Do We Really Need to Sit Up Straight?

Posture– or avoiding slouching—is often discussed by people who have lower back or neck pain.  People are often told to sit up straight, as poor posture has been thought to be one of the causes of back or neck pain. Research shows that people with low back pain may find certain postures painful, but it can’t be proven that the postures are the cause of pain.

Do We Really Need To Sit Up Straight?

Movement and changing positions can be helpful, as sedentary lifestyles are a risk factor for low back pain, among many other health conditions.

1. There is no single “correct” posture. Despite common posture beliefs, there is no strong evidence that one optimal posture exists or that avoiding “incorrect” postures will prevent back pain.

2. Differences in postures are a fact of life. There are natural variations in spinal curvatures, and there is no single spinal curvature strongly associated with pain. Pain should not be attributed to relatively “normal” variations.

3. Posture reflects beliefs and mood. Posture can offer insights into a person’s emotions, thoughts, and body image. Some postures are adopted as a protective strategy and may reflect concerns regarding body vulnerability. Understanding reasons behind preferred postures can be useful.

4. It is safe to adopt more comfortable postures. Comfortable postures vary between individuals. Exploring different postures, including those frequently avoided, and changing habitual postures may provide symptom relief.

5. The spine is robust and can be trusted. The spine is a robust, adaptable structure capable of safely moving and loading in a variety of postures. Common warnings to protect the spine are not necessary and can lead to fear.

6. Sitting is not dangerous. Sitting down for more than 30 minutes in one position is not dangerous, nor should it always be avoided. However, moving and changing position can be helpful, and being physically active is important for your health.

 7. One size does not fit all. Postural and movement screening does not prevent pain in the workplace. Preferred lifting styles are influenced by the naturally varying spinal curvatures, and advice to adopt a specific posture or to brace the core is not evidence based.

D. Slater et al. (2019) “Sit Up Straight”: Time to Re-evaluate. JOSPT.  49(8):562-564

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.