Does Sitting Cause Low Back Pain?

Sitting And Low Back Pain

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:

  1. If we determine that sitting causes or doesn’t cause low back pain, then we can act on this information accordingly.
  2. 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.

Conclusions

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.

 



 

References

(1) Heal your lower back pain with these 5 yoga poses

(2) Proper sitting

(3) Occupation sitting and cardiometabolic, mental and musculoskeletal health

(4) Sitting time (measured) and low back pain

(5) Occupational physical activity and low back pain

(6) Structure and biomechanics of nerves

(7) Physical activity and chronic pain (in mice)

4 Major Exercise Programming Mistakes

Woman stretching hamstrings.

He who represents himself has a fool for a client. – Abraham Lincoln

In many cases, it could be also said that the person who writes his own training program has a fool for a trainer.

The reason, in both cases, is the difficulty of being objective in deciding your own needs.

It’s only natural to gravitate towards what we like and what we are good at (often one and the same), which means when we write our own exercise programs, we often neglect what we need.

In fact, if you coach yourself, chances are you are making (or have done so in the past) at least one of the following common exercise programming mistakes.

Now, if you are experienced enough, with the accompanying knowledge, you can write yourself good programs, but I would always argue, that these will generally be inferior to a program written for you by a coach with equivalent or greater knowledge and experience than you.

The problem with programming mistakes is that they compound over time (more on that later), and the risks they pose are not insignificant.

Risks of Poor Exercise Programming

Before I go on to describe some of the most common exercise programming mistakes I see, I want to outline the risks involved with making these mistakes:

  • Injury. This is far and away the biggest risk of poor programming. In my opinion, if you exercise for health, you should never get injured as a result of your exercise program. I understand that for competitive athletes, a certain amount of risk is assumed in order to push the limits of performance, and I also understand that on any given day, shit happens, so a random injury might occur. But often, what seems random, is not, and if you look at past workouts, there were modifiable factors that contributed to the injury. The other injury consideration is joint degeneration.
  • Negative postural changes. Posture is complex – it has psychological and emotional components to complement the physical components that are commonly talked about. One of the influences on posture are the activities and tasks we expose ourselves to on a regular basis. With poor exercising programming, you can develop poor postural habits.
  • Suboptimal progress. To be honest, the risk of getting injured is enough of a reason to ensure good exercise programming. However, even if you are a throw caution to the wind type, good programming will ensure you make the best possible progress towards your goals, whatever they may be.

The Most Common Exercise Programming Mistakes People Make

These 4 mistakes are not listed in any particular order, and I would say, based on experience only, that the majority of people who have poor (or no) programming when it comes to their exercise make more than one of these mistakes, if not all!

1. Improper or lack of warm up

There’s a popular quote in trainer circles:

If you don’t have time to warm up, you don’t have time to work out.

Unfortunately, like many things, the quote is more popular than the practice.

Too many people make the mistake of not warming up properly before exercising, or, even worse, not warming up at all.

Excuses range from “it’s boring” to “I don’t have time” and god knows what else.

Like many things, there is a disconnect between what most people do and what those who are succesful do.

For example: professional sports clubs, with million dollar athletes, have staff dedicated to optimising warm ups in order to maximise training and game performance and minimise injury risk.

The bottom line is, warming up is important.

During a warm up, there are 3 main goals:

  • Psychological preparation – a transition period from what you were doing, to what you are going to do.
  • Physical preparation – increase body temperature, address physical qualities like mobility and muscle activation
  • Skill practice to prime the nervous system for the upcoming task

If you don’t warm up properly (or at all), you decrease your subsequent performance and increase your risk of injury. A lose-lose situation.

2. Lack of Flexibility Work

Time magnifies errors in training. – Ian King

Ian King has been a physical preparation coach for more than 30 years, and is often outspoken about many topics. However, his opinion is based upon experiencing of producing real world results with both athletes and coaches over many years, so his opinion counts.

One of the biggest topics he is vocal about, is flexibility training.

I like static stretching. I know, I know…current trends in sport science have found favor in other methods, like dynamic stretching. But, in my opinion, it’s all part of a circle that’s slowly turning. Static stretching was the big hit in the ’80s, and I suggest that it will be again. – Ian King

Not only does Ian promote the less popular static stretching, he also promotes stretching before a workout.

Now, I’m not going to regurgitate his reasons for doing so – you can read the article for yourself – but the biggest take home was that if you are performing activities that stiffen your connective tissue (just about everything involving muscular contraction), then you should be performing activities that decrease this stiffness as well.

To counter the points above, people will cite research that demonstrates decreases in power and force production immediately after stretching (lasting up to 15 minutes).

To paraphrase Ian again, if you did a study that measured strength immediately after a weight training workout, you would see a decrease in strength, and the researchers would conclude, based on that data, that weight training makes you weaker.

The solution lies in watching how top level athletes have prepared for many years, which is generally a variation of the following sequence:

  1. 3-5 minutes of general warm up to elevate body temperature
  2. Static stretching
  3. Dynamic/specific warm up
  4. Workout
  5. Go home

The added bonus of this: after your workout, when you are tired, you don’t have to do anything else, except maybe walk around a bit to cool down and start recovering.

3. Ignoring structural balance

Structural balance is a term I first read about in the writings of Charles Poliquin, another highly experienced strength coach.

Whilst we know that posture is poorly correlated to pain, we also know that the body will adapt to repetitive activities.

Thus, if all you do is run, then your body will adapt to running, which is both good and bad.

Good, because your performance will increase, bad, because you need to do more than run in your life.

Wealso  know from various research, that relative strength imbalances can lead to injury, so the implication is clear: balance your training to reduce injury risk.

This means:

  • Exercising a variety of physical qualities – strength, power, endurance, flexibility etc.
  • Performing a variety of activities.
  • Moving across different planes of motion and different “levels” (ground, standing, kneeling etc).
  • Balancing stresses across joints as best as possible.
  • Allowing for periods of higher intensity/lower volume and lower intensity/high volume.

4. “Too Much”

This is not a specific claim, but rather, an observation that most people, once they cross the line from casual exerciser to exercise enthusiast simply do “too much”.

Whether it is too much strength work and not enough flexibility and endurance work, or too much exercise and not enough rest and recovery.

I’m a massive proponent of doing something everyday if possible, but that doesn’t mean smashing yourself every day.

In my experience, this simply stems from being overly emotional about the outcomes attached to exercise.

You are not your fitness.

If you have an overly emotional attachment to certain outcomes associated with your fitness, I’d suggest you do some deep contemplation to find more balance in your life.

Conclusions

It might seem that I keep repeating myself when I talk about training: warm up, manage your volume/intensity, work on all physical qualities, prioritise rest and recovery etc etc.

That’s because:

  1. This is what the vast majority of people need to do, but don’t
  2. Training isn’t as complicated as the internet makes it out to be.

What is complicated, is you as a person (we all are), and so a good coach helps you recognise where you are, what you need and what you don’t. In fact, many of the benefits of a coach are not that you have the best program (it doesn’t exist), but rather adherence, consistency and progression, regardless of the means.

To avoid making exercise programming mistakes, it’s best to enlist help. There are options to suit all needs and budgets, ranging from free programs online all the way to individualised coaching (both online and in person).

Whatever your scenario, even for a short time it’s worthwhile investing in coaching of some form, in order to learn skills that will stay with you for life.

 

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.

 



 

References

(1) Australian Institute of Sport – The Warm Up and Cool Down

(2) Ian King Blog

(3) Ian King – The Lazy Man’s Guide to Stretching

(4) Charles Poliquin Blog