Posture and Perceived Distress: A Narrative Review of Evidences, Mechanisms, and Physiotherapy Applications

Background: Posture is closely linked to emotional expression and psychological distress, with altered postural alignment and movement patterns commonly observed in individuals experiencing anxiety and depression. While posture has traditionally been viewed as a manifestation of emotional state, emerging evidence suggests that it may also play an active role in modulating distress. Objective: This narrative review aims to synthesize existing evidence on the relationship between posture and perceived distress, examine proposed physiological and psychophysiological mechanisms, and discuss implications for physiotherapy practice. Methods: A narrative synthesis of experimental, observational, and clinical studies was undertaken, drawing from psychology, neuroscience, and movement science literature. Studies examining postural alignment, movement patterns, and posture-based interventions in relation to emotional and stress-related outcomes were reviewed. Results: Evidence indicates that contractive or slumped postures are associated with increased negative affect, fatigue, and psychological distress, whereas upright or expansive postures are linked to improved mood, self-perception, and stress regulation. Proposed mechanisms include autonomic regulation, interoceptive awareness, cognitive–affective processing, and context-dependent neuroendocrine responses. However, findings related to hormonal changes remain inconsistent, suggesting that posture-related benefits are more reliably mediated through autonomic and cognitive pathways. Notably, the majority of existing studies have not been led by physiotherapists, despite posture and movement being central to this profession. Conclusion: Posture appears to contribute to perceived distress through multiple interacting mechanisms, although effects are modest and context dependent. Physiotherapists, with expertise in posture assessment, motor relearning, and biopsychosocial rehabilitation, are uniquely positioned to translate this evidence into structured postural exercise programs. Such interventions may serve as accessible, non-invasive, and low-cost adjuncts to conventional psychological therapies. Future physiotherapy-led randomized controlled trials are warranted to establish efficacy, develop standardized protocols, and examine long-term outcomes of posture-based approaches for distress management. Keywords: Posture, Perceived distress, Physiotherapy, Stress, Anxiety, Embodiment, Postural exercise.