BraceLab Clinical Clues

November 2021 No. 24

Sitting Posture to Relieve Back Pain: One or Many?

by Jerry Ditz, DPT, Dip. Osteopractic, Cert. SMT, Cert. DN

Do you tell your patients their back pain is coming from bad posture and they should work toward a correct/ideal posture?

The concept of incorrect posture causing spinal pain lacks current evidence. (1) If focusing on a correct/ideal posture is your standard treatment approach, consider that "correct posture" is one that "shifts internal loads among various tissues (alternating dynamic and static)” as stated by Uddin et. al.(2) and support by Slater et. al.(3)

The result of shifting internal loads among various tissues is illustrated by E.W., a 34-year-old female who experienced low back and hip pain when sitting for more than 5 minutes. Her work required 8 hours per day seated in front of a computer monitor and she did not have an option to use a sit-stand desk.

At her initial visit, E.W. was instructed in the customary ideal seated ergonomic position which relieved her symptoms in the clinic. But when she returned for follow-up, she stated the seated postural change only relieved her pain for one day. After explaining the differing thoughts about static workstation ergonomic changes versus using a variety of work positions throughout you day, she was interested in trying the varied positions. The following list given to E.W. combines traditional ergonomic positions with those which exaggerate hip joint motions of flexion, extension, internal rotation, external rotation, abduction, and adduction: See Figures 1-5.

Figure 1: Seated with a low back towel roll (traditional)

Figure 2: Seated with feet on a box (hip flexion)

Figure 3: Seated with legs crossed (external rotation)

Figure 4: Seated with ankles outside chair legs (internal rotation)

Figure 5:  Seated half-kneel (extension)

Repeating these varied seated positions throughout the day, E.W. reported one week later that her symptoms were eliminated, and she was able to work all day without pain.

Currently we do not have enough evidence to determine the best postural approach when sitting in front of a monitor for prolonged periods. We do know, however, that the traditional static seated posture recommendation does not always eliminate our patient’s pain. As clinicians we must be open to adapting our treatment to evolving evidence that suggests frequently changing postures may be of value.(3)


1. Kwon BK, Roffey DM, Bishop PB, Dagenais S, Wai EK. Systematic review: occupational physical activity and low back pain. Occup Med (Lond). 2011 Dec;61(8):541-8. doi: 10.1093/occmed/kqr092. Epub 2011 Jul 4. PMID: 21727180.

2. Uddin Z, Woznowski-Vu A, Flegg D, Aternali A, Wickens R, Wideman TH. Evaluating the novel added value of neurophysiological pain sensitivity within the fear-avoidance model of pain. Eur J Pain. 2019;23:957-972.

3. Slater D, Korakakis V, O'Sullivan P, Nolan D, O'Sullivan K. "Sit up straight": time to re-evaluate. J Orthop Sports Phys Ther. 2019;49:562-564.


Download Clinical Clues No.24, Sitting Posture to Relieve Back Pain: One or Many?; November 2021

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Disclaimer: BraceLab Clinical Clues are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact.

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