Understanding the relationship between poor posture and neck pain, back pain and movement — and what you can do about it.
Have you ever caught yourself slouching at your desk or noticed your head creeping forward while looking at your phone? Many of us have been told that poor posture causes neck and back pain and that sitting or standing up straight is the solution.
But is it really that simple?
Research suggests that the relationship between poor posture and neck pain is more complex than we might think. Posture may be one piece of the puzzle, but there is no single perfect posture everyone needs to maintain to prevent pain. Instead, movement, activity levels and how well your body tolerates everyday demands may be more important considerations.
What do we mean by “poor posture” and how does it relate to neck and back pain?
Posture describes how we position our bodies when sitting, standing and moving. Common examples labelled as poor posture include rounded shoulders, forward head position, slouched sitting and an exaggerated arch in the lower back.
However, these are normal variations in human movement. A 2021 review examining posture and lower back pain highlighted that postural differences do not necessarily indicate a problem and that movement and function may be more important than appearance alone [1].
This does not mean posture is irrelevant. Certain positions can influence comfort and how our bodies manage physical demands. However, differences in posture between people with and without pain do not automatically mean that posture caused their symptoms.
Does poor posture cause neck pain?
Forward head posture is frequently blamed for neck pain, particularly among people who spend long periods working at computers or using smartphones.
A 2023 systematic review and meta-analysis of 26 studies found that some head and neck alignment measures differed between people with and without neck pain. However, forward head posture did not consistently distinguish the two groups [2].
This suggests that neck pain cannot simply be explained by how far forward someone holds their head. In some cases, changes in head or shoulder position may also be a response to existing pain rather than its original cause.
Remaining in one position for prolonged periods may contribute to discomfort, but factors such as individual tolerance, activity levels, sleep and stress can also influence symptoms.
What about lower back pain?
Similar beliefs surround lower back pain, with rounded sitting, slouching and an exaggerated lower back arch often described as positions to avoid.
However, research does not support the idea that one particular sitting or standing posture is responsible for all cases of lower back pain [1].
Multiple systematic reviews found associations between sedentary behaviour and lower back pain/back-related disability in some populations [3,4]. However, this does not establish that sitting posture itself causes pain.
These findings suggest that rather than focusing solely on sitting duration or maintaining a “correct” posture, opportunities for movement and individual responses to activity may be more useful considerations.
How to Improve Posture and Reduce Neck and Back Pain
Rather than constantly correcting your posture, consider a more flexible approach to managing neck and back discomfort.
- Change positions regularly. Alternate between sitting, standing and walking rather than remaining in one position for prolonged periods.
- Find comfortable positions. Adjust your chair, screen height and desk setup to suit your needs. Comfort and the ability to move freely are useful guides.
- Build strength and physical capacity. Regular physical activity and progressive strengthening exercises can help you tolerate everyday activities, work and exercise.
- Consider the bigger picture. Sleep, stress, physical activity, previous pain experiences and overall health can all influence how you experience pain [1,4].
When should you see a physiotherapist?
If neck or back pain is persistent, recurrent or interfering with daily activities, a physiotherapist can assess your symptoms, movement, strength and functional goals to help guide your recovery.
The bottom line
Is poor posture really causing your neck and back pain? Not necessarily.
Although posture can influence comfort, current evidence does not support the idea that one ideal posture is essential for a healthy, pain-free spine [1,2].
Instead of striving for perfect posture, focus on moving regularly, building strength, finding comfortable positions and gradually increasing your ability to do the things you enjoy.
Your body doesn’t need to look perfect to move well. If pain persists or limits your activities, consider an individual assessment rather than assuming your posture is the problem.
Book an Assessment at Pursuit
Pursuit Physiotherapy
📍 102B–740 Hillside Ave, Victoria, BC
🚗 Free 60-minute parking on site, and easily accessible by transit
📅 Book online: pursuitphysiotherapy.janeapp.com
📞 (250) 363-9707
✉️ info@pursuitphysiotherapy.ca
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References
- Kripa S, Kaur H. Identifying relations between posture and pain in lower back pain patients: a narrative review. Bull Fac Phys Ther. 2021;26:34. doi: 10.1186/s43161-021-00052-w.
- Rani B, Paul A, Chauhan A, Pradhan P, Dhillon MS. Is neck pain related to sagittal head and neck posture? A systematic review and meta-analysis. Indian J Orthop. 2023;57(3):371-403. doi: 10.1007/s43465-023-00820-x.
- Baradaran Mahdavi S, Riahi R, Vahdatpour B, Kelishadi R. Association between sedentary behavior and low back pain: a systematic review and meta-analysis. Health Promot Perspect. 2021;11(4):393-410. doi: 10.34172/hpp.2021.50.
- Alzahrani H, Alshehri MA, Alzhrani M, Alshehri YS, Al Attar WSA. The association between sedentary behavior and low back pain in adults: a systematic review and meta-analysis of longitudinal studies. PeerJ. 2022;10:e13127. doi: 10.7717/peerj.13127.
