# Posture and stillness. An evidence-based approach for sitting at work

> An exploration of evidence-based perspectives on posture, spinal health, and the impact of sedentary work habits.

## Erasmus+ Blended Intensive Program (BIP)
In October 2023, Savonia University of Applied Sciences hosted an Erasmus+ Blended Intensive Program (BIP) focused on Evidence-Based Physical Therapy (EBP). The program brought together over 40 physiotherapy students and 7 teachers from three institutions:
* Savonia University of Applied Sciences, Finland
* Universidade da Coruña, Spain
* Charles University, Prague, Czech Republic

Students collaborated on articles covering themes such as McKenzie methods, back pain, spinal cord injuries, aquatic therapy, ergonomics, Nordic walking, sports injuries, and disabilities.

## Rethinking Posture and Spinal Health
Common beliefs suggest that back pain is primarily caused by "incorrect" sitting, standing, or bending. However, scientific evidence does not support the idea that specific spinal shapes or "bad" postures are direct causes of pain. Despite this, a significant industry exists to sell products intended to "fix" posture, and some healthcare providers continue to offer advice based on these unsupported concepts.

Key takeaways regarding posture:
* **No "Right" Posture:** There is no strong evidence that an upright or "straight" back prevents back pain.
* **Core Muscles:** While often touted as a solution, there is no strong evidence that "core" training prevents pain.
* **Psychological Impact:** Media and outdated clinical advice can create unnecessary anxiety, leading people to believe that normal movement or posture is dangerous.
* **Clinical Evaluation:** While observing posture can help identify rare issues or assess a patient's distress and behavior, it should not be used to blame pain on normal anatomical variations.

## Recommendations for Healthcare Providers
* **Language Matters:** Avoid labeling postures as "bad" or "wrong," as this can increase patient anxiety.
* **Encourage Activity:** Balance advice about sitting with the importance of staying active.
* **Individualized Comfort:** Help patients find comfortable postures, noting that what feels good varies from person to person.
* **Contextualize:** Consider factors like exercise, stress, and sleep alongside physical movement.

## The Impact of Prolonged Sitting
Research indicates that prolonged sitting (e.g., two hours of computer work) can lead to increased musculoskeletal discomfort—particularly in the lower back—and a decline in cognitive function and mental state. 

To mitigate these effects:
* **Active Breaks:** Active breaks are significantly more effective than passive ones in reducing musculoskeletal pain.
* **Frequency:** It is suggested to work for 40–60 minutes followed by a 10–15 minute break, or 30 minutes followed by a 3–5 minute break.
* **Content of Breaks:** Breaks should include strengthening, stretching, and muscle activation exercises.

## Conclusion
There is no universal "good" or "bad" posture. The most critical factors in ergonomics are avoiding prolonged stillness and sedentary behavior. The most effective approach to preventing musculoskeletal disorders involves regular active breaks, changing positions frequently, and utilizing ergonomic workstations to facilitate movement.

## Contributors
* **Topi Teitto**, physiotherapy student, Savonia University of Applied Sciences
* **Joel Lankinen**, physiotherapy student, Savonia University of Applied Sciences
* **Olli Laine**, physiotherapy student, Savonia University of Applied Sciences
* **Marja Äijö**, PhD, Principal lecturer of gerontology and rehabilitation, Savonia University of Applied Sciences
* **Mari Tuppurainen**, physiotherapy lecturer, Savonia University of Applied Sciences
* **Dagmar Pavlu**, Physiotherapist, Assoc. Prof. Charles University
* **Ivana Vláčilová**, Professor, Charles University
* **Jamile Vivas Costa**, PhD, MSc, PT, Lecturer, Universidade da Coruña
* **Montserrat Fernández Pereira**, MSc, PT, Lecturer, Universidade da Coruña
* **Verónica Robles García**, PhD, MSc, PT, OT, Lecturer, Universidade da Coruña

## References
* Baker, R., et al. (2018). “The Short Term Musculoskeletal and Cognitive Effects of Prolonged Sitting during Office Computer Work.” *International Journal of Environmental Research and Public Health*.
* Christensen, S. T., & Hartvigsen, J. (2008). “Spinal Curves and Health: A Systematic Critical Review.” *Journal of Manipulative and Physiological Therapeutics*.
* Geisser, M. E., et al. (2004). “Pain-Related Fear, Lumbar Flexion, and Dynamic EMG among Persons with Chronic Musculoskeletal Low Back Pain.” *The Clinical Journal of Pain*.
* Korakakis, V., et al. (2019). “Physiotherapist Perceptions of Optimal Sitting and Standing Posture.” *Musculoskeletal Science and Practice*.
* Lewis, J. S., et al. (2020). “The Elephant in the Room: Too Much Medicine in Musculoskeletal Practice.” *Journal of Orthopaedic & Sports Physical Therapy*.
* Saito, H., et al. (2021). “Spinal Movement Variability Associated with Low Back Pain: A Scoping Review.” *PLOS ONE*.
* Slater, D., et al. (2019). “‘Sit up Straight’: Time to Re-Evaluate.” *Journal of Orthopaedic & Sports Physical Therapy*.
* Smith, J. A., et al. (2022). “Do People with Low Back Pain Walk Differently? A Systematic Review and Meta-Analysis.” *Journal of Sport and Health Science*.
* Smythe, A., & Jivanjee, M. (2021). “The Straight and Narrow of Posture: Current Clinical Concepts.” *Australian Journal of General Practice*.
* Swain, C. T. V., et al. (2019). “No Consensus on Causality of Spine Postures or Physical Exposure and Low Back Pain.” *Journal of Biomechanics*.
* Vitoulas, S., et al. (2022). “The effect of physiotherapy interventions in the workplace through active micro-break activities for employees with standing and sedentary work.” *Healthcare*.