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“Good” vs “Bad” Posture – An Outdated Paradigm?

Posture has become a contentious topic to discuss as conflicting information can be spread from the media, workplace and different health professionals. This article aims to debunk posture myths and challenge the age old paradigm of ‘good posture’.

As early as the 16th century, the posture industry purported the ideology of a “perfect” posture. The school of thought behind “Good posture” was initially described as a rigid spine, with a chin tucked in and shoulders pulled back. This “ideal” shape was originally adopted by the military and quickly became the new paradigm in the prevention of injuries and promoted better health. It is now understood there is no evidence to support these beliefs.

Fortunately, that posture ideology has begun to change. We now know that our posture is meant to be dynamic, as we are creatures designed to move and hunt (i.e not be stuck behind a desk for hours on end). Our natural spinal curves were designed to translate load efficiently and safely to allow us to move freely.

Another point to remember with posture is that we all have individual variations, as no two spines are exactly the same. This is due to genetics, how our spine is curved combined with postural adaptations as a result of the load it has been exposed to. For example a jockey has been trained to tolerate long periods of spinal flexion and jolting activity while they ride, compared to a gymnast who has been trained to tolerate ballistic end range movements within their spine. Both of these spines would have various strengths and weaknesses in which they have been conditioned to withstand.

Unfortunately, with todays common working demands requiring us to sit for prolonged periods of time, this can at times cause postural related neck and back pain. Being aware of current evidence regarding posture and various management strategies can help prevent postural neck and back pain.

What is posture?

Posture by definition is “the position in which someone holds their body when standing, sitting, and walking”. It is the constant mechanical adaptation through subconscious reflexes and habits to maintain an upright position for function. The idea that any one posture is superior to another, is based on years of cultural beliefs as opposed to quality research.

Many people believe adopting a straighter posture is the answer to preventing lower back and neck pain. If you experience pain while sitting or standing, its important to ask yourself if your back pain is because of your posture, or are you sitting or standing a certain way because of your pain? Have you ever caught yourself been in a position where you were sitting, lying in a strange way while speaking to someone, or watching television and have no pain? On the other hand, have you ever forced yourself in a straight upright position for a few minutes and experienced pain. The evidence in research repeatedly suggests no direct correlation between posture and pain.

Lower back and neck pain are at the top of of our country’s medical burden. The Australian government spends over 1.5 billion dollars a year on this musculoskeletal disorder. It is important to understand its complexity stemming from several factors. Your body’s biology, the environment you grew up with and currently live in, your level of stress are but a few determinants that will create the meaning you put on pain. Evidence has shown that smoking and poor general health have greater long term effects on the posture control system than the lumbar discs with degeneration or dysfunction.

We often assimilate the way we are shaped to posture. But some of us have flatter backs than others, some have sway backs and so forth. This is our unique anatomy. When we look at the literature, there is no strong evidence favouring a specific posture to reduce pain. This is enough to debunk the ‘perfect’ posture ideology, reinstating our natural posture as optimal for function.

Healthy individuals have the capacity to tolerate musculoskeletal stressors on a daily basis. Robust clinical studies have shown that those struggling with posture induced tightness or pain, can utilise exercise which demonstrates greater clinical significance than attempting to modify your posture. 

Protecting the spine

The common advice to prevent lower back pain or injuries is to activate the core in order to maintain good posture and protect the spine whilst lifting. We see this in the weight-lifting communities and in certain work environments where people need to lift objects from the floor. Bracing can make sense when we need to lift something fairly heavy. The heavier load, the more muscles are recruited for protection. This scenario is very different from picking up a pen from the floor. We should be able to complete this simple task with little muscle engagement or thought.

We cannot predict the probability of getting back pain from lifting with a round or flexed posture. Recent research found people without back pain, employed for more than five years were more likely to lift with a relaxed rounded posture compared to workers with back pain, who tended to adopt more of a rigid posture. Additionally, systematic reviews concluded the widely taught ergonomic interventions for lifting have not reduced overall work-related back pain.

Fearful messaging

There is no evidence that pain can be prevented by avoiding slouching. It can also leave a negative message that people will damage their spines by doing so. Instead, we can stop blaming and shaming posture for our multidimensional pain presentations.

When does posture matter?

We tend to get sore in prolonged sitting or standing. These symptoms could be related to neck position, lack of movement, inactivity, stress, and lack of muscular endurance. If you spend 8 hours looking at a computer screen instead of your usual 4 or spent a whole day in the car driving, you might have surpassed your tissue tolerance. Physiotherapists can offer specific training programs to strengthen the postural muscles. Physical training can also help improve muscle endurance to improve function and the demands of daily life.

Evidence supports regular position adjustments to find both comfortable and relaxed postures. As aforementioned, lifting should be completed with a natural posture which can present as a rounded or flexed spine. Ensuring that the task is not above your physical capacity is an important factor for consideration. So if posture isn’t always related to pain, what are some other contributing factors?

Contributing factors to back pain:

  • Feeling high levels of stress at home, or work
  • Feeling down or depressed
  • Feeling tired
  • Experiencing poor sleep
  • Not meeting the recommended daily activity guidelines for health
  • Being overweight
  • Smoking

The Role of physiotherapy

Physiotherapists are movement professionals. Physios assess your environment and activity level, helping to identify postural irregularities that may be the cause of experienced pain. They can help with activity modification, provide strengthening guidance and recommend postural adjustments to assist with moving beyond pain. Physios may assist with pain relief through the use of several treatments, using their experience to select the right one for you.

Physiotherapy treatment

  • Education on progressive load management for work and activities of daily living
  • Movement retraining
  • Activity modification
  • Joint and soft tissue stretching
  • Motor control retraining
  • Soft tissue therapy
  • Strengthening exercises

Staying active

Movement not only helps you build confidence, helps you stay fit for activities of daily living. It also builds confidence. Some of our recommended activities are:

  • Pilates
  • Walking and running
  • Swimming
  • Biking
  • Yoga

Helpful Changes:

It is important to make sure you take healthy breaks while at work. If you are experiencing muscular pain and stiffness, stand up and go for a short walk. You may be able to make a few modifications to your work environment such as raising your chair or adding a footstool for better support. Set up a clock to pace your screen time.

Here is a Peak Physio office exercise routine you can try:

Conclusion

A functional spine should be able to move in all directions. It needs to flex as you pick up a box from the floor. It needs to extend if you are putting objects overhead. Our role is to also provide reassurance and movement education.

Please remember, there is no such thing as a good or bad posture, just different variations, and options. “good posture” should be defined as the posture that is most comfortable for you and that your body has adapted over time to be strong in. There is nothing wrong with slouching! If it feels good, it might even be a symptom modifier.

Reference:

  1. Waongenngarm P, et al. Effects of active break and postural shift intervention on preventing neck and low back pain among high risk office workers: a 3 arm cluster randomized controlled trial. 2021. Scandinavian Journal of Work, Environment and Health.
  2. Waongenngarm P, et al. Effects of active break and postural shift intervention on preventing neck and low back pain among high risk office workers: a 3 arm cluster randomized controlled trial. 2021. Scandinavian Journal of Work, Environment and Health.
  3. Slater D, et al. ““Sit Up Straight”: Time to Re-evaluate.” JOSPT. 2009. 49(8): 562-564
  4. Driessen M, et al. The effectiveness of physical and organisational ergonomic interventions on low back pain and neck pain: a systematic review. Occup Environ Med. 2020. Apr;67(4): 277-85
  5. Saraceni N, et al. Exploring lumbar and lower limb kinematics and kinetics for evidence that lifting technique is associated with LBP. PLoS One. 2021. Jul 21;16(7)