Scientific evidence is lacking to solidly support the existence of a relationship between posture (good or bad) and back pain, according to our partner The Conversation.
What is established is that varying one's postures is probably more useful than rigidly conforming to a single specific "good" posture.
This analysis was conducted by Peter O'Sullivan, professor of musculoskeletal physiotherapy, Leon Straker, professor of physiotherapy and Nic Saraceni, lecturer in physiotherapy.
Back pain is the leading cause of disability in the world today.
Without having reached such an extreme, we have all had back pain one day, or we all know someone who has suffered from this type of pain at some point in their life.
Back pain often appears in adolescence, and its frequency increases in adulthood.
In 25% of people who suffer from it, it can become persistent, painful and disabling.
The pain then affects their ability to indulge in sporting and physical activities, professional activities, even to carry out simple actions of daily life.
Back pain is frequently aggravated by the simple act of sitting, standing, bending, or lifting.
It is widely believed that “good” posture is important for protecting the spine from damage, as well as preventing and treating back pain.
By “good posture”, we generally mean sitting and standing “straight” – the famous “straighten up”, “stand up straight”, etc. – or lifting things while standing up. squatting with a well-aligned back.
Conversely, it is inadvisable to hold yourself slumped when sitting or hunched over when standing, or to lift loads with an arched back.
This point of view is widely shared whether you suffer from back pain or not, and it is relayed only by occupational health and primary health care professionals...
And yet: surprisingly, scientific evidence is lacking to solidly support the existence of a relationship between posture (good or bad) and back pain.
The perception of what is considered "good" posture seems rather to result, in reality, from a combination of unfounded assumptions and social desirability ("social desirability" is defined as "the known adequacy of observed behaviors or anticipated from a person with the motivations or affects known to be typical members of a social collective”).
Systematic reviews of the evidence from work on the subject have found that ergonomic interventions for workers and advice to manual workers on the best posture to adopt for lifting loads did not actually reduce pain. backbones related to their tasks.
Sitting and standing positions
Our research group has conducted several studies exploring the relationship between postures and back pain.
We investigated whether, in a tall adolescent population, 'non-neutral' slouched or erect sitting postures (e.g., standing with an arched or slouched back) were associated with occurrence of back words, or preceded it.
Bottom line: We found little evidence to support either view.
These results are consistent with other systematic reviews that also found no differences in sitting or erect postures of adult populations with and without back pain.
In everyday life, people adopt various postures affecting their spine, but concretely, there is no single posture that is capable, on its own, of protecting against back pain: individuals who stand upright just like those who adopt a slouched posture may suffer from back pain.
The lifting posture
The recommendations made in the professional environment concerning the "good" postures or the "safe postures for the back" to adopt when one has to lift heavy loads, although very relayed, are also little or not supported.
Our systematic review thus found no scientific evidence supporting the fact that lifting loads with a hunched back would be associated with back pain or a predictor of such pain.
What's more, our recent work, conducted in the laboratory, revealed that people who had carried out a handling job for more than five years and who did not suffer from back pain were more likely to lift loads in a more hunched posture, with the round back, than the others… Paradoxically, the manual workers suffering from back pain had tended to adopt a more crouched posture and a straighter back.
In other words, according to these results, people with back pain are those who tended to follow the recommendations for "good" posture, while those who do not do not have more back pain. .
A small study study (conducted on 12 subjects) further suggested that as people with debilitating back pain recovered, they became less cautious and generally moved away from 'good' posture advice.
If it is not the posture, what is the origin of the evil?
No scientific evidence therefore indicates for the moment that there would be a single "good posture" that would be able to prevent or reduce back pain for everyone.
The spinal column, within the human species, varies greatly in configuration and size from one person to another: the posture is therefore very individual, specific to each person.
What is established is that movement is important to keep our backs healthy.
Learning to vary your postures and adopting different ones that are comfortable is probably more useful than rigidly conforming to one specific "good" posture.
While back pain can be intense and painful to bear, in 90% of people it is not associated with identifiable tissue damage or pathologies.
In some cases, back pain can start suddenly, when an unusually heavy load is carried abruptly and awkwardly, a bit like when you sprain yourself... But it can also occur as a bad pain. head, without an injury being the cause.
However, we know that individuals are more vulnerable to back pain when their health is already compromised.
Can thus play the fact:
to be stressed;
to be tired or exhausted;
sleep poorly;
to be less active.
In addition, existing back pain is more likely to persist if one:
becomes excessively worried and fearful about said back pain;
overprotect their back and avoid movement, physical activity, work and social interactions.
What to do with back pain?
In a small number of cases (1% to 5%), back pain can be caused by a pathology, including a fracture, malignancy, infection or nerve compression (the latter is associated with pain in the legs and loss of muscle strength and feeling).
In these cases, you should of course consult a doctor.
But for most people (90%, as noted earlier), back pain is associated with sensitization of back structures, but not identifiable tissue damage.
In this situation, focusing too much on maintaining “good” posture can distract from other factors known to be important to spinal health.
These factors include:
move and relax your back;
regularly engage in appropriate physical activity of their choice;
gain self-confidence and stay in shape for daily tasks;
maintain healthy sleep patterns and body weight;
take care of their general health, physical and mental.
Sometimes achieving this requires the guidance and support of a competent clinician.
OUR “DOS” FILE
Bottom line: whether you're sitting or standing, try to adopt relaxed and comfortable postures, and vary them.
And if you must lift heavy objects, currently available scientific evidence suggests that it's okay to do so…even with a hunched back.
Just make sure your physical condition is good enough for this task.
And take care of your health.
This review was written by Peter O'Sullivan, Professor of Musculoskeletal Physiotherapy, Leon Straker, Professor of Physiotherapy and Nic Saraceni, Lecturer in Physiotherapy (all three at Curtin University in Perth, Australia).
The original article was published on The Conversation website.
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