Sunday, September 1, 2019

Who Says Slouching Is Bad?

 Not all slouching is bad!
How many of you have been told that you have bad sitting or standing posture? Or it is incorrect to bend your back while lifting.

The fitness industry publicly recommends protecting your spine. A lot of personal trainers will often tell you that the "core" muscles of your spine must be consciously activated to maintain a "correct" posture to protect your spine. They also give advice about "good form" during weight training and after as well.

Sit up straight - Nah not for everyone
Well, fret not, as evidence is now suggesting that there is no perfect posture. Or at least there is no one posture that fits everyone.

Despite there being a lack of strong evidence that low back pain is caused by sitting, a huge business that claims to improve posture has grown. Many of these companies provide products and interventions claiming to "correct your posture" and help prevent pain.

In addition, there are fear inducing messages in the media that by avoiding incorrect posture like slouching, pain can be avoided.

Unfortunately, many health care professionals provide advice along this non evidence-based practice too. It is generally agreed by health care professionals that avoiding spinal flexion is the safest way to sit and bend.

Yes, awkward postures and lifting something heavy may indeed cause some episodes of acute low back pain. Indeed, some links between lifting and injury have been reported. Despite all these widespread beliefs about correct posture, research has not shown that avoiding incorrect posture prevents low back pain or that any single curve in your spine is strongly associated with pain.

Even though there is evidence that people with low back pain find certain postures provoke their pain, it cannot be concluded that these postures causes pain (Slater et al, 2019).

There is also no evidence to support posture assessment or screening for pain prevention in the work place (Slater et al, 2019). Ouch! There goes all the "ergonomic" screenings/ assessments done by physiotherapists down the drain. Fortunately, our clinic does not do any of these ergonomic assessments.

People come in many different shapes and sizes, with normal variation in their spine curvature. Depending on how your spine is shaped, you will have your own preferred lifting technique and sitting style.

Advice and suggestions given by physiotherapists and other health professionals can lead to fear and encourage hyper vigilance/ paranoia.

Despite a lack of strong evidence that "sitting up straight" prevents pain, asking our patients to work hard to achieve that may set them up for failure and cause more anxiety when their pain persists.

Prior to reading this article (Slater et al, 2019), I too am guilty of telling patients to sit up straight.

Movement and changing positions can be helpful since sedentary lifestyles are a risk for low back pain. However, we should not perpetuate worry that sitting for more than 30 minutes in one position can be dangerous and should be avoided (Slater et al, 2019).

We should in fact help people to sit, stand and move more easily. Comfortable postures vary among all of us and patients should be encourage to try different postures. A position that hurts now may not hurt in future.

Moving ahead, there will be challenges to change the idea of having one "correct" posture. Evidence does not support this view and "core" beliefs held by physiotherapists, personal trainers, doctors and society.  40 years ago, bed rest was prescribed for low back pain. Evidence now shows that bed rest is definitely not an appropriate recommendation anymore.

Our spine is strong, robust and adaptable. A campaign to change this may encounter resistance even in the physiotherapy and ergonomic professions as their business model may not be in line with what we now know to be best practice for managing low back pain.


Slater D, Korakakakis V et al (2019). "Sit Up Straight": Time To Re-evaluate. JOSPT. 49(8): 562-564. DOI: 10.2519/jospt.2019.0610

Please email me if you want the article.

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