Sitting up straight does not prevent or treat back pain, study finds

Sitting up very straight is no longer advised as treatment for or prevention of back pain, according to a new international study involving researchers at the University of Limerick (UL).

The study, published in the journal of Musculoskeletal Science and Practice, found that there is a lack of evidence for the advice that sitting upright – or correcting your usual sitting posture – either prevents or treats back pain.

“The importance of posture in back pain is overstated in general. Nobody has ever shown that people without pain should be advised to change their posture,” said study co-author, Dr Kieran O’Sullivan from the School of Allied Health at UL.

Dr O’Sullivan contends that there is not one “safe” or “proper” way to sit when it comes to back pain. “Am I comfortable and can I do what I need to do are perhaps all that are worth considering from a posture perspective,” he said.

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Four out of five people suffer from back pain at some stage in their lives. The researchers’ conclusions may provide some comfort to the thousands of people sitting at kitchen tables while working or studying from home during the Covid-19 pandemic.

“If you feel okay, then don’t worry about your sitting posture and don’t lecture your kids or friends about how they sit,” said Dr O’Sullivan, who is a lecturer in physiotherapy at UL.

For those who do suffer from back pain however, Dr O’Sullivan said that it’s reasonable to see if changing your posture helps your pain. “Don’t assume that the solution is always sitting up straight. Some people benefit from sitting up straight but slightly more people benefit from slouching.”

Psychological factors

According to Dr O’Sullivan, psychological factors such as worries and mood and lifestyle factors such as sleep and fitness are bigger influencers of back pain than posture. “The stresses and strains of home-schooling children, not having time for exercise, not being able to socialise and other health concerns are much more important than how you are sitting,” he told The Irish Times.

The study, which involved researchers from Ireland, Greece, Qatar and Australia, found that 100 people believed their own pain-free sitting posture was "suboptimal" and demonstrated a more upright posture when asked to select a good sitting posture.

Women in the study were more inclined than men to make greater corrections to their natural sitting posture. “The fact that females changed their posture even more than males when asked to assume a good posture likely reflects the greater pressure on females to conform to societal expectations of appropriate posture,” added Dr O’Sullivan.

The study builds on other recent research at UL which found that physiotherapists and members of the public have an unnecessarily negative view of “slouched” sitting posture and also that physiotherapists and manual handling instructors often promote very stiff straight ways of bending and lifting, even though they are not shown to prevent or ease back pain.

“The best advice on back pain is to move and relax, get fit and strong and not worry about the angle of your back when sitting,” said Dr O’Sullivan.