Debunking the Myth of Perfect Back Posture: 4 Ways to Reduce Lower Back Pain

October 6th, 2020  by  Dr. Dylan Peterson, Doctor of Physical Therapy

Michael grew up in Savannah, Georgia. After a year of college, he enlisted in the Army. He served in Iraq and Afghanistan beginning in 2004.

Michael seriously injured his back during military training. A parachute malfunction caused him to hit the ground hard, fracturing bones in his back.

Months after the injury, he was still recovering. One of the most painful things he had to do was stand at attention with other soldiers. Although he had “ideal” posture (back straight, core tight, shoulders back, spine aligned), it made his back ache.

After serving five years in the military, Michael is still battling lower back pain. Sitting through classes at a university in Colorado is difficult to tolerate.

New research tells us why.

New research reveals common posture advice is misguided

I used to make sure, in the past when I gave advice about posture, that my patients were sitting upright with their necks and backs in the “perfect” position and with their arms and legs at “ideal” angles. All too often, they would come back feeling tighter and sorer and in more pain.

Research has now shown that the advice I was giving and that many healthcare practitioners are still giving makes back and neck pain worse in many patients.

The typical “perfect” posture can cause you to move less, put more pressure on sensitive back structures, and produce more muscle tension and stress during the day. All of these contribute to persistent back and neck pain.

Sitting taller and straighter can help at times, but for many people it only reinforces habits that can make pain worse.

Michael was suffering from muscle spasms, “throwing his back out,” and severe pain that was keeping him from work, school, and hobbies.

As a physical therapist at Hinge Health, I worked with Michael to help him overcome his back pain. Here are four main ways you can improve your back pain the right way.

4 ways to reduce your lower back pain the right way

1. Understand Your Back Is Strong. Michael started to trust his back’s strength again although scans continued to show damage, including a spondylolisthesis (a fracture that allows one spinal bone to slide forward over another).

Many of us are given scary information or shown abnormal findings on our scans (e.g., disc degeneration, disc bulges, or pinched nerves) that can make us feel like we and our backs are breakable. When we feel fragile and have pain, it only makes sense to move differently and avoid certain activities. Unfortunately, this can make us less resilient when we bend, lift, or move around more.

With the right education, Michael began to understand that the pain he experienced with daily activities like bending, lifting, sitting, and standing did not mean that he was doing more damage to his back or that he was at risk of harming himself.

Hurt doesn’t equal harm! Even people with no damage on their scans get sore backs from long car rides. Our back structures are extremely strong, even if we have scan findings like disc degeneration, disc bulges, or spinal stenosis.

2. Relax Your Belly. It sounds counterintuitive, but research shows that people with back pain are more tense. As Michael stood at attention, he was sucking in his core and engaging big muscles around his back. He also spent a lot of time strengthening his core to protect his damaged back.

While exercising your back muscles are important, Michael was tensing his back muscles too often throughout the day, even when he did simple things like put on his shoes.

This increased muscle tension put pressure on sensitive structures of his back and caused more inflammation, more fatigue, more stress, and more muscle spasms. All of these factors contributed to his persistent back pain.

Unfortunately, the healthcare system unintentionally promotes excessive muscle tension with advice commonly given to patients to protect their back, build up their strong core, and move cautiously, according to research published in Physical Therapy.

According to the Journal of Orthopedics and Sports Physical Therapy and the British Journal of Sports Medicine (BJSM), varying your sitting posture is safe and helpful. BJSM adds that relaxing during everyday activities like bending, lifting, and twisting is safe and important to recovery.

Outdated posture advice is still very common and for many people it can contribute to persistent pain.

Michael learned to eliminate protective habits (such as tensing his core muscles all day) and gradually replace them with new habits that involved relaxing his core muscles with daily activities.

3. Sit Lots of Different Ways. This is not to say that sitting upright is bad. Rather, the evidence is giving people permission to sit all sorts of ways.

Michael learned to relax during many daily activities. He practiced breathing and relaxing his core muscles while he was sitting, bending to tie his shoes, and doing other movements.

This helped him feel less fatigued and tense when he needed to be strong or stand at attention. Changing up how we sit and stand is natural and important. Not being locked into one way of sitting or standing is good for your back and neck.

4. When the Pain Hits, Keep Going. Michael’s pain diminished, but some things are out of his control. His old injuries and the spondylolisthesis (fracture) are realities, and at times he still has pain flare-ups.

But he now knows that many things are in his control. He stays active and strong with daily exercises and focuses on relaxing his core. He understands that rest is not best when his pain flares up.

Fortunately, most days, Michael experiences no pain at all despite lifting heavy weights and running marathons.

Do this posture experiment

Finally, Greg Lehman, a pain and biomechanics researcher, suggests this experiment. Stand at attention like a soldier. This is the old definition of “perfect” posture. See how long it takes for you to get sore or feel like you want to change your position.

This experiment shows that back and neck pain is complex. It’s not just about poor posture. Pain is caused by many things, and our bodies naturally want to change positions.

So give yourself permission to sit back, and let yourself relax! It just might help!

If your employees or members are experiencing lower back pain, set up time to find out how Hinge Health can help reduce chronic back and joint pain through our virtual 1-on-1 physical therapists, behavioral health coaches, and sensor technology. If you are an individual, ask your employer or health plan about Hinge Health.

Dr. Dylan Peterson, Doctor of Physical Therapy

About the Author

Dylan is one of Hinge Health’s Clinical Specialists. He is originally from Minnesota and earned his BA in Philosophy with a minor and Psychology at Fort Lewis College. After that he earned his Doctorate of Physical Therapy at California State University - Sacramento. When he is not in the office helping the Hinge Health community as a physical therapist and pain consultant, he is an avid trail runner and not-quite-sub-4-minute-miler.

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