The Myth of Perfect Posture: Standing Up Straight, Really?

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Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine 

"Stand straight!"

"Stop slouching, you'll hurt your back!"

“You have back pain from your bad posture!”

How many times have you heard someone complain about back pain because of their "bad posture"? Maybe you too have this speech to explain your back problems? Perhaps you think that by adopting a better posture during your working hours, your lower back pain will disappear immediately?

In the following article, we will discuss the relationship between posture and back pain, to then determine if there really is a perfect posture to preserve your back. (Hint: it's not as simple as you might imagine!).

Mea culpa!

“Let’s start with a mea culpa! »

Let's start with a mea culpa! As medical professionals, we initially thought this: Sitting increases pressure on the intervertebral discs, so can lead to certain back problems (herniated discs, osteoarthritis, etc.). From a theoretical point of view, this explanation seems reasonable, in particular since several of our patients suffering from symptomatic disc herniations complained of increased pain when sitting. The therapists therefore urged their patients to modify their workstation and adopt a straight posture by digging the lower back (especially in the presence of reduced lumbar curvature).

Reality

Unfortunately, the reality is quite different. Several modern studies did not note a difference in intradiscal pressure between sitting and standing. This means that contrary to popular belief, sitting does NOT increase the pressure in your discs compared to standing. Let me tell you something even more impressive: It could even be that slouching INCREASES the height of the intervertebral discs! 

“There are currently no studies demonstrating a clear link between back pain and 'poor' sitting posture. »

Let's summarize the situation: Many have mistakenly associated sitting posture with back pain. However, there is currently no no study demonstrating a clear link between back pain and “poor” sitting posture. How then to explain that many people complain of lower back pain after maintaining a seated position for a prolonged period (driving, working day, etc.)?

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What is it really?

"It's probably not poor posture that's causing our pain, but rather our lack of physical activity."

Consider this: These days, most of us drive to work, only to sit at our desks all day. When we get home, what do we do to decompress and release our stress? You guessed it, we crash on our sofa to watch our favorite show in front of a packet of chips and a soft drink (sometimes until 2am!)… Then we wonder why we have back pain! Instead of pointing the finger at bad posture, we must instead question other factors:

  • In this situation, it is probably not the bad posture that causes our pain, but rather our lack of physical activity We often point the finger at "bad" posture as responsible for our back pain, but what about the movement restriction induced by the static sitting position? In fact, one study found that those who developed lower back pain while sitting tended to move LESS in their chair compared to those who had no pain.
  • Consideration should also be given to the management of daily stress. Many studies show the link between stress and back pain. After all, pain is a message from the brain to the "affected" regions of the body. Stress can be compared to oil being put on the fire, which here tends to amplify the brain's pain message (regardless of the actual injury).
  • There is possibly an indirect link between a poor diet. Unfortunately, there are not many studies on the subject, but it is easy to conceive that "junk food" can influence general health, weight, mood, etc. Inevitably, this can affect lower back pain in one way or another!
  • The link between sleep/insomnia and back pain: It has been observed that a poor quality of sleep in people with chronic back pain could intensify pain, in addition to affecting mood and function. It is therefore clear that a good night's sleep is essential for good back health!

The previous points demonstrate the multifactorial origin of pain. Certainly, when we have back pain, sitting for too long can make our symptoms worse, but it is probably not the primary cause explaining our problem. We must consider all the other aspects potentially responsible for our symptoms, then treat them individually to improve our overall situation. Concretely, what does that mean?

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The solution ?

“The solution to back pain is much more complex than standing up straight”

At this point, I hope you have understood this: the solution to back pain is much more complex than "standing straight"! Sometimes posture has a role to play in your back pain. Most of the time, it is definitely not the main cause of your pain. Let’s take a look together at some possible solutions to reduce pain while sitting:

Situation where it is favorable to stand “straight”

You may tell me that correcting your posture by straightening up relieves your symptoms. Or that you saw an improvement in your condition when a therapist changed your workstation. If so, great! I therefore invite you to continue your good habits, as long as your symptoms improve over time. I myself offer my patients to straighten up in certain specific situations:

  • From an aesthetic point of view (it's always prettier to stand up straight, let's face it!)
  • Symptom centralization: This strategy is taken from the Mckenzie method. If you have back pain radiating down your leg, try sitting with your lower back arched. Then determine if the localization of the symptoms has changed, for example by decreasing in the leg to "move" towards the lumbar region (a phenomenon called centralization). If so, this posture could prove beneficial and be associated with repeated extension exercises. See a qualified therapist Mckenzie method for more details.

What to do in a seated position to reduce pain?

We mentioned earlier that the lack of movement caused by the seated posture was probably more harmful than the posture itself! Thus, even if you are forced to remain seated, nothing prevents you from making a few movements to avoid inactivity. The video below is proof that there is no excuse if you ever want to relax your muscles and stay active in a seated position…no matter the context!

Beyond posture

“The best posture is the one that will take you out of the previous one. »

Once again, let us underline the fact that the origin of back pain is often multifactorial. Regardless of the posture adopted, it will be considered "bad" if you ever maintain it for the long term. Moreover, it is often said that the best posture is the one that will get you out of the previous one! If your back hurts after sitting for a long time, why not try getting up from your chair and taking a few steps. I will go even further by telling you to get up regularly, whether your back is sore or not! It's much more effective than trying to find the "perfect" posture that doesn't really exist!

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The other thing is to work on the other aspects potentially responsible for your back pain. Stress. Insomnia (or poor sleep quality). Bad nutrition. Sedentary lifestyle.

Conclusion

The perfect posture makes more than one discuss it. The problem is that no one has ever defined what exactly an ideal posture is! Is it a posture that is elegant to see? Or rather, which requires minimum work from our muscles? Or, the one that reduces your pain? Well, know that even medical professionals don't seem to not be entirely unanimous On the question! What is certain is that the link between posture and back pain is surprisingly inconsistent in light of the latest scientific evidence.

Morality ? If you have back pain, don't put too much emphasis on your posture. If a postural modification alleviates your symptoms, so much the better! Besides your posture, know that movement is your best ally to fight your back pain. Also assess your stress level, level of physical activity, quality of sleep, etc. Your back will thank you!

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