Does Bad Posture Cause Back Pain?

The research tells a very different story from what you may hear in the media.

You have probably heard the claim that bad posture causes back pain, or that you should work on your posture to get rid of low back pain. You can find this claim all over the internet — from physical therapists, chiropractors and personal trainers. If you do a Google search for “posture and pain,” you get 4 million hits. With so many posture police on patrol, you will almost certainly be told sooner or later by some authority that your posture needs work.

For example, if you have a relatively large curve in your upper back (kyphosis), you might be told that you have “upper cross syndrome.” This pattern involves rounded shoulders, a sunken chest, and a forward head. Common “corrections” are to stretch the chest muscles and strengthen the muscles between the shoulder blades.

Or, if you have a relatively large arch in your low back (lordosis), you may be told you have lower cross syndrome. In this pattern, the pelvis tips down in front (anterior pelvic tilt), and the stomach protrudes forward. To fix this, most people will tell you to strengthen your abs and glutes, stretch your hip flexors, and spend time during the day sucking in your gut and/or keeping your core active.

Another popular idea is that asymmetries cause pain. For example, a therapist may try to identify and correct a twist or tilt in the alignment of your pelvis, because they’re worried this will rotate or bend your spine. They may be interested in whether one of your legs is longer than the other, because this will tilt one side of your pelvis higher than the other.

These ideas have intuitive appeal, and are advocated by numerous experts. But are they supported by evidence? And should you spend time trying to analyze your own posture and correct deviations from what is considered optimal?

Let’s look at some evidence that might help us answer these questions. Although you wouldn’t know it from reading most books or articles, there are many studies looking for associations between pain and measures of postural alignment. And most of them find none. Let’s take a look.

What do studies find on the connection between posture and pain?

Research looking for correlations between back pain and posture typically involves one of several different study designs. In cross sectional studies, researchers recruit people and divide them into groups — those with and without back pain. Then they use x-ray, radiograph, or some other means to measure pelvic or spinal alignment, such as leg length discrepancy, pelvic tilt, degrees of curvature in the low back, upper back, or neck. After these measurements are made, researchers determine whether there are significant differences in postural alignment between the groups with and without pain.

In prospective studies, researchers analyze the posture of a certain group of people without back pain, and then determine whether the subjects with a certain posture are more or less likely to have low back pain in the future.