and it won’t lead to effective management of their problem.
Moreover, any practitioner who claims to be able to alter these asymmetries with hands-on treatment is likely ill-informed and not working from a best practice, research-backed model.
When seeking a healthcare practitioner to help you manage pain, you are better off to find someone who listens intently, provides you with a clear explanation that encompasses the broad spectrum of causes for pain (not just presenting you with a list of your physical asymmetries), and then creates a tailored care plan that involves hands-on treatment, exercise rehabilitation, education and lifestyle management.
We are all different shapes, sizes and have a wonderful array of asymmetries; they’re all normal!
This article first appeared in the Diss Express in July 2026.
