Why “perfect” posture is a myth

People often blame their neck and back pain on “bad posture”. We’ve heard multiple patients ask us if they should buy posture correcting braces, or elastic bands that help pull their shoulders back, or devices that vibrate when you slouch into “poor” posture. Everyone is trying to attain the “perfect” gold standard posture of sitting with the head aligned perfectly on top of the shoulders, the shoulders rolled back, no hunchback, and a slight curve in the small of the back. In reality, we have seen equally as many people in clinic with “poor” posture and “perfect” posture complaining of neck and back pain from work related sustained sitting. One of the most surprising findings in research examining posture and back pain is that there is no relationship between having “bad” posture and having neck and back pain.^{1, 2, 3, 4, 5, 6} People who have “poor” posture don’t necessarily have pain and those with “perfect” posture aren’t necessarily pain free.

“Bad” Posture vs. Sustained Posture

One of the biggest misconceptions is that the “bad” posture, which often includes having a forward head position and the shoulders rolled forward, leads to pain. However, as stated above, research shows that it is not this position itself that causes neck and back pain, it is the length of time you hold this posture, or any posture, that causes neck and back pain. SUSTAINED POSTURES cause pain and discomfort. Sitting slouched forward and sitting upright with great alignment can both cause discomfort when you hold these positions for an 8-hour work day. It is the LACK OF MOVEMENT and STATIC POSITION that leads to postural stress and causes muscles to fatigue and become uncomfortable over time versus one specific posture that is causing pain and discomfort. Sitting slouched forward and sitting with “perfect” posture is going to cause some level of discomfort when you have been sitting in the same position over an 8-hour work day. A perfect example is comparing a high school student and a 45-year-old desk worker. Often times both of them have the same “slouched forward” posture, and they both hold these postures at school and work over an 8-hour day; but we rarely see high school students in clinic complaining about neck and back pain. This is likely because the 45-year-old desk worker has been holding the same sustained posture for 8 hours a day for 20+ years and will often hold this same posture on the commute home and while at home in front of the television. Although the slouching student has the same posture in class, he also has multiple breaks throughout the day is likely involved in sports or gym class where he is moving into different positions. It is not the slouching position itself that causes discomfort and pain, it is the accumulation of one posture over time that causes postural stress.

What’s the best posture to prevent neck and back pain?

The best posture is your next posture! There isn’t one specific posture that will prevent discomfort and pain, moving through different postures throughout the day will prevent postural strain and fatigue on muscles which will in turn prevent discomfort and pain from occurring. 

Below are our key suggestions to prevent postural related pain:

1. Break up long periods of sitting time

Research shows that taking frequent breaks from one sustained posture improves overall levels of muscle fatigue⁷. The best break is to stand and walk around to prevent sustained postural stress and to promote increased blood flow.

2. Invest in a sit-stand desk

Sit to stand desks allow you to break up sustained sitting time and they also allow you to move through different postures throughout the day, so the same muscles don’t fatigue^8,9.

3. MOVE!

As stated above, the best posture is your next posture. Moving through different positions and postures throughout the day will prevent the sustained stress on certain muscle groups which causes postural related discomfort and pain.

References:

1. Barrett E, O’Keeffe M, O’Sullivan K, Lewis J, McCreesh K. Is thoracic spine posture associated with shoulder pain, range of motion and function? A systematic review. Man Ther. 2016 Dec;26:38–46. 
2. Ettinger B, Black DM, Palermo L, et al. Kyphosis in older women and its relation to back pain, disability and osteopenia: the study of osteoporotic fractures.Osteoporos Int. 1994 Jan;4(1):55–60.
3. Grob D, Frauenfelder H, Mannion AF. The association between cervical spine curvature and neck pain. Eur Spine J. 2007;16(5):669–678.
4. Richards KV, Beales DJ, Smith AJ, O’Sullivan PB, Straker LM. Neck Posture Clusters and Their Association With Biopsychosocial Factors and Neck Pain in Australian Adolescents. Phys Ther. 2016 May 12.
5. Damasceno GM, Ferreira AS, Nogueira LA, et al. Text neck and neck pain in 18-21-year-old young adults. Eur Spine J. 2018 Jan.
6. O’Sullivan PB, Smith AJ, Beales DJ, Straker LM. Association of Biopsychosocial Factors With Degree of Slump in Sitting Posture and Self-Report of Back Pain in Adolescents: A Cross-Sectional Study. Phys Ther. 2011 Feb.
7. Edwardson CL, Yates T, Biddle SJH, et al. Effectiveness of the stand more at (smart) work intervention: cluster randomised controlled trial. BMJ2018;22.
8. Kowalsky RJ, Perdomo SJ, Taormina JM, et al. Effect of Using a Sit-Stand Desk on Ratings of Discomfort, Fatigue, and Sleepiness Across a Simulated Workday in Overweight and Obese Adults. J Phys Act Health. 2018;15(10):788–794. doi:10.1123/jpah.2017-0639
9. Thorp AA, Kingwell BA, Owen N, Dunstan DW. Breaking up workplace sitting time with intermittent standing bouts improves fatigue and musculoskeletal discomfort in overweight/obese office workers. Occup Environ Med. 2014 Nov; 71(11):765-71. Epub 2014 Aug 28