What is the best posture? Does it even exist?
All of us remember a time as a kid when somebody told us to “sit up straight.” Maybe it was your mom tired of you watching TV. Or maybe it was a teacher making sure you were paying attention in class. Or maybe it was just your inner voice trying to get yourself to be the best version of you. Either way, we all scooted our butts towards the back of the seat, pulled our shoulder backs, and centered our heads over our shoulders all in one motion to oblige that other person or voice. But other than looking better, is sitting up straight actually beneficial? Almost every patient I encounter states that they have “poor” posture, so is “good” posture the key to neck and back pain? Let’s find out.
Are any of these better than the other?
First of all, what is “good” posture and what is “bad” posture?
Most would probably agree that “good” posture is sitting up straight while “bad” posture is slumping. However, the degree of “sitting up tall” or “slouching” varies significantly between people and also health-care providers. One study[i] even asked 295 physiotherapists in Europe to choose the “best” sitting posture between nine different pictures and there wasn’t anything close to a unanimous decision. If clinicians can’t decide on the best posture, how can anybody? Not a good start for your mom and your teachers.
Does poor posture lead to future spine pain?
One study [ii] looked at college freshman women and their sitting positions during class. Their pictures were analyzed for three things: 1) elevation of one shoulder, 2) elevation of one hip, and 3) deviations of the spine from the midline. Twenty-five years later, these women were contacted again to see who had pain. The researchers found that none of the postural changes had any association to an increase in low back, mid back or neck pain. So, if you sat pretty poorly during your schooling years (which is probably everyone), don’t fret about it being the single cause of future pain.
What about not having a curve in my neck? Or too much curve in my low back?
Many clinicians over the years have come up with terms describing non-ideal spinal curvature. You might have heard of “texting-neck” or “military neck.” Or possibly “upper crossed syndrome” or “lower crossed syndrome.” Maybe a term like “swayback” for the low back curvature. The focus of each of these terms is deviation away from the average amount of curvature in either your neck or low back. The idea is that being different from average leads to an increased chance of pain. However, there are various studies that show there is no correlation between spinal curvature and spinal pain [iii] [iv]. These studies were done years and years ago and have been repeated several times, yet we still believe that the “average” spinal curvature is somehow better than anything else. This is just false. Heck, the first person to deadlift 5x his bodyweight was Lamar Gant, and he had a pretty severe case of scoliosis (sideways curvature of the spine). If a 132-pound person with scoliosis can deadlift 661 lbs then you can see how resilient our spines really are.
So does posture not matter at all??
Spinal pain is multi-factorial. There are various things that contribute to who has pain and who is going to get pain. What the research is pretty clear about is that posture ALONE is not a good predictor of pain. But that doesn’t mean posture doesn’t play some role in spinal pain. In fact, it can often be the difference between a successful outcome and an unsuccessful outcome in a patient with pain.
What’s the best posture for those in pain then?
The one that causes less pain.
Does sitting up tall increase your sciatic pain? Then slouch a little.
Does slouching intensify your headaches? Then sit up tall.
Every person is different, and every case of pain is different. Therefore, the ideal posture is different for every single person. I’ve had a few patients with pain that feel worse with “good” posture and feel better with slouching. These same patients are often amazed and also relieved when I tell them they should slouch while sitting. In general, if a certain posture makes you feel better, then do it more often. If a certain posture makes you feel worse, avoid that one.
What if I’m not in pain, what is my best posture?
Your next one. Our bodies are made to move, not to sit or stand in one position for hours on end. So if you’ve been sitting, stand up. Been standing up too long? Sit down. Sitting with right leg crossed over left leg? Switch legs. Slouch. Then sit up tall. Then go back to standing. Take a walk. Go exercise. Lie down on your stomach. Then on your back. Keep changing everything. Don’t have a “usual” or “normal” posture.
There you have it. Basically, posture doesn’t really matter… until it does. Also, don’t argue with your mom.
[i] Man Ther. 2012 Oct;17(5):432-7
[ii] Spine (Phila Pa 1976). 1985 Dec;10(10):872-7
[iii] Spine (Phila Pa 1976). 1985 Sep;10(7):644-8.
[iv] Eur Spine J. 2007 May; 16(5): 669–678.