The role of posture in spinal pain: a survey of the perceptions and practices of clinicians and academics in six continents

J Bodyw Mov Ther. 2026 Jul;47:41-59. doi: 10.1016/j.jbmt.2026.03.015. Epub 2026 Mar 12.

ABSTRACT

BACKGROUND: Evidence-based recommendations support personalised relaxed postures and reassuring patients about posture safety rather than emphasising specific 'good' and 'bad' postures. However, global alignment of spinal pain practitioners' and academics' perceptions and practices with these recommendations remains unclear.

OBJECTIVE: To explore whether spinal pain practitioners' and academics' perceptions and practices align with current evidence-based recommendations across diverse global health systems.

DESIGN: Cross-sectional mixed-methods survey.

METHOD: This survey of 84 participants (45 clinicians, 39 academics) across nine countries used a bespoke online questionnaire with closed-ended and open questions. Data covered socio-demographics, understanding of posture and postural hygiene, assessment and management practices, and knowledge of standardised methods. Qualitative and quantitative data were analysed using thematic analysis and Fisher's exact test respectively.

RESULTS: Most participants (75.0%) viewed posture as a risk factor for spinal pain, with postural hygiene predominantly defined as adhering to specific 'good' postures (63.1%). While 53.6% assessed posture and 39.3% assessed postural hygiene, only 15.5% and 14.3% respectively measured these objectively. Between 51.2% and 88.1% were unaware of standardised assessment methods or outcome measures. Perceptions, knowledge, residence in low- and middle-income countries, and being a clinician significantly influenced practices (p < 0.05).

CONCLUSIONS: Current perceptions and practices contradict evidence-based recommendations. The prevalent belief in universal 'good' and 'bad' postures, particularly among clinicians and those in low- and middle-income countries, risks reinforcing maladaptive patient beliefs and adverse outcomes. Targeted educational interventions are urgently needed to align clinical practice with modern pain science emphasising individualised, patient-centred care.

PMID:42264821 | DOI:10.1016/j.jbmt.2026.03.015