Can poor posture lead to back pain?

Most likely, you have heard that poor posture contributes to back pain or that improving your posture can help you stop experiencing low back pain. This assertion can be found all over the internet, coming from personal trainers, chiropractors, and physical therapists. In a Google search for “posture and pain,” 4 million results come up. You’ll almost likely hear sooner or later from a higher authority that your posture requires improvement because there are so many posture police on patrol.

For instance, if your upper back has a pronounced curvature (kyphosis), you may be diagnosed with “upper cross syndrome.” This posture has forward-facing head, sinking chest, and rounded shoulders. Stretching the chest muscles and building up the muscles between the shoulder blades are common “corrections”.

Or you might be diagnosed with lower cross syndrome if your low back has a pronounced arch (lordosis). Anterior pelvic tilt characterises this pattern, which also features a forward-facing stomach protrusion. Most people would advise you to work on your glutes and abs, stretch your hip flexors, and spend time throughout the day sucking in your stomach or otherwise keeping your core active in order to correct this.

The notion that asymmetries create pain is another common one. For instance, a therapist might work to spot and fix a twist or tilt in the position of your pelvis because they fear this would lead your spine to rotate or bend. Given that this will lead one side of your pelvis to be tilted higher than the other, they could be curious in whether one of your legs is longer than the other.

These concepts make intuitive sense and are supported by many professionals. But are they backed up by facts? Do you think it’s worth your time to examine your own posture and fix any deviations from the ideal?

Let’s examine some evidence that could provide insight into these issues. There are numerous research exploring for correlations between pain and measurements of postural alignment, despite the fact that you wouldn’t know it from reading the majority of books or papers. Most of them discover none. Let’s look at it.

What do studies on the relationship between pain and posture reveal?

Typically, studies that examine the relationships between posture and back pain use one of several different study approaches. In cross sectional studies, participants are gathered and split into two groups – those experiencing and those not experiencing back pain. Then, they utilise an x-ray, radiograph, or another technique to assess the pelvic or spinal alignment, such as the difference between the lengths of the legs, the tilt of the pelvis, or the angles of the low back, upper back, or neck. Researchers next assess whether there are any appreciable variations in postural alignment between the groups with and without discomfort.

In prospective studies, the posture of a particular population of individuals without back pain is examined, and the researchers then evaluate whether the participants with a particular posture are more or less likely to get low back pain in the future.

The majority of these research’ findings contradict the idea that poor posture causes back pain, even though their conclusions are not entirely apparent. Here are a few typical results:

  1. There is no link between uneven leg length and back pain. [1]
  2. There was no discernible difference in the lumbar lordosis or the discrepancy in leg length among the three groups of 321 guys with severe, moderate, or no back pain. [2]
  3. There is no link between neck curvature measurements and neck pain.[3]
  4. There was no discernible difference between 600 patients with and without back pain in terms of lumbar lordosis, pelvic tilt, leg length disparity, or the size of the iliopsoas, hamstring, and abdominal muscles. [4]
  5. Back discomfort in adulthood was not more likely to affect teenagers with postural asymmetry, severe thoracic kyphosis, and/or lumbar lordosis than their peers with “better” posture. [5]
  6. Greater increases in low back curvature during pregnancy did not enhance the risk of back pain in pregnant women. [6]
  7. The prevalence of back discomfort is not higher in people who work in occupations that require repeated uncomfortable postures. [7]
  8. Even while a few research have discovered a connection between spinal alignment measurements and pain, these are the exceptions. [8, 9]

A 2008 systematic review that included more than 54 studies on the relationship between pain and posture best captures the weight of the evidence. [10] Even though the studies’ overall quality was subpar, taken as a whole, they failed to find any indication that sagittal (back to front) spinal alignment measurements and pain are related.

According to the data mentioned above, there is little to no association between posture and discomfort. Given that other studies have discovered additional characteristics, such as exercise, job satisfaction, educational attainment, stress, and smoking, that are associated with low back pain, these findings are startling. [11]

Even if there is a link between pain and posture, this does not establish a cause-and-effect relationship. It’s possible that discomfort contributes to poor posture rather than the other way around. This makes perfect sense. People who receive an injection of a back-pain-causing substance will naturally adopt new postural techniques. [12]

Furthermore, even if poor posture does cause back discomfort, assuming that it can be fixed is still a big jump. Another example to support the idea that improving “bad” posture may lessen back discomfort.

Why does pain not correlate with posture?

The evidence presented above is unexpected and illogical. Why does pain not correlate with posture? The poor correlation between posture and pain can be attributed to at least three reasonable causes.

  1. Over time, tissues adjust to stress

According to the premise that poor posture leads to discomfort, it places too much mechanical stress on specific locations, which over time results in microdamage. This sounds reasonable, but it ignores the fact that tissues can change in response to stress.

Your joints, ligaments, and tendons will adapt to tolerate the local stresses brought on by different postures, much as your muscles will become stronger when subjected to the tension of lifting weights. [13]

  1. Tissue damage and discomfort are not the same

The fact that tissue damage does not equate to pain, even when poor posture results in it, is the second factor preventing the correlation between posture and pain.

Numerous research have been done on the frequency of different types of tissue damage in people who do not experience pain. These repeatedly demonstrate that significant numbers (e.g., 20–50%) of individuals with pain-free shoulders, knees, or backs also have bulging discs, rotator cuff tears, or torn menisci. [14] A person over 30 has a very high probability of having major damage seen practically anywhere an MRI is directed, even in areas where there is no discomfort.

The cause? The causes of pain are numerous, and tissue damage is just one of them. [15] Therefore, pain will not necessarily be experienced if posture is causing some sort of long-term tissue damage.

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