Sit however you like, as long as you get up often

Physio · 8 minute read

Your watch buzzes when you slump, and your mum said the same thing for free. Decades of looking for the posture that causes back and neck pain haven’t found one. How long you stay put, and how strong you are, matter a lot more.

You’ve been told to sit up straight since you were seven, and lately your chair has an opinion too. So when your neck aches by Thursday, the slouch looks guilty. Our physios hear this theory a lot, often from someone who has already bought the lumbar cushion.

Nobody has found a posture that causes pain

Researchers have pooled every study of how people sit, stand, bend and twist, and none of it has been shown to cause back pain, only to go along with it sometimes. When over a thousand Australian teenagers were photographed sitting and sorted from upright to slumped, the slumpers had no more neck pain than the rest. Even physios can’t agree: 544 of them split between three upright versions, with no strong evidence for any of them. The Victorian government’s own health website says there’s no evidence poor posture or a weak core causes back pain.

Why staying still is the part that hurts

Sit 20 people at a desk for an hour with no break and 40% of them have a sore lower back by the end of it. That was one lab study, and it’s the story we hear in the clinic. Standing is no safer: two hours on your feet brought on a sore back in 40% of people who had never had one, in one lab study, and up to 70% in others. Muscles holding one position get tired, the back stiffens, and that’s the ache.

The ache arrives while you’re sitting, so sitting gets the blame, and because you were slumped at the time, the slump gets it too. You never feel the two hours before it, in the same chair in the same shape and fine. Pain is also an alarm, and in people whose back has been sore for months it tends to be set more sensitively: they feel a firm press as painful sooner than people whose backs are fine, even away from the back. The sore spot is real, and so is the touchier alarm.

Book a physio appointment

Why building strength helps

Exercise is one of the best-supported treatments for a back that keeps aching. Across every trial pooled so far, people whose back had been sore for months and who exercised ended up noticeably less sore than people left to wait or given the usual advice. Neck pain responds to strength too: 573 office workers were split into groups, and those given one hour a week of strength training at work had about half the neck and shoulder pain of colleagues who weren’t. That’s one trial, so don’t bank on half.

Australia’s guidelines ask for muscle-strengthening activity on two or more days a week. Our strength classes run as a circuit of stations with every level in the same room on different weights. If your back needs the strength built carefully, Clinical Pilates starts with a one-on-one physio assessment and a program written for you, which you then do in a class of four.

What to do instead of sitting up straight

1. 1Change position before you need toAustralia’s guidelines say to break up long sitting as often as possible, so take the first fidget as your cue. A minute or two on your feet every half hour beat two long breaks in the one workplace study that compared them, and added up to 40 minutes less sitting a day.
2. 2Set your desk up for comfort, then change itScreen where you can see it without craning, a chair you can shift in, and then lean back for the phone call and perch forward for the email.
3. 3Build strength twice a weekA strength class, Clinical Pilates or a program from one of our physios all count, starting lighter than feels impressive.
4. 4Give it a fortnight, then come inAn ache after an hour in one spot is asking for a change, so get up and see whether it eases. If it’s still there after a couple of weeks, book a physio appointment.

What our physios do when you arrive blaming your posture

Your physio listens to the whole story first, then has a proper look, which can mean measuring your strength on the VALD plates. You get a straight answer on what we think is going on, often some mix of time in one position, strength that has slipped behind what your days ask of it, and a touchy alarm. Treatment starts that session and you leave with a written plan. If a big week has left your neck tight, we can add remedial massage into the appointment. You don’t need a referral or a scan to see one of our physios.

The takeaway

There’s no posture that’s been shown to protect you and none that’s been shown to wreck you. How long you sit still and how much strength you have in reserve decide whether a desk day ends in an ache, so get up often, lift something twice a week, and if the ache is still there in a fortnight, come and let us look at it.