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The Trouble with Chairs

Back pain and even worse hazards of sitting in chairs way too much

3,750 words, updated Jul 16th, 2014
by Paul Ingraham, Vancouver, Canada bio
I am a science writer, the Assistant Editor of ScienceBasedMedicine.org, and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I’ve written hundreds of articles and several books, and I’m known for sassy, skeptical, referenced analysis and a huge bibliography. I am a runner and ultimate player, and live in beautiful downtown Vancouver, Canada. • full bioabout SaveYourself.ca

This article is of interest for people with minor low back pain who could use some tips on how to cope with spending too much time in chairs. If you are having more serious or chronic back pain, please go directly to this article: Save Yourself from Low Back Pain! If you have a fresh case of back pain that's kind of freaking you out, please see The Bark and the Bite of Low Back Pain: When should you worry about low back pain, and when you shouldn’t you?.

Life in chairs is hazardous to your health. We know this today thanks to good science, from sources like British Journal of Sports Medicine (more on this below). But during my decade as a Registered Massage Therapist, I learned of the more obvious, musculoskeletal of chairs just from watching my clients suffer through their desk jobs — it seemed obvious that chairs were dangerous.

I described The Chair Problem to clients in many ways. I called my excessively sitting clients “chair warriors” who came to me with “chair wounds.” I said things to them like, “Did you get in a fight with a chair?” (So witty.) I told them that sitting in a chair is practically like an Olympic event, and they were elite chair athletes — that they could only do thanks to regular chair endurance training since kindergarten.

“If you put a caveman in a chair for eight hours a day,” I’d quip, “you’d probably kill him.”

Occasionally, I told the young chair warriors scary stories about the crippled old ones. I saw people at every stage of their chair-o-centric careers, and at every stage of chair-induced disability …

I tried to convince the younger ones to protect themselves as early as possible.

And then I became a writer, and soon needed my own advice. Now my butt feels numb half the time. I creak and crackle almost continuously. My neck has a nasty crick three days out of five. My shoulders are hunched forward like they’re being pulled on by teams of oxen. And ominous pains flicker around my body like brush fires in the distance.

Chairs are bad news. Sitting a lot is bad news. Why and what can you do? In this article, I’ll review the general health effects of being sedentary, but focus on the musculoskeletal effects — the aches and pains and stiffness.

What were the bodies like on the beach? Ugly and white and ruined by offices.

Leonard Cohen, The Favourite Game

The still life: what is the problem with sitting, exactly?

We are sedentary. Everything our great grandparents did was more work. The population of agricultural workers is less than a third what it was fifty years ago, let alone a hundred years ago.1 The most trivial tasks required more physical effort then than now, and most things that are hard work have been automated: transportation, agriculture, manufacturing. The age of information has created legions of workers who literally only lift their fingers for eight hours every day.

And we pay for it. Musculoskeletal problems, at least, seem to be steadily on the rise. (That’s hard to prove, but there is evidence.23)

The basic problem is that biology is a use-it-or-lose-it business. Everything in the human body works on feedback. Nothing works (or heals) without stimulus. For example, a fascinating 2007 study showed that tendons are harmed by both over and under use.4 Tissue can literally die without stimulation. A bed sore is a rotting patch of stagnant tissue, and it’s a real and serious problem for anyone who actually can’t move. This is how Christopher Reeve died in 2004: an infected bed sore.

So what about when you can move, but just don’t move much? Many chair-bound workers are basically suffering from sub-clinical bed sores. Your muscles start to scream for the physical and neurological stimulation they need to survive and thrive, and you only move just enough and just in time to stop tissue from actually starting to become necrotic (dead).5 But they certainly get “sick,” especially in the shoulders, back and hips — which tend to remain relatively immobile even when we get up and go to the water cooler.

The cost of a cozy life (feeling stiff and sore is the least of it

Research has shown that chronic inactivity causes marked degeneration of virtually every measure of physical fitness,6 such as relatively obvious problems like the degeneration of reflexes,7 and interesting examples like reducing the tendon rot from disuse mentioned above.

Research like this began a long time ago,8 and has advanced steadily since — a litany of bad news for chair warriors, connecting inactivity to cardiovascular disease, diabetes, and cancer.91011

That’s all pretty grim, but it gets worse…

It’s a bit like smoking. Smoking is bad for you even if you get lots of exercise. So is sitting too much.

Travis Saunders, quoted in Sitting is the New Smoking — Even for Runners

Are you an active couch potato?

An active couch potato12 describes exercisers who sit most of their day (kind of like a weekend warrior, but the emphasis is different13). It aptly describes nearly everyone who sits at work but is otherwise active. Despite their activity, active couch potatoes may have the same health risks as entirely inactive ones.

Not only is there a clear correlation between inactivity and certain kinds of cancer, but it may not be possible to compensate simply by getting more activity when you’re not in the chair. Schmid et al found that the cancer risk was the same if the chair time was the same, whether subjects were otherwise active or not. “[The results] indicate that the increased risk of cancer seen in individuals with prolonged time spent sedentary is not explained by the mere absence of physical activity in those persons,” the researchers say.

Sitting is the new smoking

To whatever extent activity fails to compensate for regular sitting, that makes it hazardous like regular smoking: a harmful habit, no matter what else you do. We may have to reduce the total chair time to nullify it's negative effects … not just try to exercise to compensate for it. Maybe in the future people will marvel at how a few generations of people ruined themselves because they didn't know better than to sit down all day.

We’re soft

Canadians and Americans — and the citizens of some other rich countries as well — have become a physically soft people and fitness crazes and diligence don’t seem to be enough to stem the tide. An old friend of my family’s has been an outdoorsman for his whole life. He’s one of those people who doesn’t just go camping, he “goes into the bush” for a while. He tells me that he’s seen a trend in his Outward Bound students, even the ones who are superbly gym-fit:

“They’re wimps,” he says. “Pure and simple. Put them on a mountainside, they’re whipped in a few hours, if not a few minutes. I can go for days, forever practically. They ask me, ‘Aren’t you tired yet?’ I never am.”

They’re wimps,” he says. “Pure and simple.”

In the science fiction classic, Ringworld, Larry Niven paints a future full of frail, sensitive people. Pain and effort are virtually eliminated, and fitness and pain tolerance along with them. But so what? It’s no great loss, as long as no one has to do any physical work or suffer. Right?

But we may underestimate the severity of the problem.

Do not try this at home

This is a true story, as far as I know: an aging farmer fell off a ladder and hurt his back. He refused to be taken to the doctor. “Not necessary,” he insisted. “Haven’t been to a doctor in thirty years, and I ain’t starting now!” But he was too crippled to resist, and his children took him to get help. The doctors soon discovered that he had broken his back — but not for the first time. He had, in fact, fractured his back twice previously, and healed, without ever getting help.

An anecdote like that is no basis for drawing any firm conclusion, but it does strongly suggest a question: are hard-working people truly tougher? A lot tougher? Are we sedentary folk a lot more prone to injuries and complications? When you ask the question like that, it’s hard to believe that we aren’t. But the researchers will have to settle it.

Meanwhile, I can tell you that I’ve certainly seen a lot of pathology in my work that is tough to explain any other way. I’m going to keep encouraging people to be as active as possible: use it or lose it is a very basic biological principle. We ignore it at our peril. Chop wood, carry water!

…this idea, that humans are essentially weak creatures, is actually deeply woven into a lot of the ways in which humans think about our bodies.

Brains Plus Brawn, by Daniel E Lieberman

You’re not siezing up (not literally anyway)

There’s a popular notion that sitting causes real shortening of muscle tissue: that you “freeze like that.” Specifically, the idea that sitting causes your hip flexors to truly shorten — to cinch up and stay that way, to lose extensibility — is widespread. This is not wrong in itself. For instance, a good quality 2012 study found that high heels cause adapative shortening of the calf musculature by 13%.14 And here’s an example of the argument being made by a particularly credible and eloquent expert, evolutionary biologist Daniel Lieberman:

Paper after paper, study after study, have shown that chairs give us back problems because they shorten our hip flexors, give us weak backs, of course it make us sedentary. We take years off our lives probably by sitting in chairs, but we like them because they’re comfortable. You go to an African village, you find me a chair with a back. That’s a rare thing out there.

Brains Plus Brawn, by Daniel E Lieberman

Unfortunately, it’s not quite as clear cut as that. Even when muscles do shorten, it doesn’t necessarily mean much. That calf muscle shortening I mentioned above? The authors of that paper also found that it had no measurable effect on ankle function.15 Todd Hargrove of BetterMovement.org explained this very well:

It is well known that completely immobilizing a joint for an extended period of time can lead to loss of muscle sarcomeres and contracture and cross linking of connective tissue. However, it appears that one can fully prevent any negative effects of extended immobilization on tissue length with only short and infrequent bouts of movement. In one study, researchers kept the soleus muscle of a rat completely immobilized in a cast for 10 days. Every two days the cast was removed and the muscle was stretched for fifteen minutes. This was enough to preserve tissue length, but not enough to make the rat happy with the experiment.16

In another study, just half an hour of stretch a day preserved range of motion and muscle length in a muscle that was immobilized in a shortened position for the rest of the day. These studies suggest that sitting in a chair almost all day every day would not cause loss of tissue length, provided you get up to go the refrigerator every once in a while.

So it takes an enormous amount of abuse of your body to have any effect on muscle length, it probably doesn’t matter all that much, and it’s really not that hard to prevent. A lot of sitting is almost certainly problematic,17 … but probably not because of “seizing up.”

Is stretching the answer?

No — certainly not in the sense that you need to stretch a great deal to keep your muscles from shrivelling up. Any movement is sufficient to prevent that (see previous section). Although it’s better than nothing, getting out of the chair to stretch specifically is simply the wrong tool for the job. A little static elongation of muscle tissue just does not constitute adequate stimulation to be an antidote for all the effects of four hours of sitting per day, let alone eight or twelve.

What you need is a concept I call “mobilizations”: repeated, rhythmic elongation and contraction of muscle tissue (see Mobilize!). For instance, when most people get up from a long sit, they will instinctively stretch their arms backwards, opening up the chest, and a few will then close the chest as well, flexing the same muscles they just stretched.

That’s the perfect thing, but you need to do more of it. Doing it once pulls your chest and upper back muscles away from the brink. Do it ten times in a row a few times a day is mobilizing, and effective preventative health care.

Should I get an expensive chair?

The importance of extremely comfy and ergonomically dazzling chairs is generally exaggerated. There is simply no such thing as a perfect chair: your body isn’t comfortable with any position for hours at a time. The problem isn’t the position that your body is in, but the lack of motion and variety of stimulation.

Therefore, the best chair is two or three quite different chairs used in rotation, including or used in conjunction with an destabilizing cushion, such as a Disc-O-Sit or Sissel Sit, or a fitness ball.

In my office, I have a standard office chair and a stool, both of which I use in combination with a Disc-O-Sit for plenty of variety. Because I have a home office, there are plenty of other places I can sit to work. All of this variety is more important than having one fancy chair.

What if I still want to get a good chair?

If you’ve got the cash, by all means — get yourself a fancy chair. If you’re going to do this, I recommend that you go “all out,” and get yourself a Herman Miller “Aeron” chair for about $1200CDN: they are unambiguously the best widely available ergonomic chair. (There are probably even better chairs out there, but they are even more expensive and I don’t think another several hundred clams gets you that much more.) The Herman Miller Aerons come in three sizes, which is a simple and effective solution to the most significant chair problem for many larger and smaller people: anyone large or small uses up the adjustability of their chair just getting it to fit.

My “ergnomics schmergonomics” rant

Ergonomics “professionals” all over the world are busily working on the wrong thing, trying to get people into good positions so that their workstations are as efficient as possible and require as little movement as possible. The goal of this kind of ergonomics is to turn people into cyborg-like extensions of their cubicles. The goal is also damage control: how to minimize the consequences of an insane amount of sitting, while still actually keeping people in their chairs.

The goal of this kind of ergonomics is to turn people into cyborg-like extensions of their cubicles.

And it’s all a sinister plot, obviously. Modern workplace ergonomics is a classic, Dilbert-esque piece of corporate manipulation. It fails to solve an obvious problem in an obvious way. The obvious problem is sitting, and obvious solution is getting up and moving around regularly — what more progressive ergonomics professionals call “micro-breaking.”

This is not to say that conventional ergonomics is useless or trivial — even if you get up fifty times a day, a bad mouse position is still going to torment you. But let’s get it in perspective!

This perfectly illustrates what I’m trying to say: that conventional ergonomics solutions may be missing the point, and often get out of hand.

This perfectly illustrates what I’m trying to say: that conventional ergonomics solutions may be missing the point, and often get out of hand.

Isn’t it good enough that I get up regularly for meetings, faxes, etc?

Yes and no. Any kind of getting up is so much better than being glued to your seat that I am always reluctant to criticize it. It really is better than nothing. But it really isn’t enough, either.

The key point that usually gets overlooked is that walking around the office does not — and I know this will come as a big shock — actually give your back muscles all that much to do. Photocopying isn’t really a big musculoskeletal challenge. Going the bathroom isn’t exercise.

How much mobilizing is enough?

Approximately five minutes of mobilizing per hour is probably an effective antidote to the worst consequences of excessive sitting. To be sure, double it.

How can that be enough? Simple: sitting wouldn’t be particularly stressful, except that we do so much of it. It’s not hard to counteract the effects of an hour of sitting with a few well-chosen exercises. If you make a point of flexing and using the muscles that are most needful, it probably doesn’t take much to undo the damage.

Getting up and bending over to touch your toes thirty times every half hour may seem forced, contrived or arbitrary — but it’s the only cure for a forced, contrived and arbitrary amount of sitting.

What are the three most common office ergonomics disasters?

In my experience, the worst ergonomics offenses are: no micro-breaks, high monitors, and holding the phone to your ear. Always get on your feet for at least one minute in twenty, even if you don’t do any exercises, even if you just stand at your keyboard. Never look up at your monitor — it is a complete mystery to me why monitors have elevated stands at all. And never talk with a phone pinched between your head and shoulder, unless you just happen to enjoy stubborn headaches and neck cricks.

Should I consider standing on the job?

Another trend with a dark side: standing to work is not a great solution.

Standing to work has been gaining popularity as an answer to the perils of sitting. For instance, according to a business blog, several Japanese companies have ditched desks entirely. Everyone stands to do their office work!

Was it a tough change? Yes. The first month, or even two, is apparently quite difficult as the body adjusts. But then you begin to feel healthier, perhaps lose a few pounds due to the activity resulting from constant balancing, and you realize you are more productive.

After keeping an eye on this trend for the last decade, I have finally decided to (mildly) advise against it. No, you should probably not choose to stand on the job, unless it particularly appeals to you or fits your circumstances. Standing seems to be just another form of stagnancy, with its own dangers. The Cornell Human Factors and Ergonomics Research Group (which looks like an interesting resource) identifies a number of problems with standing to work:

Standing to work has long known to be problematic, it is more tiring, it dramatically increases the risks of carotid atherosclerosis (ninefold) because of the additional load on the circulatory system, and it also increases the risks of varicose veins, so standing all day is unhealthy. The performance of many fine motor skills also is less good when people stand rather than sit.

They review a few other problems with sit-stand workstations, and conclude with the advice to mainly sit to work but get up and move regularly:

The key is to build movement variety into the normal workday.”

In other words, regular microbreaking. If you do choose to stand to work — and obviously it does make more sense for some jobs and situations — then here’s quite a decent little article about choosing a desk (from Macworld Magazine, of all places).

Anything else I should know about being a chair warrior?

Above all, take the risk seriously. True health and fitness are simply not compatible with serious chair warriorism. If you can’t avoid chairs, most people have to take preventative measures in order to survive their careers.

The best example I know of is a young man, mid-twenties, an extremely fit hockey player, roller blades everywhere — and a hardcore workaholic computer programmer, sixteen hours per day (no joke). His chair time is so physically punishing — and his athletic activities so demanding — that he has found that prevention is an absolute necessity. For him, the problem is unambiguous and the consequences of negligence are immediate: if he isn’t careful to protect his body from all that sitting, he starts to suffer right away.

The same thing is happening to you at eight-hours per day — just not as fast.

About Paul Ingraham

I am a science writer, former massage therapist, and assistant editor of Science-Based Medicine. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook and Google, but mostly Twitter.

Further Reading

Notes

  1. Food and Agriculture Organization of the United Nations, visited June 4, 2002, www.fao.org. BACK TO TEXT
  2. Jiménez-Sánchez et al. Has the prevalence of invalidating musculoskeletal pain changed over the last 15 years (1993-2006)? A Spanish population-based survey. Journal of Pain. 2010. PubMed #20356799.

    Is body pain getting worse? It seems to be in Spain. Studying health surveys of the population of Spain, researchers looked for changes in rates of serious musculoskeletal pain since the early 90s, finding that it “increased from 1993 to 2001, but remained stable from the last years (2001 to 2006).” They also found that it was more common in women (almost twice as much), the poor, the insomniac, and people with other health problems.

    BACK TO TEXT
  3. Harkness et al. Is musculoskeletal pain more common now than 40 years ago? Two population-based cross-sectional studies. Rheumatology (Oxford). 2005. PubMed #15784630.

    In the northwest region of England, researchers examined then-and-now data try to figure out if people hurt more than they used to, between the 1950s and today. They used data collected by the Arthritis Research Campaign, looking at the prevelence of low back and shoulder pain. Interviews and questionnaires were used. They found that “the prevalence of musculoskeletal pain is much higher than that reported over 40 years ago. The change in prevalence is unlikely to be entirely due to the study design.” pointed out in that the appearance of an increase “could be partly explained by the ‘worried well’. The ‘worried well’ are those patients who are concerned about their health, and attend their GP to seek reassurance about their well-being.”

    Their data also contributes to the evidence showing that low back pain dominates the middle of life, and does not increase steadily due into the golden years, as so many people assume.

    BACK TO TEXT
  4. Arampatzis et al. Adaptational responses of the human Achilles tendon by modulation of the applied cyclic strain magnitude. J Exp Biol. 2007. PubMed #17644689. Tenocytes (tendon cells) adapt to the forces imparted on them, creating a tissue tolerance “set point” depending on your activity level. This set point can decrease with disuse, and increase with exercise — as long as there’s enough rest. Activity that is too frequent or intense might damage cells without giving them a chance to adapt. Biological proof of “use it or lose it.” BACK TO TEXT
  5. It sounds like I’m exaggerating, but it’s probably literally true. Bed sores do not take all that long to form. Ask any nurse. People who log serious time in chairs are also certainly flirting with pressure sores. It’s just they are easily prevented with relatively little movement. BACK TO TEXT
  6. Blair. Physical inactivity: the biggest public health problem of the 21st century. British Journal of Sports Medicine. 2009. PubMed #19136507.

    This article presents data of how healthful mild to moderate exercise is, and connects a lack of exercise with “killers” — obesity and smoking, for instance, are strongly correlated with inactivity.

    BACK TO TEXT
  7. Nakazawa et al. Effects of long term bed rest on stretch reflex responses of elbow flexor muscles. Journal of Gravitational Physiology. 1997. PubMed #11541174.

    From the abstract: “All subjects showed that both short and long latency stretch reflex FMG activities of muscle biceps brachii were reduced immediately after 20 days bed rest, and then recovered gradually to pre-bed rest levels at one- to two-months after bed rest ....” Note, however, that another muscle studied did not show reflex degeneration in the same conditions.

    BACK TO TEXT
  8. Livingston. Psychological and neuromuscular problems arising from prolonged inactivity. New York Academy of Science. 1967. BACK TO TEXT
  9. Schmid et al. Television viewing and time spent sedentary in relation to cancer risk: a meta-analysis. J Natl Cancer Inst. 2014. PubMed #24935969. BACK TO TEXT
  10. Katzmarzyk et al. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Medicine & Science in Sports & Exercise. 2009. PubMed #19346988. BACK TO TEXT
  11. Hamilton et al. Role of low energy expenditure and sitting in obesity, metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes. 2007. PubMed #17827399. BACK TO TEXT
  12. The term was coined by Australian researcher Genevieve Healy, PhD, of the University of Queensland. BACK TO TEXT
  13. Weekend warriorism refers specifically to overdoing it on the weekend — generally sedentary and perhaps out of shape, but exercising intensely at widely spaced intervals. Someone who ran every evening for an hour wouldn’t be a weekend warrior … but they could still be an active couch potato. BACK TO TEXT
  14. Csapo et al. On muscle, tendon and high heels. J Exp Biol. 2010. PubMed #20639419. BACK TO TEXT
  15. According to Csapo et al, chronic heel wearers do have shortened calf muscles, stiffer Achilles tendons, and a smaller ankle range of motion, but these changes “seem to counteract each other since no significant differences in static or dynamic torques were observed.” BACK TO TEXT
  16. Williams et al. The importance of stretch and contractile activity in the prevention of connective tissue accumulation in muscle. Journal of Anatomy. 1988. PubMed #3225214.

    “It was found that the connective tissue accumulation that occurs in inactive muscles can be prevented either by passive stretch or by active stimulation.” An important point here is that stretch isn’t doing anything that muscle contraction isn’t, so the evidence does not particularly support a stretching habit.

    BACK TO TEXT
  17. Perhaps the flexors do not actually shorten, but may well still feel significantly shortened, stiff, tight. Indeed, that is my subjective experience. I do not believe, and never did, that my hip flexors “shorten” in any meaningful, literal way when I sit all day, but they certainly do become cranky and uncooperative feeling, in the same fashion that is associated with the phenomenon of so-called trigger points elsewhere in the body. That sensation can be quite stubborn, and I am really conscious of it, particularly when I transition from a day of sitting at work to full-power athletic activity in the evening (which I do at least weekly). And there is no question this sensory phenomenon is worse when I’m pulling longer days in the chair.

    BACK TO TEXT