Back pain from sitting: is it posture, or sitting still?

Back pain from sitting seems to have less to do with the shape you sit in than with how long you stay in it. No posture is a proven cause of back pain, and people with and without back pain stand with the same curve in the lower back. What went with back pain in the studies was long sitting and long driving. So the change worth making is to move more often: shift position freely, and get up for a minute each time a task, a call or a stretch of road comes to an end.

Peter O'Sullivan is a specialist musculoskeletal physiotherapist and a John Curtin Distinguished Professor at Curtin University. On Rangan Chatterjee's podcast Feel Better, Live More in 2024, he went through ten common beliefs about back pain. When the host read out the sixth, that poor posture causes it, O'Sullivan answered: "Not true. There's not a single study that supports that" (1:30:30). The usual version of the rule, that "if you sit slouch, you're going to get back pain," has in his words "no evidence to support that" (1:31:53).

O'Sullivan and his team developed cognitive functional therapy, an approach to persistent pain, and his website offers clinical training in it, so this article sets each of his views beside the research. Below: what the posture studies found, what the sitting studies found, and how to build movement into the long sits you already have.

Does bad posture cause back pain?

1. The standing curve is the same with and without pain

If slouching caused back pain, you'd expect people with back pain to stand or sit with a different shape. In a 2014 review, researchers pooled 43 studies that measured the lower back and pelvis in adults with and without low back pain. Across 8 studies of the standing curve of the lower back, the difference between the two groups was close to zero (SMD 0.01) (Laird et al., 2014).

What did differ was movement: on average, people with back pain moved their lower back through a smaller range and more slowly (speed SMD -1.46, 8 studies). The authors don't know whether that comes before the pain or after it.

2. Researchers found no agreement that any posture causes it

A 2020 umbrella review brought together systematic reviews on spine posture, standing, sitting, bending and twisting, awkward postures and heavy physical work. Some reviews found links with low back pain and others didn't. The authors concluded there was "no consensus regarding causality," and that "association has been documented but does not provide a causal explanation" (Swain et al., 2020; abstract only).

That cuts both ways. Nobody has shown that posture causes back pain, and nobody has shown that it plays no part at all. What the research doesn't support is the idea that one correct way of sitting protects your back.

3. Where the "sit up straight" rule comes from

O'Sullivan thinks the rule taps into what we find beautiful and what we teach children about holding their bodies. Watching his daughter learn ballet, with its "shoulders back" and braced trunk, he puts it this way: "That's fine for ballet, but don't take that into your life, thinking that it's dangerous to relax your back" (1:31:41). He adds that teaching people a slumped back is dangerous makes them watchful of their bodies in a way that doesn't help.

Robin Nürnberg, a German physiotherapist who posts as Critical Physio and offers coaching and an online seminar, made a similar case on the Coach Stef Podcast (in German, from about 2:13). Sitting bolt upright all day is hard work for the muscles, in Nürnberg's account, a bit like holding a plank for a whole workout. Slumping all day is probably no better. What counts is how long you stay in one position, and the more variety, the better.

On AlmaPhysio, an Italian physiotherapy clinic's channel, physiotherapists Gianluca Italiano and Mattia Disanza add a reason to stop checking. If your attention is always on whether you're sitting straight, they say, your thoughts keep going back to your back, and the pain can go up with them (9:03, paraphrased from the Italian).

What goes with back pain: long, still days

4. Long sitting and long driving went with more back pain in surveys

A 2021 review pooled 27 surveys on sitting and low back pain, in adults and children. Adults who reported long sitting had about 1.4 times the odds of back pain (OR 1.42), and adults who reported long driving about twice the odds (OR 2.03) (Baradaran Mahdavi et al., 2021).

Read those numbers with care. Every pooled study was a snapshot, so none can say whether sitting came before the pain or the pain led to more sitting. The results varied a lot from study to study, and the broader link between a sedentary lifestyle and back pain in adults lost statistical significance when a single study was left out. Still, the links point toward time spent still, not the shape of the spine.

5. Sitting measured with sensors told the same story

In a Danish study, workers in physical jobs wore sensors for several working days, so their sitting was measured, not recalled. More total sitting in the day went with higher odds of reporting intense back pain. Sitting outside work carried the link; sitting at work on its own did not reach significance (Gupta et al., 2015). It was one small study at one point in time, so it shows a link, not which came first.

6. New chairs and desks haven't been shown to prevent it

If stillness is the issue, a better chair is the wrong fix. A 2010 review of trials in workers found that changing chairs, workstation equipment or how work was organized did no better than no change at preventing low back pain or making it less intense; the evidence was of low to moderate quality (Driessen et al., 2010; abstract only).

Sit-stand desks were studied mostly in office workers who didn't have back pain. Switching between sitting and standing went with slightly less low-back discomfort, and the authors say changing posture "may" lower the chance of developing back pain (Agarwal et al., 2018; abstract only). Nobody knows yet how much switching is enough, or what it does for a back that already hurts. If you own one and like it, use it as one more way to change position.

How to break up a long still day

7. Sit however you like, and keep changing

"Although your posture doesn't need to be perfect, try and move often," says NHS inform, the Scottish public health site. The AlmaPhysio physiotherapists give the same advice in their own words: sit however you like, but change position often and stay active, because the trouble is a position held out of habit for too long (4:13, paraphrased from the Italian).

In practice: lean back for a while, then forward; cross your legs, then put them out in front; stand for the next call. None of them needs to be the right one.

8. Tie a minute of moving to an ending that already happens

Endings make good cues, because they happen anyway: a call ends, an email goes out, a task is done, a drive reaches a stop, an episode finishes. Get up and move for a minute at each one: refill your water, walk to the window, step out of the car.

Add a floor for the long stretches with no natural end, such as a long block of work or a road with no stops. The 1h Protocol to Manage Back Pain uses "at least about every half hour you sit" as its starting point; that's a setting to try, not a tested number. In office studies, short breaks where people got up and changed position may have helped with back pain and discomfort, and work didn't suffer, though the authors say more good studies are needed (Waongenngarm et al., 2018; abstract only). The NHS gives the same direction as general health advice for all adults: "break up long periods of not moving with some activity" (NHS).

If you drive for work, the stops are your cues: step out for a minute at each stop or drop-off before you set off again. If you can't leave your seat, stand, shift or change position where you are. For the wider workday, see back pain at work.

9. Move before the lift after a long sit

One moment deserves its own plan: the lift that comes straight after a long sit, like the case from the boot after a long drive or the box after a morning at a desk. The program's suggestion is to walk about for a minute first, so your back isn't going straight from still to loaded, and to make the first lift a lighter one if there's no minute to spare. Our guide to lifting with back pain covers what the bending research found.

When sitting pain needs a doctor

Serious causes of back pain are rare, but a few signs mean you should get checked. Get medical help straight away if your bladder or bowels have changed; you've lost feeling around your genitals or bottom, or sex feels different; both legs feel weak, numb or tingly, or you can't walk because of the pain; the pain started after a serious fall, accident or blow to your back; or you have chest pain or trouble breathing with it, or the pain came on suddenly and is far worse than anything you've had before, or it's getting worse fast. See a doctor first if you have a fever or feel generally unwell; you've had cancer or lost weight without trying; or the pain is worse at night or doesn't change at all when you move or rest, it's high up between your shoulder blades, or one leg feels weak or numb.

Back to the ballet class

The posture rule is old and well meant. The studies point somewhere simpler. No sitting shape has been shown to cause back pain, while long, still stretches went with more of it. You don't need a better chair. You need more endings that get you up, and the freedom to vary how you sit. Pick your longest sit tomorrow and find the moment that already ends it.

For the bigger picture of why back pain comes and goes, start with our guide to lower back pain.

To build this around your own day, try the 1h Protocol to Manage Back Pain, a program of practical education. Its free first chapter starts with a quick check for warning signs, then asks how your back days go and finds your pattern. If your pain builds over long sitting or driving and eases when you move, that's the Long Still Day, and you start by getting up for a minute after each task. The full program takes about an hour: seven chapters show why your back keeps flaring, walk one back day with you at your own times, and plan a flare, the days after it and the days that don't go to plan. You leave with two or three things to start now, each with an alternative for harder days, a flare plan with one line in your own words, a flare card for your lock screen, and fourteen days to try it, with a sheet, reviews on days 7, 14 and 30, and four one-tap check-ins by email if you're signed in. Start free

Frequently asked questions

Does bad posture cause back pain?

No posture is a proven cause. People with and without back pain stand with the same lower-back curve (Laird et al., 2014), and a review of reviews found no agreement that posture causes back pain, even though some studies found links (Swain et al., 2020). What went with back pain in surveys was long sitting and driving.

What's the best way to sit with back pain?

Whichever way feels comfortable, for a while, then a different one. No single position has been shown to protect your back. Change position often, and get up for a minute when a task or call ends.

Is sitting all day bad for your back?

Long sitting went with more back pain in surveys of adults (about 1.4 times the odds), and long driving with about twice the odds (Baradaran Mahdavi et al., 2021). Those were snapshots, so they can't show that sitting causes the pain.

Does a standing desk help back pain?

In office workers without back pain, sit-stand desks went with slightly less low-back discomfort (Agarwal et al., 2018). They haven't been tested well in people who already have back pain. You don't need to buy one: standing for calls and getting up between tasks change your position too.

How often should I get up from my desk?

No study has set a number. The program's starting point is a minute up at the end of each task or call, and at least about every half hour you sit, or at each stop if you drive. Treat that as a setting to try for two weeks, then adjust it to your day.

Sources

This article draws on Professor Peter O'Sullivan's interview on Feel Better, Live More, videos by the AlmaPhysio physiotherapists and Robin Nürnberg, and the studies and guidance listed below.

• How to Break Free from Chronic Pain and Reclaim Your Life, with Professor Peter O'Sullivan (podcast episode, Feel Better, Live More, episode 472, 2024)
• AlmaPhysio, Mal di schiena: falso mito #1 la postura (YouTube video, in Italian, 2020)
• Robin Nürnberg on the Coach Stef Podcast, episode 80 (podcast video, in German, 2025)
• Laird et al, Comparing lumbo-pelvic kinematics in people with and without back pain (systematic review and meta-analysis, 43 studies, 2014)
• Swain et al, No consensus on causality of spine postures or physical exposure and low back pain (umbrella review of systematic reviews, abstract only, 2020)
• Baradaran Mahdavi et al, Association between sedentary behavior and low back pain (systematic review and meta-analysis of cross-sectional studies, 27 pooled, 2021)
• Gupta et al, Is objectively measured sitting time associated with low back pain? (cross-sectional sensor study, Danish workers in physical jobs, 2015)
• Driessen et al, Physical and organisational ergonomic interventions on low back pain and neck pain (systematic review of trials in workers, abstract only, 2010)
• Agarwal et al, Sit-stand workstations and impact on low back discomfort (systematic review and meta-analysis, workers without back pain, abstract only, 2018)
• Waongenngarm et al, The effects of breaks on low back pain, discomfort, and work productivity in office workers (systematic review of trials, office workers, abstract only, 2018)
• NHS inform, Back problems (health information page, 2026)
• NHS, Physical activity guidelines for adults aged 19 to 64 (health information page, 2024)