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Posture and Back Pain: What Research Says
- Luke Schembri
- Aug 17
- 4 min read
Updated: Oct 3
Introduction
Back pain affects millions worldwide and is often blamed on “poor posture.” As an advanced physio, I discuss what current evidence says about posture and back pain—and how to apply it day to day.
Contents
What is "poor posture"?
Historically, healthcare professionals have emphasised maintaining a "neutral spine" to prevent back pain. Deviations from this ideal posture, such as slouching or forward head posture, were considered primary contributors to discomfort and musculoskeletal issues. This perspective led to widespread ergonomic interventions and posture correction strategies aimed at alleviating back pain.
Does posture cause back pain?
Emerging evidence suggests that the direct correlation between poor posture and back pain
may be overstated. A systematic review published in the Journal of Biomechanics found no
consensus on the causality between spine postures or physical exposure and low back pain.
This indicates that factors other than posture, such as sleep deprivation, stress, prolonged
physical inactivity and deconditioning could play more significant roles in the development of back pain.
10 key facts about back pain (what they mean for you)
Physiotherapist and researcher Peter O'Sullivan has been instrumental in reshaping our
understanding of back pain. In his 2020 publication in the British Journal of Sports Medicine,
O'Sullivan presents ‘ten key facts that everyone should know about back pain’, challenging common misconceptions:
1. Persistent back pain can be scary, but it's rarely dangerous.
2. Getting older is not a cause of back pain.
3. Persistent back pain is rarely associated with serious tissue damage.
4. Scans rarely show the cause of back pain.
5. Pain with exercise and movement doesn't mean you're doing harm.
6. Back pain is not caused by poor posture.
7. Back pain is not caused by weak core muscles.
8. Back pain is not caused by spine degeneration.
9. Effective treatment for back pain is safe and inexpensive.
10. Back pain can get better even if you've had it for a long time.
These insights emphasise that back pain is a multifaceted issue, often influenced by
psychological and social factors rather than solely by physical posture.
If you've been dealing with persistent back pain, I strongly suggest listening to Dr Rangan Chatterjee’s podcast episode featuring Professor Peter O’Sullivan. Their conversation discusses this topic in more detail. I've signposted this episode to my back pain patients in the past and many have found it profound!
How to Break Free from Chronic Pain and Reclaim Your Life with Professor Peter O’Sullivan
YouTube version: https://www.youtube.com/watch?v=U4RO8UjIgN8
Psychosocial Factors & Stress
Contemporary research highlights the significant impact of psychosocial elements on back
pain. Factors such as stress, anxiety, depression, and job dissatisfaction have been linked to
the onset and persistence of back pain. This biopsychosocial model suggests that
addressing mental and emotional well-being is crucial in managing and preventing back
pain.
The Role of Physical Activity
Physical inactivity is a notable risk factor for back pain. Engaging in regular exercise, including activities like walking, stretching, and strength training, has been shown to reduce the risk of developing back pain and aid in recovery. A study highlighted in The Times suggests that reducing daily sitting time and incorporating movement can prevent the worsening of back pain.
Re-valuating Ergonomic & Standing Desks
While ergonomic adjustments, such as using standing desks, have been promoted to
combat back pain, recent studies question their efficacy. Research published in PubMed
indicates that prolonged standing does not necessarily confer cardiovascular benefits and
may introduce other health risks. Experts recommend integrating regular movement
throughout the day rather than relying solely on ergonomic tools.
Practical implications: What Actually Helps
Understanding that poor posture is not the primary cause of back pain has significant
implications for treatment and prevention strategies:
Holistic Approaches: Emphasising a comprehensive approach that includes
physical activity, mental health support, and lifestyle modifications.
Patient Education: Educating individuals about the multifactorial nature of back pain
to reduce fear and promote active participation in recovery.
Personalised Care: Developing tailored interventions that address individual risk
factors, including psychosocial elements and physical activity levels.
Conclusion
The traditional emphasis on poor posture as a primary cause of back pain is being
reconsidered in light of contemporary research. Recognising the complex interplay of
physical, psychological, and social factors offers a more accurate understanding of back
pain and informs more effective prevention and treatment strategies.
Posture & Back Pain FAQs
Does poor posture cause back pain?
Not on its own. Back pain is multifactorial; posture is one piece. How you move and load over time matters more.
Should I get a standing desk?
It can help some people, but varying positions and moving often usually helps more than any single setup.
What should I start today?
Short, regular movement breaks, simple strength work and sensible pacing. I can help tailor this to your day.
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