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Downloaded from wwrwjospt.org al UFSCAR - UNIVERSIDADE FEDERAL DE SAO CARLOS on August |, 2019. For personal use only. No other uses without pemission, Journal of Orthopacdie & Sports Physical “Therapy 6) — >>> vIEWPONNT |———— DIANE SLATER, MSc, PG Cert, BSc (Hons)! e VASILEIOS KORAKAKIS, PhD, MSc, BSc! PETER O'SULLIVAN, PhD, Grad Dip Manip Ther, Dip Physio2 e DAVID NOLAN, MSc Physiotherapy* KIERAN O'SULLIVAN, PhD, M Manip Ther, B Physio!>s “Sit Up Straight”: osture is a frequent topic of discussion for patients, clinicians, the media, and society. A common beliefs that spinal pain is caused by sitting, standing, or bending“incorrectly” Despite the absence of strong evidence to support these common beliefs, a large posture industry has flourished, with many interventions and products claimingto “correct” posture and prevent pain. Unfortunately, many health care prof evidence-based perspective. In this View- point, we reflect on common beliefs re- garding posture and spinal health and why they are so widely held, and consider how clinicians can positively influence these beliefs. Beliefs About Posture Health care professionals and the com- munity typically agree that avoiding spinal flexion is the safest way to sitsº and bend.* Patients and pain-free members of the community are commonly advised to sit upright and undertake bending and lift- ing tasks in a “natural” lordotic posture. Manual handling guidelines in the United States and the United Kingdom advocate a straight back or a slight bend of the back during lifting tasks. A slightly lordotic posture is also commonly identified as the ideal standing position. The assumption is that maintaining these postures might protect spinal structures, and posture ionals provide advice in line with this non- beliefs likely reflect the fact that sitting, standing, and bending are often provoca- tive for complaints such as low back pain. Award postures and heavy lifting may precipitate episodes of acute low back pain, and some links between lifting and injury have been reported. Despite wide- spread beliefs about correct posture, there is no strong evidence that avoiding incor- rect posture prevents low back pain, or that any single spinal curvature is strongly associated with pain. Protecting the spine is also advocated by the fitness industry. Common advice is that the “core” muscles of the trunk must be consciously activated to main- tain a “correct” posture and protect the spine. Advice about “perfect form” given in relation to weight-training is often applied away from the lifting platform. While there is additional muscular effort required for correct posture when sit- ting and lifting, there is no evidence to ime to Re-evaluate “ Orthop Sports Phys Ther 2019;49(8):562. 564. doi 10.2519/ospt 20190610 suggest that correct posture prevents or reduces pain and disability. People with low back pain bend their spine less and show more trunk muscle activity when forward bending and lifting. The notion that people with low back pain must be careful and “protect” their spine is further challenged by the association of higher levels of fear and lower self-eflicacy with a guarded way of moving? The non-evidence-based perspective that pain can be prevented by avoiding incorrect posture, such as slouching, is reinforced by fear-inducing messages in the mainstream media. People might be- come concerned about their spinal health when they are exposed to articles about potentially damaging postures and ad- vertisements for posture-correction aids. Unhelpful posture ideals are also rein- forced by long-standing stereotypes that suggest posture reflects a person's sex, dignity respectability attractiveness, and morality* Assessing the Posture of People With Pain Observing the posture of a person pre- senting with musculoskeletal pain has a role. It may help patients to feel they are being taken seriously and allow the cli- nician to identify rare cases of clinically Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar. 2School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia. *Body Logic Physiotherapy, Shenton Park, Australia. PhysioWorks, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom. SSchoo! of Alied Health, University of Limerick, Limerick, Ireland. Health Research Institute, University of Limerick, Limerick, Ireland. Diane Slater and Professors O'Sullivan and O'Sulivan provide professional development workshops on low back pain, which incorporate/discuss the role of posture in low back pain. The other authors certfy that they have no afliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. Address correspondence to Diane Slate, Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, PO Box 29222, Doha, Qatar. E-mail: diane.slaterdaspetarcom * Copyright G2019 Joumal of Orthopaedic & Sports Physical Therapy 562 | auGusT 2019 | VOLUME 49 | NUMBERS | JOURNAL OF ORTHOPAEDIC €) SPORTS PHYSICAL THERAPY 
