Debunking the Myth: There is No Link Between Poor Posture and Back Pain

How many times have you been told to sit up straight or improve your posture to avoid back pain? Probably more times than you can count. But what if we told you that the link between ‘poor posture’ and back pain is nothing but a myth? Yes, you read it right. Numerous studies have shown that poor posture does not necessarily cause back pain, and that even the definition of ‘poor’ posture is questionable.

In this blog post, we will dive into the facts and findings that prove the absence of any direct link between poor posture and back pain. We will also explore the common myths and assumptions that have contributed to the long-standing belief that poor posture is the leading cause of back pain.

So, whether you've been struggling with back pain or just someone who's keen on maintaining good posture, this blog is for you. Let's get started!

Good or bad posture? Trick question!

What is meant by ‘poor posture’?

To begin with, let's get the basics straight: posture refers to the ‘alignment’ of your body when you sit, stand or lie down. The common belief is that ‘poor’ posture (think slouching, slumping, drooped head etc) puts undue strain on your muscles, ligaments and spine, leading to a range of problems, including back pain. However, research shows that posture itself is not inherently good or bad. Let’s repeat that for the people in the back:

POSTURE IS NOT GOOD (‘STRAIGHT’) OR BAD (‘POOR’ or ‘SLUMPED’). THERE IS NO SINGLE ‘CORRECT’ POSTURE.

Instead, it's about how well your body can adapt to different positions, movements and activities. It should also be noted that asymmetry in the human body is completely normal, and there is limited evidence to suggest that posture can be ‘fixed’ with exercise (especially as there’s no need for it).

Poor posture and back pain

Let's address the next myth: that maintaining a ‘good’ or ‘straight’ posture can prevent back pain.

Some studies have shown that forcing yourself to sit up straight or stand rigidly can be counterproductive and increase your risk of developing back pain. This is because holding a static posture for prolonged periods can cause muscle fatigue and strain, which can lead to discomfort and pain. Other evidence suggests that people who already have back pain are more likely to hold themselves in a straight or rigid posture. At this stage, there is no evidence to support a causal relationship between posture and back pain (regardless of whether the individual is active or sedentary). Instead, experts recommend adopting dynamic postures, which involve frequent changes in position, movement, and activity. This allows your body to adapt and flex to different demands, reducing the risk of muscle tension and fatigue. The best posture? Your next posture! Or in other words, keep moving (don’t stay in one position for too long).

Summary

The infographic below provides the key facts you need to know about posture and back pain. If you want to find out more, try the Empowered Beyond Pain podcast by visiting https://bodylogic.physio/podcast/trailer/.

References

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Peter B O’Sullivan, J P Caneiro, Mary O’Keeffe, Anne Smith, Wim Dankaerts, Kjartan Fersum, Kieran O’Sullivan, Cognitive Functional Therapy: An Integrated Behavioral Approach for the Targeted Management of Disabling Low Back Pain, Physical Therapy, Volume 98, Issue 5, May 2018, Pages 408–423, https://doi.org/10.1093/ptj/pzy022

Richards KV, Beales DJ, Smith AJ, O’Sullivan PB, Straker LM. Neck Posture clusters and their association with biopsychosocial factors and neck pain in australian adolescents. Physical Therapy. 2016;96(10):1576-87. doi: 10.2522/ptj.20150660.

Dankaerts W, O’Sullivan P, Burnett A, Straker L. Differences in sitting postures are associated with nonspecific chronic low back pain disorders when patients are subclassified. Spine (Phila Pa 1976). 2006 Mar 15;31(6):698-704. doi: 10.1097/01.brs.0000202532.76925.d2. PMID: 16540876.

Dankaerts W, O’Sullivan P, Burnett A, Straker L, Davey P, Gupta R. Discriminating healthy controls and two clinical subgroups of nonspecific chronic low back pain patients using trunk muscle activation and lumbosacral kinematics of postures and movements: a statistical classification model. Spine (Phila Pa 1976). 2009 Jul 1;34(15):1610-8. doi: 10.1097/BRS.0b013e3181aa6175. PMID: 19564772.

Wernli, K, O’Sullivan, P, Smith, A, Campbell, A, Kent, P. Movement, posture and low back pain. How do they relate? A replicated single‐case design in 12 people with persistent, disabling low back pain. Eur J Pain. 2020; 24: 1831– 1849. https://doi.org/10.1002/ejp.1631