By: Dr. Marc Robinson, PT, DPT, Cert. MDT
A Physical Therapist's Perspective On Lower Back Pain and Posture
Are you ready for a challenge?
You are now entering a safe space. A place for leaving biases at the door and exploring the possibility of new information.
Conventional medical wisdom provides a narrative that poor posture equates to lower back pain.
Is this true? Does poor posture cause lower back pain?
Think of every time someone told you to sit upright and improve your posture.
I visualize a middle-aged school teacher with thick black glasses tapping a student on the back with a meter stick.
Or a piano tutor sternly instructing a future virtuoso to sit up straight at the keyboard.
Physical Therapists and healthcare professionals including myself have mentioned that poor posture can lead to back pain
But does the research support this perspective?
In reality, the research does NOT show strong correlations between poor posture and lower back pain.1
In other words, poor posture does not cause lower back pain.
You have to be kidding me!
By the way, research rarely shows any causation. Correlation is the proper terminology.
So, why do we still instruct people to improve their posture?
Are we giving advice from preconceived beliefs and biases?
Unfortunately, some people are. But not everyone.
In this article, I want to provide a more accurate viewpoint of posture and shed light on how posture can influence lower back pain.
Merriam-Webster defines posture in simple terms as, “the position of the body.”2
Okay, simple enough.
A more juicy definition of posture is the “attitude [manner] assumed by body either when the body is stationary or when it is moving.”3
Posture can be static (stationary) or dynamic (moving).
To have “good” posture, we need to control both stationary and moving positions.
Control is the key. I’ll explain this in more detail.
Now, is there a “good” and “bad” posture?
Posture isn’t as black and white as this graphic.
“Good” and “bad” posture depends on the context.
When working with patients in the clinic, I define “bad” posture as a position that increases the patient’s symptoms or makes them feel worse.
“Good” posture is the position that helps to alleviate their pain or improve their symptoms.
By helping someone identify the postures that increase or decrease pain, I am able to teach my patients how they can control pain on their own.
Talk about empowerment!
Once they understand how posture affects their pain, they have the remote control on their symptoms.
They could increase or decrease the volume on their pain at will.
How great would it be to achieve this level of control?!
In many cases, you can be taught how to find “good” and “bad” postures.
That’s great news for you!
For example, if you have lower back pain and slouch, this could make your pain increase. By keeping the spine in a more “neutral” position, the pain is likely to be alleviated.
This pain pattern is very common for people with lower back pain. Mostly because our western society sits for long durations of time.
Obviously, there are exceptions. There are rarely absolutes in life.
For other patients, I found the pattern of pain was the opposite of what I just described.
Slouching would decrease their pain and moving the spine in a more neutral position would increase their pain.
Jeez, lower back pain is complicated.
For this reason, an accurate assessment is crucial to the successful management of lower back pain.
Fortunately, we have a scientific method to determine these correlations and give you control of your pain.
So, is slouching bad?
To Slouch or Not to Slouch
Slouching is not inherently bad. Slouching occurs when the low back rounds out or flexes.
It is perfectly normal for the low back to flex forward.
For example, your low back will round out when you bend forward to touch your toes.
Now, let’s discuss sitting.
If you slouch in sitting, it’s not going to kill you.
But here is the caveat.
We sit for many hours in one day. Our spines were designed for movement.
Sitting all day is like putting a lion in a cage. It suppresses our natural desire to move.
In addition, excessive sitting places a high demand on the structures in the lower back.
I like to use the dynamic disc model to demonstrate the negative consequences of excessive slouched sitting.
Between each vertebra in the back, there are discs which provide cushion and nutrients to the spine.
The center portion of the disc is filled with a gel-like material known as the nucleus pulposis.
Mechanically, slouched sitting puts compression on the front part of the disc which pushes the nucleus pulposis backward.
Disc protrusions or herniation usually occur posteriorly or backward. In other words, slouched sitting mimics the mechanism of a disc herniation.
What is a disc herniation?
A disc herniation occurs when the nucleus pulposis leaks outside the outer wall of the disc. The disc material can push up against a nerve root causing sciatica or lower back pain.
These consequences can result from neglecting the importance of posture.
I have seen firsthand how these consequences can hurt entire families.
Lower back pain has profound psychological, physiological, and sociological effects.
In other words, it affects our mind, body, and the people around us. Not something to be taken lightly.
But our outlook and perspective on lower back pain should be positive and optimistic because lower back injuries can heal.
There is research to support that people can recover from low back injuries. I have also seen people miraculously cured of lower back pain by following the right treatment plan.
So, what should you know about slouched posture?
Be aware that prolonged slouched postures place unnecessary strain on the lower back. Years of slouched posture may eventually take a toll on the lower back.
Let’s apply what we have learned so far to a real-life scenario:
John has a desk job. He sits for 8 hours per day. John was in a car accident years ago and he has a history of lower back pain.
If he sits for many hours, his back starts to ache.
John would benefit from changing his sitting position frequently such as standing up every 30 minutes, stretching his low back while sitting, and maintaining the arch of his lower back when sitting in his office chair.
John may benefit from a sit to stand desk to change his position and a low back support to maintain the arch of the low back.
Here is why I want him to use a low back support.
The muscles in the lower back help to support his spine. However, the muscles can fatigue resulting in his lower back slouching.
Remember that slouching for long durations of time places excessive strain on the lower back.
If John tries hard not to slouch, he may overuse his muscles which can compress the spine:
The low back support allows the muscles to rest so he can maintain a better posture without working so hard.
He can concentrate on his job instead of getting distracted by lower back pain.
No one want to lose productivity at work.
John doesn’t have to use to low back support all the time. He can remove it and sit actively by using his muscles.
In fact, alternating between using the low back support and his muscles will help to train his postural muscles.
A low back support positioned in the small of your lower back will help to keep your lower back from slouching.
The Evercore low back support is convenient because it straps around office chairs which is perfect for long days at the office.
Like all tools, you shouldn’t overly rely on it, but it can help to keep you out of lower back pain for the reason mentioned above.
The Take Home Message
Does poor posture cause lower back pain?
It’s not exactly proven by the research. But does this mean we should neglect our posture?
The position of our lower back DOES matter.
It’s just that posture affects us differently than what was previously believed.
A quote from Morgan Freeman helps us paint a better picture of posture, “Your next posture is your best posture.”
A new understanding of posture will help more people avoid lower back pain and ultimately live pain-free.
Our culture likes to throw shade at poor posture. We have become so fixated on “perfect posture” that we lose sight of what is important…
These are key:
It is more advantageous to focus our energy on these principles rather than….
These negative beliefs have a harmful effect on our mind and body because they proclaim a narrative that we are broken and need to be fixed.
Now is a great time to realize you are not as broken as you think you are.
No need to feel guilty of having “bad” posture.
Just be aware that controlling and changing your posture matter.
Check out our collection of Evercore Low Back Supports if you need help to alleviate strain on the lower back.
We offer various sizes to support the lower back during those long days at the office.
1. Christensen, et al. (2008) Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health. J Manipulative Physiol Ther. 2008 Nov-Dec;31(9):690-714. http://www.ncbi.nlm.nih.gov/pubmed/19028253
2. Posture. (n.d.). Retrieved from https://www.merriam-webster.com/dictionary/posture
3. Gardiner MD. The principles of exercise therapy. Bell; 1957.