Sit up straight. It's advice most of us have heard at least once.
But there is no strong evidence that sitting, standing or bending in way that most might deem incorrect will lead to back pain, says Professor Peter O'Sullivan.
O'Sullivan is a Kiwi and professor of musculoskeletal physiotherapy at Curtin University in Perth.
He says it's time to turn our backs on the posture industry and follow the science that suggests sitting and slouching are not evil.
Good posture now being questioned Photo: creative commons - flickr - Charles Hutchins
Thoughts about the ideal sitting and standing posture have been around for centuries, O'Sullivan tells Jesse Mulligan.
“This idea of forcing people into a position that’s unnatural actually can be uncomfortable.
“We’ve done quite a lot of work looking at people with pain, particularly ongoing and disabling back pain, and the one thing we’ve found, and other researchers have as well, is that people with pain tend to hold very guarded or rigid postures and tense postures.
“So, this idea of holding a single position that’s tense and guarded actually doesn’t make much sense … that doesn’t fit with what we understand for what’s good for the spine in terms of its health.”
Caring for our whole body’s health, including getting regular exercise, movement, sleep, mental state, and diet, is better for our backs, he says.
“All of those things we know are helpful for your spinal health and they are often not the targets that occur with people when they develop pain, they go ‘oh my god, I better straighten my back and brace my core’, which may be a bit of a decoy from what should actually be a helpful way to manage the problem.”
Although most cases of back pain do get better over time, there’s an increasing fear in society about injuring our backs by moving around, he says.
“So we need a holistic way of considering pain and that now is being brought into all the training programmes.
“I’ve certainly had discussions with colleagues in New Zealand, where that understanding is now consistent within the training of physiotherapists and has it be and it should be within all aspects of health because the mind and body aren’t strange and separated; your thoughts, your emotions, pretty drive your actions and there’s lots of evidence to support that.”
In fact people who over-protect their backs by avoiding movement are more likely to cause stress on their spines, he says.
“The evidence would say that engaging with physical activities that you enjoy, that are probably social, that you’re going to keep doing regularly is the best activity for you.
“If you are creating a force through that part [the core muscles] of your body, that’s okay, but to brace your core when you sit, stand, bend, and lift, that’s not evidence-based and people without pain don’t do that, so we don’t see a reason why people with pain should do that.”
We need to have better trust in our spines, he says.
“Telling people to be careful with their back and take care of it, and don’t do this and don’t do that, they’re really unhelpful messages, they don’t build confidence in people’s ability to control their health.
“I think we have this mindset in our society that pain is a sign of damage so you’ve got to protect it or you’ve got to scan it, where actually we know for the majority of people, you won’t find something on a scan that tells you what’s going on with your back.
“So the approach we’re taking and we’re testing in a number of trials is actually giving people the understanding and the tools to build confidence back in their back and care for their lifestyle and develop a positive mindset around the back.
“We’ve seen significant long-term reductions in levels of pain and disability for these people and actually unhooking from depending on medical care and getting off the likes of opioids in that journey, but it’s a really hard thing to do because the whole health system is set up to do the opposite, unfortunately.”
