Rethinking Good Posture: Why Pulling Your Shoulders Back Isn’t the Answer

Anna Staehli Wiser, DPT, FAAOMPT

The Posture Myth Most People Get Wrong

If you’ve ever been told to “sit up straight,” chances are you were also told to pull your shoulders back. While well intentioned, this cue can worsen symptoms in people with neck and upper back pain. Pulling the shoulders back does not significantly reposition the spine, and instead often increases muscular tension in the neck and upper shoulder region.

Why “Shoulders Back” Can Increase Neck Tension

Actively retracting the shoulder blades increases activity in the levator scapulae and upper trapezius, both of which attach to the cervical spine. Increased activation of these muscles has been associated with greater neck pain and muscle fatigue in individuals with postural dysfunction and prolonged sitting habits.¹,²

A Better Starting Point: “Lift Your Sternum”

A more effective cue is to focus on gently elevating the sternum. This subtle adjustment promotes thoracic extension, improves rib cage positioning, and allows the head to balance more efficiently over the spine. Improving thoracic posture has been shown to reduce mechanical strain on the cervical spine and decrease neck pain.³

What Better Posture Actually Does

Rather than forcing the shoulders backward, optimal posture reflects a stacked alignment in which the rib cage, spine, and head are balanced. This reduces the workload of cervical extensors and improves overall biomechanical efficiency.³,⁴

Awareness Alone Is Not Always Enough

While “sternum up” is a useful cue, long-standing postural habits often involve structural adaptations. Prolonged flexed postures are associated with thoracic spine stiffness and reduced mobility, which can limit the ability to achieve upright positioning without intervention.⁵

Restoring Mobility: Why the Spine Needs Help

Manual therapy, including joint mobilization and manipulation, has been shown to improve thoracic mobility and reduce neck pain when combined with exercise.⁶ These interventions help restore the movement necessary for improved posture, making upright positioning more natural and sustainable.

Strength Matters: Supporting Your Posture

Postural endurance depends on the strength of spinal stabilizers, including the erector spinae and deep cervical musculature. Strengthening these muscle groups has been shown to improve pain and function in individuals with chronic neck pain.⁷ Without sufficient endurance, individuals tend to revert to slouched positions due to fatigue.

The Role of Passive Support

Even with improved strength and awareness, prolonged sitting leads to muscle fatigue. The use of lumbar support has been shown to help maintain spinal alignment and reduce strain on the lumbar and thoracic regions during seated tasks.⁸ Placing a lumbar support cushion in the small of the back can significantly reduce the tendency to slump over time.

The Big Takeaway

Good posture is not about forcing your shoulders back—it is about creating a system where your body can maintain alignment comfortably and efficiently.

• Start with “sternum up”

• Restore mobility where needed

• Build strength for endurance

• Use support when necessary

References:

1. Cagnie B, Cools A, De Loose V, Danneels L, Cambier D. Differences in muscle activity between patients with chronic neck pain and healthy controls during functional tasks. Clin Biomech (Bristol, Avon). 2007;22(1):21-28.

2. Szeto GPY, Straker LM, O’Sullivan PB. A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work—2: neck and shoulder kinematics. Man Ther. 2005;10(4):281-291.

3. Lau KT, Cheung KY, Chan KB, Chan MH, Lo KY, Chiu TTW. Relationships between sagittal postures of thoracic and cervical spine, presence of neck pain, neck pain severity and disability. Man Ther. 2010;15(5):457-462.

4. Falla D, Jull G, Hodges P. Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain. Exp Brain Res. 2004;157(1):43-48.

5. Edmondston SJ, Sharp M, Symes A, et al. Changes in mechanical load and extensor muscle activity in the cervicothoracic spine induced by sitting posture modification. Ergonomics. 2011;54(2):179-186.

6. Cleland JA, Childs JD, McRae M, Palmer JA, Stowell T. Immediate effects of thoracic manipulation in patients with neck pain: a randomized clinical trial. Man Ther. 2005;10(2):127-135.

7. Gross A, Paquin JP, Dupont G, et al. Exercises for mechanical neck disorders: a Cochrane review update. J Orthop Sports Phys Ther. 2016;46(3):159-168.

8. O’Sullivan K, O’Dea P, Dankaerts W, O’Sullivan L, Clifford A, O’Sullivan P. Neutral lumbar spine sitting posture in pain-free subjects. Man Ther. 2010;15(6):557-561.