Is Bad Posture Really Causing Your Back Pain?

Last week we talked about weak glutes and the week before that it was tight hip flexors. This week we're going to move away from the hips and talk about something that everyone’s heard of: posture.

The odds are high that someone’s told you to sit up straight at some point in your life. Now posture devices, office chairs, and thousands of videos repeat the same message: your back hurts because you have bad posture. I’m starting to think that I should’ve been on Myth Busters because I come back every week and write about how a commonly held belief isn’t true. This week isn’t so different after all but there is lots of room for nuance, as usual.

TLDR

• There’s no consensus on posture causing back pain [1].
• Spinal and pelvic postures don't consistently differ between people with and without back pain.
• People with back pain tend to move slower and with less total motion.
• The amount of time spent in a position is as important as the position that you’re in.
• Corrective devices may not be compatible with your natural shape and morphology.
• Try to add more variety to your postures and change position regularly.

What posture means

Posture is just the position your body’s in at any particular moment. Sitting slouched, standing upright with your shoulders back, and lying down are all postures. When people discuss posture, however, we tend to refer to the general combination of joint positions that someone takes across several postures. You’ve probably heard someone say that another has good or bad posture before - and this is a reference to how they choose to position themselves across many different postures, and not a single definable position.

Just like people have different heights, limb lengths, and body weights, people also have different degrees of spinal curvature. One person may have greater lordosis (curve of the lower back) than others. Some people have subtle lateral deviations that slant their postures to one side. A review examined the link between spinal curves and pain and couldn’t distinguish postures that divided healthy back from painful ones [2]. In the image below you can see three healthy spines with flatter, average, and deeper curves.

Why the belief sticks

I think we might care about posture for social reasons. Standing straight with purpose makes us look confident while slouching makes us look tired and meek.

544 physiotherapists were asked to choose the best sitting posture: almost all chose some version of upright sitting posture with a visible lower-back curve over slouched sitting [3]. The interesting part is that research consistently fails to show the importance of posture on pain outcomes. So then why are we constantly talking about ergonomic chairs and standing desks if none of this matters?

The truth is that posture/position does matter, but probably not as much as switching positions regularly does. As we stay in a posture for extended periods, the tissues that are strained by that posture slowly creep into joint laxity, causing acute instability. If held chronically, tissues can adapt such that: movement is altered, instability persists, or there’s an increased injury risk from repetitive strain. Research may not be always be able to tease out the importance of switching positions often, but if you have to remain in a position for extended periods of time (like at many jobs), it is wise to adjust that position to minimize strain on your joints and muscles.

People with back pain do move differently

Here’s some of the nuance that I mentioned at the top: a meta-analysis of 43 studies found no difference in lumbar lordosis or standing pelvic tilt between people with and without back pain. But the people with back pain tended to have less lower back motion, move slower, and have reduced proprioception (awareness of body position) [4]. We don’t know whether they started guarding and moving less because of their pain (this would be my guess), or that they have pain because they move less. Regardless, liberating some motion in those spines in a safe, stable position, would likely do them some good.

As a biomechanist, I care more about which movements someone can perform without pain rather than their ability to stand with perfect posture. This provides the menu of options to gradually build from and later expand to more degrees of freedom motion.

What about posture devices?

A fairly direct test of my viewpoint comes in a 2026 Cochrane review study released just 2 weeks ago [5]. The looked at the use of assistive technologies (like lumbar supports, belts, etc) for treating chronic low back pain. They concluded that lumbar supports used alone offer little or no benefit for pain and disability in people with chronic back pain. These devices are typically recommended because they help prevent people from entering into unsafe postures or they can serve as a reminder to maintain a posture.

There’s a few problems with the reliance on postural devices. 1) you’re offloading work that muscles should be doing to an external device. This leave you weak and reliant on the external support. 2) the position that the device puts you in may not even be appropriate for your morphology and natural shape. It may be ‘correcting’ for something that doesn’t fit you and may not require correcting.

What I'd actually do

1. Change position regularly. Every 30-45 minutes, stand up or walk for 2-5 minutes. You don't need a perfect replacement posture. Give your back a different task.
2. Keep several sitting options. Use the backrest sometimes. Sit forward sometimes. Put one foot on a small box, then switch sides. Let comfort guide the position and change it before stiffness builds. The image below shows four options.
3. Choose safe positions. Don’t throw the baby out with the bath water. It is still worth staying in neutral postures (and switching between them often) even though the research can’t causally link posture and pain. You’ll never catch me recommending staying in prolonged spinal flexion.
4. Build capacity twice per week. Walk often. Push yourself to resistance train.

The mistake I made for years was treating my back like a fragile object and avoiding movements that I thought would hurt me. Move in the ways that don’t cause you pain and build capacity to return to full function. Movement is medicine.

As always, have a great weekend.

Best,

Mitch

Want to know which back pain pattern matches you? Take my free 2-minute quiz and find out.

References

[1] Swain et al., 2019. No consensus on causality of spine postures or physical exposure and low back pain: A systematic review of systematic reviews. Journal of Biomechanics. https://doi.org/10.1016/j.jbiomech.2019.08.006

[2] Christensen and Hartvigsen, 2008. Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health. Journal of Manipulative and Physiological Therapeutics. https://doi.org/10.1016/j.jmpt.2008.10.004

[3] Korakakis et al., 2018. Physiotherapist perceptions of optimal sitting and standing posture. Musculoskeletal Science and Practice. https://doi.org/10.1016/j.msksp.2018.11.004

[4] Laird et al., 2014. Comparing lumbo-pelvic kinematics in people with and without back pain: A systematic review and meta-analysis. BMC Musculoskeletal Disorders. https://doi.org/10.1186/1471-2474-15-229

[5] Arienti et al., 2026. Assistive technologies (lumbar supports and other devices) for treating chronic low back pain. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD015492.pub2

Disclaimer: this content is educational only and does not constitute medical advice. See a practitioner if you suspect serious spinal trauma from a fall or accident, or if you experience any of the following red flag symptoms: loss of bowel or bladder control, numbness in the groin or saddle area, rapidly worsening leg weakness, back pain with fever or feeling generally unwell, or unexplained weight loss with back pain.