While working with patients who are experiencing low back pain, one of the most common things that I hear from them is that they are “trying to have good posture,” or are “sitting up straight,” or worse yet they “know my back hurts because I have bad posture.” All of these thoughts about posture are very common. There is a long-held belief that back pain is caused by “bad posture,” “sitting slouched,” or by bending or twisting. Many of the patients I work with have already been treated with no benefit by other health care providers who have instilled this belief in them-that pain is caused by posture and that in order to get out of pain, they have to maintain “good posture” and should not let their spine bend, slouch, or twist. The problem with this is that this belief has not been shown to be true.
Multiple studies on the neck and low back have followed groups of people who would be classified as having good and bad posture, to see if there is a difference in the incidence of pain between the two groups. What they have found is that the posture that a person naturally has DOES NOT predict future pain episodes. Therefore, it is not true that having a certain posture causes pain. We all have different shapes and sizes and different postures. This variation should be considered normal based on our body type and is not likely to change over time or specifically with a few sessions of treatment.
What about once someone has pain? Do they need to change their posture to get out of pain and then maintain this forever to prevent reoccurrences? Well, the answer to this depends. It depends on how long the pain has been present. If someone has recently injured themselves and has an acute episode of pain, it might make sense to avoid the positions that caused the pain or makes the pain worse. For instance, let’s say someone was doing yard work and bent over to pull something heavy from the ground and felt sharp pain in the low back. Now, every time they bend forward, it is very painful. If this is within the first couple of weeks since the injury, it makes sense to avoid that aggravating position or movement, and keep the back more straight and upright.
This is an adaptive change in behavior that with time, will allow the pain to subside until they can start moving normally again.
Now, let’s take another example where this type of behavior might not be so helpful. Imagine this same person is now 6 months past the lifting injury and is still focusing on sitting up straight and avoiding bent or slouched positions. By 6 months, any tissues that were injured from the lifting incident would have already healed, but the person is still protecting it and avoiding movement like the injury just happened. This is now maladaptive and does not promote recovery and return to normal movement and function. For this person, maintaining a “good posture” is not helping them get over their pain.
In people with longer standing pain, the research has shown that they have more muscle activity throughout their low back area than people without pain do. Their muscles are working overtime-still guarding and protecting the back. Now, think of how it feels to maintain “good posture” all the time. It requires work and more muscle activity than sitting back relaxed and even slouched in a chair. Their attempt to have “good posture” because this is what their therapist, chiropractor, personal trainer, or doctor told them to do, is actually making them worse-not allowing them to move normally and keeping the muscle tighter. Our bodies, and particularly the spine, are made to move and need movement in a variety of directions to stay healthy.
Anything that restricts normal movement, particularly when someone is in pain for a long time, will have a negative effect on their recovery.
To get out of pain, we should be striving for the restoration of normal, relaxed movement. Hands-on treatment to the spine can assist with moving easier with less pain, and when combined with evidence-based education about the robustness and resiliency of our spine, most people are able to return to bending, twisting, lifting, standing, and sitting anyway they want or did prior to their pain episode.
Now, let’s return to how this all relates to posture. Despite what you may have heard, there is no ideal posture for spinal health. We all have different postures and alignments depending on our body types. Knowing this, we should strive to use postures that are varied and relaxed. Our best posture is likely our next one! We should sit up straight at times, but not all the time. It is great to slouch at times, but not all the time. We can twist, or lean, or lay back, but not all the time. If you feel good and confident about yourself when you sit up tall or stand up straight, great-do it. Just don’t do it all the time! And, if you are in pain, know that it is ok to still move and that maintaining that upright, “good posture” may not be something that you want to be in all the time to help you get out of pain. Looking at the picture below, we may have something good to learn about posture variability from out kids!
This information may be new to you and contrary to things you have heard or read elsewhere. As always, feel free to contact me at firstname.lastname@example.org if you have any questions.
Thanks for reading,