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Back Pain and Other Hazards of Sitting In Chairs (Way) Too Much

Recent personal experience proves that a lot of sitting actually is as risky as I’ve been telling people all these years

3,000 words, updated Jan 2nd, 2014
by Paul Ingraham, Vancouver, Canada bio
I am a science writer, a former massage therapist, and the Assistant Editor of Science-Based Medicine since 2009. I am nearly done with a long-procrastinated Bachelor of Health Sciences degree. I am a middle-aged runner and ultimate player with plenty of personal experience with athletic injury and chronic pain. Readers often want to know more about me and my qualifications, because my style and subject matter is controversial. Most importantly, yes, I used to actually believe and practice almost everything that I now debunk and criticize. I live by the ocean with my wife in beautiful downtown Vancouver.

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

Leonard Cohen, The Favourite Game

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 back pain, please go directly to this article: Save Yourself from Low Back Pain!.

The original title of this article was “I Hate It When I’m Right”, which I still love to say out loud (who wouldn't?). Unfortunately, Google can’t index a non-title like that, and people just weren’t finding the article when they were searching for “back pain” or “what can I do about sitting way too much in chairs”.

In this article, I have the rare pleasure of talking about two of my favourite things in one place: writing and massage therapy, together at last, like peanut butter and chocolate. I’ve been sitting in a chair a lot recently, writing even more than usual. And I’ve rediscovered that chairs actually are torture devices — just like I’ve been telling my clients.

Over the years, I have described The Chair Problem to my clients in many ways. I call my excessively sitting clients “chair warriors” who come to me with “chair wounds.” I say things to them like, “Did you get in a fight with a chair?”

I tell them that sitting in a chair is practically like an Olympic event, and they are elite chair athletes — that they can only do it because they’ve been training for it since kindergarten.

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

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

With this perspective, it isn’t difficult to see what the relatively minor injuries are going to lead to. To the young chair warrior, the stiffness is just an irritation; to a physical therapist, it’s the beginning of the end, the thin edge of the wedge! Without preventative measures, many of these people will become casualities.

I tell my clients this, and then I say, “Sometimes ten minutes of advice is worth ten hours of massage.” And I start trying to convince them to protect themselves as early as possible.

…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

Chair warrior evangelist, heal thyself!

When you repeat something often enough, it starts to lose its power. Like repeating a word over and over again until it sounds ridiculous, my own advice was starting to seem silly in my own ears. How appropriate, then, that I have recently suffered from some nasty chair-induced discomfort!

It’s not like I’ve never tangled with chairs before. I went to school. And years ago, I actually chose massage therapy as a career because I wanted work that kept me more physically active. (Ironically, the three-year education in massage therapy was largely spent in chairs, and uncomfortable ones at that.)

Unfortunately, even as a massage therapist, I can’t avoid chairs — because I’m also a writer. Massage therapy is a job that I love, but writing is my identity. I like almost everything about writing — I’m basically a curmudgeonly and cerebral loner — except the damned chairs. If only it wasn’t for all the sitting

I’ve had much more opportunity to write in the last year, as my massage therapy practice has become more or less self-sustaining. And so I’ve had my tush in a sling more often. And I gotta say: “Yikes! Chairs are bad!” It’s one thing to know about it intellectually, and quite another to actually feel the pain.

I’ve long had a professional habit of trying to identify with my clients — I will often do the same exercises that I’ve prescribed, for instance — but this is ridiculous! I am now sharing their pain. My butt feels numb half the time. I creak and crackle almost continuously. My neck has a crick three days out of five. My shoulders are hunched forward like they’re being pulled on by teams of oxen. And ominous pains are flickering around my body like brush fires in the distance.

So my enthusiasm for the war against chairs is refreshed. For the rest of this article, I will review some basic chair lore in Q&A format.

What is the problem with sitting, exactly?

The problem is immobility. Biology is a use-it-or-lose-it business. Everything works on feedback. Nothing works without a stimulus. The first consequence of serious immobility is soft-tissue stagnancy, the worst manifestation of which is the “bed sore.” A bed sore is literally a rotting patch of tissue, starving to death, and is a real and serious problem for anyone who actually can’t move. This is how Christopher Reeve died in 2004: an infected bed sore.

When you actually can move, but don’t move much — like a lot of office workers — you 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). 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.

What isn’t the problem? No, you’re not literally 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%.1 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.2 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.3

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,4 … 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.

What’s your famous “ergnomics schmergonomics” rant?

It’s not actually famous. I just made that up. But here it is anyway:

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?

Actually, it doesn’t take all that much. An adequate antidote for an hour of sitting is approximately five minutes of mobilizing.

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 really 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 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. Csapo et al. On muscle, tendon and high heels. J Exp Biol. 2010. PubMed #20639419. BACK TO TEXT
  2. 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
  3. 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
  4. 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