How does sitting cause low back pain?

In this article I’ll certainly answer the quesiton “How does sitting cause low back pain?” First I’ll tell you why a lot of researchers claim that sitting doesn’t cause low back pain.  Then I’ll explain the mechanism of injury.  And then we’ll explore what to do about it.

Sitting does not cause low back pain

This is the claim made by many researchers.  But other researchers claim that there is “an association between higher sitting time and low back pain“. Why the disagreement?  In short, because there can be lots of “confounding factors” in research. That is to say that a lot of other things can muddy the waters. I can’t  help but think a lot of these researchers have never spent time talking to clinicians.  72% of the last 800+ low back pain patients seeing our Edinburgh osteopaths say that sitting aggravates their low back pain.  Now that isn’t the same as causing it, but it’s what is known as a positive association.  So, I think the reason some researchers claim sitting doesn’t cause low back pain is because they’re being pedantic.  Let’s re-phrase the question for them.  “Does sitting contribute to low back pain?” The answer now has to be an unequivocal “yes”.

Important questions

What I’d like to ask you is “How does your lower back feel if you’ve been sitting for an hour?  How does it feel if you sit on a sofa, or in the car?  How does it feel when you get up from sitting?”  If your back feels worse for any of these, then sitting is contributing to your low back pain.

How does sitting cause low back pain?

Sitting is something you tend to do for long periods.  Especially if you have a job that involves sitting for most of the day.  Think about it…  If you spend more than 50% of your working day sitting, then you have a sitting-down job.  What happens to your lower back when you spend prolonged periods sitting? In technical terms, we call this “sustained loading”.  And what about if you sit for long periods day after day (even with weekends off)? We call that “cumulative loading”.

Types of loading

Sustained and cumulative loading are 2 of only 3 ways of damaging your lower back.  The third way is “peak loading” – that’s when either you have a significant trauma (external peak load) or you lift something very heavy (internal peak load). So the only ways of damaging your lower back are:

  1. Peak load
  2. Sustained load
  3. Cumulative load

And sitting for most people amounts to sustained AND cumulative loading.  A double whammy.

Effect of posture

How you load your back will determine whether and how much you damage your back. So, if you put your lower back into more extreme positions for longer periods, you are more likely to damage it i.e. slumping would be worse for your back than sitting up straight.

Effect of movement

Varying your posture reduces the effect of sustained loading.  So, if you stay in the same posture for a long period you are more likely to damage your back, than if you vary your posture.

Anyway, let’s get back to that re-phrased question…

How does sitting contribute to low back pain?

There’s a good chance that your low back pain has not been caused by just one thing.  In most people there are a number of factors coming together to result in you developing low back pain.  Here are some common ones:

  • Sitting for prolonged periods
  • Lack of physical activity
  • Heavy work
  • Being significantly overweight
  • Work-related stress
  • Past episodes of low back pain

The metaphor I use is the Cliff of Pain (click the link to see a video explainer).  There are a number of risk factors for low back pain.  They all contribute to pushing you closer to the edge of the cliff.  The thing that pushes you over the edge (e.g. a sudden bend, picking something up, a sneeze, getting out of your chair) is not the cause, it’s just the trigger.  Another metaphor would be the last straw on the camel’s back.  It’s the effect of all the straws that does the damage, not the last one.

What to do about it?

You should know that the biological purpose of pain is to act as an alarm system. It’s there to protect you.  So if sitting increases your pain, don’t do it, or do it differently such that it doesn’t increase your pain.

Most Health & Safety officers/managers are still encouraging their colleagues to sit at right angles at the hips and knees. They do this in the mistaken belief that this is the best thing for your lower back.  It isn’t.  Movement is the best thing for your back.  But as far as sitting goes, variety is the best thing, There is no such thing as the perfect seated posture as far as your lower back is concerned.

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