POSTURE: Straighter Isn’t Always Better

August 23, 2018 at 2:31 PM

“Shoulders back, stomach in, chest out.  Stop slouching Darryl, or you’ll get back pain later on in life!” I can still hear Granny saying those words to me when I was a kid.

We have all heard many times before.  And we have come to believe it to be true.  After all, so many people have been saying it for so long.  Our doctors, physios, grandparents, parents, ACC ads on TV, the list goes on.  It’s always the same message: Sitting and standing upright and ‘straight’ is the best posture for a healthy spine and preventing back pain.

Then came the core stability revolution of the 90’s.  This was supposed to be the answer for every low back pain sufferer on the planet.  An entire industry was born around this idea. Gym classes, personal trainers, Pilates, and yoga all began to really focus on the ‘core’ muscles.  Physios, doctors and specialists alike emphasised the importance of strengthening the core muscles to help relieve and prevent back pain. Many health professionals still focus on this idea.

There is nothing wrong with strengthening the core muscles.  It is important for overall health and function to have a strong, conditioned muscular system that includes the muscles of the abdominals, back and gluteals. Having been a physio for nearly 20 years, I have prescribed core strengthening exercises for many of my patients.

However… Beliefs about upright sitting and standing postures as well as core strength and stability and their relationship to pain and prevention of back pain, have morphed into becoming some of the very factors that may drive people’s pain, not alleviate or prevent it. In a nutshell, so much poorly guided focus on posture and core stability can have the opposite effect… it can make back pain worse.

Although it has now become ingrained in our psyche to accept these ideas as fact,  there is actually no evidence to support the idea that standing or sitting in upright rigid postures will be of any benefit to low back pain.  Or that switching your ‘core’ muscles on, on a continual basis, will have any benefit either. In fact, there is strong evidence to say that these postures and exercises can make our pain worse. And even more evidence to say that being static (not moving) is bad for spinal health.

I’m not saying there is anything wrong with having a strong core. In fact, it is healthy for the spine.  But we need to focus on working the core muscles through movement and exercise, rather than constant engagement.  You wouldn’t work your biceps in the gym and then keep them contracted for a week until it was time to do the workout again.

We know from recent studies that people with ongoing low back pain have more back muscle and abdominal activity than people without pain. Therefore it does not make sense to encourage people in pain to adopt even more rigid and tension-filled postures. It ends up placing a more compressive load on an already painful and sensitised structure, which is highly counterproductive. There’s a saying in physiotherapy circles: “You can always tell someone with back pain, they sit up really straight”.

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Above - Too Straight

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Above - Slouching

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Above - Ideal seating posture

Where appropriate, I teach all my patients with low back pain how to sit, stand and move correctly in a relaxed and safe manner. This takes a lot of load off their spine and for the majority of the people, results in significantly less pain, especially if the pain has been there for a long time.

Thankfully, the paradigm shift has begun regarding posture and core stability for the care of low back pain.  But it will take a long time to change beliefs that are entrenched in our society. At Auckland Physiotherapy we follow up-to-date, evidence-backed research and don’t just do things because ‘they have always been done that way,’ or follow trends simply because they’re popular at the moment.

One of my passions is helping people with ongoing low back pain even if you have tried many different types of approaches and haven’t had good results. Below are some tips for sitting properly without pain and overloading your spine:

  1. Breathe normally and into your belly.

  2. Don’t over correct your posture- relax!

  3. When sitting in a chair let your low back sink into the chair.  Make the chair do the work NOT your muscles

If you’re one of many people who thought you needed rigid posture for proper back health, or if you suffer from back pain and want to learn how to find relief and prevent further pain, come see me for a consultation and we can get you back on track.

Darryl Reid

 

Darryl Reid is a Senior Physiotherapist, specialising in reoccurring spinal pains, sports injuries and chronic pain. To book an appointment with Darryl click here or call us on 09 366 4480.