If you have ever experienced pain in your shoulders, upper back, lower back pain or beyond - it is likely that you may have been told that “bad” posture is a contributing factor, or even the cause of your problem.

Concepts of “good” and “bad” posture have been widely adopted within a healthcare setting and within our general community for decades (Korakakis et al., 2019; Gilman, 2013). But how much does standing and sitting up straight really matter? And where did this concept come from?

LET’S FIRST HAVE A LOOK AT THE HISTORY OF POSTURE.

Dating back as early as the 16th century, upright posture was seen as important in the development of the military drill formation (Gilman, 2013). “Standing at attention” was the best position for carrying and using weapons, a way to enforce discipline, and for all soldiers at attention to look identical (Gilman, 2013).

The importance of upright posture moved from the military into civilian life in the 18th century. It was seen as a characteristic that differentiates humans from primates; it separated the “primitive” from “advanced” (Gilman, 2013). This then took a rather dramatic leap into the idea that “bad” posture was associated with physical and mental illness in the 19th century.

Within the 20th century, “good” posture was not only a sign of “optimal” health but it was also associated with class and being a civilized citizen who was able to contribute to society (Gilman, 2013). By the time we get to the late 20th century traditional societal and cultural beliefs were challenged, therefore etiquette and hierarchy were no longer credible arguments to withhold the idea of “good” posture. This is where we see medical definitions of posture and ideas that skeletal balance is important to support structures beginning to develop (Gilman, 2013).

NOW LET’S HAVE A LOOK AT THE CURRENT RESEARCH.

“Funnily enough the literature shows that there is a lack of agreement with regards to what actually is an optimal sitting and standing posture

— Korakakis et al., 2019

So how can we achieve the perfect posture to prevent musculoskeletal pain, if there is no universal agreement on what it is?

Currently there is limited evidence to support the idea that any specific spinal posture causes low back pain (Korakakis et al., 2019; Laird, Gilbert, Kent and Keating, 2014; Slater et al., 2019).  This makes sense, as we know that the experience of pain is multifactorial and there are both biological and psychosocial components to consider (Read our blog on pain HERE) (Laird, Kent and Keating, 2012).  

So why do we aim to achieve just one “perfect” position and avoid all others in hope that we can prevent pain? Would it not make more sense to consider the whole human? Not just the biological, but also the psychological and social elements that we know contribute to our overall experience of pain.

Despite many healthcare interventions aiming to “correct” postural dysfunctions and imbalances (Kokakis et al 2019; Laird, Gilbert, Kent and Keating, 2014), the research to support this is scarce (Laird, Kent and Keating, 2012).  The idea that modifying posture is directly related to improved pain and function has not been established in current research (Laird, Kent and Keating, 2012). This suggests that we have followed the course of history and transformed the meaning of posture to suit the times in which we live, without the support of high quality evidence. Ultimately the idea of “good” and “bad” posture in the prevention and causation of musculoskeletal pain can be seen as a societal construct not as evidence based information.

A positive take home is that people come in all different shapes, sizes, and spinal curvatures – we all look and move differently and the research supports the normality of this and that the way we sit, stand and move is not a one size fits all approach. This is exciting and very liberating.

It seems that just moving regularly, as opposed to critiquing the way we stand and sit is a more important and effective component to preventing and treating musculoskeletal pain.

If you’d like some  assistance or more information on how to manage your pain, our allied health team can help. Find our contacts by clicking the button below and reach out to get honest, evidence informed advice.

CONTACT US

BOOK TO SEE ONE OF US

REFERENCES:

1. Gilman, S., 2013. “Stand Up Straight”: Notes Toward a History of Posture. Journal of Medical Humanities, 35(1), pp.57-83.
2. Korakakis, V., O'Sullivan, K., O'Sullivan, P., Evagelinou, V., Sotiralis, Y., Sideris, A., Sakellariou, K., Karanasios, S. and Giakas, G., 2019. Physiotherapist perceptions of optimal sitting and standing posture. Musculoskeletal Science and Practice, 39, pp.24-31.
3. Laird, R., Gilbert, J., Kent, P. and Keating, J., 2014. Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis. BMC Musculoskeletal Disorders, 15(1).
4. Laird, R., Kent, P. and Keating, J., 2012. Modifying patterns of movement in people with low back pain -does it help? A systematic review. BMC Musculoskeletal Disorders, 13(1).
5. Slater, D., Korakakis, V., O'Sullivan, P., Nolan, D. and O'Sullivan, K., 2019. “Sit Up Straight”: Time to Re-evaluate. Journal of Orthopaedic & Sports Physical Therapy, 49(8), pp.562-564.