Why sitting makes low back pain worse and what to do instead

You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. Hey everybody, it's your co-host Sebastian with the Restoring Human Movement. Thanks for joining the show with me today. If you're an active individual and you've been dealing with lower back, hip, groin, knee, or foot, ankle types of problems, you should subscribe to the show. We have lots of content about this, lots of giveaways in our show notes as well of more elaborate content that we've spent a lot of time curating, so you guys get the best information and videos out there.

Now, I am going to cover today the idea of how lower back pain is really, really made worse with a lot of people with sitting. Sitting time and even sitting in different positions and even standing. So, if you've been dealing with lower back pain, you know by now that sitting kind of sucks. And this is common with various different types of lower back pain. For example, people with discogenic lower back pain from a disc injury don't like sitting. It hurts to sit. Now, even if they have better posture, a lot of times it still hurts to sit. And if you've been dealing with lower back pain associated to a pinched nerve or arthritis or degenerative disc disease, then typically sitting is not good for those people either.

So, what is the natural thing that people do? Well, if sitting is bad, standing is better. So, they start getting a standing desk. The standing desk oftentimes works for a lot of people for a long time until it doesn't. Now, the reason why standing desks tend to work for a lot of people is because they've been dealing with discogenic lower back pain. They have disc irritation. The pressure of sitting, especially in a flexed position, doesn't feel very good. And so, standing tends to feel a lot better. Now, there's a lot of people who actually have more lower back pain with standing. And these are people who have facet irritation.

They have degenerative disc disease, less disc height, and so on. Generally, the older you get, the more standing in the same position doesn't feel good either. So, if sitting hurts people with lower back pain and standing hurts people with lower back pain, what's our options? Movement. Now, the way I describe to all of the people who I talk to who are asking this question about lower back pain associated to sitting or standing time, we talk about what we call metabolic equivalence. So, metabolic equivalence is a basic number which gives us an idea of how much activity it takes your body to be in a certain activity.

So, if I was running really hard, I would have more metabolic equivalence being used than if I just sat on my butt. And generally speaking, people who are in positions or activities with higher metabolic equivalence tend to fare better, especially if sitting bothers them. Another way to think of this, too, is to find positions where you have to take a break from that position. When you're sitting in a position or standing in a position and you're there for a very long time, such as hours, like you can sit down and be in a chair for hours, the other reason this is possible is because you're putting more load on your passive tissues, your joints and ligaments to keep that support so you can stay there for a long period of time.

If I did a handstand, I cannot stay there for a long period of time. If I was in a wall sit position or a semi-squat, I can only hold as long as my muscles will tolerate. Now, when you're in a more uncomfortable position, not uncomfortable pain-wise, but uncomfortable as in I can't sit here this long because you have to do some support, generally it's because now you're not just using your passive tissues for activity, you're also using your active tissues to hold you in that position. This leads to higher metabolic equivalence because your body has to do a little bit of work to hold yourself in that position.

And eventually when your body gets a little tired or those tissues get tired, those muscles and tendons get a little fatigued, you have to change positions. So part of the reminder here for you to change positions because movement sometimes or a lot of times makes people feel better is when your body gets tired of being in that position. Now, some of you may be thinking, well, how am I supposed to work all day and keep changing positions or how can I sit in an awkward position and what positions can I sit in to make myself feel better but also get my work done? That is the catch-22. And I would love to say that everybody is designed to sit for multiple hours at a time at a job or stand for eight hours a day at the door at Costco and feel good.

And I would be lying, like people aren't really designed to operate that way. What we're doing is we're putting a very intriguing, beautifully designed, struck organism like a human and putting it into a scenario that it's not really designed for. And so I think the easiest answer is you move more or find different positions every couple hours. You break it up. You do what we call movement snacks. You take a phone call while you're walking. You, if you need to type, it's not really easy to type while you're sitting on the floor looking at a computer, but you can certainly be on a floor looking at a computer if you're on a Zoom call.

Alternatively, if you've been told to sit different ways like perching, perching is so hard to type in. Now you can, but it's kind of awkward and it makes your neck hurt a little bit. So maybe just reserve your really bad posture sitting time for when you need to type. I'm not going to go into if you have a job where you have to type all the time because that's a little bit harder. But if you are like most people's jobs where you spend part of the time reading the computer and part of the time typing on the computer, part of the time doing conference calls or meetings, and some you have to show your face, some of you don't.

If you don't need to show your face, see if you can get it on your phone and go for a walk. That will help you dramatically. You get in the 10,000 step rule and you start to actually use your body and let your spine relax a little bit. It will really, really help. For those of you who are on Zoom calls and need to show your face, you'd be surprised how normal you actually look when you just tilt your computer screen to only show your torso and up and you're actually kneeling on the ground or you're seeing crisscross applesauce or you're into a 90-90 shin box on the ground. Like a lot of times people do look completely normal as long as they can move their monitor around.

Now, it's really hard if you have a desktop that's attached to the screen and you can't move it anywhere. This is maybe where something like a desk that goes up and down can actually help, but you need to make sure actually that ideally the monitor gets at eye level because remember, it doesn't have to be so low anymore where you can't actually type. Now, for those of you who like the idea of a standing desk, you feel better at a standing desk, but you want to get a little bit more movement in, there are things called walking pads, which I really like. It's just a little fold-up treadmill that you can use.

They're very cheap. They're very affordable. And those actually get a little bit of movement in, but in my experience, they're very hard to type using that. It's hard to even mouse doing that, but it's easy to read things. I do a lot of video editing, which is very useful to do with something like that. And for those of you who are typing most of the day, this is going to be a very hard thing for you to hear, but we need to make some changes, I think, to your job and your lifestyle. I have told people over and over again, and as much as I'd love to say, that an adjustment or some tissue work or a magic exercise or stretch is going to help the scenario, it's hard to combat 10 hours a day plus a sitting.

It's so hard to combat that. So there's two ways of addressing having a chronically stiff back. Number one is you fill the person's deficiencies. For example, they are really weak in their core. Give them core exercises. They have stiffness of one of the hips because of an old hip injury, and that hip is really chewing away at their lower back for doing work. Give them a hip stretch. Give them a strength in the hip. If you have someone who's physically deconditioned, so they don't generally do any strength training, they lack what we call general physical preparedness, it's hard for them to get on and off the ground because they're just weak and they haven't done it for a while.

Maybe those people are ones that we would add in strength conditioning. If you had a condition for a very long time and you've developed stiffnesses in all the muscles around the spine, those people may respond a little bit better to soft tissue care of various different types. But for those of you who actually have a lot of those parts already in your life, you go for walks, you're mindful about your posture, you do your weight training, you do your stretching, you eat really well. For those people, maybe the better answer is how do we subtract things out of their life? Because clearly over the weekend, most of you feel better.

You sit less. I don't know how many times I've heard that when people are having chronic lower back pain, they go on a trip out of town to a tropical place like Hawaii and they come back and they say, you know, I'm really surprised. I was on the trip and I barely had any lower back pain. Why do you think that is? Well, I mean, it could be a lot of things, but probably, did you sit more? Well, actually we went on hikes and we snorkeled and like we walked around and looked at things. And I mean, I kind of think it's probably just your, your physical activity. Some of you may say, well, it's less stressful there.

Maybe, but also your physical activity changes, your habits change. You got a different bed. You ate different things. Like there's tons of variables that we can consider. But the fun thing about working with people with all these different variables is finding out what the best thing for you to do comes down to your unique story. There is no template. So everybody's a little bit different, although there's commonalities amongst us because we are human. And a lot of us have similar reasons why we have our problems. But the small variables are actually where the rubber hits the road and you can make some major changes over somebody's lifetime.

So if you guys are looking for help, remember we do have telehealth options, 714-502-4243. We see many of our people telehealth and we're licensed in different states. So you can always reach out to us and see if we can help you as well. We're in Costa Rica, California. Subscribe to the show. See you next time.