HEAD up. Shoulders back. Sit up straight. No doubt you heard these commands as a child, and they have probably prompted you to sit or stand a little straighter right now. With UK adults , and millions experiencing backache, you would be forgiven for linking the two and being as concerned about your posture as your parents.
âThe public genuinely think that itâs dangerous to slouch. We have done multiple studies in different countries about this,â says , who specialises in back pain.
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To a legion of slouchers, then, it may come as a surprise to hear that clear evidence of what constitutes good posture and whether your deportment is harming you is only just coming to light. The revelations are overturning many common assumptions. New studies are unravelling the link between posture and pain, highlighting the problems that we really should care about and even identifying ways of sitting and standing that can boost our mood. So, sit back (slouch if you want) and prepare to have your ideas about posture turned on their head.
The ideal posture is something that humans have been talking about since at least the Ancient Greeks â think of all those statues with athletic-looking physiques, standing upright, back straight. âWritten evidence in the West begins with the Greeks, but in my fantasy, I can see some Neanderthal mother yelling at her kids to âstand up straight and stop looking like those Homo sapiens across the valleyâ,â says , Georgia, the author of Stand Up Straight! A history of posture.
What exactly is ideal though? In part, our views of posture are guided by our culture. âA lot of what we think of as good posture is about aesthetics and ideas about what is deemed elegant, attractive, interested or motivated,â says OâSullivan. âMy research shows that women are more critical about their sitting posture than men, maybe reflecting greater societal expectations of appropriate posture among women.â
How we hold our body is also intimately linked with ideas about health. We associate a fit soldier as upright-looking and a physically weak, dying person as hunched over, says , Australia.
Yet from a medical standpoint, ideal posture is a hazy concept. Physiotherapists generally advise that the , which is comfortable, stable and symmetrical and doesnât overstrain any specific muscle or joint. But what does this mean in practice? Should we aim to be as straight-backed as possible, in the perfect plumb line posture that your parents probably had in mind when they told you to sit up straight when you were younger?
It is difficult to say. Our spine is naturally S-shaped when viewed from the side, with a slight inward curve in the lower back (the lumbar region), an outward curve in the upper trunk (the thoracic region) and another inward curve at the neck (the cervical region). All of us have different degrees of curvatures, depending on our genetics, life experience and habits. Our posture changes as we age, too, becoming more stooped.
All of which makes it difficult for medical experts to come to an agreement on perfect posture. One study led by OâSullivan, for example, asked physiotherapists to , giving a range of nine options, from sitting bolt upright through to a pronounced slump with the chin jutting out. Around half thought that an upright lower back with a more relaxed upper trunk was best, but about a third thought that a forward tilt from the hips with the spine held in a straight line was optimal.
âA lot of what we think of as good posture is about what is deemed elegant and attractiveâ
Whatâs more, while we all have views on what constitutes good posture, we rarely live up to them. This was demonstrated last year by a team of researchers led by Vasileios Korakakis at the Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar, in . Most naturally sat in a mild slump, but when asked to adopt an optimal sitting posture, all sat up much straighter â the women more so than men.
But is slouching actually causing us any harm? Search online and you will find numerous websites outlining how âbadâ postures lead to neck, shoulder and back pain, along with techniques to fix them. There is even a UK .
If only things were that simple. For a start, although sitting with your neck or spine at an odd angle can cause temporary muscle soreness due to overactivity in certain muscles or a decrease in oxygen to tissues, the link between posture and longer-term pain is highly contentious.
Pain in the neck
While some, often smaller, studies do show an apparent link, larger, more rigorous analyses donât. âThereâs very little evidence that our regular posture can predict whether weâre going to get chronic pain,â says Straker.
Other researchers go even further. âItâs not that there isnât much evidence to link bad posture with causing long-term pain, thereâs none,â says OâSullivan.
For instance, a , concluded that there was no reliable evidence to determine that specific driving postures were associated with lower back pain. Meanwhile, a , found no difference between the habitual shoulder posture of the two groups. The list goes on.
For , the lack of evidence linking posture and pain became apparent after a number of parents brought their teenage children into her clinic with concerns over their posture. None of them had pain, says Richards, and it became clear that there wasnât much evidence on the possible pitfalls of their posture to give her cause to intervene.
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To address this academic void, Richards . All were part of a long-term investigation of the role that early events have on later life. Each person was categorised for their natural sitting neck posture â upright neck and body; slumped chest with head jutting forward; erect chest with forward head; and an intermediate position with a gentle spinal curvature â as measured by body sensors. Five years later, the team recorded whether each participant had experienced neck pain that persisted for three months within the previous year.
The results were surprising. For male subjects, sitting neck posture at age 17 wasnât a risk factor for neck pain at 22. For female participants, those who sat upright were actually more likely to have experienced prolonged neck pain, whereas more slumped postures were protective. The generic public health message to sit up straight to prevent neck pain needs rethinking, concluded Richards and her team. Richards thinks that the female subjectsâ neck pain could be a result of sustained, low-level muscle activation needed to maintain an upright position, a posture perhaps triggered by other factors such as anxiety.
Statue still
While the link between specific postures and long-term pain is unravelling, the way we sit and stand is still important, not least because it can affect your mood (see âChange your posture to change your moodâ). Furthermore, your posture might still lead to problems down the line â not necessarily because of how you position your body, but because of how long you stay that way. Many of us are becoming more sedentary. âOver time, we are becoming less active, at work and in our leisure time, and we see this in most countries,â says OâSullivan.
This means that whatever posture we are prone to, we are holding it for longer periods of time. And over the years, our bodies mould themselves to the shapes we hold them in. âThe body responds to what we do with it, particularly for children and young adults,â says Straker. âBones are getting rebuilt every day, and they get rebuilt in response to the stresses we put on them.â
Researchers strongly suspect that prolonged slumping could eventually have a permanent effect on the shape of our bodies. âMy best guess is that if you spend an awful lot of time hunched over, then youâre more like to be hunched over permanently,â says Straker. The implications of this lasting shape change are unknown â the cumulative effect of decades of slouching in front of a screen havenât yet been studied â but some researchers are concerned.
âWe donât know yet whatâs going to happen to these kids who slouch all day long,â says , San Francisco. If you develop an excessive forward curve of the thoracic spine, âover time, youâre going to lose the ability to inflate your lungs fullyâ, she predicts.
If you are prone to sitting or standing in one position for too long, you can counteract the effect on your body by stretching and strengthening the muscles and ligaments that would otherwise become shorter and weaker as a result. Pilates and yoga can help you achieve this result. These kinds of exercises also help maintain the bodyâs ability to sustain a full range of movement, something that concerns Straker and other physiotherapists far more than âpoorâ posture.
Strength and flexibility exercises can also counteract the pronounced stooping of the thoracic spine that affects 40 per cent of adults over the age of 65 (see âStop the stoopâ). A severe stoop can seriously affect quality of life, for instance, by slowing down walking speed.
One thing that isnât helpful, says OâSullivan, is forcing yourself to hold positions that are unnatural in an attempt to improve your posture. âWhen you ask people to sit âproperlyâ â in other words, straight â that just tends to make them sore and uncomfortable,â he says.
This is one reason why some physiotherapists â who, as a profession, were once obsessed with âcorrectâ posture â now think we should be far less concerned about our posture and instead focus on moving about more. âI would suggest worrying about it less and change posture more frequently. The best posture isnât the same for everyone,â says Richards.
And thatâs a message the experts finally do agree on. âDonât worry about sitting posture, and donât hassle your kids about how they sit,â says OâSullivan. âJust make sure you move around lots in between your slouching.â
Change your posture to change your mood
Long-term pain may not be an inevitable consequence of bad posture (see main story), but the notion that âgoodâ posture is beneficial isnât completely ill-founded. Certain postures can lift your spirits.
An awareness of a link between our body and our emotions goes back to the 19th century, when philosopher William James suggested that we donât laugh because we are happy, rather we are happy because we laugh.
This idea is now known as âembodied cognitionâ, where the body influences our thoughts. For instance, when you meet a loved one, your heartbeat may increase and you might feel their skin against your own as you embrace. The brain, which is constantly assessing changes to information from the outside world and from our internal body, combines this new data and conjures up the appropriate emotion. Only then do we consciously perceive the feeling of love, or joy.
Several experiments support this idea. For instance, studies by Elizabeth Broadbent at the University of Auckland, New Zealand, have shown that the posture of people with depression tends to be more slumped than that of people without the condition. But the effect goes both ways. Her team randomly split people without depression into two groups, using physiotherapy tape to strap their back into either a slumped or upright seated position. The participants then gave a speech. Afterwards, the upright group not only , but were less stressed as measured by blood pressure.
Another experiment, by , used biofeedback to manipulate peopleâs style of walking on a treadmill.
Students were initially shown positive and negative words and asked how well each word described them. They were then guided into walking in a style that resembled that of someone who was unhappy or extremely happy.
These gaits were based on experiments showing that people who are sad tend to walk with an increased sideways body sway, decreased arm swing and have a more bent over posture than those who are happy.
At the end of the study, the participants were given a surprise test â to remember as many words from the start of the study as possible. Participants recalled more negative words when walking in a style that resembled individuals who are sad than they did when walking with a happier gait. The researchers suggest that the walking style may have triggered a change in emotional state, which then affected memory recall.
