Prolonged sitting is a common and problematic issue with multifactorial implications on health and wellbeing. Today, Australian’s lead more sedentary lifestyles than ever before. The industrial shift to a service-orientated office worker economy, and the increase in recreational use of computers, laptops, smartphones and other devices due to cultural adaptations and increased availability and affordability of technologies means we spend a great deal of time prolonged sitting. Low back pain and other lifestyle- and work-related musculoskeletal disorders appear to also be on the rise in Australia. In fact, 16% of the Australian population reported having low back pain in 2015-15, and studies indicate that at least two-thirds of the population will experience at least one episode of low back pain in their lifetime. Could there be a link between low back pain and prolonged sitting? In this blog, we will discuss these concepts in overview.
Background and statistics
A large number of the Australian workforce are engaged in work in which they are primarily sitting for prolonged periods at a time. These include workers in primarily office environments such as those in admin, finance and accounting, technicians and professionals and more. Many of these workers spend 76% of their time sitting—or approximately 6 hours sitting a day—and this is just while at work. Furthermore, a quarter of the Australian population report that they sit for more than 8 hours each day.
Computer work is a classic example of sedentary work. Computer work streamlines what would otherwise be timely tasks, such as copying files of leaving the desk. This cultural shift to a fast-paced economy and the reduction of time-consuming tasks also reduces the number of restorative breaks from work and increases prolonged sitting and repetitive tasks. This may increase productivity in the short-term, but this style of work is not sustainable over time. Indeed, several studies have examined presenteeism (i.e., being present at your workplace for more hours than is required) in office workers and found that presenteeism is correlated to work-related neck and low back pain and physical and emotional stress; and this in fact, leads to increased absenteeism (i.e., being absent from work due to an ailment) in these workers.
The effects and mechanism of prolonged sitting on back pain
Work-related low back pain is due to cumulative trauma disorders, repetitive strain injuries, and overuse injuries. For workers who spend most of time using computers, work-related low back pain is a very common problem.
When sitting, many workers sit in such a position that their lumbar (i.e., low back) spine is in a flexed (i.e., forward bent) position. This is a very common poor sitting posture that puts considerable force on the spine. The spine is made of several joints, ligaments, muscles and capsules and importantly intervertebral discs. During flexion in a healthy disc there is normal migration of nucleus pulposes (i.e., inner gel-like substance), which tensions the annulus fibrosis (i.e., outer disc tissue) causing an increase in tensile forces at the fibres closest to the annulus. The nucleus pulposes also has shock-absorbing fibres that are held within the gel-like substance.
The nucleus pulposes changes its shape becoming longer and thinner when we bend forward in the low back. In sitting, there is also increased compressive forces on the front part of the discs that deforms it. This leads to a complex cascade of inflammatory, derangement and degenerative changes in the disc and surrounding tissues. In summary, prolonged sitting has a cumulative effect on discs, in which constant compressive loading can lead to small tears and delamination of the highly structured collagenous tissues causing pro-inflammatory processes. If repeated injuries occur, the disc will favour flexion as fibres and tissue begins to deform leading to disc bulging. Further injuries in the absence of recovery leads to degenerative changes in the tissue and potentially a disc herniation causing neurological issues.
McKenzie Method of Mechanical Diagnosis and Therapy
Seeing as prolonged sitting causes increased flexion forces on discs leading to back pain, we can infer that extension (i.e., backwards bending) is responsible for decreased tension on the disc. Indeed, many studies have shown that this is in fact the case from a biomechanical standpoint; but, what about from a clinical standpoint? Do low back extension exercises help reduce low back pain and disability associated with prolonged sitting?
Several systematic reviews and trials have demonstrated that extension exercises, such as those prescribed by McKenzie practitioners, have a positive effect on reducing the intensity of self-reported non-specific low back pain in the short- medium-term, particularly when used with other ancillary interventions like soft tissue massage, mobilisations, manipulations and strengthening exercises. These extension exercises provide patients with a self-management strategy to actively participate in their care. The exercise is often performed on the floor with the patient laying on their front side. Another aspect to consider about these extension exercises is that in order to perform them, patients will have to remove themselves from sitting postures. This reduces the time patients are in a prolonged sitting posture and therefore also reduces the flexion loading forces on lumbar spine discs.
Other Exercise for low back pain as a result of prolonged sitting
Sitting in a slumped, flexed position results in a lower activation of core muscles, such as lumbar multifidus, iliocostalis lumborum and the transverse fibres of internal oblique. As a result, these muscles become weaker, which makes it harder to stand upright and maintain good posture when sitting. This can lead to additional compressive loading forces on the discs. Therefore improving core strength and stability is an important clinical consideration in patients who present with low back pain and do a lot of prolonged sitting.
Systematic reviews and randomised controlled trials have concluded that balance, motor control and core stabilisation exercises of the deep trunk muscles that encompassed sitting, kneeling, quadruped and supine postures and involved alternating supporting objects between hard and soft and having patients move their head or upper limbs with their eyes closed were most effective at reducing self-reported non-specific low back pain. Examples of these types of exercises include:
- Pressure feedback core exercise in supine and prone positions
- Multifidus exercises (e.g., leg raise progression, push up progression, lateral ball rolls, bear crawls etc.)
- Frontal & side plank exercise (with arm and leg raise variations)
- Pelvic floor exercises
- Wobble board oblique twist (with/without dumbbell assistance)
- Thera-band reverse wood chop exercise
- Single leg standing on foam (with/without eyes closed)
- Tandem standing with perturbation in form of rapid arm movements (with/without eyes closed)
Please visit our website and blog pages for more information on low back pain and sitting:
- How Chiropractors Treat Back Pain
- Exercises for Low Back Pain
- Lumbar Extension Exercises in Low Back Pain
- The Role of Gluteal Muscles in Low Back Pain
- Physical Activity and Chronic Disease
- 14 Myths and Truths of Low Back Pain
- Low Back Strains and Sprains
- Low Back Pain Overview
- Lumbar myelopathy
- Cauda equina syndrome
- Lumbar spinal stenosis
- Bone Spurs
- Degenerative disc disease (DDD)
- Pinched nerve
- Lumbar radiculopathy
- Lumbar facet joint pain
- Bulging Disc
- Herniated Disc
- Disc protrusion
- Discogenic pain
- Post laminectomy syndrome
- Ankylosing spondylitis
- Reiter’s syndrome
- Psoriatic arthritis
- Enteropathic arthritis
- Sacroiliac disorders
- Foot drop
- Spinal neurofibroma
- Acute low pain
- Chronic low back pain
- Stiff low back
- Trigger points in the low back
- Red flags for low back pain
- Internal disc disruption
- Lumbar spondylosis
- Lumbar facet syndrome
- Lumbar foraminal stenosis
- Lumbar disc herniation
- Lumbar osteoarthritis
- Lumbar osteophytes