The Truth about Posture: A Realistic Sitting Hygiene Routine that will Help you Stay Healthy

Danny Dinh

Physiotherapist

September 29, 2022

Before you start reading this article, please do something for me. It will make sense later on, I promise. Whether you’re reading this at your desk, in the subway, or in the toilet, sit straight. Pull your shoulder blades back, contract your lower back, and imagine that a string is tied from your head to the ceiling, forcing you to hold your head high.

Great, now hold this position and read on.

Intro

If I had a loonie every time I heard one of these phrases from patients coming to me with neck or back pain while sitting, I’d probably be able to afford a new work setup myself.

Desk jockeys, have you ever said or thought of any of these phrases? Well, whether you did or you’re lying to yourself, this article is for you.

Lawyer, physical therapist, or gamer… Whoever you may be, if you clicked on this article, then chances are you spend the majority of your day sitting and will benefit from this read.

By reading this article, you will obtain a realistic sitting hygiene routine that you can implement immediately. We will also demystify some common posture tips and myths so that you may customize the routine in a scientifically-backed way.

Realism

A good sitting hygiene protocol is the same as any good training program: it has to be realistic and progressive. 

Here are some bad ideas:

1. Asking someone who has been using the same type of chair his entire career to now sit in a lumbar-cushioned expensive office chair.
2. Making any changes at all to a desk setup when you are completely pain and problem-free.
3. Transitioning from sitting for 8 hours/day to standing for 4 hours after purchasing a standing desk.

What do all these ideas have in common? They implement changes that are either unnecessary or too drastic. This all goes back to load management (“How was load management used in Ms. T.’s rehab?” in my tennis elbow article).

Going from sitting for 8hrs to standing for 4hrs is just too drastic. Is standing for 4 hours bad? Of course not. But over the years, your muscles, tendons, and bones would’ve gotten used to being loaded in the sitting position for the majority of the waking day. To go from that to now being loaded in the standing position, which is much more demanding, could lead to musculoskeletal issues.

What an extreme case, right? I mean, who would really go from 0 hours standing at work to 4 hours in one go?

This might seem like an exaggerated example, but I have treated at least 3 cases who started experiencing back pain after effecting a transition of the sort due to a well-intentioned but misguided desire to better their sitting hygiene.

The myth of the perfect posture

In physical therapy school, we called it forward head posture. On social media, it is also called text neck or tech neck. I’ve even seen it called military neck in older publications. Whatever you may call it, common society has made having a forward head posture synonymous with having a bad posture. The vast majority of my patients complaining of neck pain while working at a desk will point to their forward head posture as the main culprit.

They often find it surprising when I tell them that there is actually no association between forwarding head posture and neck pain. This is a bold claim I am making, but I would not be making it if it was not backed by modern scientific research. 

A study conducted by Richards et al. in 2016 looked at 1108 adolescents (a demographic often accused of having terrible posture due to their usage of cellphones) and concluded that “no association between cluster membership and neck pain and headaches challenges widely held beliefs about the role of posture in adolescent neck pain” (cluster memberships meaning having a specific posture).

Two additional studies looking at adults in 2018 and 2021 established a similar conclusion.

But what about low back pain? If not neck pain, could “bad posture” cause low back pain? Unlikely. What is even more surprising is that even having a nice rigid posture can lead to low back pain according to this 2015 case-crossover study and this 2015 randomized pilot trial.

The takeaway from this

Okay, so we just busted a few myths. What should you take away from all this? Does this mean that everyone should walk around with their heads slumped forward like Gollum from Lord of the Rings? 

Heavens no. Sitting straight with a head held high is perfectly fine and many people feel more confident and comfortable that way. The point of debunking the myth that bad posture = neck and back pain is simply to say that when constructing a sitting hygiene plan, the emphasis should not be placed on having a straight posture.

This is great news for you because you can’t have a perfectly straight posture for 8 hours straight. I can’t either. In fact, no one can.

Also, treating neck pain is much more complex than simply telling someone to sit straighter. Here is an example of how I treated a recent desk worker with neck pain.

We’re more than halfway through with the article. Are you still sitting straight? If not, that’s fine, you’re just like the rest of us. If you still are, congratulations on your dedication. Now imagine staying like that for the entire day. If you’re scoffing right now because you’re used to sitting straight like that for entire days on end, text me at 438-801-0417 to impress me.

A sample protocol

Here is an example of a realistic sitting hygiene protocol that I would give to someone complaining of stiffness during their workday (or gaming session).

This is not the perfect plan for you. It is well made, has been tested many times, and is made by a man on the internet with good intentions but zero knowledge about your medical history or your needs. If you’d like a custom-made sitting hygiene plan, give me a call or book an appointment. I’d love to help you out! Now, let’s get into the steps of the sitting hygiene protocol.

1. Sit down at your desk. Look at your screen, move your mouse, and type at your keyboard as if you were working or gaming. Are you perfectly comfortable? Do you feel like your neck and back are as relaxed as possible? If so, great. Don’t change anything. This means that your “default” position is already great. If you’re not comfortable, try adjusting your monitor, your chair, and your armrests. You can also add a lumbar roll to your backrest. Experiment with these options to make your default sitting position as comfortable as possible.
2. Eat some movement snacks. Something that works with many of my patients is to steal a trick from the optometrists’ playbook. Every 20 minutes, look at something 20 feet away for 20 seconds and move for 20 seconds. This movement should be done while sitting so as to disrupt your workflow as little as possible and can consist of something simple like pumping your ankles, making circles with your wrists, or stretching your back. Seated thoracic extensions are my personal favorite exercises to get a nice stretch in during a long work session. Accessories such as a standing desk or a desk treadmill are not required but are great to give you more movement options during those movement breaks.
3. Minimize the time you spend sitting outside of work or gaming hours by doing a sport. Whether it be a 30-minute walk at the neighborhood park, joining a morning yoga Zoom class, hitting the gym, jogging, or martial arts, anything goes. The goal is to move. The mental and physical benefits of exercising are infinite and are something that passionate me, there will be an article on that topic alone. Suffice it to say that there is no medical pill as beneficial as exercising regularly. A nice ballpark figure is 30 minutes of moderate-intensity aerobic physical activity 5 days per week, which is recommended by the American College of Sports Medicine.

Now that you have this sample sitting hygiene protocol, it is time to customize it. But remember the earlier points made on realism! Do not make any drastic changes in a short period of time. A good guideline for making changes is to not make a change of more than 10% during a 1-week period.

This means that if you’re currently sitting for 8 hours at work and just purchased a standing desk (or can move your laptop to a standing height), start by just standing for 40 minutes in total every day next week. This can be broken up into 2 periods of 20 minutes at the start and end of your day..

Moving forward

If any of the information or stories in this article speaks to you, feel free to check out my profile to read more of my articles or to book a 1-hour private room evaluation with me.

If you’d like to discuss any of the points raised in this article in more detail, I would love to speak to you. You can contact me by email at dannydinh.physio@gmail.com or by phone at 438-801-0417. I currently offer free no-strings-attached 15-minute phone call sessions to discuss how I can best assist you.

Further reading

Here are some suggestions of articles I have written recently, organized by topics.

An in-depth explanation of my physiotherapy philosophy: Part 1, Part 2

Neck pain: a case study, answering common questions from patients

Low back pain & sciatica: case study 1, case study 2, case study 3

Knee pain: case study 1

Shoulder pain: case study 1

Elbow pain: tennis elbow case study

An explanation of referred pain

Why choose telerehabilitation

7 reasons why I love my profession

Sources: 

Correia, I. M., Ferreira, A. de, Fernandez, J., Reis, F. J., Nogueira, L. A., & Meziat-Filho, N. (2020). Association between text neck and neck pain in adults. Spine, 46(9), 571–578. https://doi.org/10.1097/brs.0000000000003854

Damasceno, G. M., Ferreira, A. S., Nogueira, L. A., Reis, F. J., Andrade, I. C., & Meziat-Filho, N. (2018). Text neck and neck pain in 18–21-year-old Young Adults. European Spine Journal, 27(6), 1249–1254. https://doi.org/10.1007/s00586-017-5444-5

Kent, P., Laird, R., & Haines, T. (2015). The effect of changing movement and posture using motion-sensor biofeedback, Versus Guidelines-based care, on the clinical outcomes of people with sub-acute or chronic low back pain-a multicentre, cluster-randomised, placebo-controlled, pilot trial. BMC Musculoskeletal Disorders, 16(1). https://doi.org/10.1186/s12891-015-0591-5

Physical activity guidelines resources. ACSM_CMS. (n.d.). Retrieved September 29, 2022, from https://www.acsm.org/education-resources/trending-topics-resources/physical-activity-guidelines

Richards, K. V., Beales, D. J., Smith, A. J., O'Sullivan, P. B., & Straker, L. M. (2016). Neck posture clusters and their association with biopsychosocial factors and neck pain in Australian adolescents. Physical Therapy, 96(10), 1576–1587. https://doi.org/10.2522/ptj.20150660

Steffens, D., Ferreira, M. L., Latimer, J., Ferreira, P. H., Koes, B. W., Blyth, F., Li, Q., & Maher, C. G. (2015). What triggers an episode of acute low back pain? A case-crossover study. Arthritis Care & Research, 67(3), 403–410. https://doi.org/10.1002/acr.22533

Images courtesy of: Massage Therapy Journal, The Lord of the Rings, Amazon, Back Intelligence