What is the correct posture?

This is a very topical subject at the moment and one that patient’s with lower back pain frequently comment on when they have a consultation. It is often a negative belief that their posture is poor or bad and is probably the reason why they have back pain. Other common beliefs are that their back is too arched (increased lumber spine lordosis), they are mis-aligned, they have tight muscles, the pelvis is too tilted and they have a leg length discrepancy. None of these associated beliefs have any significant links or evidence to suggest they are causative factors of lower back pain. A recent research article (Dreischarf et 2016) measured the lumbar spine movements over a 24 hour period and noticed that the average range of movement over this period was 8 degrees compared to 33 degrees when standing.

In summary we have such a variety in lumbar spine positions throughout a day.  What is normal? Standing desks have gained popularity to get us away from prolonged sitting but is prolonged standing any better? A whole industry of specific ergonomic chairs and aids to manage lower back pain exists. It doesn’t matter how comfortable the chair is, just move! A variety of postures seems to be the sensible option combined with regular movement and exercise rather than a static supposed correct posture because we truly don’t know ( and if it even exists) what a correct posture is. Just have a look at the way small children move around and how they lift and sit, no one is telling them how to move and what to protect when they are lifting. That brings on to the subject of what is a correct lifting technique?

A recent study by Nolan et al 2017 evaluated both physiotherapists and manual handling advisors beliefs on lifting and backs. The anecdotal notion that we should lift with a straight back and that lifting can be dangerous is a belief long held in the health care system and many workplaces involving manual work. Has it unintentionally been driven by us the health care professionals? Interestingly the study results showed a high percentage of physiotherapists (75%) and manual handling advisors (91%) perceived that a straight back posture was safer than a rounded back posture when lifting.

There is increasing evidence that people with chronic lower back tend to adopt more extended postures, with increased muscle tone and as a result more bending at the knees (Geisser et al 2004, O’Sullivan 2005). Their elevated fear of bending is also an associated characteristic (Slaboda et al 2008).

This presentation is one that we see frequently amongst the chronic lower back pain patients and our philosophy is very much towards regaining normal movement patterns with a promotion of positive beliefs and a return to normal activities of daily living.

At this stage more research is needed to assess correlations between lifting advice and postures to the causes of lower back pain.

Matt W

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