Evidence-Based Physical Therapy (EBP) uses the best research evidence with clinical expertise and user’s preferences to produce the most appropriate and effective care. At week 43 in 2023, we had Erasmus+ Blended Intensive program (BIP) in Finland, Kuopio Savonia University of Applied Science about EBP. This BIP program opened with welcome words of the president of The European Network of Physiotherapy in Higher Education (ENPHE) and followed with the basis of EBP and teachers who highlighted the main challenges at different Physical Therapy fields week 43 in 2023 we had Blended Intensive program (BIP) in Finland, Kuopio Savonia University of applied science. More than 40 physiotherapy students and 7 teachers from three universities (Savonia University of Applied Sciences, Finland, Universidade da Coruña, Spain, and Charles University Prague, actively participated this week and shared experiential group dynamics and social activities. Students worked together and wrote articles devoted to the following themes: Evidence Based in McKenzie, back pain, spinal cord injuries, aquatic therapy, ergonomics at work, Nordic walking, sport injuries, sport and young adults: Prevention of sport injuries and children with disabilities. In the following you can consult the works presented by the students on each topic.

“Good or bad posture”

Posture is a topic that comes up a lot when people talk about health. Patients, healthcare professionals, the media, and society, in general, discuss it frequently. Many believe that back pain mainly comes from sitting, standing, or bending in ways considered “wrong.” Despite this belief, there isn’t strong scientific proof to support it. However, there’s a thriving industry that sells products claiming to “fix” your posture and prevent pain. Unfortunately, some healthcare providers also give advice based on these unsupported ideas. In this article, we’ll explore these common beliefs about posture and spinal health, understand why they’re so widespread, and talk about how healthcare professionals can positively influence these beliefs. (Slater, et all. 2019; Smythe & Jimanjee. 2021.)

Many people, including healthcare professionals and the general public, think that sitting and bending forward are harmful. Patients are often told to sit and lift with an upright or straight back. The idea is that this protects your spine, but there isn’t strong evidence that it prevents back pain. There’s also no clear link between a specific spinal shape and experiencing pain. (Korakakis, et al. 2019; Swain, Pan, Owen, Schmidt & Belavy. 2019; Slater, Korakakis, O´Sullivan, Nolan & O´Sullivan. 2019; Christensen & Hartvigsen. 2008.)

The fitness industry says that using your “core” muscles will keep you in the “right” posture and protect your spine. However, there isn’t strong evidence that this prevents pain. (Swain, et all. 2019) Surprisingly, people with back pain might actually move less and use their trunk muscles more when bending, lifting or moving. This challenges the idea that rigid postures are necessary for people with back pain. (Smith, et all. 2022; Geisser, Haig, Wallbom & Wiggert. 2004; Saito, et all. 2021.)

The media often spreads unverified claims that “bad” postures cause pain. These messages might make people anxious about their spine’s health when they read articles or ads that say certain postures are harmful. Old ideas about “good” and “bad” postures also keep these beliefs alive. (Slater, et all. 2019.)

Evaluating how someone with musculoskeletal pain stands can be useful in a clinic. It can help patients feel their pain is taken seriously and can help healthcare providers identify rare problems. More importantly, it can tell healthcare providers about the person’s behaviour, muscle tension, anxiety, distress, and body image. This shows how the person deals with their pain. But just because a posture can trigger back pain doesn’t mean it causes the pain. (Slater, et all. 2019.)

There’s no proof that looking at and changing how someone stands or moves can prevent pain for people at work. People have different spines and postures. Training people who don’t have pain to move and work in a certain way can make them think daily tasks and work are dangerous, which isn’t true. (Swain, et all. 2019; Smythe & Jivanjee. 2021.)

Healthcare providers need to be careful with the words they use when talking about posture. Telling patients to find one “right” posture can make them feel bad and worried if their pain doesn’t go away. Saying things like “sitting is bad for you” should be balanced by saying it’s important to stay active. While sitting a lot can make back pain worse, healthcare providers shouldn’t make people too scared to sit. And they should be careful not to blame pain on normal posture differences, so people don’t worry about minor “posture problems.” (Slater. 2019; Smythe & Jivanjee. 2021.)

Healthcare providers can help people find comfortable postures and let them know these are safe. This can relieve pain. Comfortable postures vary from person to person, so it’s important to try different ones. Healthcare providers should also help people change habits that make their pain worse. Remember, the posture that feels good during the painful situation might not be needed forever. People like dancers or soldiers who need certain postures for their jobs can learn to keep an upright but relaxed posture, which can help manage symptoms. (Slater, et all. 2019; Smythe & Jimanjee. 2021.)

We need to change the way we think about “good” posture since there isn’t strong evidence for these common beliefs. When we talk about spine health and pain, we should also consider other factors like exercise, stress, and sleep. Changing how we think about posture might be hard, especially for professions like physical therapy and ergonomics, which have business models that don’t agree with the most current practices for managing back pain. But it’s important to make this change. (Slater, et all. 2019; Lewis, Cook, Hoffman & O´Sullivan. 2020.)

Prolonged sitting might be a factor for muscle discomfort. In a study we read the participants were sitting for two hours and doing tasks in computer. The study investigated changes in discomfort, cognitive functions, muscle fatigue, pelvis movement and mental state. During the working discomfort increased in all body areas and specially in low back. Cognitive functions and mental state also decreased. About muscle fatigue and pelvis movement there were no effects. The conclusion of the study was that there may be consequences for muscle discomfort and cognitive functions in sitting prolonged. Also breaks to change position and posture are recommended. (Baker, Coenen, Howie, Williamson & Straker 2018.)

According to Vitoulas et al. (2022) it doesn`t matter how you take your breaks if its something active. Active breaks decreased musculoskeletal pain significantly more than passive breaks. It`s also suggested that continuous working time is from 40 to 60 minutes with 10-to-15-minute breaks or 30 minutes of working time with 3-to-5-minute breaks. In conclusion it`s best to take active breaks regularly during working hours and include strengthening, stretching and different kinds of muscle activation exercises in the break. (Vitoulas et al. 2022.)

The conclusion about our articles is that there is no “good” or “bad” posture but still there are a lot of beliefs about that. More crucial thing about ergonomics is stillness and sedentary working. The best way to avoid musculoskeletal disorders is taking breaks during working hours and have active breaks including muscle activation. Ergonomic workstation is helpful for chancing your position and you should use different postures of back. Active breaks, chancing postures and having ergonomic working station should be all taken in consideration for the best benefits of ergonomic guidance.

Learning experiences

During the BIP-week we got to use English language with colleagues from Spain and Czech. All of us have moderately good English language skills so we did not find communicating or writing this article difficult in terms of foreign language. Evidence-based physiotherapy is definitely an important topic to us close to graduation. Our work should be based on the best available evidence, patient values and our clinical experience. We learned that evidence is the best way to approach the truth, but context absolutely matters. Our patients will all be unique individual single sample studies with lots of variables and we must take it into consideration when applying research into practice. Research provides us a good foundation to start from with the patient.

Topi Teitto, physiotherapy student, Savonia University of Applied Sciences, Kuopio, Finland

Joel Lankinen, physiotherapy student, Savonia University of Applied Sciences, Kuopio, Finland

Olli Laine, physiotherapy student, Savonia University of Applied Sciences, Kuopio, Finland

Marja Äijö, PhD, PhD, Principal lecturer of gerontology and rehabilitation, Savonia University of Applied Sciences, Finland

Mari Tuppurainen, physiotherapy lecture, Savonia University of Applied Sciences, Kuopio, Finland

Dagmar Pavlu, Physiotherapist, Assoc. Prof. Charles University, Czech Republic

Ivana Vláčilová, Professor, Charles University, Czech Republic

Jamile Vivas Costa, PhD, MSc, PT. Lecturer at Department of Physical Therapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy and Researcher at Psychosocial intervention and functional rehabilitation group, Universidade da Coruña, Spain

Montserrat Fernández Pereira, MSc, PT.  Lecturer at Department of Physical Therapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy and Physiotherapist at Spinal Cord Injury Unit, A Coruña Hospital (CHUAC), Spain

Verónica Robles García, PhD, MSc, PT, OT. Lecturer at Department of Physical Therapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy and Researcher at the Neuroscience and motor control group, Universidade da Coruña and Biomedical Institute of A Coruña, Spain

References:

Baker, Richelle, Pieter Coenen, Erin Howie, Ann Williamson, and Leon Straker. 2018. “The Short Term Musculoskeletal and Cognitive Effects of Prolonged Sitting during Office Computer Work.” International Journal of Environmental Research and Public Health 15 (8): 1678. https://doi.org/10.3390/ijerph15081678.

Christensen, Sanne Toftgaard, and Jan Hartvigsen. 2008. “Spinal Curves and Health: A Systematic Critical Review of the Epidemiological Literature Dealing with Associations between Sagittal Spinal Curves and Health.” Journal of Manipulative and Physiological Therapeutics 31 (9): 690–714. https://doi.org/10.1016/j.jmpt.2008.10.004.

Geisser, Michael E., Andrew J. Haig, Agnes S. Wallbom, and Elizabeth A. Wiggert. 2004. “Pain-Related Fear, Lumbar Flexion, and Dynamic EMG among Persons with Chronic Musculoskeletal Low Back Pain.” The Clinical Journal of Pain 20 (2): 61–69. https://doi.org/10.1097/00002508-200403000-00001.

Korakakis, Vasileios, Kieran O’Sullivan, Peter B. O’Sullivan, Vasiliki Evagelinou, Yiannis Sotiralis, Alexandros Sideris, Konstantinos Sakellariou, Stefanos Karanasios, and Giannis Giakas. 2019. “Physiotherapist Perceptions of Optimal Sitting and Standing Posture.” Musculoskeletal Science and Practice 39 (February): 24–31. https://doi.org/10.1016/j.msksp.2018.11.004.

Lewis, Jeremy S., Chad E. Cook, Tammy C. Hoffmann, and Peter O’Sullivan. 2020. “The Elephant in the Room: Too Much Medicine in Musculoskeletal Practice.” Journal of Orthopaedic & Sports Physical Therapy 50 (1): 1–4. https://doi.org/10.2519/jospt.2020.0601.

Saito, Hiroki, Yoshiteru Watanabe, Toshiki Kutsuna, Toshihiro Futohashi, Yasuaki Kusumoto, Hiroki Chiba, Masayoshi Kubo, and Hiroshi Takasaki. 2021. “Spinal Movement Variability Associated with Low Back Pain: A Scoping Review.” Edited by Lisa Susan Wieland. PLOS ONE 16 (5): e0252141. https://doi.org/10.1371/journal.pone.0252141.

Slater, Diane, Vasileios Korakakis, Peter O’Sullivan, David Nolan, and Kieran O’Sullivan. 2019. “‘Sit up Straight’: Time to Re-Evaluate.” Journal of Orthopaedic & Sports Physical Therapy 49 (8): 562–64. https://doi.org/10.2519/jospt.2019.0610.

Smith, Jo Armour, Heidi Stabbert, Jennifer J. Bagwell, Hsiang-Ling Teng, Vernie Wade, and Szu-Ping Lee. 2022. “Do People with Low Back Pain Walk Differently? A Systematic Review and Meta-Analysis.” Journal of Sport and Health Science 11 (4): 450–65. https://doi.org/10.1016/j.jshs.2022.02.001.

Smythe, Andrew, and Mayur Jivanjee. 2021. “The Straight and Narrow of Posture: Current Clinical Concepts.” Australian Journal of General Practice 50 (11): 807–10. https://doi.org/10.31128/ajgp-07-21-6083.

Swain, Christopher T.V., Fumin Pan, Patrick J. Owen, Hendrik Schmidt, and Daniel L. Belavy. 2019. “No Consensus on Causality of Spine Postures or Physical Exposure and Low Back Pain: A Systematic Review of Systematic Reviews.” Journal of Biomechanics, August, 109312. https://doi.org/10.1016/j.jbiomech.2019.08.006.

Vitoulas, Stergios, Konstantis, Vasileios, Drizi, Irene, Vrouva, Sotiria, Koumantakis, George, A., Sakellari, Vasiliki 2022. The effect of physiotherapy interventions in the workplace through active micro-break activities for employees with standing and sedentary work. Healthcare 10(10): 2073. https://doi.org/10.3390%2Fhealthcare10102073.