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Good posture causes (some) neck pain [STUDY]

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Women who sat slumped rather than upright actually had a lower risk of persistent neck pain, according to a new study in the journal Physical Therapy. Specifically: posture, neck pain, and some other variables were assessed in several hundred 17-year-olds, and then again when they were 22. The risk of developing persistent neck pain was higher in those with a conventionally “good” posture, rather than the much-demonized “poor” posture of a slumped thorax and forward head posture. 🤯

What a delightfully counter-intuitive result! I always pounce on these.

“But they were young!” will be a common objection to this (and I have already seen it). “Quelle surprise, duh, and whoop-de-doo: of course young women had no trouble with poor posture. Give them another 20 years, they’ll all be in pain by then.” But that hot take ignores half the data to score a cheap point.

The study did not just show that young woman with supposedly poor neck posture had minimal neck pain: it also showed that young women had more pain with allegedly “good,” erect posture. Despite their youth! With hardly any waiting at all, a mere five years, three of them while still teenagers! Young people do get neck pain. And, in this study, the young ‘uns with “better” posture got more.

I do not think this means we need to coach people to slump. It’s not like there was a huge difference here. The erect-posture group wasn’t exactly being destroyed by a plague of neck pain; their risk was only a little greater. If the numbers were flipped and showing a benefit to erect posture, every posturologist in the land would be smugly touting it, but I would write it off as trivial. There also wasn’t any difference in the young men studied.

The only implication is not so much that the postural truth is the reverse of the conventional wisdom, but just that there is no postural “truth” — that our traditional expectations of the importance of posture are just minor and doomed to be confounded by many other factors.

Which is what the research has been pointing to for ages (indeed, it has never really pointed anywhere else).

And so the evidence-based thing to believe is that we shouldn’t worry all that much about our posture one way or the other. And that has been the main message of my writing on this topic for well over a decade now. See Does Posture Matter? That has now been updated with this study, of course.


“Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study”
Richards et al. Physical Therapy. Volume 101, Number 3. 03 2021.