The “correct” posture does not prevent back pain, and the “incorrect” posture does not cause it

There is a common belief that “correct” posture is important for protecting the spine and preventing and treating back pain.

“Correct” sitting posture is typically defined as an aligned and upright back, while for bending, it’s recommended to bend the knees with a straight back. We often avoid slouching while sitting and lifting objects with a rounded back. This view is widely accepted by people with or without back pain, as well as by health professionals.

Paradoxically, there is no strong evidence linking “correct” posture to back pain. The perceptions of “correct” posture stem from a combination of social misinformation and unfounded assumptions.

Systematic reviews (studies that review multiple studies in a field) have found that ergonomic interventions and advice for both office workers and manual laborers do not reduce work-related back pain.

Sitting and standing posture

Several studies investigating the relationship between spinal posture and back pain, such as whether sitting with a slouched back or adopting a non-neutral standing posture (e.g., hunching or excessive extension), do not support the belief that these cause back pain.

People adopt a range of spinal postures, and no single posture protects a person from back pain. People with both slouched and upright postures can develop back pain.

We have often seen such posters in healthcare facilities, workplaces, or online. However, these guidelines are not scientifically proven.

Posture when lifting objects

Globally accepted advice about the “correct” or safe postures for lifting objects also lacks evidence. The literature shows no strong evidence linking lifting with a rounded back to back pain.

It seems that people with back pain tend to follow advice about “correct” posture, but even people who don’t lift in the “correct” way don’t necessarily experience more back pain.

Everyone develops different postures and movement patterns over time that are well-suited to their body. Attempting to change these patterns may not necessarily help alleviate pain.

If not posture, then what?

Currently, there is no evidence to suggest that one single “correct posture” can prevent or reduce back pain or avoid potential injury.

Human spines come in all shapes and sizes, so posture is highly individualized. Movement is important for back health, so learning different and comfortable postures is likely more useful than strictly adhering to a specific “correct” posture.

While back pain can be intense and painful, for most people, it is not linked to identifiable damage or pathology. Back pain can be a tissue injury caused by awkward, sudden, heavy, or unusual strain on our back, but it can also appear like a bad headache, without a specific cause related to injury.

It is important to know that a person is more vulnerable to pain when they are:

• feeling stressed
• in a bad mood
• tired or overworked
• sleeping poorly
• less physically active.

Pain is more likely to persist if a person:

• worries excessively about their back pain
• overprotects their back and avoids movement, physical activity, work, and social engagement.

What can we do for back pain?

In a small percentage of people (1-5%), back pain may be caused by pathological conditions such as fractures, malignancy, infection, or nerve compression. In such cases, we seek medical care. For most people (90%), back pain is related to sensitization of the structures, but not identifiable tissue damage.

In this case, excessive focus on maintaining the “correct” posture may distract from other factors known to be much more important for spinal health.

These include:

• moving and relaxing our back
• engaging in regular physical activity of our choice
• building confidence and maintaining fitness and strength for routine daily tasks
• maintaining healthy sleep habits and body weight
• taking care of overall physical and mental health.

Sometimes this requires some support and guidance from a qualified health professional. So, whether sitting or standing, find comfortable, relaxed postures and vary them. When lifting something, current evidence suggests it’s okay to lift naturally, even with a rounded back. However, ensure that you are well-adjusted and strong enough for the task and take care of your overall health.