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.

References

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 pain, slipped discs and your core muscles if you're interested in reading more.

Look Ma No Hands

One of my favorite riders Mario Cipollini shown here winning the 2002 World Cycling Road Race Championships in the picture above. What does super Mario have as a advantage over his fellow sprinters? Besides his abundance of fast twitch muscle fibers, his strong core muscles are his best kept secret. Even Lance Armstrong spends extra time working on his core muscles so he can be more stable and hold his time trial position longer in the quest to get mere seconds over his competitors.

Why this topic, you may wonder? Well, many of our patients this past fortnight are cyclists, triathletes preparing for a cycling stage race in Thailand at the end of the month. Hence, I've decided to do a topic on this as it benefits all athletes and even patients who don't play sport and yet have low back pain.

Consider some research done on cyclists on whether a torso (or trunk) stabilization device would reduce metabolic cost of producing cycling power - increasing cycling efficiency and lower energy expenditure for the same cycling power output. All this translated means cycling faster using less energy. 

The cyclists were tested on a cycle ergometer at different power outputs, different pedal cadences with and without torso stabilization. The results show that with a stable torso, submaximal cycling power was reduced (increase in cycling efficiency was seen), meaning cycling faster with less effort. This reduction was also related to pedaling cadence. Greatest reduction was seen at lower pedaling rates where pedaling force was greatest.

The researchers concluded that implications of this study are significant for cyclists. High cadence pedaling appear to increase efficiency by reducing the amount of energy required to stabilize the upper body while cycling. Cyclists with greater core stabilty will have an advantage over those with weaker stabilzing muscles. (My patients reading this now should realize why I spent so much time teaching you how to use your deep, core muscles).

I'd like to point out that you need to learn how to activate your core muscles without activating the superficial muscles and still be able to transfer them to your sport or activity. I know for a fact that many of our patients have been taught wrongly despite having 'learnt' it before from previous physiotherapy, Pilates or other core classes. Please come talk to us if you have any questions.

Reference

McDaniel J et al (2005). Torso Stabilization Reduces The Metabolic Cost Of Producing Cycling Power. Canadian J App Physiology. 30(4) : 433-41. https://doi.org/10.1039/h05-132.