If you have heard it once, you have heard it a thousand times. Your middle school teacher yelling at you to “sit up straight and pay attention!” Your grandmother telling you to “stop slouching.” The latest and greatest Instagram guru saying you should “never round your back while you’re sitting.” All of your life you have been told that you must have good posture or suffer the consequences. Many are told, if you have low back pain, your bad posture must be the culprit. This is a common belief held by patients and healthcare practitioners alike. In reality, it is not true.
Let’s first talk about what is often meant by both “good” and “bad” posture. It is important to note that there has never been a clear, standardized, scientific definition of either. Some clinicians prefer to use the term “neutral” for a good posture. While this certainly sounds logical, it is not so easily applied to real life. Normal ranges of motion for all joints fall on a spectrum of accepted ranges, and what appears to be “neutral” for one person will not be the same for another. Especially when it comes to low back pain, many patients will lack the ability to even flex their lumbar spine at all, unable to achieve a “neutral”. We cannot accurately and reliably apply such a broad ranging term for meaningful use to patients and practitioners.
If “neutral” is ruled out, it is often accepted that “good” posture is an upright and extended back, while “bad” posture is a slouched and flexed position.
The trouble with this thought process is that it is not supported in scientific literature. There is very limited evidence to support that a flexed posture is correlated with increased low back pain, and that improving that posture to be more extended will improve pain. There is no evidence that points to the specific benefits or harms of any one individual posture. What the literature does report on is the possible negative effects of prolonged static posture. Whether considered “good” or “bad”, sitting in the same posture for prolonged periods has been linked to both back and neck pain.
“So, am I supposed to sit upright or slouched?”
The easiest answer is, yes. You should likely do both. What the literature does begin to support is postural variability. As stated above, prolonged postures of any one kind may be connected to discomfort and even pain. The best way to combat these effects? Sit in many different postures throughout the day. Allow your body to move how it wants to move, and rest how it wants to rest. And before that position starts to feel a little uncomfortable, find another one. Sit up, lean back, slouch forward, stand, turn to the right, turn to the left, and any other position you may find comfortable.
The key word here is variability. This is an important concept to us at Human Function & Performance. It is best defined as the ability to handle the demands of different stressors. Variability is required in order to maintain our health. Joints must move through their full range of motion to remain nourished and maintain those ranges (think: use it or lose it). Muscles must be able to contract to handle loads yet relax when other muscles are bearing the load. The human body as a whole must be able to get into an excited, sympathetic nervous state in situations of danger requiring adrenaline, but must also be able to get into a relaxed, parasympathetic nervous state in order to fully rest. If there is decreased variability in any of these processes, or any other systems within the body, then there is rigidity. There is dysfunction. There is decreased ability for the body to adapt and handle different demands. One of the most common dysfunctions of the human body is pain.
This concept is especially important when it comes to patients with low back pain, and why our stereotypical concepts of “good” and “bad” posture are not perfect. “Good” posture is extended. But extended posture is our pain response. No human in history has ever had a painful experience and immediately slouched over and relaxed. Instead, we extend our bodies, gasp in air, get rigid, and say “ow.” This response is good in its initial phase, as that rigidity creates safety. It is protection from placing our harmed body part into more harm. However, when it comes to more chronic and long-term pain, like most low back pain cases, this continued response is counterproductive to our healing. If we constantly remain in this extended, rigid posture, we do not place our body into a relaxed, healing state. This relaxed state is flexion. If I told you to close your eyes and relax as best as you could into your chair, you would slouch over, flex your back, and let out a calming exhalation. The effect is a resting, healing, parasympathetic environment. An environment conducive to variability. One that the body is more willing to adapt and accept change. And in order to heal and get rid of pain, the body must change.
If you are someone that is dealing with low back pain, it is important to understand that the human body and its pain responses are far more complex than to be caused or fixed by “good” or “bad” posture. Especially because we can now admit that there is really no good definition of either. But if you are someone who spends all day at work sitting at a desk and goes home to sit some more, then it is important to remember to spend time in different positions throughout the day. Allow your body to experience variable positions so it is capable of handling variable positions.
If you have any questions about these concepts or anything else related to posture, then please reach out to me. My email is Colten@humanfunctionandperformance.com. If you are someone that is currently experiencing low back pain and would like to learn more about how your pain can be treated, then please reach out to us at Human Function & Performance. We would love to help you overcome your pain and get back to the life you want to live.