Pain and Injury Myths: #2 - Bad Posture is the cause of pain

Welcome back to the Pain and Injury Myths Blog Series.

If you’ve ever found yourself confused about pain - why it shows up, what it means, and how to fix it - you’re not alone. Our understanding of pain is shaped by everything from personal experience to outdated fitness advice, and even social media. The result is a mix of helpful insights and misconceptions that can make navigating pain even more frustrating.

In the first post of this Pain and Injury Myths series, we looked at the widespread belief that pain always equals damage. It’s a myth that continues to influence how people think about their bodies and recovery. As an Exercise Physiologist and Personal Trainer, I’ve seen how these kinds of beliefs can limit one's ability to recovery from injury or improve their health and fitness.

This series is about challenging some of those beliefs - not by dismissing people’s experiences - but by offering an evidence-informed lens on how pain works.

So, let’s get into our next myth…

Myth #2: "Bad" posture is the cause of pain (Perfect posture prevents pain

It's hard to escape the message: Perfect posture equals a healthy, pain-free body, while any deviation from the "ideal" is injurious. For decades, in schools, workplaces, gyms, and clinics, we have been preaching to “sit up straight,” “stop slouching,” and “brace the core”.

Deeply engrained, is the unwavering belief that such actions will protect us from aches and pains, especially in the neck and lower back.

The Reality: There’s No Such Thing as "Perfect" Posture

It might go against the grain, but when we look into the evidence, there’s little to suggest that posture is the villain it’s made out to be. This doesn't then suggest that posture is irrelevant, but rather, that its impact on injury and pain has less importance than other behavioural factors. Regular movement and beliefs about pain may play a larger role in pain.

Structural differences between people are wide-ranging - just think of how much variation exists in something as visible as the jawline or the shape of a nose. So then, would we not expect there to be differences in deeper structures like the pelvis, and the many bones of the shoulder girdle?

Across the body, we find differences in bony bumps and protrusions, hip socket depth, muscle length, and tendon attachment points. I’m getting bogged down in details, I know. But, essentially, these structural variations directly influence how someone’s posture may appear. Not to mention how the body moves in space. So then, should we all really expect to align to a universal posture template?

"The best posture is your next posture"

This is a common phrase that’s gained traction in Fitness and Rehab circles. What this means is that movement variation is a key element to physical health, rather than any one specific position. The issue is not the way someone sits at their desk, but rather that they are sitting for extended durations with little movement variation.

• Sitting tall - or slumped - for any prolonged period will likely lead to muscle fatigue or stiffness.
  

• Shifting into more comfortable positions throughout the day is completely reasonable - and encouraged.
  

• Constantly bracing the core and back in pursuit of a “perfectly stacked” spine is unnecessary and unrealistic.
  

• Regular movement breaks and general physical activity matter far more than obsessing over posture.

Evidence doesn’t clearly show a Posture-Pain link

Just as MRI findings of tissue damage can exist with or without pain, lower back curvature can be no different between people with lower back pain, and those without. Some studies have not found a clear association between forward head posture and neck pain in adolescents. Some association has been seen for older adults, but it can’t be said that age itself isn’t the key determinant. Other studies have found that even working in awkward postures does not immediately mean someone is doomed to a life of back pain.

Routine manual handling training and workplace ergonomic assessments (both which I’ve done for a living in the past), that heavily promote perfect postures and positions could unintentionally reinforce the belief that typical daily activities and work environments are inherently risky. This may lead to unhelpful fear around movement and posture, rather than promoting confidence in the body’s resilience and adaptability.

Some questions we could to ask here are:

• Is it the movement or posture causing pain and injury?

• Or is it the prolonged or repetitive nature?

• Was the body stressed too much, for too long, too soon?

In other words, injury can commonly be caused when the body’s tissue(s) are exposed to stresses greater than it has the capacity to adapt to. Or that recovery between bouts of stress, and lifestyle factors that promote recovery, could be inadequate.

When posture DOES matter

First and foremost, posture matters any time it matters for YOU. If you're particularly sensitive in certain postures, doing certain movements, or at certain ranges of motion within a movement, modifying any of the above is appropriate. Over time, rather than avoiding these postures, can you gradually expose your body to them (loaded or not) to tolerate it more. We are incredibly adaptable.

Some other times where posture matters:

Lifting heavy loads:

• We get more access to the big powerful muscles - the primary movers - when spinal position is closer to neutral.
  

• If squatting under load or lifting from the floor - "bum back, chest up" helps put the glutes and hamstrings under tension, ready to produce force.
  

• Bracing the core, ensures that force is distributed across the body. It reduces the risk of excess load going through tissues (namely the lower back).
  

• You do not need to brace your core and align your spine to bend over and pick up a pen. We brace for the appropriate demands of life.
  

Training to build muscle:

• Loaded muscle stretch is a key component of weight training. During a push up, for example, "Chest up, shoulders back" puts the chest muscles under more loaded stretch, AND prepares the muscle to produce more force.

Range of Motion & Movement Variability

• The ability to move in and out of positions comfortably is more important that perfect posture.
  

• If demands of life require more access to certain postures (reaching overhead), access to this range and working on the mobility to gain it is valuable.
  

• Moving through postural extremes, not staying rigid, improves mechanics and flexibility over time.

The idea that there’s a perfect posture to prevent pain is outdated and unhelpful. Instead of chasing the illusion of perfect posture, it’s more effective to focus on movement variety, strength, and regular activity.

Trying to “fix” posture may actually cause more harm than good. Ironically, by creating hyper-vigilance, unnecessary tension, and fear of movement, normal body sensations could become painful.

The most helpful mindset is one that embraces the body’s ability to adapt. Let’s let go of posture perfectionism. Move often, move differently, and adopt the postures that feel most comfortable.