What is the Best Sitting Posture & Why is Posture Important?

You’ve heard a ton of people say it…”sit up straight”, “I have terrible posture”, etc… But, what exactly is the best sitting posture and why is it important?

Prolonged sitting can cause several health problems. Speaking from a musculoskeletal perspective, it is associated with an increase in neck and back pain. Neck and arm pain occurs in about 20-60% of office workers, and are some of the most common occupational disorders worldwide.¹ Office workers also have the highest prevalence of neck symptoms vs. other occupations² and vs. other locations in the body. Improper posture is also more pronounced in those with neck pain vs. those without neck pain.⁵

Risk Factors for Neck Pain

Known risk factors for the development of neck pain include^{2, 6, 7}:

It is interesting to look at these risk factors, as some of them are modifiable. Things like training to improve your physical capacity, being aware of posture/sitting time throughout the day, psychological health/mindset, cervical (neck) range of motion, and body mass index can all be modified through lifestyle changes and help reduce the risk of developing neck pain.

Risk Factors for Low Back Pain

Overall, it is very difficult to define risk factors for low back pain as there is a wide variety of presentations of low back pain.¹¹ Limited evidence is available associating posture and job strain with the onset of low back pain.⁸ 

In general, risk factors for the development of chronic low back pain include:

1. A history of low back pain⁸
2. Pain intensity⁷
3. Presence of yellow flags (aka psychological factors of coping strategies & fear avoidance behaviors)^{9, 10}

Although you may have one, two, or all of these risk factors, it does NOT mean you are doomed to have low back pain or chronic low back pain! It may just require a little more effort on your end whether it is advocating for yourself, being more intentional about listening to your medical provider (i.e. performing your home exercise program from your physical therapist), or seeking care from a psychologist.

There is a link between health and productivity.³ If you don’t feel good, you’re not going to perform as well as you would like at work, in the gym, or in life.

What does the Research Say is the ”Ideal” Workplace Set Up is?

According to the literature, the following should be considered when setting up your workspace:

1. The computer should be directly in front of operator.¹² Not having the computer in front of the operator (i.e. off to side) is associated with increased risk of neck and low back pain in women.¹²
2. Sitting straight & upright in chair with support to the upper & lower back¹³ with maintenance of physiological curvature of the spine.¹⁴
3. Shoulders should be relaxed with the neck bent forward or back with no rotation > 20 degrees.¹³
4. Elbows should be bent to 90 degrees and close to the body, forearms parallel to the ground, and wrists straight.¹³
5. The upper edge of computer screen should be below eye leve with < 30 degrees of flexion (forward bending) at the neck.¹³
6. Knees at the same level or slightly higher than the hips, with the feet slightly elevated.¹³

There are several problems with the traditional workplace set up. Inconsistent evidence exists for arm supports and alternative computer mouse designs.¹ Low evidence supports implementing supplementary breaks in the reduction of neck & right upper extremity pain among data workers.¹ Low to very low evidence suggests training in ergonomic interventions may or may not prevent work related musculoskeletal disorders of the upper limb &/or neck.¹ Also, low to moderate evidence exists suggesting ergonomic interventions were not more effective than no intervention for short and long term low back and neck pain incidence/prevalence. 

When we look at the research on strategies to create an ergonomic set up, the evidence is actually pretty poor.

What Strategies can we Use to Manage a Traditional Workspace?

If we have to deal with a traditional workplace set up, there are a few things you can implement into your day to help manage it.

1. Set a timer to move after a certain period of time.  I would say the ideal time is every 30-60 min with a minimum of moving every 2 hours. One poor quality study stated that more than 3 hours of sitting increased the risk of low back pain, while other studies said 4-6 hours.
2. Do one exercise every time you stand up to do something (grab something from printer, bathroom, water, etc.).

Example exercises include scapular retractions, upper trap stretch, thoracic extension/rotation, or hip extensions. Performing exercises on breaks reduces the rate of head, neck, upper/lower back pain.¹³ Also, if less than 10% of working time is spent taking breaks, your productivity will not be affected.¹³ Physical exercise in the workplace is associated with improved outcomes (pain, disability, flexibility, range of motion, strength, quality of life) and can be as little as small sessions throughout the working day (10-15 minutes for 3-5 days/week).¹⁶ In one study, workplace implementation of ergonomics and neck specific exercise decreased sickness absenteeism in office workers.³ The combination of exercise and psychotherapy, such as with diaphragmatic breathing and stress management, can improve pain, anxiety, range of motion, and quality of life in office workers with low back pain.¹

So, What is the ”Perfect” Posture?

Sorry to break it to you, but the “perfect” posture doesn’t exist.  It’s really the ability to get into and out of different positions.  So just like with life, variety of movements and balance of positions are key even with sitting. 

Standing, treadmill, and bike desks have become popular recently. The idea of these devices sounds great, but there is limited evidence regarding their use.  It has been found that treadmill and cycle desks increase energy expenditure in sedentary workers²¹ and improve recall ability.²² But, they reduce typing speed and increase typing errors.²²  They also have no effect on blood pressure, cholesterol, dopamine, cortisol, or cognitive function.^{21, 22}  Standing desks do provide a variety of positions for you to sit, stand, or lean throughout the day.  Plus, reduction of sitting time is associated with reduced low back pain²³ and sit-stand workstations may reduce cardiometabolic risk in asymptomatic office workers.²⁴ You have to weigh the pros and cons of using an alternative desk and choose accordingly!

The perfect posture doesn’t exist. What’s important is the ability to get into and out of different positions throughout your day.

So, what is the ”Ideal” Workplace Set Up?

The key is going to be a the ability to get into a variety of positions such as sitting, standing, leaning, laying, etc.  Plus, a positive work environment will play a role. Psychological health is impacted by the work environment, which in turn impacts pain experience!

In general, there is inconclusive evidence about what is best, so experiment and figure out what works for you both mentally and physically!

The Importance of Preventative Exercise

As mentioned before, modification of sitting ergonomics with general health education does not prevent neck pain.  But, the addition of specific exercise AND ergonomic modifications helped improve neck pain over the long term.¹⁸ It was also found that stretching was better than ergonomic modifications for neck, shoulder, or low back pain.¹⁹ Strengthening also has better evidence over endurance and stretching to reduce neck pain in office workers with non-specific neck pain.⁴ Stretching and endurance muscle training has a protective effect against developing low back pain for office workers with lower than average extension flexibility or decrease trunk muscle endurance.²⁰ 

Including a combination of stretching, strengthening, endurance training, and change in workplace ergonomics can help!

This is why I created my anti-sitting mobility program, which is a basic full body mobility program for all levels. The program focuses on areas that commonly get tight with prolonged sitting.  It can be fit into your schedule on your lunch break, at the beginning or end of your day, or can even be used as a warm up before working out! It only takes about 15-20 minutes to complete!

As always, I’m here to help, so feel free to comment below or shoot me an email with any questions or feedback you have!

Citation of Sources:

1. Hoe  VCW, Urquhart  DM, Kelsall  HL, Zamri  EN, Sim  MR. Ergonomic interventions for preventing work‐related musculoskeletal disorders of the upper limb and neck among office workers. Cochrane Database of Systematic Reviews 2018, Issue 10. Art. No.: CD008570. DOI: 10.1002/14651858.CD008570.pub3. Accessed 09 August 2021.
2. Chen X, O’Leary S, Johnston V. Modifiable individual and work-related factors associated with neck pain in 740 office workers: a cross-sectional study. Braz J Phys Ther. 2018;22(4):318-327. doi:10.1016/j.bjpt.2018.03.003
3. Pereira M, Comans T, Sjøgaard G, Straker L, Melloh M, O’Leary S, Chen X, Johnston V. The impact of workplace ergonomics and neck-specific exercise versus ergonomics and health promotion interventions on office worker productivity: A cluster-randomized trial. Scand J Work Environ Health. 2019 Jan 1;45(1):42-52. doi: 10.5271/sjweh.3760. Epub 2018 Aug 22. PMID: 30132008.
4. Louw S, Makwela S, Manas L, Meyer L, Terblanche D, Brink Y. Effectiveness of exercise in office workers with neck pain: A systematic review and meta-analysis. S Afr J Physiother. 2017 Nov 28;73(1):392. doi: 10.4102/sajp.v73i1.392. PMID: 30135909; PMCID: PMC6093121.
5. Nejati P, Lotfian S, Moezy A, Nejati M. The study of correlation between forward head posture and neck pain in Iranian office workers. Int J Occup Med Environ Health. 2015;28(2):295-303. doi: 10.13075/ijomeh.1896.00352. PMID: 26182924.
6. Côté P, van der Velde G, Cassidy JD, Carroll LJ, Hogg-Johnson S, Holm LW, Carragee EJ, Haldeman S, Nordin M, Hurwitz EL, Guzman J, Peloso PM; Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine (Phila Pa 1976). 2008 Feb 15;33(4 Suppl):S60-74. doi: 10.1097/BRS.0b013e3181643ee4. PMID: 18204402.
7. Sihawong, R., Sitthipornvorakul, E., Paksaichol, A. and Janwantanakul, P. (2016), Predictors for chronic neck and low back pain in office workers: a 1-year prospective cohort study. Journal of Occupational Health, 58: 16-24. https://doi.org/10.1539/joh.15-0168-OA
8. Janwantanakul P, Sitthipornvorakul E, Paksaichol A. Risk factors for the onset of nonspecific low back pain in office workers: a systematic review of prospective cohort studies. J Manipulative Physiol Ther. 2012 Sep;35(7):568-77. doi: 10.1016/j.jmpt.2012.07.008. Epub 2012 Aug 24. PMID: 22926018.
9. Caroline Meyer, Camille M. Denis, Anne D. Berquin, Secondary prevention of chronic musculoskeletal pain: A systematic review of clinical trials, Annals of Physical and Rehabilitation Medicine, Volume 61, Issue 5, 2018, Pages 323-338, ISSN 1877-0657, https://doi.org/10.1016/j.rehab.2018.03.002.
10. Pincus T, Burton AK, Vogel S, Field AP. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine (Phila Pa 1976). 2002 Mar 1;27(5):E109-20. doi: 10.1097/00007632-200203010-00017. PMID: 11880847.
11. Sitthipornvorakul E, Janwantanakul P, Purepong N, Pensri P, van der Beek AJ. The association between physical activity and neck and low back pain: a systematic review. Eur Spine J. 2011 May;20(5):677-89. doi: 10.1007/s00586-010-1630-4. Epub 2010 Nov 27. PMID: 21113635; PMCID: PMC3082686
12. Ye S, Jing Q, Wei C, Lu J. Risk factors of non-specific neck pain and low back pain in computer-using office workers in China: a cross-sectional study. BMJ Open. 2017 Apr 11;7(4):e014914. doi: 10.1136/bmjopen-2016-014914. PMID: 28404613; PMCID: PMC5594207.
13. Celik S, Celik K, Dirimese E, Taşdemir N, Arik T, Büyükkara İ. Determination of pain in musculoskeletal system reported by office workers and the pain risk factors. Int J Occup Med Environ Health. 2018 Jan 1;31(1):91-111. doi: 10.13075/ijomeh.1896.00901. Epub 2017 Oct 2. PMID: 28972599.
14. Szczygieł E, Zielonka K, Mętel S, Golec J. Musculo-skeletal and pulmonary effects of sitting position – a systematic review. Ann Agric Environ Med. 2017 Mar 31;24(1):8-12. doi: 10.5604/12321966.1227647. PMID: 28378964.
15. Driessen MT, Proper KI, van Tulder MW, Anema JR, Bongers PM, van der Beek AJ. The effectiveness of physical and organisational ergonomic interventions on low back pain and neck pain: a systematic review. Occup Environ Med. 2010 Apr;67(4):277-85. doi: 10.1136/oem.2009.047548. PMID: 20360197.
16. Gobbo S, Bullo V, Bergamo M, Duregon F, Vendramin B, Battista F, Roma E, Bocalini DS, Rica RL, Alberton CL, Cruz-Diaz D, Priolo G, Pancheri V, Maso S, Neunhaeuserer D, Ermolao A, Bergamin M. Physical Exercise Is Confirmed to Reduce Low Back Pain Symptoms in Office Workers: A Systematic Review of the Evidence to Improve Best Practices in the Workplace. J Funct Morphol Kinesiol. 2019 Jul 5;4(3):43. doi: 10.3390/jfmk4030043. PMID: 33467358; PMCID: PMC7739349.
17. Shariat A, Alizadeh R, Moradi V, et al. The impact of modified exercise and relaxation therapy on chronic lower back pain in office workers: a randomized clinical trial. J Exerc Rehabil. 2019;15(5):703-708. Published 2019 Oct 28. doi:10.12965/jer.1938490.245
18. Johnston V, Chen X, Welch A, et al. A cluster-randomized trial of workplace ergonomics and neck-specific exercise versus ergonomics and health promotion for office workers to manage neck pain – a secondary outcome analysis. BMC Musculoskelet Disord. 2021;22(1):68. Published 2021 Jan 12. doi:10.1186/s12891-021-03945-y
19. Shariat A, Cleland JA, Danaee M, Kargarfard M, Sangelaji B, Tamrin SBM. Effects of stretching exercise training and ergonomic modifications on musculoskeletal discomforts of office workers: a randomized controlled trial. Braz J Phys Ther. 2018;22(2):144-153. doi:10.1016/j.bjpt.2017.09.003
20. Sihawong R, Janwantanakul P, Jiamjarasrangsi W. A prospective, cluster-randomized controlled trial of exercise program to prevent low back pain in office workers. Eur Spine J. 2014 Apr;23(4):786-93. doi: 10.1007/s00586-014-3212-3. Epub 2014 Feb 4. PMID: 24492949; PMCID: PMC3960439.
21. Nastja Podrekar, Žiga Kozinc & Nejc Šarabon (2021) Effects of cycle and treadmill desks on energy expenditure and cardiometabolic parameters in sedentary workers: review and meta-analysis, International Journal of Occupational Safety and Ergonomics, 27:3, 728-736, DOI: 10.1080/10803548.2018.1562688
22. Podrekar N, Kozinc Ž, Šarabon N. The effects of cycle and treadmill desks on work performance and cognitive function in sedentary workers: A review and meta-analysis. Work. 2020;65(3):537-545. doi: 10.3233/WOR-203108. PMID: 32116273.
23. Brakenridge CL, Chong YY, Winkler EAH, Hadgraft NT, Fjeldsoe BS, Johnston V, Straker LM, Healy GN, Clark BK. Evaluating Short-Term Musculoskeletal Pain Changes in Desk-Based Workers Receiving a Workplace Sitting-Reduction Intervention. Int J Environ Res Public Health. 2018 Sep 10;15(9):1975. doi: 10.3390/ijerph15091975. PMID: 30201930; PMCID: PMC6164528.
24. E. F. Graves, L., C. Murphy, R., Shepherd, S.O. et al. Evaluation of sit-stand workstations in an office setting: a randomised controlled trial. BMC Public Health 15, 1145 (2015). https://doi.org/10.1186/s12889-015-2469-8

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Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.