Posture. What do we really know?

Posture. What do we really know?

Posture is a frequent topic of discussion for physiotherapists at Malvern Physiotherapy Clinic, clients, the media and society. A common belief is that spinal pain is caused by sitting, standing, or bending “incorrectly”. Many patients tell us, “I know I have bad posture” before we begin examining them. It is often assumed that “incorrect” posture is the cause of pain and needs changing, but does it? What does the science tell us?

Is there such a thing as perfect posture?

Not really. We know there is a large variability within normal populations of body alignment. Traditionally, physiotherapists have encouraged a midline or neutral posture that keeps the spine and soft tissues in an unloaded position and helps our muscles work at their optimum position. But this is different for each individual.

Is poor posture associated with pain?

Across many areas of the body (lower back, mid back, neck and shoulders) there is not much evidence that links posture to pain. Studies have looked at groups of people with back pain and those with no pain and found no difference in lumbar spine sitting and standing postures. In fact, a study examining the sitting posture of pain-free subjects shows just as many sat in a slumped posture as those with pain.

Researchers have looked at neck and head posture and the association with neck pain and headaches. Again, there is not a strong relationship according to science. Some studies have found that people who suffer from neck related headaches tend to drift into a more forward head posture over time AND having stronger muscles at the back of your neck can decrease the risk of neck pain. So maybe the relevance of posture is more dynamic rather than static.

So if not pain, what is posture associated with?

Age! A study shows neck alignment changes consistently with age. Genetics seem to play a role too. It is very common to observe similar postures amongst family members.

Can posture ever become a problem?

Yes, absolutely! Which is why individual analysis and assessment of your problem is essential.  Movement variability is as important as the position you sit in. You could sit in “perfect” posture all day but if you never relax or move out of that position your tissues will get sore. We have sensors in our tissues called Acid Sensing Ion Channels or ASICS that sense pH changes. If we do not move around, these ASICS can be stimulated enough to cause pain or discomfort. This is what makes us want to wiggle and stretch during a long flight.


PMT? A great acronym to help us remember the important points about posture.


Are you sitting at end range with tissues on stretch? If so, they will get sore sooner or later. Can you change the way you are positioned to take this strain away from your muscles and joints?


How hard are you working your muscles to hold your posture? Ideally, in sitting, we want our muscles to be relaxed and not working hard to stay perfectly upright. Over the course of a few hours, they will get sore and tight.


Anything will get sore if you stay there long enough. So get up and move often!

Take home message

A few points to remember about posture;

  • There is no such thing as perfect posture
  • Posture is not always to blame for our pain
  • Keep strong and keep moving

PMT – position, muscle and time!

Written by Alisa McLachlan

Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapy 2019)

Published March 9, 2021


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