Fibromyalgia is a complex chronic pain condition commonly associated with widespread pain, fatigue, sleep disturbances, increased pain sensitivity, and difficulty performing everyday activities.
Because fibromyalgia involves changes in how the nervous system processes pain, researchers have long looked for measurable factors that may help explain why symptoms vary so dramatically from one person to another.
A 2025 study published in Scientific Reports examined an interesting possibility: Could the three-dimensional alignment of the spine help predict the severity of fibromyalgia symptoms?
The results showed a surprisingly strong relationship between several postural measurements and outcomes including pain sensitivity, sleep quality, pain-related thinking, and overall fibromyalgia impact.
What Did the Researchers Study?
Researchers evaluated 303 patients diagnosed with fibromyalgia syndrome according to established American College of Rheumatology criteria.
Rather than relying only on a traditional posture examination, the researchers used a validated 3D surface-imaging system to measure several aspects of spinal and pelvic alignment.
The measurements included:
- Sagittal imbalance — how far the body shifts forward or backward
- Coronal imbalance — side-to-side displacement
- Vertebral rotation
- Pelvic obliquity — whether one side of the pelvis sits higher than the other
- Pelvic torsion
- Pelvic rotation
The researchers then used several machine-learning models to determine whether those measurements could predict clinical outcomes including pain sensitivity, sleep quality, the Fibromyalgia Impact Questionnaire, and the Pain Catastrophizing Scale.
The Relationship Was Remarkably Strong
The best-performing machine-learning models demonstrated very high predictive values.
For example, spinal and postural measurements produced an R² of 0.97 for sleep-quality scores, 0.95 for algometric pain sensitivity, 0.94 for pain catastrophizing, and 0.88 for overall fibromyalgia impact.
In simple terms, the researchers found that differences in three-dimensional spinal and pelvic alignment were strongly associated with differences in fibromyalgia symptom severity within this group of patients.
Two measurements appeared particularly important: sagittal imbalance and pelvic obliquity.
Vertebral rotation also demonstrated an interesting nonlinear relationship with symptoms. When rotation exceeded approximately 10 degrees, its contribution to predicted pain severity increased substantially, particularly when combined with greater sagittal imbalance.
Why Could Posture Matter in Fibromyalgia?
Fibromyalgia is not simply a muscle or joint disorder. It is associated with central sensitization, in which the nervous system becomes increasingly sensitive to sensory and painful input.
That makes the relationship between biomechanics and the nervous system particularly interesting.
Abnormal spinal alignment can change the way gravity and mechanical forces are distributed through the spine, muscles, joints, and surrounding tissues. Researchers are investigating whether persistent abnormal mechanical input may contribute to the overall sensory burden experienced by some patients with chronic pain conditions.
The current study does not prove that poor posture causes fibromyalgia.
However, it does suggest that spinal biomechanics may be one meaningful piece of a much larger puzzle.
This Does Not Mean Fibromyalgia Is “Just a Posture Problem”
This distinction is important.
The study was observational and cross-sectional. Researchers measured patients at a particular point in time and identified relationships between their spinal alignment and clinical symptoms.
That means the study can demonstrate an association, but it cannot establish that spinal misalignment caused fibromyalgia or that correcting alignment will cure the condition.
Fibromyalgia remains a complex disorder influenced by neurological, biological, psychological, sleep, activity, and other factors.
What this research does provide is additional evidence that objective spinal biomechanics may deserve consideration when evaluating patients with fibromyalgia, particularly when significant postural abnormalities are present.
Why Objective Measurements Matter
One of the most interesting aspects of this research is that the investigators did not simply categorize posture as “good” or “bad.”
They measured specific three-dimensional deviations and used those values to examine how structural differences related to clinical symptoms.
That philosophy is similar to how we approach spinal biomechanics at Strong Spine & Body.
Rather than evaluating posture exclusively by appearance or treating only the location where someone hurts, we look for measurable abnormalities in spinal alignment and function.
How We Evaluate Spinal Alignment at Strong Spine & Body
At Strong Spine & Body in Sandy Springs, we use comprehensive examinations, postural analysis, and digital biomechanical radiography to evaluate spinal alignment.
For patients who demonstrate significant structural abnormalities, our Chiropractic BioPhysics® approach may incorporate individualized chiropractic adjustments, Mirror Image® corrective exercises, corrective spinal traction, neuromuscular re-education, and objective reassessment of progress.
The goal is not to claim that spinal correction treats or cures fibromyalgia.
Instead, we want to identify whether a patient has measurable biomechanical abnormalities that may be contributing to their overall mechanical stress and functional limitations, and determine whether those findings are appropriate to address as part of a broader healthcare strategy.
You can learn more about our Chiropractic BioPhysics® approach here.
A Growing Area of Research
This study adds an interesting new dimension to the discussion surrounding fibromyalgia.
For years, patients with fibromyalgia have often experienced significant symptoms despite relatively few objective findings on conventional examinations.
Advanced biomechanical measurements and machine-learning analysis may help researchers identify patterns that traditional methods have overlooked.
More research—particularly prospective studies and clinical trials—is needed to determine whether improving specific spinal alignment abnormalities actually produces meaningful improvements in fibromyalgia outcomes.
For now, the findings provide another reason to consider posture and spinal biomechanics as part of a comprehensive evaluation rather than looking only at the location of pain.
Read the Original Research
The study discussed in this article was published in Scientific Reports in July 2025:
Moustafa IM, Khowailed IA, Mohammad Zadeh SA, et al. Advanced machine learning applications in fibromyalgia to assess the relationship between 3D spinal alignment with clinical outcomes. Scientific Reports. 2025;15:22804.
You can also read the patient-focused summary from CBP NonProfit. Read the CBP NonProfit research summary
Important: This article is provided for educational purposes. The research demonstrates associations between 3D spinal alignment measurements and fibromyalgia-related clinical outcomes. Individual evaluation and treatment recommendations vary.
