The long held belief that sitting upright in a lordotic posture is the best appears to be common among both clinicians and the general population. Furthermore, we are bombarded with messages and reminders that sitting up straight is the best posture to prevent aches and pains, especially in the lower back. For example, from when we were young, we have been told to sit with our back straight, not to slump or slouch, otherwise we would get low back pain or a hump. At work this message is further reinforced by ergonomic programs to prevent back pain. However, evidence shows that healthy individuals often habitually adopt relaxed and flexed sitting postures.
So, what is the best sitting posture? There is no agreed gold standard of good posture, in fact it has been seen that the upright posture needs higher levels of muscle activity and could increase tiredness and discomfort. Moreover, there is no evidence that any of the recommended posture would reduce the risk of low back pain and, to date, all the research has shown that there is no relationship between any postural factors, including the shape and the curves of the back and developing low back pain.
The conclusion of this is that if there is not back pain, the priority shouldn’t be to change the sitting posture, but be healthy. To prevent spinal pain, addressing sleep deprivation and stress are more important than the way people sit. Therefore, it is better to assume that there may be no one optimal posture but rather any positions that are maintained for a period of time without interruption, may lead to discomfort and pain. People may need to adopt several sitting postures and keep moving around them if they have to sit for prolonged periods of time
On the other hand, it is true that once back pain is a problem, then posture may indeed affect it. As mentioned above, sitting for a long time is one of the first things to limit. Furthermore, once the back is aching, modifying the sitting posture to reduce the overloading of the structures that are sensitive can help to reduce the pain and allow to move with more confidence and less pain.
Modifications of sitting posture will depend on the individual person including pain location, type of pain and aggravating positions. For example, to help reduce pain in the hip when sitting modifications would be different to helping reduce pain in the lumbar spine when sitting. Even two different individuals with lower back pain may have different modifications.
In general, having good ergonomics (good desk and chair set up) will help to keep tension away from certain muscles. The key is to MOVE MORE, and keep moving.
Zoe Rippon
Senior Physiotherapist | Back in Motion Melbourne on Collins