Posture is a popular topic of discussion among healthcare workers, patients and people of all ages. It is prevalent in the fitness industry, the media and society as a whole. Everyone has been told to sit up straight and mind their posture at one point in life. The belief being that sitting with upright posture prevents neck and back pain, it prevents people from developing long term postural changes and prevents developing weakness and health-related issues. Our society spends a lot of money developing ergonomic equipment in the workplace for desk workers and people spend a lot of time in the day worrying that they have been slouching for too long and fear the above postural changes described. However, despite all of the time, education, product development and resources spent focusing on posture, there is no strong evidence in the literature that supports the notion that sitting slouched leads to pain and that one posture is better than another. This challenge might come as a surprise but below, I will highlight some points and use the available scientific evidence to support my claims.
The first point to be addressed is that poor, flexed posture causes pain. There indeed is no strong evidence that supports posture itself leads to pain. That does not discount the fact that once a person is already in pain, that certain postures will cbe painful but that activities such as sitting too long, being on the phone for too long and watching TV are not directly responsible for causing pain alone. Our understanding of pain has progressed a lot and we now understand that pain is very individualized and specific to each person. Beyond stresses to tissues and muscles and discs lies psychosocial contributions to pain that will be different for each person. This includes belief systems, fear of movement/positioning, stress/anxiety and quality of sleep. Taking these factors into consideration suggests that insistent instructions to sit up straight and the societal belief that poor posture leads to pain and damage especially problematic for people. Although these instructions are of course good natured and meant to protect, they may actually lead to more harm than good. People stressing about sitting up straight, being constantly aware of sitting up straight and worrying about how much time they have slouched can act as a nocebo which is the opposite of a placebo effect and is capable of producing pain.
In addition, the notion that sitting erect with appropriate curves in the low back may actually not be comfortable. Everyone is built differently and there are those with less spinal curvature in the low back or perhaps too much curvature leading to stress which may be more uncomfortable. Furthermore, evidence shows that people with neck and low back pain actually have more muscle activity than those without pain making it a better strategy for the person to relax and adopt postures that are comfortable. This leads to a notion that the “next posture may be the best posture” in which the person may be best off adopting postures that are comfortable and getting up and moving regularly.
This blog is meant to not only challenge the widely accepted postural beliefs but to hopefully give those reading a break and to know that it is safe to adopt different postures, to take away the burden of constant stressing about how you are sitting and to help you relax. The spine is extremely robust and able to tolerate many stresses. Posture and pain in itself are different for everyone due to the different beliefs and anatomical builds of the patient. Again, this is not to say that posture does not matter because those already in pain will have certain postures and positions that aggravate and relieve pain. If you are someone experiencing pain with sitting, standing, bending, movements of the neck etc. contact us at Breakthru Physical Therapy and get your individualized assessment to help put you in the best position to meet your goals!
Slater, D et al. “Sit Up Straight”: Time to Re-evaluate. J Orthop Sports Phys Ther 2019;49(8):562-564. doi:10.2519/jospt.2019.0610