Sitting is the new smoking. – everyone
You’ve heard it. You’ve read it. Somewhere in your brain is the meme that sitting is the new smoking.
Yes, sitting for long periods without moving is unhealthy, mostly from a metabolic point of view, but does sitting cause low back pain?
In reality, like all things related to pain, it’s complex, and as a result, the research seems to be mixed, which is a far cry from what you’ll read in most health articles posted online, in newspapers and magazines.
What Does The Popular Media Say?
It’s really common for articles in the popular media, both online and offline, to say that sitting causes low back pain. (1,2)
Most say that the incidence of low back pain has increased because of increased sitting time or via mal-adaptive processes (like muscle shortening) as a consequence of sitting.
You will read about how sitting shortens hip flexors and hamstrings, about how sitting compresses the spine and the discs and about how sitting weakens “the core”.
Because these mechanisms sound plausible, and because they are repeated so often, they are gradually accepted as fact, without much further questioning.
Unfortunately, what makes sense in theory doesn’t always pan out to work in the real world, which is why we use the scientific method to try and determine cause and effect.
This is important for two reasons:
- If we determine that sitting causes or doesn’t cause low back pain, then we can act on this information accordingly.
- If we determine a causal relationship between sitting and low back pain, we can then look at why this might be happening, in order to better treat it.
What Does The Research Say?
When we look at the research around sitting and low back pain, the results are mixed.
One study (3) took a group in 1993 and followed up at 5 year intervals until 2012. They looked at mental health, metabolic health and musculoskeletal health. They found no association with occupational sitting and low back pain.
Another study (4) I looked at objectively measured sitting time as a risk factor for low back pain. This is important, because most studies rely on self-reported data, which is typically inaccurate. The authors found that total sitting time (most studies just measure occupational sitting time) was associated with low back pain intensity, when other factors were controlled for. This means that the more these people sat, the more intense low back pain they experienced.
The third study (5) I looked at wasn’t a study, it was a review. A review is when researchers look at all the studies on a certain topic that meet certain criteria, and then compile their results.
Aside: a meta-review is when researchers review all the reviews on a topic to get an idea of what “works”. This is regarded as the best form of research evidence, because it is more robust and has more statistical power (is more likely to be correct).
In this review the authors reached the following conclusions:
Although occupational physical activities are suspected of causing LBP, findings from the eight SR reports did not support this hypothesis. This may be related to insufficient or poor quality scientific literature, as well as the difficulty of establishing causation of LBP. These population-level findings do not preclude the possibility that individuals may attribute their LBP to specific occupational physical activities.
So as you can see, from my small sample, one showed a link, another showed no link and the review found no link, but also acknowledged potential issues as to why this is so.
So, Does Sitting Cause Low Back Pain?
As you can see, the results were not conclusive. Even if increased sitting time is associated with low back pain, it doesn’t mean it causes low back pain.
This is because, pain is emergent, not dependent.
An emergent property is a property which a collection or complex system has, but which the individual members do not have. A failure to realize that a property is emergent, or supervenient, leads to the fallacy of division.
What this means, is that pain arises based on many factors, that are unpredictable, so to try and isolate one variable, like sitting, as the cause, is impossible.
No one thing causes pain.
A “More” Plausible Explanation?
If we look at why somebody might experience pain after sitting, we have to ask:
Was it the sitting, or something the sitting did?
Do people who experience low back pain from sitting also experience low back pain from other activities?
What about positions that replicate sitting, but aren’t sitting?
If they do, then what do these activities have in common?
Finally, is there ways they can sit that don’t cause them pain?
Most of the time, we will find that sitting is not the sole cause of low back pain, and when it is apparently so, it’s likely that there are still other factors at play.
One way to explain why we get pain in certain positions, is to understand the sensitivity of peripheral nerves.
When we occupy any position, particularly when pressure on the body is involved (sitting, lying etc), there is a compression of body tissues taking place, including the peripheral nerves.
When we apply pressure to peripheral nerves, they deform.
This deformation causes altered neural blood flow – rabbit models show a reduction of up to 70% of their blood flow when a strain of only 8.8% is applied.(6)
This could feasibly be a driver of nociception (bearing in mind that pain is produced by the brain, there are no “pain signals”) which could result in a pain experience.
So instead of thinking that sitting causes low back pain, it is probably better to look at the function of your body as to why you don’t have the capacity to sit for extended periods, and address those issues.
Just because sitting doesn’t necessarily cause low back pain, doesn’t make it harmless. Sitting has many pronounced negative effects on our metabolic functions, and movement has many pronounced benefits, including reduced incidences of pain (7).
Additionally, if you understand that no one thing causes pain, you will be in a much better position to deal with pain when it happens.
This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.
This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.
(2) Proper sitting