The Evidence is In: Slouching IS the Culprit!

Lower back pain is prevalent and patients frequently seek help to deal with the pain and functional limitations that arise.  It sounds oversimplified, but commonly lower back pain begins without any trauma, but more due to the cumulative effect of too much lumbar flexion each and every day—sitting in slouched posture at the computer, sitting to eat all meals, brushing teeth, washing feet, doing laundry etc.  We don’t get out of that position very much and over time, the back can become aggravated as a result.

A recent study provided information about the type of movements of the lumbar spine performed by 208 pain-free individuals over a 24-hour period, and the proportion of time spent in flexion and extension.

 Main Results:

The median total number of movements with a change in the lordosis angle greater than 5° was approximately 4,400 within the 24 hour period. Most of these occurred within a small range of movement.

On average, full flexion was achieved 50 times within the 24 hour period, whereas full extension was achieved 0 times.

94% of the day was spent in the 0-50 degree range of flexion and 2% of the day (24 minutes) was spent in any extension relative to the standing position.

Conclusions: The data illustrated the spine mainly moves through a small range of movement during normal daily activities, the minimal amount of time spent in any lumbar extension, and the majority of time spent in flexion.

A huge 66% of the movements occurred within a very small range – only 5 to 10 degrees of movement. It appears that those movements are occurring within the flexion range, but of course may not be at full end-range. It is good to finally have some evidence about the number of movements and the type of movements that an individual without symptoms performs in a normal 24 hour period. What this research does not tell us is if individuals with lower back pain have a different movement pattern.

Physiotherapy for people with lower back pain often involves education on correcting sitting posture using a lumbar support in chairs to prevent slouching, and various spinal mobilizations and exercise into lumbar extension to lessen or abolish the pain and functional limitations due to living in flexed positions!  Back pain can often be completely abolished when lumbar flexion positions can be avoided for a short time, and repeating lumbar extension movements.

Flexion Inspection

Most back problems are not really muscular.  It sounds weird to say, but so many people’s pain actually starts for no obvious reason, without any trauma. They might wake up with pain, or it might just start in their back after they’ve been sitting for awhile.  It is really common to hear that back pain starts when someone stands up again after bending forward to pick something up.

In life, we all spend WAY too much time bending forward. That forward bending movement is called flexion, and think about it– whenever you sit, are you slouching much?  Do you sit to get to and from work in a car or on transit?  Do you sit at work?  You certainly sit to eat your meals, and when you have a chance to relax you will likely sit more in front of the TV, or reading, or out for dinner or the movies.  Pretty much all our entertainment is in back flexion. Then if you sleep on your sides, your hips and knees are bent, allowing your pelvis to tip backward, and hey, more flexion. Then you bend forward to brush your teeth, sit on the toilet, tie up your shoes, reach into the fridge, etc.  You see my point: we live life in a flexed, rounded forward position.  It is no wonder that eventually your back can have enough and freak out a little.

It is important to make sure you get out of this back flexion quite regularly:  you can try sitting with a lumbar support, change your position at your desk often, get up and move around if even for short periods, and some will find that moving your back into extension (arching) is helpful relief.