Our body is designed to support natural movement, with our musculoskeletal system working in a complex and magnificent way to keep us moving efficiently and painlessly as we stand, walk, kneel, lie down and sit. Yet since the adoption of the 9-5 workday, and with the workforce moving towards making greater working from home allowances with less incidental movement, many people are now spending longer portions of their day sitting down - and for many, it is taking a toll on their back health, specifically in the development of aches and pains in the lower back.(1)
With the prevalence of sedentary jobs rising by 83% since 1950 in America,(2) and almost half of all men and women now spending an average of 6.3 hours out of an 8-hour work day in sedentary and seated positions in Australia,(3) managing and preventing sitting-related problems is more important now than ever to help maintain our long-term health and wellbeing. As physiotherapists that work extensively with helping our clients in Hong Kong optimise their ergonomics while helping to alleviate and prevent their back pain, which is estimated to affect 7.5% of people at any one time,(4) understanding the relationship between how much you sit and your low back pain is a priority for us.
Here’s an overview of what long periods of sitting could mean for your back, how pain can arise, and why it’s essential to treat low back promptly - which is where we can help.
How Sitting Affects Our Body
Given that our bodies are designed for free and unrestricted movement, when we sit down, our muscles, bones and joints, including the spine, can start taking pressure in an unnatural way. Your spine is your body’s central support structure, providing you with much-needed mobility while remaining rigid enough to support the weight of the body. By design, the spine relies on ongoing mobility and movement to keep itself healthy and pliable.
When we sit for prolonged periods of time, like when we don’t leave our desk at work, the stress and strain on our back muscles and the spinal (intervertebral) discs increases.(5) Our intervertebral discs act like cushioning pads between the vertebrae, with the pressure within the disc being linked to our posture as illustrated in the diagram below. This means that the way we sit, like if we slouch forwards for example, can result in almost double the stress on our spine compared to standing.(6)
When We Sit For Long Periods, It Can Encourage Poor Posture
Part of the impact of sitting on our low back is the tendency to adopt a less-than-ideal sitting posture - and our brain may be working against us in this regard. While sitting in one position has become a normal part of the day for many of us, doing this with limited movement breaks has been shown to decline the rate at which blood flows to areas of our brain known as our cerebral blood flow, which can leave us feeling tired and less alert.(7) It can take as little as 15-20 minutes of uninterrupted sitting for our brain to start sending messages to our body to rest, which can reduce our focus and encourage us to adopt a slumped posture.(8) When these messages are being sent regularly throughout the day and our posture regularly falters, the resulting stress can be a significant contributor to the development of low back pain.
Sitting For Long Periods Affects Our Muscle Strength, Too
We rely on the muscles in our body to support our body and stabilise our movement and posture. When we sit for long periods and don’t actively work our muscles, or focus on our muscle strength outside of work hours, our muscles can start to lose not only their strength and mass, but has also been shown to result in increased passive back muscle stiffness.(9) This can lead to restrictions and dysfunctional movement patterns that mean that our muscles are unable to perform their supportive and stabilising roles as effectively as they used to, which can make us more vulnerable to low back pain.
How Much Is Too Much Sitting?
Research has found that sitting for longer than four hours each day significantly increases your chance of cardiovascular disease, diabetes and several other obesity-related conditions.(10) To help, for those occupations which are predominantly desk based, an expert panel recommends that workers should aim to initially progress towards accumulating two hours per day of standing and light activity (light walking) during working hours, eventually progressing to a total accumulation of four hours per day. To achieve this, the recommendations are that seated-based work should be regularly broken up with standing-based work, the use of sit-stand desks, or the taking of short active standing breaks.(11)
Interestingly, in terms of what constitutes ‘prolonged sitting’ in a single bout, the consensus is that any sitting that exceeds 30 minutes is considered ‘prolonged’.(11,12,13)
How To Minimise Low Back Pain When Sitting
When it comes to minimising low back pain associated with sitting for too long, there are two overarching approaches that can be taken: sitting less, and exercising to strengthen key muscles.
Sitting for shorter periods
The impact of prolonged sitting is found to be offset when it is broken up by activities like frequent short-duration walking breaks.(7) Common strategies that have been found to help break up bouts of sitting during work can be categorised to help you select what will work best for you:(13)
Phone-based strategies
- Stand up at the end of each phone call
- Stand up before making a phone call
Work tasks
- Stand up after completing a task
- Walk to a colleague instead of emailing them
Listening to your body
- Stand up when you feel tired or uncomfortable
- Using glasses to drink water and walking to fill up the glass more regularly
Work environment
- Using the stairs more frequently
- Using a toilet further away from your desk
- Using a printer further away from your desk
Colleague prompts
- Stand up when you see a colleague standing, whether that’s via zoom or in person
Strategies promoting regular interruptions during the day
- Standing up at the start of the day
- Standing for regular blocks of time throughout the work day
Timer or clock prompts
- Stand at regular intervals using a timer, clock, stopwatch or alarm
With Hong Kong’s COVID restrictions easing, more opportunities for physical activity may also arise, such as travelling to and from work, walking across the office or to meetings, or intentional exercise after work.
Exercise to strengthen key muscles
The key muscles and ligaments that are put under strain from prolonged sitting are the muscles of the legs and trunk. Strengthening and stretching the muscles involved in sitting will help you to maintain correct posture for longer,(14) and can delay the onset of pain. One form of exercise we highly recommend is Pilates, as it helps to increase muscle strength, endurance, flexibility, improve posture and balance,(15) and has been shown to be effective in reducing low back pain.(16)
Physiotherapy Treatment For Low Back Pain
While reducing prolonged sitting periods is important for back pain care and prevention, once pain develops, it is important to get help to relieve the symptoms and protect against long term injury with physiotherapy.
Our highly-experienced and specialised physiotherapists work by completing a comprehensive assessment that identifies the barriers to your recovery of your low back pain. This includes assessing your strength, posture, muscle imbalances and dysfunctions, the influences of other areas of your body, and then create a individualised treatment plan to help address your symptoms in the immediate term, but we always look at the long-term, meaning we’ll also work extensively to help reduce your risk of redeveloping symptoms in the future.
To book your appointment with our fantastic team, call us on +852 2801.4801 or book your appointment online.
References
- https://pubmed.ncbi.nlm.nih.gov/26311951/
- https://pubmed.ncbi.nlm.nih.gov/21647427/
- https://pubmed.ncbi.nlm.nih.gov/22227284/
- https://www.iasp-pain.org/resources/fact-sheets/the-global-burden-of-low-back-pain/
- https://www.uclahealth.org/spinecenter/ergonomics-prolonged-sitting
- https://ergo.human.cornell.edu/DEA3250Flipbook/DEA3250notes/sitting
- https://journals.physiology.org/doi/full/10.1152/japplphysiol.00310.2018
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822118/
- https://pubmed.ncbi.nlm.nih.gov/31514046/
- https://journals.lww.com/acsm-essr/Fulltext/2010/07000/Too_Much_Sitting__The
_Population_Health_Science_of.3.aspx - https://www.researchgate.net/publication/283847435_The_sedentary_office_An
_expert_statement_on_the_growing_case_for_change_towards_better_health_and_productivity - https://www.acpjournals.org/doi/10.7326/M17-0212
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186123/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110226/
- https://pubmed.ncbi.nlm.nih.gov/23738249/
- https://pubmed.ncbi.nlm.nih.gov/26133923/