For decades, healthcare providers such as PTs have been advising people with low back pain (LBP) to sit up tall, not slouch, not twist, and to avoid excessive lumbar flexion. Sadly after decades of research on these interventions, we can safely conclude that LBP is far more complex than just fixing postures and correcting movements.
What some papers argue is that patient instructions to “sit up tall” and “keep the spine protected in neutral” are in fact contributing factors to chronicity.
For instance, this study titled, “Does movement matter in people with back pain?”, found that individuals with LBP had less lumbar flexion ROM, slower movements and greater lumbar extensor muscle activity. The study basically showed that people with chronic LBP are generally “over-protecting” themselves due to fear and concern for worsening their condition.
The advice they received about protecting their spine during the acute phase of their injury was being followed to a tee, even months and years later with the fear that if they moved their spine too much, they would never get better.
Subconscious over-protection is disastrous for recovery and a potential contributing factor to chronic LBP.
This 2022 case series study involved 12 people with disabling non-specific LBP. Many of the participants were able to successfully alter their beliefs about their LBP following a 12-week course of PT involving “re-conceptualisation of movement and posture, from threatening, to therapeutic”.
They found that most of the patients transitioned from “non-conscious protection” to “conscious non-protection”.
I suggest that we stop fear mongering by not instructing patients to sit up tall, but instead tell them to sit however they feel most comfortable and when they experience discomfort, it is a sign that they need to MOVE! I also suggest telling people that to keep the spine healthy they must bend and twist as much as tolerated and as soon as possible as I instruct in this video.