Stress, Posture, and Back Pain, Are they Linked?

The old saying about “You are what you eat” helps us remember that we should eat healthy food. Could a catchy saying help us remember that our physical bodies are affected by our emotional experiences, especially when it comes to stress?

The connection between stress and back pain

Maybe the catchy phrase could be “You are what you feel.” Our psychological experiences trigger physiological responses, according to several studies, including one published in Chronic Stress in 2017.

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In this study, researchers looked at how the brain responds to stress and how those responses affect the physiology of the body. Researchers found through complex brain activity that stress increases cortisol, which can increase pain. While the connections between stress and pain were not completely related, researchers could not find a consistent correlation. But, they did find some correlation, in both the humans and the animals that were studied.

Throwing obesity into the mix

One correlation was between stress and obesity, that as stress increases, so does obesity. In a study published in Medicine, researchers found that back pain and obesity were linked. Researchers also found: “the association between measures of obesity and back pain with regards to mental health, we found that the associations tended to be stronger in those with an emotional disorder.”

The same study questioned whether being obese was a result of having back pain, but the biggest concern was that back pain management is needed to target fat loss for people who have an emotional disorder, which could be related to stress. Regardless of the original cause, back pain, obesity, and emotional disorders are connected.

Caring for the whole person

The SA Journal of Physiotherapy studied how psychological stress caused low back pain in employees at Gauteng, South Africa. Over 47% of employees suffered from low back pain at the time of this study in 2010. Of those employees, 65% of them also experience psychological stress at work. While the study did not determine what caused stress, there was a direct correlation between low back pain and psychological stress. The study recognized that health care providers need to be aware of the correlation so they can educate and support their patients who have low back pain or stress, or both. It is important to help people who suffer from low back pain learn relaxation techniques so they can manage stress.

Understanding posture and how it affects back pain

The next question is how posture affects back pain. A plethora of studies have been conducted on the connection between posture and back pain. Posture can affect back pain and its intensity. One of the most recent studies related to back pain and posture was published in BioMed Central Musculoskeletal Disorders in 2018. This study looked at how postural awareness affected back pain using the Postural Awareness Scale. Using a large sample and cross-validation, researchers found that postural awareness was connected to the intensity of back pain. Interestingly, the study found that when people improved their postural awareness through a variety of interventions, their pain intensity decreased.

The Posture Awareness Scale has 13 choices and includes options like:

• Needs to concentrate to be aware of posture
• Awareness of bad posture because of pain
• Knows how to change posture to relieve pain
• Slumps down when sitting
• Unaware of posture when focused
• Often checks posture when working
• Always aware of sitting or standing posture
• Aware of posture even when focused
• Regulates how she/he feels through posture

A vicious cycle with no clear catalyst

With the variety of studies connecting posture and back pain as well as stress and back pain, it is clear that posture and stress do cause back pain. And, back pain could also be an issue that could cause stress. Back pain could also be a cause of poor posture. The connections are clear, but what is not clear is which symptom is the original catalyst.

Having good posture means that the vertebrae of the spine are in alignment. Good posture can happen when sitting and standing, but also when resting, reaching, bending, and moving. When the spine is out of alignment in any part, back pain can happen. In many cases, simple daily activities like using a computer, carrying a baby, or pulling weeds can result in back pain. Other causes for posture-related back pain can be accidents, sports-related, or present at birth.

With poor posture, the body reacts by tensing the muscles which can cause back pain. So, for many people, paying attention to posture can help relieve pain and it can help prevent pain, too. Along with paying attention to posture, being healthy both physically and psychologically can help prevent back pain.

What does good posture look like?

According to a study published in 2012 in Manual Therapy, physiotherapists are still undecided about what the best posture actually is. However, most physiotherapists selected two best postures out of nine selections, but the two that were chosen most frequently were distinctly different from each other. Interestingly, all 295 physiotherapists who were involved in this study disagreed about what a neutral spine looked like. They did agree that the best sitting posture had a natural shape of the spine. They also liked the idea of sitting with relaxed muscle tone.

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The known knowns and known unknowns

Despite the wide variety of studies that have been conducted on low back pain, posture, and stress, there are clearly more studies that need to be done. What is also clear is that there is a correlation and that people should pay attention to their posture so they can recognize what does and does not cause pain. Additionally, people and their health care providers should pay attention to stress levels so they can prevent physical pain from developing in the back. Those who already have back pain should also be closely monitored to see if stress or other psychological problems develop due to the pain.

About Dr. Wells

Serving Anchorage, Juneau, and the surrounding communities, Dr. Brent Wells, D.C. offers patient-centered, personalized, and innovative chiropractic care. A California native, Dr. Wells earned a bachelor’s of science degree from the University of Nevada. He then attended Western States Chiropractic College in Portland, Oregon. In 1998, he and his wife Coni moved to Alaska and opened Better Health Chiropractic & Physical Rehab. He continues his education to remain active and updated in all studies related to neurology, physical rehab, biomechanics, spine conditions, brain injury trauma, and more.