Posture and Low Back Pain: Does "Good" Posture Really Ease Back Pain?
“What is the best posture for sitting at my computer?”
My common reply is, "Your best posture is your next posture." There has been a lot of research on this topic over the past decade and I think you all will be quite surprised at what the studies have found. Before I review the research, we need to have a look at what the medical fraternity (MDs, DOs, RNs, DPTs, DCs) has been telling us for years. I am also guilty of this myth. The common advice is, when sitting unsupported you should sit up straight, belly pulled in, shoulders back, neck long and chin tucked in. We may have even called it “Military Posture,” “Upright posture,” or even “Straight back posture.” The belief was that this upright spinal posture was ideal for sharing the load onto our spine.
Well, guess what? The research does not support the claim that maintaining an erect or straight back posture eliminates or even prevents low back pain. Yikes, I said it, and I’m ready for the naysayers to start emailing and calling me to tell me I’m wrong. Then proceed to tell me all about some great anecdotal evidence of their husband or wife or child that had low back pain and cured it with posture corrections in sitting and standing. That story is common but the advice that everyone with low back pain can get rid of it with correcting what is thought to be harmful postures has no scientific evidence. As a matter of fact, there is evidence that states some people that maintain the most “erect posture” are more likely to exhibit chronic low back pain later in life. The hypervigilant individual that tightens the trunk muscles in static postures is actually creating problems. The researchers found that when you are sitting and drawing in your belly muscles at the same time you are holding your low back in a rigid and slightly arched position (lumbar lordosis) you are creating a potential problem of chronic pain from sitting. In order to hold this rigid upright sitting posture, the low back paraspinals (trunk extensors) and the abdominals (trunk flexors) create excessive load on the spine due to their oppositional actions on the spine in a static position.
This prolonged load can sensitize low back structures and cause pain. Hence, my common statement – “your best posture is your next posture”. If you keep moving in your chair the spine and hips will be able to adjust to various positions and not get stiff.
Another study reported that female teens at age 17 that had adopted an erect sitting posture had significantly more chronic low back pain than the boys who typically sat in a slouched posture for prolonged periods of time. They also found that mental health was a key factor in predicting who will have low back pain into adulthood. Physical activity plays a big role in who does and doesn’t experience low back pain. The boys were more likely to exercise more frequently than the girls and their back extensor muscles were stronger than the girls' extensors.
We carry these belief systems into adulthood. Here is a great example of carrying a belief system into dysfunction. Recently I had 2 new patients with chronic low back pain sitting in my office telling me their story of years of chronic persistent pain. They proceed to tell me about the details of their back pain while sitting with an erect posture rigid as a rock wall. When I asked them if that was how they always sat (up straight with belly drawn in and back extensors holding a curved low back). They answered, "Yes, of course, I'm holding my core tight to protect my back". I asked them to just try and sit against the chair in a slouched position with all their trunk muscles relaxed, and guess what happened. Their pain diminished significantly to the point that they couldn't believe it and they started to tighten back up because they thought that resting in this slouched posture would eventually cause back pain and real trouble. Once they understood that their belief system was flawed and they challenged it in a safe environment of a PT practice, they understood the vicious cycle they were in. In only a few visits I was able to empower these patients to relax more, change positions at the computer frequently (5-6 times an hour), get up and walk around the office 2 times an hour and get some regular aerobic activity. The PT work for these two patient cases was minimal. Once I understood their flawed belief systems, then help them change bad habits (sitting in an erect posture) because it was hurting them, and within a very short period of time, the pain diminished and recovery took place. Lastly, there was a sense of relief to understand that sitting slouched on the couch to watch a movie was okay. Just don’t do it night after night without exercise for months on end. These two patient presentations are quite common. The hypervigilant behavior around exercising and erect sitting postures has increased over the years due to so many media-driven messages about health and wellness. Hypervigilance can bring about a state of increased anxiety which can cause exhaustion. This can then cause low back pain. Most importantly, don’t worry about sitting in that recliner reading. Its okay to relax.