“Sit up straight!” “Stop slouching!” These might be things that someone like your parents might have scolded you for when they looked at your posture. Maybe you straightened you back up to avoid being yelled at. How long did it last? What is a good posture? How important is it to your pain and discomfort? How do you obtain a better posture? We are going to answer these questions for you!

 

The idea of what good posture is goes back in history a long, long, time. You may have even heard the term “military posture” to signify a soldier standing completely upright as the gold standard as to what an upright posture should look like. This belief has stuck with us over centuries. Proper posture is more complicated than just standing or sitting up straight. The concept of what we think good posture versus bad posture is, is actually not supported by any credible evidence. This doesn’t mean, however, that posture isn’t important, because it is! It just might not be as important or as much of the cause of your symptoms as you might think.

Posture and Joint Loading

“Good posture” is generally depicted as standing or sitting “straight” or “upright”. On the other hand, “bad posture” is often associated with slumping and slouching.  Forward head position is the most common form of “fault” of the neck, involving forward placement of the head in relation to the shoulders. A slouching low back posture is common low back fault, and signifies sitting more on the back of your tail bone, causing a flexion of your lumbar spine.

All of these types of positions or postures load tissues of our backs and neck differently. This means that you are constantly overusing certain muscles, and underutilizing others. When it comes to posture as a source of pain or discomfort, it is the total force through a particular issue that we need to focus on, rather than the position of that tissue. This means, it’s not just the particular position but the time spent in the position, or “sustained postures”, that we need to be thinking about. It’s not that one position is necessarily “good” or “bad”. It is much more about how long you are in the position for.

If you hold a small pen out in front of you, for the first 5 minutes the pen will feel light, but after 30 minutes your muscles get tired and starts to feel heavy. Your hand might start shaking and you might feel discomfort. It is not the activity of holding a pen that is the problem, it is how long you are trying to do it for. This is also supported in the research:

In a recent systematic review by Mahmoud et. al (2019) it was found that forward head posture was not correlated with incidence of neck pain in adolescents and older adults (aged >50 years). They did find a weak association in adults aged 18-50 years, however, the quality of the studies were quite poor. In another systematic review by Swain et. al (2019) there was no link between slumping postures and pain, as well as any other lumbar posture and pain.

What Position is Good Posture?

Our body is an adaptable machine. When we expose it to constant and persistent positions, our body adapts to get good at those positions or postures. For some people, being in a slouched posture may cause pain and discomfort, and for others slouching may actually feel quite good. The opposite is also true. For some people being in a stereotypical “good posture position” might actually cause pain or discomfort. For example, someone with a disc problem will likely experience an increase in pain when sitting slouched over for long periods of time, that is relieved with standing. Conversely, for someone with spinal stenosis standing for prolonged periods of time might aggravate symptoms, and these symptoms improve with sitting in a slouched posture. 

So before we jump to a conclusion about posture being a source of pain, it is important to rule out some other things that might be causing the pain or discomfort, and understand why certain positions may be comfortable or uncomfortable.

Good posture is essentially the position you are not currently in. It’s not about the position of the posture, but the amount of time in sustained postures that is more of a factor in contributing to pain and discomfort. There are studies that have shown that prolonged sitting, no matter how straight or upright you are, increases the risk of low back pain.

This means that what is most important is getting in frequent movement throughout the day and to reduce time in sustained postures. Our bodies like to move and move often. It is important to change position frequently throughout the day. While there is no exact prescription for this as everyone is different, start with changing your position every 30 minutes. You can go out and buy an expensive office chair, but if you are sitting in it all day without changing position or moving often, you still can feel pain and discomfort. This is not to discount things like ergonomics as important, but they are only a piece of the puzzle.

Strategies to Reduce Sedentary Posture

Here are some strategies to reduce sedentary posture (Conen et al 2016)

  • Task substitution
    • Alternating tasks to use different muscles groups or parts of the body
    • Alternate between sitting and standing while completing tasks
  • Task Interruption
    • Ensure that you take break, especially where there is not high task variability
    • Use short breaks to perform stretching or suitable exercise to offload the muscle groups that you are using during sedentary tasks
    • Use natural stopping points (between tasks, during/after phone calls, after checking your email) to change position and stretch
  • Increasing Incidental Exercise
    • Use the stairs instead of the elevator at the office 
    • Take part in walking meetings
    • Walk or standing during meal breaks or when not on camera during a video call
    • Use active methods for commuting (walk, bike, bus, etc)

 

In summary, the concept of “good” posture vs “bad” posture is not supported by evidence. Poor posture on its own it not associated with pain. What is most important is to avoid sustained posture throughout the day. Office ergonomics are only a part of the puzzle and will not completely fix pain when sitting for prolonged periods of time. Make sure to incorporate stretching, exercise, and alternative movements during the work day to take some of the stress off some of the muscle.

Looking to learn more about ergonomics? Check out our post HERE about desk ergonomics!

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