Why I won't tell you to sit with ''good posture"

Many people who come to me with back or neck pain start off apologising, telling me how they know they should have better posture. This focus has often been reinforced when they’ve seen other health professionals, and by family and friends.

You may feel you have "bad" posture, that you’ve somehow failed at sitting or standing properly, and that this is definitely contributing to your pain. This is all useful information for me, as it helps me understand your habits, perceptions of what is causing the issue, and what you may have tried already. But I don’t start by focusing on posture, and I don’t use the words "good," "bad," or "correct." Here’s why:

1. Natural Variability in Anatomy – There’s natural variability in people’s anatomy, and that doesn’t make it “wrong.” People are often told they have too much lordosis (an excessive curve in the lower back), a loss of the natural curve in the neck, or a rounding of the upper back (kyphosis). However, surprisingly, there is no evidence to support posture as a direct cause of back pain.

   
   

2. Will ''Sitting up straight'' Help? – If I tell you to change your shape—e.g., reduce that curve or sit up straighter—will that actually help? Can you do it on the spot? Is it even relevant to your pain? What I’ve realised is that when people try to "have good posture," they often end up adding unnecessary tension to a system that’s already tense. How long can you maintain any posture before it becomes uncomfortable?

   
   

I’ve noticed that people with back pain are often not the ones who slump, but rather the ones who sit very upright. They are constantly tensing the muscles, which may be contributing to the pain in the first place. In an effort to protect themselves from the pain, they’re often holding their breath as well. They’re trying so hard—maybe too hard! This is not a criticism, just an observation. People can actually be too hard on themselves, and this rooted belief about posture, which is perpetuated all around the internet, is not helping.

So, what can we focus on instead?

1. Relaxation – Many people struggle to simply relax, and that's often a good place to start. Find a position that you feel is comfortable, rather than the one you think you "should" be in.

2. Movement – Our bodies don’t like ANY fixed position for a long time. Studies show that simply changing position is great for preventing and dealing with back pain (1). You could sit in various positions on a chair, sit on a ball, on the floor, stand, and take breaks. It could be as simple as a 20-second break to wriggle, stretch, or take a short walk, or get a cup of tea.

3. Breathing – Consider the health of your diaphragm (your main breathing muscle) and hips. Can your spine and neck stack comfortably on top of them, or are you fighting with yourself? By improving your ability to breathe deeply, your posture will naturally change and shift without you forcing it.

4. Mobility and Strength – Mobility is key. Often, our backs are tight and stiff. As well as being able to relax, they need to do their main job of moving: bending forward, twisting, arching back, and bending sideways. Studies show that people with back pain move differently, with a reduced range and slower speed (2). Whether through regular stretching, yoga, Feldenkrais, general fitness or pilates classes, or other modalities, it’s important to focus on improving your mobility, ease and strength through range.

What do you think? I’d love to hear your thoughts or comments!

1. PMC8091075

2. Research on Movement in Back Pain