Back pain from standing? Here’s why it happens & how to relieve the pain

We all know that sedentary behavior such as sitting or lying can predispose to back pain. As a physical therapist, I have also seen numerous cases where standing provokes back pain. This is particularly common in occupations such as office, factory, and construction workers. Although there are many reasons for this, certain lifestyle and workplace modifications can be actioned to minimize back discomfort.

To help you prevent further agony, I will answer some frequently asked questions by my patients about back pain from prolonged standing.

Why does prolonged standing cause back pain?

There is no one single reason why people experience back pain from standing too long. Although it is not uncommon for individuals such as workers to report lower, middle, and even upper back pain. Various factors such as pre-existing back conditions, past injuries, lack of muscular endurance, and even stress can contribute to these issues.

Back pain is typically multifactorial. This means that there is a multitude of reasons why someone might be experiencing these issues. Based on my clinical experiences with patients, there has been a myriad of instances why one might suffer back pain from standing too long. These include:

  1. Pre-existing injuries: Previous injuries to the back or other areas of the body (e.g. knee, shoulder, etc.), may predispose to back pain. Especially if the injuries have not been rehabilitated or managed properly, this could lead to general weakness and additional stress through the back.
  2. Back conditions: In more infrequent instances, back pain can be caused by specific conditions such as spondylolisthesis and canal stenosis. However, this is only consistent for around 5-10% of cases.
  3. Poor posture: Certain postures adopted by your body can increase stress through the upper to lower back from standing. This can include individual characteristics such as a large curvature of the low back (hyperlordosis) and poor foot posture.
  4. External factors: Other factors outside of the intrinsic characteristics of the body can influence back pain. Specific examples including poor ergonomics at work, inadequate footwear, and even sudden changes in your daily routine (e.g. increased time standing at work) can create additional strain through the back. Even psychosocial factors such as stress, anxiety, and lack of social support can heighten the body’s susceptibility to pain and aches.

Is standing bad for your back?

As mentioned in the previous question, there can be many reasons why standing can cause issues in the back. Given the fact that your body is unique to everyone else, there is no specific answer to this question. If you are experiencing pain whilst standing, it would be advised to seek a physical therapist to help find a solution.

However, for most readers, standing is NOT “bad” for you back. As bipedal mammals, we were created to stand, walk and move. An important point I reiterate to my patients is that around 90% of cases of back pain are classified as “non-specific”. This means that the issues in your back are not due to any structural “abnormalities” or “damage” in the back. In fact, there are many additional benefits to standing such as increased productivity and calories burnt throughout the day.

Is sitting better for back pain?

Once again, how your body reacts to being in positions such as sitting and standing will be dependent on numerous factors.  In most situations, sitting is NOT better for low back pain. Sedentary behavior such as long periods of lying or sitting increases the chance of low back pain. Key reasons why this is the case include the loss of muscular endurance, increased joint stiffness, and strain through the back. Additionally, sedentary behavior such as sitting can lead to an increased risk of chronic conditions such as diabetes and heart disease.

So why might sitting feel more natural and less painful for some people? Great question. Pain is not necessarily an indication that your back is being damaged. Perhaps the spinal structures are highly sensitized or maybe the muscles lack endurance. Our bodies naturally will have preferred movement patterns. Although sitting can help with pain relief, standing should not be avoided. Seeing a health professional such as a physical therapist will help you understand why sitting feels more comfortable than standing.

What treatments are there for back pain from standing too long?

As with most instances of persisting back pain, it is highly recommended that you see a relevant health professional such as a physical therapist. We will assess you to determine the most suitable way to manage your pain. Depending on your therapist’s findings, treatments can vary from pain management strategies to stretches and exercises.

Usually, I would always incorporate an exercise program and recommend taking regular breaks from prolonged standing. This ensures that you are re-engaging the correct postural muscles and to reduce the stress through the back.

Although an assessment should always be performed before prescribing exercises, there are 3 fundamental exercises I have recommended for those who suffer back pain when standing. These will be detailed below:

1. Shoulder blade squeeze in standing or sitting

This exercise is typically performed by those with neck and/or upper back pain. When standing in the same position for a long time, your upper back and shoulders begin to roll forward. This exercise helps to recorrect the body’s natural posture

2. Threading the needle

When assessing patients with middle back pain, a common characteristic I have observed is the stiffness around the thoracic spine or the ribcage area. When treating my patients, I use a technique called joint mobilization to help loosen up these stiff structures. However, this can be done by yourself with this one simple exercise. Not only are you stretching the muscles parallel to the ribs but also encourage movement through the spine.

3. Dead-bugs

Those who experience back pain when standing tend to prefer being in more flexed positions such as sitting. The dead-bug strengthens up your core and back without you having to enter aggravating positions.

What are some alternatives to standing?

There are indeed alternatives to standing but also dependents on the plausibility of your work. For example, if you are an office worker you might have more options than a construction worker. To combat back pain, you will need to find:

  1. Positions that ease your back pain
  2. Strategies to avoid positions that aggravate your back pain

One position I would recommend to those with back pain when standing is the perched sitting posture. The image below demonstrates accurately, as the worker is positioned somewhere in between sitting and standing. Hips positioned slightly above knees. Back and pelvis in a more neutral position.

In a 2018 study conducted by the University of Waterloo, it was shown that those with low back pain preferred to remain perched as opposed to standing. These researchers suggested that this position helped reduce the stress and demands from the back. Office furniture such as adjustable standing desk chairs should be considered.

Perching to ease back pain
Perched sitting position at an ergonomic desk. Source

If this arrangement is not feasible, adjusting from sitting to standing may also help with back pain. For example, you can set an alarm on your phone to remind you to switch positions every 30 minutes. To facilitate this, changing workstations or using sit-to-standing desks may be required.

How do you know if your back pain is serious?

As discussed above, most low back pain is considered ‘mechanical’ and can be managed accordingly. For the vast minority of people, back pain can become unrelenting and more serious. This can include issues such as canal stenosis to even a vertebral fracture if you have been involved in a traumatic incident. Under these circumstances, it is essential to see a physical therapist or medical doctor.

For those suspecting something more serious, here are a few red flags to watch out for. However, just because you have 1 red flag does not necessarily mean your condition is serious.

These symptoms include:

  • Referred pain to the legs (e.g. sciatica, pain to the legs)
  • Unable to walk or weight-bear without pain
  • Intense and unrelenting pain
  • Constant night pain
  • Radicular pain (e.g. intense burning sensation down the leg)
  • Persistent pins and needles
  • Difficulty going to the toilet (e.g. excreting, urinating, etc.)

Please see a medical health professional as soon as possible if you present with these symptoms.

Disclaimer: The content written on this page was created for educational purposes. Information on this page should not be used as medical advice or a substitution for seeking the services of a health professional. Anyone suffering from back pain should book in a consultation with their primary healthcare practitioner (e.g. physical therapist, family doctor etc.).

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Leon Mao
Leon Mao

Leon is an Australian physiotherapist who specializes in working with musculoskeletal conditions. He graduated from the University of Melbourne with his Doctorate in Physiotherapy before entering the workforce. He is now consulting from Top to Toe Health as a clinical and telehealth physiotherapist and primarily works with office-based workers and athletes. For any inquiries or further information, please visit Digital Physio.

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