What Éric-Olivier loves most about physical therapy is his ability to have the chance to truly learn about his patient beyond the body mechanics. Getting to know patients allows him to better tailor h...
- I think it’s my posture. Since Covid-19, I’ve been sitting a lot more. I should probably change my desk and buy a standing one.
- You better watch your posture and stand up straight, or you will have back pain.
- I’m tired of my back pain… oh, then you should probably change your chair.
- Try spending more time standing its good for your back
- Don’t have your head too forward, or else you’ll have neck pain, stop looking at your screen.
- I think what you have is called a texting neck problem (people get told that by some “professionals” …)
Do these claims sound familiar to you? Posture is a vast and gray topic many claim to be professionals and gurus of, but what does the science say and what is accurate and helpful in all this? My goals with writing this are to find to demystify posture and make it accessible to everyone, show you why posture is important and yet not so important and give you tools to help your back and neck when you don’t have the choice but to sit or stand all day.
For those looking for a quick answer, the answer to “should you be conscious of your posture and work on it” is YES. The answer to “is there a good and a good, bad posture” the answer is NO, there isn’t a single posture that is bad for you when held for a short time. Every position held for a short period is perfectly healthy and isn’t problematic usually. Any sustained position for too long or overly repeated over a period can be harmful and induce pain. This is true for sitting perfectly upright with your head straight arms at 90º on armrests as well as sitting slumped in a chair. These two positions are each other’s opposite, yet both are bad for you, and this is true for any position between these two that is sustained for too long.
Most of us think of posture as sitting but sitting is only one type of posture. Posture is an umbrella term that englobes (sitting, bending, standing, walking, lying on your back/stomach and your side). Posture is simply the position of your body at a given time.
Even though humans have evolved from primates, we haven’t evolved from our ancestors walking in the same streets as us 150 years ago. What we do every day has extremely changed. From the time we were apes to our great grandparents, never in history have humans been built and expected to stay in the same position for most of the day. Our ancestors used to run and be in movement, hunting and gathering all day. This is what our body is built for, constant movement, also known as “always changing our posture.” We weren’t and still aren’t built to sit static for 4 hours before a one-hour lunch break (where we sit to eat and look at our phone) before going back for a second shift of sitting. Nowadays, especially since COVID, most of us go through our day without spending more than one or two hours moving.
For example, we will assume that your job requires you to sit all day as this is the reality for most of us now. Most of our day is dedicated to sitting, whether by working, studying, eating, watching TV, reading on the couch… like it or not, most of our days are spent sitting. If you work standing all day in the same position, such as a cashier, this is also true for you. The only difference is that you stay standing in the same position for too long and don’t sit often enough. As you will see as you read the article, both extremes are to be avoided.
Ever wondered what your back goes through every day (ok, I know probably not, but this is useful). Our back can move in a lot of directions. For this article, we will only use two directions. The first one is called flexion (bending forward), which is the movement that occurs in your back when you try to touch your toes, the movement that curves your back like a turtle shell. Flexion postures would be sitting in any way that isn’t upright, bending, lying on your side in a fetus position, lying down in child pose, and walking uphill.
The second movement is called extension (leaning backward), which is the movement that happens when you get up from sitting for a few hours in your chair and try to lean back with your hands on your hips, or for the limbo adepts, the position of your back when you lean back to pass under the undefeated broomstick. When we are standing, usually, our back is in extension. Other extended postures would be sitting upright, standing, walking on flat and downhill, lying on your back and stomach, for instance, watching tv lying on your elbows.
To give you an idea of what a typical day looks like for your back, on average, your spine will move for a whopping total of 4400 times in a day (1). You will pass roughly 5 hours (4.9) of your day in a moderate amount of flexion (bent forward) while passing a meagre 24 minutes in moderate extension (leaning back) (1). You will also, on average, go 50x to the limit of your flexion (your spine bent to its maximum forward) and never go to the maximum of your extension (1). We will get back to these later, but already, we can see there is a huge discrepancy between how long and often your spine is bent forward compared to backward.
Regularly interrupting with movement is the optimal sitting posture for spinal health and the prevention of low back pain. Because when we are sitting, we are in a flexion position. The goal would be to break that flexion and stand up every so often and extend backward as much as a possible. Here are a few examples of exercises that promote extension that could be worth testing out.
Extension in standing
Thoracic extension in sitting
Extension in lying
1. 30/30 rule
If you find yourself having to sit all day, every 30 minutes, stand up for 30 seconds and lean back as much as possible or go for a quick 30 second walk. If you find yourself standing all day, every 30 minutes, sit down or try touching your toes for 30 seconds.
Not only will this be useful for you back, but it will also help improve your concentration by allowing you to rest every 30 minutes. I typically suggest 30 minutes because this is usually where people start feeling uncomfortable. The goal is to reset before it becomes painful.
2. Correcting it yourself
A quick and easy way to fall in that extended posture but not overly upright is to do what is known as the slouch-overcorrect technique. This simple exercise will take you 30 seconds but allows you to find that sweet spot. You round your back to the absolute maximum and then extend to the absolute maximum while remaining seated. Repeat this 5-10 times and at the end of the last maximal extension, relax by 10%, so you don’t stay in an extreme position. Naturally your body will gradually fall more and more into flexion, with time, which is why starting in a more extended position is a good idea.
3. Lumbar roll
If you don’t want to have to consciously keep in mind to stay upright as this can indeed be tiring, a better option would be simply placing a roll (lumbar roll) on your seat. This will allow you for the time that you are sitting to maintain a more upright posture. This can easily be removed regularly and, even when in place, allowing you to change positions.
4. Back braces/belts
I wouldn’t recommend back braces for posture. The problem with back belts or back braces compared to the other options mentioned is that they are much more rigid and don’t allow you to change posture. They hold you in that upright posture until you remove them. They also reinforce the idea that there are good and bad postures. This goes against everything that was said in this article. I also believe that it would be better to try to control this without external means at first, so you don’t depend on them over time.
The take home message to me is that there are no inherent bad postures, only postures held for too long. If you want to make your life easier and not focus on changing your entire office and posture, every 30 minutes take 30 seconds to change posture. If you are sitting, get up and if you are standing, sit down. Posture is quite simple, but people tend to make it more complicated than it needs to be.
I tried but it changed nothing, I still have that back/neck or other body pains… if this is the case, I would recommend seeking professional help to see what the source of your pain is. Physical therapist would be a good way to start.
If you want to know the next steps if physical therapy fails to provide you with the relief you are looking for, make sure to read the third and last article of this series. This article looks at more invasive treatments such as injections and surgeries. I also give more tools to help you control your symptoms and stay as active and functional as possible.
If you feel like you would benefit from an evaluation to identify and treat your pain from a health professional, you are welcome to make an appointment with me. It will be my pleasure to guide and help you.
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 firstname.lastname@example.org or by phone at 514-692-3347. If you are not sure if you want to book an appointment or if I can help you, make sure to call me. It will be my pleasure to answer and guide you.
1. The McKenzie institute international, PART A, The lumbar spine PDF, P. 74