Are you sitting comfortably

A month ago The BBC ran an article on complaints about how hard the new Thameslink train seats are (see it here, it also features the first osteopath I’ve ever seen asked to give his expert opinion).  I’ve had the opportunity to ride one of them now and can confirm that, in a modern world of uncomfortable public seating, these are the worst so far.  They are very hard, very upright and quite straight in the back.  “Surely sitting straight and upright is good for you?”  I hear you cry…I’ll come back to whether it is good for most of the population later but it most certainly is not good for anyone who cannot comfortably hold that position.

The problem is that not everyone has an “ideal” shaped back.  Many people, including myself have increased curves…they are kypho-lordotic.  They are not necessarily just slouching.  They may have developed wedge-shaped vertebrae, either as a teenager (common amongst those with a fast growth spurt) or in older age due to osteoporosis; others just may no longer be able to straighten, as soft-tissues in the chest (muscles, tendons, fascia, ligaments) have shortened over time as a result of hours at a desk, or even over-work of the chest relative to the back, at the gym.  An upright seat, hard padding with no give and a back that cannot straighten means that the passenger will be sitting with their head tipped forward, that is 4-5kg pulling forward and needing constant support from the muscles of the neck and back.  Evidently that is a potential recipe for pain and dysfunction.

On 5 March the Guardian ran an article stating that there was little evidence connecting back pain with slouching and bad posture (read it here).  It was a confusing mess of clearly contradictory definitions of posture – quoting an osteopath (another one), a ballet teacher and a physiotherapist.  Worryingly the article suggests that workstation assessment was about sitting up straight and that sitting up straight was not particularly useful. 
My suspicion is that the journalist has got a number of different quotes and weaved them together but has confused three different things

1. Ideal posture – this is the biomechanical ideal.  The patient is symmetrical left and right, with small curves in the cervical, thoracic and lumbar spine and the centre of gravity running straight down through the centre of the head shoulders hips and ankles.  It is one of four main postural descriptions of antero-posterior curve variations.  The evidence suggests that it has little effect on overall propensity to back pain
2. Good posture – What a dancer strives for.  This is posture that looks elegant and may tend towards the “flat back” type rather than “ideal posture”.  Osteopaths at least would historically have believed this less than ideal as the curves dissipate forces and the straighter back tends to concentrate these at the base of the spine and sometimes the base of the neck
3. Comfortable position – This is what a postural workstation assessment should be about and is what the Health and Safety Executive guidance is aimed at.  The workstation (or train seat) should allow you to sit in a position where you can reach everything you need comfortably without straining, where your bodyweight is easily supported without overuse of muscles, which can otherwise become fatigued, and where you can easily change position to rest the muscles you are using.

If you have ideal posture, lucky you, you will be most easily able to find a comfortable position in more circumstances, if you don’t, don’t worry, nor do most people but do strive for a comfortable working position.  That said not all postural issues start with structural change and if you have noticed that your posture has recently become farther from ideal then you should get it checked out.  Small minor injuries can change the way we stand or sit and that functional change can, over time become a structural one.

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