Back pain is the leading cause of disability worldwide. Most people experience an episode of back pain in their lifetime. It often emerges during adolescence and becomes more common in adults.
For up to 25 percent of people who develop back pain, it can be persistent, disabling, and distressing.
It can affect a person’s ability to participate in activities of daily living, physical activity, and work. Activities such as sitting, standing, bending and lifting often aggravate back pain.
There is a common belief that “good” posture is important for preventing and treating back pain, as well as protecting the spine from damage.
Good posture is usually defined as “sitting upright”, standing “tall and aligned”, and lifting with a squat technique and “straight back”.
Conversely, “bear” sitting, “tilt” standing, and lifting with a “round back” or sloping posture are often cautioned against.
This approach is widely held by people with and without back pain, as well as by physicians in both occupational health and primary care settings.
Surprisingly, there is a lack of evidence for a strong link between “good” posture and back pain.
Perceptions of “good” posture arise from a combination of social desirability and unfounded conjectures.
Systematic reviews (a study looking at multiple studies in one area) have found ergonomic interventions for workers, and advice on the best posture for lifting manual workers, did not reduce work-related back pain.
sitting and standing posture
Our group has conducted several studies exploring the relationship between spinal posture and back pain.
We examined whether “slack” sitting or “non-neutral” standing postures (for example, leaning back or leaning back) in a large population of adolescents were associated with or predicted future back pain.
We found little support for this approach.
These findings are consistent with systematic reviews that found no consistent differences in sitting or standing posture between an adult population with and without back pain.
People adopt many different postures of the spine, and no one posture saves a person from back pain. People with both reclined and upright posture may experience back pain.
lifting posture
Even globally accepted occupational health practices regarding “good” or safe back posture during lifting are lacking in evidence.
Our systematic review found no evidence that lifting with a rounded-back posture is associated with or predicts back pain.
Our recent laboratory study found that people without back pain who engaged in manual work for more than five years were more likely to get up with a more inclined, rounded-back posture.
In comparison, hand-to-hand workers with back pain tended to use squat lifts more with straighter backs.
In other words, people with back pain who follow “good” posture advice, but people who don’t lift the “good” way, don’t get more back pain.
In one small study, as people with disabling back pain recovered, they became less protective and generally walked away from “good” posture advice.
If not seat then what else?
There is no evidence that a “good posture” can prevent or reduce back pain. People’s spines come in all shapes and sizes, so posture is highly individualized.
Movement is important to back health, so learning different postures and adopting different postures is likely to be more helpful than strictly following a specific “good” posture.
While back pain can be intense and distressing, for most people (90 percent) back pain is not associated with recognizable tissue damage or deformity.
Back pain can be like a sprain related to a strange, sudden, heavy, or involuntary load on our back but can also be like a bad headache where there is no injury.
Importantly, people are more vulnerable to back pain when their health is compromised, such as if there is:
Back pain is more likely to persist if a person:
What can people do for back pain?
In a small group (1-5 percent), back pain can be caused by pathology that includes fractures, malignancy, infection, or nerve compression (the latter is associated with leg pain, and loss of muscle strength and sensation). . In these cases, seek medical care.
For the majority of people (90 percent), back pain is associated with sensitization of the structures of the back, but there is no identifiable tissue damage.
In this situation, too much focus on maintaining “good” posture can distract from other factors thought to be important for spine health.
This includes:
- move and relax your back
- engaging in regular physical activity of your choice
- Build confidence and stay fit and strong for normal daily tasks
- maintaining healthy sleep habits and body weight
- Taking care of your general physical and mental health.
Sometimes it requires some assistance and coaching with a skilled therapist.
So if you are sitting or standing, find comfortable, relaxing positions and vary them.
If you’re lifting, current evidence suggests it’s okay to lift naturally — even with a round back. But make sure you are fit and strong enough for the task, and take care of your overall health.
Peter O’Sullivan, Professor of Musculoskeletal Physiotherapy, Curtin University; Leon Strucker, Professor of Physiotherapy, Curtin University, and Nick Saraceni, Lecturer, Curtin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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