Poor posture is often blamed as the cause of neck and back pain. Especially now, given the current social climate surrounding working from home and the increased use of smartphones and similar devices, more attention is being placed on our posture. But is poor posture really the cause of your pain?
Unfortunately, there isn’t a clear answer to this question and it’s hard to determine within medical literature which comes first; the pain or the poor posture (it seems the medical industry has its own version of “the chicken or the egg.”). Meaning, do you begin to feel uncomfortable in an area of your body and compensate to reduce the stress placed on the soft tissue/joint/joint capsule? Or does your body adapt to your lifestyle first (e.g. office workers leaning forward, hairdressers and labourers favouring low back lifting patterns) and the pain comes because of this?
The Known Relationship Between Pain and Posture
What we do know about pain and posture is that age has an impact. In a systematic review performed on the relationship between forward head posture and neck pain it was found that there is no significant association between forward head posture and neck pain in adolescents, nor in adults aged 50 years or older. However, there was a link made between FHP and neck pain in adults under 50. In this same systematic review, it was shown that adults with neck pain showed an increase in FHP when compared to asymptomatic adults. (1)
There is also a genuine association found between office workers and ‘non specific’ neck pain. A 2019 study on the association between certain workplace settings and neck pain found that office workers are the most likely occupation to have complaints of neck pain (that have been studied). Despite these findings, the high incidence of neck pain for office workers is not purely because of ‘posture.’ There is a whole array of risk factors that can negatively affect your musculoskeletal health at work including: age, gender, increased sitting hours, job strain, and stress. Some strategies shown to reduce non-specific neck pain in this population were a ‘neutral’ thorax sitting position, greater cervical range of motion and muscular endurance, and increased physical activity. (2)
Bio-mechanically, a change in neck flexor endurance makes sense given FHP places these muscles in a shortened or ‘concentric’ position. However, studies performed on this seem to show that even if you have forward head posture there is no reason why your deep neck flexors should behave any differently to someone who doesn’t have forward head posture. Plenty of studies show that treating the deep neck flexors (with a strengthening regime) can improve both neck pain and disability measures.
Reducing Postural Pain
Suffice to say, poor posture may be causing you pain, but it’s unlikely to be the root of your pain. Poor posture simply makes your pain worse and exacerbates a condition you may already have. And ultimately the role poor posture plays in your pain boils down what’s affecting you? If you experience musculoskeletal pain that worsens when you’re working in a sustained posture, then poor posture is most likely contributing to your condition. It’s still not likely to be the cause of your condition, though. The cause is more likely a response to the muscles fatiguing/losing their endurance throughout the day. Recent studies have shown some easy ways to help deal with ‘postural pain’ or pain that is exacerbated by posture. One of which is simply walking! One recent randomised controlled trial performed with a six month follow up showed that introducing daily walking as an intervention had a significant decrease in the six month incidence rate of neck pain in office workers (the reduction was reported as 78% in this study). (3) Additionally, a study of muscular activity and perceived dysfunction during prolonged sedentary work showed that muscles fatigue after around 40 minutes. The study went on to show that a break involving standing and stretching for five minutes was not only the most effective break type in reducing perceived discomfort, but that this break could keep the muscles’ state at a recovery level of about 30-45 minutes. (4) What is great about these therapeutic interventions, apart from the obvious proven benefit, is that they are cheap and easy! However, if these remedies aren’t helping, and your pain is getting worse then it is always worthwhile being assessed by a GP or your musculoskeletal health professional of choice.
Dr. Lachlan Fisher B.HSc/App.Sc (Chiropractor)
(1) N F Mahmoud, K A Hassan, S F Abdelmajeed, et al. The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis Current Reviews in Musculoskeletal Medicine. 2019.
(2) D Jun, V Johnston, S M McPhail, S O’Leary A Longitudinal Evaluation of Risk Factors and Interactions for the Development of Nonspecific Neck Pain in Office Workers in Two Cultures Human Factors. 2019.
(3) E Sitthipornvorakul, R Sihawong, P Waongenngarm, P Janwantana. The effects of walking intervention on preventing neck pain in office workers: A randomised controlled trial. Journal of Occupational Health. 2020;62.
(4) Y Ding, Y Cao, V G Duffy, X Zhang It is Time to Have Rest: How do Break types affect muscular activity and perceived discomfort during prolonged sitting work. Safety and Health at Work. 2020;11: 207-214