I am going to jump straight to the punch line and say, if you are not in pain, your posture does not matter.
And even if you are in pain, your posture is not the cause of the pain, but it might be something that irritates it. We will get in to it.
But first, a big thank you to Doctor Hazel for inviting me to write for her blog, it’s a real honour. This all came about because I questioned a post she put up, not to cause any offence but just to create some healthy conservation and questions which was great. The Doc is someone who puts up so much good content and is clearly well read I was certainly sweating before clicking send!
So posture. Back to the punchline, if you are not in pain, your posture does not matter. We know this because:
Scientific research tells us there is no causative link between pain and posture, for neck, mid back or low back pain. No causative link means there is nothing to prove that having ‘bad’ posture causes pain, so we simply cannot say it does. In fact, there is no links between postural factors, shape or curves of the spine and the way we use our spines with getting pain (reference).
We cannot define what ‘bad’ posture is. Optimal posture does not exist (reference). Is bad posture sitting slumped at a desk? Well I would challenge everyone to sit up dead straight for a whole day and not get pain. Because if I sit up straight all day, my back hurts, and I need to slump back to my comfortable position to make it feel better. In fact, sitting up straight and holding ourselves braced will tire our muscles (reference) and ourselves and could cause discomfort. One study showed that people with low back pain actually demonstrated greater muscle contraction and an inability to relax these muscles (often associated with fear of moving and negative beliefs about the spine). Another that pain free individuals adopt a flexed sitting posture. The latest research even found that slouching improved disc height and hydration, so the total opposite to common thought, not a particularly good paper, but great because it shows how different everyone is.
So what does this mean?
Essentially, it is not a question of how we sit, or stand, or bend even, but just that we spend too long in one position.
Posture, bad posture and ‘sitting up straight’ has become a myth from a long time ago where it was considered ‘proper’ to stand and sit up straight in society. This has been passed down over the years and ingrained in us by society and our parents…”sit up straight”, “mind your back” still rings in my ears. The trouble with these connotations is that it can lead us to relate any pain that we might get to posture. There is a lot of interesting research around back pain and what causes it and there are so many factors to consider and often it is not just one singular factor. One of these factors is Expectation (reference). A bit like a self-fulfilling prophecy and if we set someone up to think that sitting slumped, or rounding your back will give them pain, then it actually might do. Watch this video for a great example of how expectation of taste can skew your thoughts.
The other issue is, that if we get a bit of normal pain, and are told our posture “sucks” or that its bad to have these normal aches and pains, this relation to these secondary things can cause pain to persist, sometimes long term. For example, We then try to do everything to change our posture to make our pain better….and our pain does not get better.
So why does sitting up straight make my back feel better when I have pain?
It doesn’t always and that is part of the problem. Going back to the punchline, if you are not in pain, your posture does not matter. When you are in pain, sitting slumped might be something that irritates that pain. Similar to if you bend forwards or lift something up. If you have back pain, you tend to avoid bending and lifting. Sitting is the same, it is an action, like bending or lifting, which irritates the back, but we don’t tend to avoid it, we keep doing it and it keeps irritating the back. But in the same way, bending and lifting is not the cause of back pain, it is just something that annoys it. We call this sensitisation and to help improve on those symptoms you need to break the habit for a while. If improving our posture was the magic bullet for curing back pain, then all these ergonomic changes to desks and chairs that we have done over the years would have cured it. However it hasn’t, back pain continues to rise to epidemic levels and there again is little evidence in the research to say these ergonomic interventions make any difference.
So to summarise, if you have pain, certain movement may be off limits for a period of time, but with the right rehab approach you can break that cycle or habit of pain and get back to any movement or any posture with weight or without weight, nothing is off limits!
If you don’t have pain, Kieron O’Sullivan, a leading voice in this field sums it up nicely, “If you don’t have back pain then do not give posture a second thought”. Keep on slouching!
When might posture matter? What should we think about?
This a topic for another day, but briefly, posture may matter during high load activities and when we are completing performance tasks. What to think about – think about being healthy. Things like sleep deprivation, stress and lack of physical activity have a much bigger link to back pain. Most people don’t realise that not getting enough sleep can cause your back to be sore (reference), in the same way it can cause a headache, or a cold. So focus on your health, keeping yourself moving throughout the day and achieving some regular physical activity.
Set a notification on your phone or have a post-it note on the corner of your monitor to get you to stand up and move around every 1 hour. Go and make that cup of tea! (no sugar :)) (Even with these great new standing desks, it is important you walk around every 1 hour)
Go for a walk at lunchtime. Engage in regular activity, something that gets the heart and lungs working. Find something you enjoy and do it for 30-60 minutes, 3-4 times a week.
Do some of these, 5-10 repetitions every 1 hour throughout the day:
For a quick, easy watch on understanding more about posture and why we don’t need to worry about it so much, check out this video from Greg Lehman, a top physiotherapist and chiropractor.