Sitting up straight to reduce back pain is a myth

If you ask most people how to prevent back pain they will say: “Sit up straight and mind my back,because our parents have instilled this in us,” says Kieran O’ Sullivan, senior lecturer at the University of Limerick and lead physiotherapist at the sports spine centre in Aspetar hospital, Qatar. We are, says O’Sullivan, almost paranoid about posture. Yet the evidence linking posture and backache is surprisingly insubstantial.

There is no agreed gold standard of good posture. A study of 295 physiotherapists in four European countries asked them to pick their perfect posture from pictures of nine options ranging from slumped to upright. While 85% chose one of two postures, these were very different, with one having less lumbar curve than the others and a more erect upper back. The researchers warned that this posture would actually need higher levels of muscle activity and could cause greater tiredness and discomfort. The other favourite had more lumbar curve, but the researchers said there was no evidence it would reduce the risk of back pain. In fact, different postures suit different people – women, for example, tend to have a larger hollow in their lower back.

O’Sullivan says that rather than focus on the right posture, the ability to vary it and shift easily may be more important: “While it is appealing to think that if you sit up straight you will not get back pain, this is not supported by big studies across many countries.” Indeed, while many websites swear that bad posture (usually defined as slumping, leaning forwards or standing with a protruding belly) causes everything from back pain to varicose veins and indigestion, there is no evidence that it causes general health problems.

This brings us to the question why would anyone choose to correct their posture , says Dr Eyal Lederman, an osteopath and honorary senior lecturer at University College London’s Institute of Orthopaedics and Musculoskeletal Science. “To date, all the research has shown that there is no relationship between any postural factors, including the shape and curves of the back, asymmetries and even the way we use our spine, to that of developing back pain.”

There is no relationship between sitting and developing back pain. Yes, if you already have back pain, you might feel it more when sitting; but it is not the cause of the back pain.” Lederman argues that we have evolved to be able to bend and lift: “These natural activities are safe and beneficial to our spinal health; we must stop being afraid of them.”

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