Is there a relationship between posture and pain in lower back pain patients?

Posture is a 'body's attitude or positioning of the limbs when standing or sitting'. There are many examples of different postures which include lordotic posture, swayback posture, flat back, and anterior pelvic tilt. There has long been discussion about whether 'poor' posture causes lower back pain, but does the evidence reinforce or negate this?

There are many extrinsic variable as to why someone may suffer with lower back pain, and these may include exercise, work satisfaction, education level, stress, and smoking. Some may feel or have been told that their 'posture' is a leading cause of their lower back pain, but this needs to be reinforced by evidenced-based research.

The evidence suggests that there is no gold standard definition for good or bad posture, and there is no single correct posture that will eliminate back pain. Pain can absolutely lead to poor posture, however, it is fairly weak to suggest that poor posture can lead to pain. Numerous studies have identified that there is a weak link between these postures being a causative factor for back pain. Rather than trying to change posture, such as anterior pelvic tilt, extenuated lumbar lordosis, swayback, or flat back, we should be encouraging exercise and movement. From an osteopathic approach, focus should be drawn to maintaining movement, improving function, furthering strength and stability, patient education, and being conscious of good form during strenuous exercise.

Kripa, S. and Kaur, H. (2021). Identifying relations between posture and pain in lower back pain patients: a narrative review. Bulletin of Faculty of Physical Therapy. 26: 10.1186.