“Good” posture does not prevent back pain, and “bad” posture does not cause it health and well-being

Back pain is a leading cause of disability worldwide. Most people experience an episode of back pain during their lifetime. It usually occurs in adolescence and is more common in adults.

For 25% of people who develop back pain, it can be persistent, disabling and distressing. It can affect a person’s ability to participate in daily life, physical activity, and work. Activities such as sitting, standing, bending and lifting can aggravate back pain.

It’s a common belief that “good” posture is important for protecting the spine from damage, as well as preventing and treating back pain. Good posture is often defined as sitting “upright”, standing “tall and straight” and lifting with a squat technique, and having a “straight back”.

Conversely, sitting “out,” standing “on the side,” and lifting with a “rounded back” or excessive posture are often cautioned. This view is widely held by people with and without back pain, as well as by clinicians in occupational health and primary care settings.

Surprisingly, there is no evidence for a strong link between “good” posture and back pain. Perceptions of “good” posture come from a combination of social desirability and unfounded assumptions.

Systematic reviews (studies that looked at a number of studies in the same field) found that ergonomic interventions for workers and advice for manual workers on the best posture for lifting did not reduce work-related back pain.

Sitting and standing posture

Our group has conducted several studies investigating the relationship between spinal posture and low back pain. We investigated whether “reclined” sitting or “non-neutral” standing posture (eg, low back or slouching) was associated with or predicted future low back pain in a large proportion of adolescents. We found little support for this view.

These findings are consistent with systematic reviews that found no consistent differences in sitting or standing posture between adult populations with and without low back pain.

People adopt different postures of the spine and no single posture can protect a person from back pain. People who lie down and stand upright may experience lower back pain.

There are many such posters in our workplaces. However, these guidelines do not have an evidence base. Photo: Panther Media GmbH/Alamy Stock Vector

lifting pose

Nor is there any universally accepted occupational health practice evidence for “good” or safe back postures during lifting. Our systematic review found no evidence that arching was associated with or predicted low back pain.

Our recent laboratory study showed that people without back pain who had been working at a manual job for more than five years were able to bend over and round the back.

In comparison, manual workers with lower back pain used more squats with straighter backs.

In other words, people with back pain follow “good” posture advice, while people who don’t lift “good” don’t have back pain.

In a small study, as people with back pain recovered, they became less protective and generally moved away from “good” posture advice.

If not a pose – what else?

There is no evidence for one “best posture” to prevent or reduce back pain. People have different shapes and sizes of spines, so posture is very individual. Movement is important for back health, so learning to change and adopt a variety of comfortable postures can be more beneficial than sticking to a certain “good” posture.

Low back pain can be severe and distressing, but for most people (90%), back pain is not related to tissue damage or pathology. Back pain can be like a joint related to uncomfortable, sudden, heavy or unaccustomed loads on our back, but it can also appear like a headache without any injury.

Most importantly, people are more likely to experience back pain when their health has been compromised, such as someone who:

Back pain if a person:

What can people do for back pain?

In a small group (1% to 5%), low back pain can be caused by pathology, including fracture, malignancy, infection, or nerve compression (the latter is accompanied by leg pain, loss of muscle strength and sensation). In such cases, seek medical attention.

For 90% of people with back pain, it is associated with sensitization of the structures of the back, but no tissue damage is detected.

In this situation, too much focus on maintaining “good” posture can be a distraction from other factors that are important for spinal health.

These include:

  • you moved and rested your back

  • regular physical activity of your choice

  • building confidence and being fit and strong enough to carry out normal daily tasks

  • Maintain healthy sleep habits and body weight

  • care for general physical and mental health

Sometimes this requires some support and coaching with a qualified clinician.

So, if you sit or stand, find comfortable, relaxed positions and change them. If you’re lifting, current evidence suggests that it’s okay to lift naturally, even if you have a round back. But make sure you are fit and strong for this task and take care of your general health.

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