The link between posture and back pain isn’t what you think: ScienceAlert

Back pain is the leading cause of disability worldwide. Most people experience an episode of back pain in their lifetime. It often arises during adolescence and becomes more common in adults.

For 25 percent of people who develop back pain, it can become persistent, disabling and distressing.

It can affect a person’s ability to participate in activities of daily living, physical activity and work. Activities such as sitting, standing, bending and lifting often aggravate back pain.

There is 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 commonly defined as sitting ‘straight’, standing ‘tall and aligned’ and lifting with a squat and ‘back straight’ technique.

Conversely, sitting “stands up,” standing “stands up,” and standing up with a “rounded back” or hunched posture are frequently advised.

This view is widely held by people with and without back pain, as well as by both occupational health and primary care physicians.

Surprisingly, there is a lack of evidence for a strong relationship between “good” posture and back pain.

Perceptions of “good” posture originate from a combination of social desirability and unfounded assumptions.

Systematic reviews (studies that look at several studies in one area) have found that ergonomic interventions for workers and advice for manual workers about the best posture for standing have not reduced work-related back pain.

Sitting and standing posture

Our group has conducted several studies exploring the relationship between spinal posture and back pain.

We investigated whether sitting “settled” or “non-neutral” standing postures (eg, supine or squatting), in a large adolescent population, were associated with or predicted future back pain.

We found little support for this view.

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

People adopt different spinal postures and no single posture protects a person from back pain. People with slumped and upright postures may experience back pain.

Lifting posture

Globally accepted occupational health practices regarding “good” or safe back postures during lifting are also lacking in evidence.

Our systematic review found no evidence that lifting with a rounded back posture is associated with or predictive of back pain.

Our recent laboratory study found that people without back pain, employed in manual labor for more than five years, were more likely to stand up with a more hunched posture and a rounded back.

In comparison, manual workers with back pain tended to adopt more of a squat lift with a straighter back.

In other words, people with back pain tend to follow “good” posture advice, but people who don’t lift the “good” way don’t have more back pain.

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

If not the posture, what else?

There is no evidence of a single “good posture” to prevent or reduce back pain. People’s spines come in all shapes and sizes, so posture is very individual.

Movement is important for back health, so learning to vary and adopt different comfortable postures is likely to be more helpful than rigidly adhering to a specific “good” posture.

Although back pain can be intense and distressing, for most people (90%) back pain is not associated with identifiable tissue damage or pathology.

Back pain can be like a sprain related to uncomfortable, sudden, heavy or unaccustomed loads on the back, but it can also occur as a headache where there is no injury.

Importantly, people are most vulnerable to back pain when their health is compromised, such as if someone is:

Back pain is more likely to persist if a person:

What can people do with back pain?

In a small group (1-5 percent), back pain may be caused by pathology including fracture, malignancy, infection, or nerve compression (the latter is associated with leg pain and a loss of power and muscle sensation). In such cases, seek medical attention.

For most people (90%), back pain is associated with sensitization of back structures, but not identifiable tissue damage.

In this situation, focusing too much on maintaining “good” posture can be a distraction from other factors known to be important to spinal health.

This includes:

  • move and relax your back
  • performing the usual physical activity of your preference
  • build confidence and stay fit and strong for regular daily tasks
  • maintain healthy sleep habits and body weight
  • take care of your physical and mental health in general.

Sometimes this requires some support and training with a specialist doctor.

So whether you’re sitting or standing, find comfortable, relaxed positions and vary them.

If you’re lifting, current evidence suggests it’s okay to lift naturally, even with a rounded back. But make sure you’re fit and strong enough for the task, and take care of your overall health.

Peter O’Sullivan, Professor of Musculoskeletal Physiotherapy, Curtin University; Leon Straker, Professor of Physiotherapy, Curtin University, and Nic Saraceni, Professor, Curtin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Leave a Reply