Question: Do you have any tips on how to sit with good posture? My doctor told me I need to fix my posture to help with my low back and knee pain.
Answer: The short answer is – yes I have some tips but first I’m going to challenge the widespread (mis)beliefs about “perfect posture”.
Is posture important?
Posture is a frequent topic discussed by clinicians and patients alike, media and society. There is an inherent belief that pain (particularly in the spine) is caused by sitting, standing or bending “incorrectly”. There is little evidence to support these common beliefs and a large posture industry has flourished, with many interventions and products claiming to “correct” posture and prevent pain (Slater, Korakakis, O’Sullivan, Nolan, & O’Sullivan, 2019).
Bottom line – posture is not as important as we once thought. In fact, the focus should be less on ergonomics, postural assessments and training, and more on movement, challenging and changing pre-existing ideas of posture through education, and improving locus of control. Let me explain.
Firstly, there is no single “correct” posture. There is no such thing – there may be more “aesthetically pleasing” postures than others, but there is no one perfect posture. In fact, there are significant variations in posture across populations. People will generally have three typical spinal curves (a neck curve, mid back and lumber curve) but even these curves vary between people. Some people have shoulders that “round” forward more than others, some heads or chins jut forward, some have large mid or low back curves, some have a “sway” posture, and some have a straight or military style posture. None of these postures are inherently bad or good, they are just variations of how people stand upright. To have “perfect” posture is to have “imperfect” posture. Despite common assumptions, there is little evidence that one posture is better than another or reduces risk of pain (Slater et al., 2019)
If a health care professional checks your posture and they notice you have one shoulder higher than the other, or a “flat” back or “rounded” shoulders, don’t be alarmed. Think of it in the same way you’d think of variations in skin, eye or hair colour, or any other variation or asymmetry of the human body. Structurally, we all have our own idiosyncrasies – it’s normal to have one shoulder slightly higher than the other or one leg slightly longer than the other.
Now, I’m not saying throw the baby out with the bath water. Significant spinal conditions or “postures”, such as, severe scoliosis, Scheuermann’s disease, osteoporosis or arthritis, may need to be assessed and treated in various ways because they can have a significant impact on function and activities of daily living. The bottom line is, posture is not as important as we once thought, and there certainly isn’t a perfect posture to aspire to or maintain.
Posture and Pain
Contrary to popular belief, just because you have a “less than ideal posture” does not mean it is the cause of your pain or that you have poor function (Slater et al., 2019). Posture is in fact poorly correlated with pain, for example, rounded shoulders, forward head or a curved low back does not correlate well with or predict pain. Instead, our body (namely our nervous system) becomes a little over sensitive to certain positions. The posture you adopt to sit, stand, bend or lift is likely not dangerous or risky, instead focus on how often you move and change your posture. Frequent posture changes are often helpful in reducing or managing pain or discomfort. Spines are incredibly robust, tough and adaptable structures capable of moving and loading in a variety of positions.
In the work place, many people correlate their posture at the computer, how they use their mouse and/or their chair with the pain they are experiencing. To help fix your posture and subsequent pain, the internet, colleagues, or health care professionals may tell you that you should sit up straight, pull your shoulders back, tuck your chin in and make minimal movements while working at your desk. In some cases, people end up getting an ergonomic assessment of their work station only to have the pain persist. Now, don’t get me wrong, having your monitor at eye level is likely better than having it so you are repetitively turning your head to look at it. Certain equipment or work stations may cause “postural stress”. A postural stress is a challenge to your posture that’s imposed on you, as opposed to something you’re doing to yourself. It’s a situational issue, as opposed to the result of bad habit or prolonged, fixed posture. For example, a cashier whose till is positioned a little too far away, causing chronic reaching or uncorrected vision problems, forcing routine squinting and awkward head repositioning. Now, proper assessment and intervention can certainly help in these situations.
However, in the context of sitting at the computer working or watching TV for long periods, the reality is that there is little evidence that supports “correcting” posture and ergonomic assessments that actually fixes the problem or reduces pain. A 2018 (de Campos et al.) study found that compared to exercises and movement in office workers, ergonomics made no difference to pain and feelings of stiffness (for both neck and low back pain). Furthermore, there is no “one size fits all” approach – the best posture is a comfortable one. And when that one gets a little uncomfortable, move to another. This is especially important if you have arthritis.
What’s the Answer?
Think about how unrealistic it is to hold any posture, let alone the “perfect” posture, all day while at your computer. Yes, there may be some positions or ergonomic considerations that maybe helpful but any prolonged and uninterrupted posture (even with the best ergonomic equipment) will be the primary culprit of your aches, pains and stiffness. Why? Simply put, muscle fatigue and lack of circulation. Emotional status and stress also plays a compounding role.
Tips for Addressing Posture at Work
It’s important to have flow and be dynamic with your posture as much as you possibly can. Regardless of how “good” your posture may be, I can guarantee that trying to hold it for an extended period will cause discomfort. Muscles like to be contracted, lengthened and relaxed, as do joints like to be moved and loaded – doing this keeps them healthy and happy. A muscle that is asked to stay static but under load for a long period of time (like your neck and back muscles holding you up right when you’re seated at your desk) is like pulling a rubber band taut- the band goes white as the rubber stretches and over time it fatigues and can ultimately break. Now, I am not suggesting that your muscles snap, but I am saying they fatigue and can scream out at you in pain when held in a position or posture for a prolonged period of time. Exercising, loading or weight bearing activities during the day, and limiting prolonged postures can help reduce and manage your “desk neck” or low back aches while at work.
Lastly, you were designed to move. Avoid muscle fatigue and sustained tissue loading by changing your posture often. This means that your best posture is your next posture!
If you wanted some guidelines about “best” spinal sitting posture, see below.
- [Joints] not too close to end range (e.g., having legs straight out in front of you propped up on another chair) or held acutely bent for too long (e.g., having one leg folded underneath you while sitting).
- Ensure equipment allows for variability/adjustments.
- Several seated postures may be appropriate, avoid fixed sitting postures (yes, this means you can slump!). Remember, choose a posture that is comfortable and change it when you need.
- Reduce repetitive actions (e.g., using your mouse and typing) and isometric muscular contractions (e.g., holding your phone to your ear with your neck and shoulder) by taking breaks often and using ergonomic equipment (e.g., a headset).
- Lumber support aids, elevated foot rests and other similar aids can help if they suit your needs and work for you.
Remember, it’s more about the lack of movement and prolonged uninterrupted time spent in a position or posture than the posture itself.
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de Campos, T. F., Maher, C. G., Steffens, D., Fuller, J. T., & Hancock, M. J. (2018). Exercise programs may be effective in preventing a new episode of neck pain: a systematic review and meta-analysis. Journal of physiotherapy, 64(3), 159-165.
Driessen, M. T., Proper, K. I., Anema, J. R., Knol, D. L., Bongers, P. M., & van der Beek, A. J. (2011). Participatory ergonomics to reduce exposure to psychosocial and physical risk factors for low back pain and neck pain: results of a cluster randomised controlled trial. Occupational and environmental medicine, 68(9), 674-681.
Kim, S. E., & Junggi Hong PhD, A. T. C. (2013). Ergonomic interventions as a treatment and preventative tool for work-related musculoskeletal disorders. International Journal of Caring Sciences, 6(3), 339.
Slater, D., Korakakis, V., O’Sullivan, P., Nolan, D., & O’Sullivan, K. (2019). “Sit Up Straight”: Time to Re-evaluate. Journal of orthopaedic & sports physical therapy, 49(8), 562-564.