Can bad posture cause back or neck pain?

Yes, but not because of the position itself. Holding one position for hours is what loads the same tissues without a break, and that is the pattern that shows up as pain.

01Is it the position, or the hours spent in it?

Not the way most people think.

The saying going around is that sitting is the new smoking. Here is the correction I make: "the issue is not sitting or standing for 10 hours a day, but the real issue is being static." A position is not the problem. Living in one position for hours at a time is.

And it does not show up the same way in everyone. "Poor posture shows up in the body in several different ways depending on people's body composition and factors." So what follows is the pattern I see most, not a rule about you.

02What is actually happening in your neck and shoulders?

Think about a wall sit.

Now put that on your neck. "What people don't realize is our neck and head are essentially doing a wall sit on our torso for hours on end when we're on the phone or on our laptop." The muscles holding your head up never get a rest, so they fatigue, and fatigued tissue under a constant load is where the ache starts.

There is a number for that load. According to one published study, the adult head weighs roughly 10 to 12 pounds. As the head moves farther forward, the mechanical demand on the neck increases substantially. Biomechanical modeling has estimated cervical spine forces of approximately 27 pounds at 15 degrees of forward head tilt, 40 pounds at 30 degrees, 49 pounds at 45 degrees, and up to 60 pounds at 60 degrees.

Source: Hansraj KK. Assessment of Stresses in the Cervical Spine Caused by Posture and Position of the Head. Surgical Technology International. 2014;25:277-279. PMID 25393825, pubmed.ncbi.nlm.nih.gov/25393825.

Then the shape of you changes to match the job. "This sitting for hours on end really promotes this poor posture because it creates passive shortening of the muscles on the front side of your body." Chest, neck, hip flexors. Meanwhile, the back side goes quiet. "It shuts off and deactivates the back side, which are your actual postural stability muscles."

That is the mechanism. Muscle answers the stimulus it gets: "based off the stimulus that it gets, it sends a signal to the brain to either shorten, relax, keep you erect and upright and have a better posture." Give it hours of the same stimulus and that is the posture it keeps.

03What does poor posture look like?

When someone walks in, the first thing we see is the forward head posture. Chin closer to the chest. "The head is much more forward compared to the body if we were to draw a plumb line to see how the body lines up."

Then the shoulders. "We see a lot of forward and rounding shoulders." People look narrower than they are because the shoulders are drawing in toward the middle.

The picture that sums it up: "It's like people are closing off their bodies instead of standing up nice and straight and tall."

04Why is this getting worse?

Because of how much of the day now happens in one shape.

"We are spending much more time on our phones in positions that are causing us to fold forward, shorten the front side of our body, and adapt to the stresses of gravity on our body." Work or lifestyle, it does not matter which. The phone is not going anywhere, and neither is the laptop.

What changed is how little we have to move to get through a day. "There is less movement variability because we're able to accomplish so much with moving so little because everything is so accessible from our phones now." Convenience is the cause: doing so much while moving so little.

That is true at any age. I do think it shows up earliest in the youngest patients, and "I do believe there is a posture pandemic among Gen Z." But the desk worker in their fifties and the student in their twenties are folding forward for the same reason.

05What actually corrects it?

Here is the part that matters for anyone shopping for a solution.

"The issue here is posture is an active process." Your body holds itself up by working, all day, against gravity. Anything that promises to hold you up for you is solving the wrong problem. I am writing a whole piece on posture correctors for that reason.

What actually changes posture is teaching. "True correction for posture requires neuromuscular education and teaching the muscles on the backside of the body to stay engaged, to allow the shoulders to be pulled back, to allow the head to sit over the spine, and to allow the pelvis to sit in a neutral position."

If your posture already hurts, here is what I tell people. Pain is information, and it deserves an exam before it gets a gadget.

The first thing we have to do is stop pouring gas on the fire. The best thing you can do is break the monotony of being static by setting an alarm on your phone to get up every 45 minutes and move. Stretch, do some exercises, or simply go for a walk and loosen your body up. A more detailed approach would be to focus on lengthening the front and strengthening the back. Think stretching your chest and hips and activating your glutes, low back, and upper back. To take it to the next level, see a skilled clinician who can help manually release these muscles on the anterior side of the body and help teach you how to engage the musculature on the back side.

06What can you do this week?

Same plan, the way I say it to my youngest patients.

If you are in your twenties, on your phone or at a desk most of the day, and you want to change this, first: "I'm proud of you for taking the steps, the active steps, and solving a problem which you're recognizing early."

You are probably not going to stop being at a desk. "But what you can control is your movement variability."

So: "try to set a timer or an alarm on your phone to get up and move every forty-five minutes." Maybe an hour at most. When it goes off, "a simple walk up and down the office or around the house will suffice."

If you want to take it a level up, "focus on lengthening the front side of your body and strengthening the back side of your body." On the break, "maybe you're stretching your chest, or you're stretching your hip flexor, or you're stretching your lower abdominals." Or "maybe you're strengthening your upper back and traps to be able to hold your shoulder back." A few supermans on the floor, or some glute bridges. Small and often.

One last thing

This is education, not medical advice, and reading it does not make me your doctor. If something hurts, and especially if it is getting worse, get seen by someone who can examine you in person.