The Backbone of America

President Donald Trump delivered his remarks at the commencement ceremony of the United States Military Academy, also known as West Point, on Saturday, June 13. As he proudly announced the expansion of the armed forces under his administration—with the Space Force, hypersonic missiles and all—the president's customary political posturing was present.

But West Point's graduating class was soon joined by audiences on social media. A video clip of the ceremony, in which Trump can be seen taking tentative and shaky steps as he walked down a ramp at his entrance, began trending on Twitter, along with the hashtag #TrumpIsNotWell. The hashtag, which remains trending, is reflective of a long-existing concern where Americans have raised an eyebrow at the President's awkward balance and posture at public appearances.

It remains unclear whether it’s Trump’s physical or political backbone that warrants greater scrutiny, but one thing is certain: Trump’s positioning sheds light on the larger, intergenerational crisis concerning the decline of American posture.

Poor posture is an epidemic that easily outpaces COVID-19. For years, it's adopted many names, from the classic "tech neck" to the more recent "Zoom hunch." These pithy labels, however, can be misleading. Though the rise of technology has certainly played a significant role in the spread of poor posture among younger generations, poor posture was reaching the youth long before iPhones did. While straining your neck to look down at an electronic gadget for hours at a time would undoubtedly play a part in accelerating the rise of bad posture, the root cause of the increase in poor posture lies in education.

With the establishment of the American compulsory education system 100 years ago came concerns for the health-related impacts of children sitting at desks for six hours a day—an unprecedented expectation at the time. To address those fears, school officials zealously enforced posture in education by incorporating posture into daily curricula. The American Posture League (APL) was born in 1914 with hopes to standardize posture education across the nation. Under the APL's watch, posture education was not only enforced consistently across the country, but posture evaluations gave measurable and trackable results. Thus, the maintenance of posture in American schools was not only strictly enforced, but also closely monitored.

The efforts of school officials and the APL ultimately proved successful—that is, until posture education vanished in the 1960s. However pervasive the importance of maintaining good posture once was, with sayings like "don't slouch" and "keep your elbows off the table" ringing through American schools and households alike, the pressure to sit upright soon buckled under the influence of pop culture. The flapper movement, for example, championed slouching as an act of protest, associating upright posture with rigidity and conformity. Throughout the 20th century, America experienced a push toward making schools more progressive and less disciplinary in nature. As a result, posture education, alongside the punitive and rigid nature of traditional schooling, received the boot. The consequences of this removal have reverberated into the modern day; research now finds American posture in rapid decline. The lack of attention to posture—coupled with even longer school days, the ubiquity of gadgets like mobile phones, and full-day video-conferencing schedules—experts warn, is a recipe for disaster.

The impact of poor posture has proven to be much greater than what meets the eye. Excessive slouching stunts growth in both individuals and the economy—after the common cold, back pain is the largest cause for absenteeism from work, accounting for 15 percent of sick leaves. It also accounts for the third-highest amount of healthcare spending at a staggering $87.6 billion. And, for younger generations, bad posture is linked to a multitude of immediate physical and mental health impacts, including anxiety, depression, and fatigue.

More alarmingly, spine-related health problems have also been found to be a major contributor to the opioid crisis. With back pain being the second most common reason that people see a doctor, individualized attention for back pain cases has become rare, and treatments for them became more generalized. Today, the general treatment that doctors offer are opioids. The problem is that opioids are overprescribed and anything but a viable solution. According to experts, while opioids temporarily alleviate neck and back pain, they do little to fix the underlying problem. Rigorous physical therapy and posture education, experts advise, remain the only solutions. Yet in modern doctors' offices, these recommendations are completely absent. As more and more Americans go to the doctor for back pain, less and less receive the treatment they need. And from the perspective of the pharmaceutical industry, the reasoning is clear: there is far more profit to be gained in prescribing pills than physical therapy.

The solution is simple: reimplementation of posture education in schools. In order to circumvent profit-driven incentives in the healthcare industry, deliver effective measures to decrease neck and back pain, and bolster long-term musculoskeletal health across the board, action must start precisely where the problem did: in education. Several studies measuring the effectiveness of postural education programs—conducted with various age groups, regions, and sample sizes—found statistically significant trends in the improvement of posture and general musculoskeletal health. In one study published in the Journal of Orthopaedic Science this past July, a one-year postural education program was found to decrease lower back pain in students by up to 49 percent. Just as they were 100 years ago, proper posture education and maintenance should be required and standardized components of schooling.

In the wake of COVID-19, the epidemic of poor posture makes its stand yet again. As schools implement remote learning solutions and students continue to fall victim to the "Zoom hunch," American posture continues to worsen. But with or without remote solutions, President Trump still stands staunchly to push for brisk school reopenings—at a press conference last month, he championed the necessary "mental, physical, emotional, and academic development that schools provide." His posture on education is undoubtedly a resolute one, and for the sake of health, productivity, and the economy alike, that posture should also include—well, posture.