Throughout our lives, we are often told to stand or sit up straight and keep our backs as neutral as possible, with the assistance of ergonomic chairs at work or corrective braces to encourage good posture and to prevent back pain. But do we know what ‘good posture’ is? And do we have to correct our posture to get out of pain? Recent literature provides insights that challenges our current beliefs on posture and the impact it has on back pain.
One of the major myths surrounding posture is that having poor posture or having anatomical variances (such as anterior/posterior tilt or lumbar lordosis) can be a leading cause of someone’s back pain. Whilst side to side asymmetry and anatomical variances can influence spinal alignment and biomechanics, it is quite normal for an individual to have these variances. Whilst it may cause our posture to look awkward at times, it is not responsible or the sole driver for our back pain. A systematic review completed by Roffey et al (2010), presented strong evidence from six high quality studies that there was no association between awkward postures and LBP, and that it is unlikely that these postures are independently causative of LBP in the population of individuals studied. Another systematic review by Alsaadi et al. (2011) found weak evidence supporting a direct link between posture and the development of nonspecific low back pain, indicating that other factors such as genetics, lifestyle, and psychosocial factors may play significant roles.
Another misconception is that maintaining a perfectly straight spine always can prevent or reduce back pain. Whilst the notion of having a perfect posture to get proper muscle activation and natural curves may be somewhat useful for spinal health, rigid adherence to this may increase muscle tension and subsequently, we begin to make rules for our body which limits freedom of movement. Furthermore, this encourages the belief that if we break away from “correct posture’, we are doing something wrong and that it is potentially harmful to our backs. If we adhere to a strict posture that feels unnatural, this is likely to cause sensitisation to the tissue like being in a slouched or uncomfortable posture. At the end of the day, we all have individual postures and default positions that are incredibly difficult to correct. It is important that rather than focusing on ‘correct’ posture, we need to focus on movement, as the back enjoys this! If we do have soreness in the back or if there are some postures we are sensitised to, it is better to find another position (or posture) to give that posture a break and then re-expose the body to it gradually. It is important to find opportunities for different movements that may be more beneficial and may help with our pain. Even just general movement and exercise can alleviate some of this pain! For those who do have chronic back pain, it is important to remember that our pain experience is multifactorial, and it is an interplay of biomechanical, psychosocial, and environmental factors rather than just a postural or alignment issue.