Sunday, January 17, 2021

Is Good Posture Just A Myth?

If 295 physiotherapists (from four countries) cannot even agree on which is the best sitting posture, then how can the average person know what is? 

Other than having the physiotherapists do a back beliefs questionnaire (BBQ), the above mentioned study had a range of nine sitting options ranging from slumped to upright sitting. 85 percent of the physiotherapists surveyed selected one of two postures as 'best', with one posture being selected more significantly than the other. 

However, those two frequently selected postures were very different to say the least. The physiotherapists who selected the more upright posture had more negative low back pain beliefs in the BBQ. The main differences were what constitutes what a 'neutral' spine is and what is the best sitting posture is.

If you are slouching at your desk, almost everyone will tell you to sit up straight and watch your back. This is especially so when bending forward or while lifting. Back in 2019, I first suggested that slouching while sitting is not necessarily bad for you, challenging society beliefs about posture and back pain

So many companies have spent money on ergonomic programs to prevent back pain. This would usually involve a health professional/ physiotherapist (trained in ergonomics) checking your office chair/ desk height, screen height/ position with respect to your keyboard/ mouse to ensure everything is lined up in a straight line.

However, there is very little evidence linking back pain to poor posture. Oops, this basically means a huge profitable industry on work place/ home office ergonomics has very little sound evidence. 

All the published research to date has shown that there is no relationship between any postural factors causing back pain. This includes the shape and curves of the back, asymmetries and how we use our backs.

Yes, if you already suffer from back pain, you may feel it more while sitting, especially for long periods. But sitting is not the cause of the back pain.

One of my patients told me that she just bought a two thousand dollar Herman Miller chair due to working from home 'causing' her back pain. It definitely helps with sitting up straight, however, it did not seem to help her back pain. That's why she still came to see me yesterday.

So, if you currently do not have neck/ back pain, you do not need to worry about your posture. If you do have pain, then your posture may affect it. Sitting for a sustained period is best avoided. The best ergonomic chair/ table will still give you pain. It is better to move more. Take breaks. Get advice and/or treatment to move with confidence and less pain.


O'Sullivan K, O'Sullivan P et al (2012). What Do Physiotherapists Consider To Be The Best Sitting Spinal Posture? Manual Therapy. 17(5): 432-437. DOI: 10.1016/jmanth.2012.04.007

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

Our spines have natural curves. It is not totally straight at all. You can see from the picture above that the neck is slightly concave, the chest area is convex while the lumbar (low back) region is again concave. In an ergonomic assessment, a 'good' posture usually refers to eliminating/ straightening out these curves.
Here are some common myths and facts about low back painslipped discs and your core muscles if you're interested in reading more.

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