Posture and Pain

Posture is a controversial topic among health professionals. Many people have strong beliefs around posture, but these ingrained beliefs are often unsupported by evidence. ‘Good’ posture is generally idealised as being ‘straight’ and ‘upright’, while ‘bad’ posture is associated with slumping and stooping. Each of these postures load tissues differently. It is often how long the tissue is loaded for that is key, rather than set definitions of good and bad.

History of postural beliefs – Ancient Greek philosophers determined upright posture was ‘linked to the divinity and intelligence of human beings. This idea persisted through history, and upright, rigid posture was widely adopted for correct military drills. Over the 17th and 18th centuries, ‘good posture’ came to signify health, strength, and beauty. ‘Bad’ posture became an indicator of disability and moral degeneration. The idea of ‘good’ and ‘bad’ posture causing and contributing to pain and disability became ingrained in medical science and societal beliefs and is still present to this day. Some credibility can be given to this historical ideal, as severe progressive kyphosis (“hunch back”) is a hallmark of untreated spinal tuberculosis. 

However, in the absence of such disease the relationship of ‘good’ and ‘bad’ posture is not supported by the evidence. A study of 1108 Australian teenagers found that forward/slumped neck postures had no association with neck pain and headaches, challenging widely held beliefs. Similar evidence exists for back pain, with a recent study finding no link between slumping or awkward postures and pain.

Clinically, context is the most important factor when considering posture in presenting patients. Sustained postures can significantly contribute to pain, for example it has been found that less movement between postures when sitting increased risk of chronic low back pain. Movement and changing positions to reduce time in sustained postures are likely more important than posture itself.