About 80% of the population in the UK and USA have sedentary jobs[i], with statistics from the British Heart Foundation suggesting the average working-age adult spends around 9.5 hours a day sitting[ii]. This has been further exacerbated by the trend towards working from home, leaving many people hunched over a computer or laptop for hours on end, with little need or incentive to get up and walk around. This Back Care Awareness Week (3-7 Oct), it’s important to recognise how working patterns can be a breeding ground for lower back issues such as slipped, bulging and degenerative discs. It’s time to take action which can prevent long-term, chronic office-related back pain.
One of the major issues that contributes to ‘flare ups’ or the onset of lower back issues among desk-based workers in particular comes from the unique combination of forces in the lower back when sitting for extended periods. Firstly, almost no-one in an office environment will be sitting on their ‘sitting bones’. Instead they will be slumped into the office chair, bottom forwards, rounding into the back of the chair. The upper body is often then upright, or more likely peering forwards at a computer screen. Many workers sit like this for sustained periods.
When in this position, the natural arching (backward bend) of the spine is significantly reduced and a position of flexion (forward bending) is adopted. This has the effect of compressing the front part of the spinal discs particularly those at the L4 L5 and L5 S1 – the last two mobile joints of the spine. A great way to help illustrate this is to think of discs like jam doughnuts. When we bite down on the front of a doughnut, the jam will be pushed towards the back of the donut, sometimes to the extent that it leaks out the back as it breaks through the dough encasing.
As this compression is happening, there is a stretch being put through the muscles of your back, as well as the ligaments of the spine. This chronic stretch for sometimes 30-45 minutes, or even hours at a time, has the effect of weakening the ligaments, and creating vulnerability. It also creates a degree of stiffness and tightness in the muscles as they get tired of holding on. A common mistake people make is assuming these tight muscles need further stretching – this is not the case!
The key issue with this combination of forces is that it essentially weakens the structure of your lower back. Over the following weeks, months and years, this gradually degrades the structure of the lower lumbar spine, and discomfort in the lower back turns into an ache, then a mild pain then it starts to become a throbbing. Before you know it, years have gone by and nothing much has been done to deal with it. The back pain at work was an inconvenience, but now it’s not just at work, it’s constant and much more difficult to ignore.
If this all sounds familiar, that is because it is probably the most common general theme for those suffering from lower back pain. Furthermore, a recent survey among my patients highlighted how almost a third of back pain sufferers (32%) have waited until their discomfort is unbearable before seeking help, with almost 20% taking four or more different medications at any one time to get through the agony. Many do not realise, however, that they need to seek help for back pain within 12 weeks of symptoms starting to avoid chronic problems.
So, what can be done for those who are desk-bound for most of the working week? How can they prevent the onset of chronic back pain or do they have to accept it as part and parcel of working life?
Well, the good news there are various strategies that can be adopted and which will make a significant difference in managing and, in many cases, preventing office-based back pain. Key to remember is how back pain does not have to be the necessary ‘evil’ of desk-based working. The recommendations below are a good starting point to help kick-start a healthy attitude towards back health…
Be a fidget wherever you are, your back will love it!
One of the biggest issues with the spine was mentioned earlier on, sustained compression and stretch. We see this process in extreme cases in bedsores in hospital patients. If not moved, the pressure on the skin creates damage and sores develop. Sitting still for extended periods when working, whether at home or in the office is no good for your lower back and in particular it allows the sustained stretch on the ligaments to deform them through a process called creep. The great thing is, creep doesn’t happen if you take the stretch off. So being fidgety disrupts the number one issue with long hours at a desk. Most simply this is just repositioning yourself in your seat, or better still, getting up at regular intervals, to walk around, get a drink – anything that gets the body, and spine, out of one set position.
Invest in sit/standing desks and go electric
Sit/standing desks are another great tool here, and electric rather than manual versions. Why not use a timer and every 20-30 minutes be sure to switch position. The regular switching – providing it doesn’t disrupt the task at hand too much – is another extension of the “fidget principle”. Combined with above, this can really help keep stress moving around the lower back, spine and muscles, instead of focusing on one specific area.
Don’t underestimate the importance of a good chair
When it comes to chairs there are many different opinions online, but key to remember is that a good chair has got to support your back first and foremost. Ideally, this should be used alongside an electric sit-stand desk and another “posture chair” – so a trio of back support. The chair itself does not have to have a lumbar support – in fact these are often less good as they don’t support as well as a simple towel which we will discuss in a separate point.
Encourage great posture with a ‘Posture Chair’
This could be a kneeling chair, a perching chair, or even a swiss/balance ball. The thing with these chairs is that they often allow you to work a good posture and also, like the kneeling and perching chairs or stools, they allow for a lower level of strain on your lower back from the hamstrings. When sitting with the hip at 90 degrees, your hamstrings, if tight, will pull on your lower back flattening the natural lordosis. This is unhelpful. In these two chairs, your thighs are slanted down and therefore there is less pull from the hamstrings on your lower back. In combination with a sit-stand desk and a good chair, this could be considered the ‘gold standard’ for back health.
Incorporate the ‘towel stretch’ into your daily work routine
This is a great exercise for lower back health and easy to do during the day, whether working from home or in the office. A smaller towel, perhaps the size of a tea towel or hand towel, rolled tightly and placed between your lower back and the seat can help support the natural arch in your lower back and prevent strain focussing disproportionately on the lower lumbar spine.
The Towel Stretch
Relax for two to five minutes.
- Roll up a bath towel tightly to approximately the size of a foam roller.
- Lie on your back with knees bent.
- Engage your core and lift your bottom and back off the floor.
- Place the towel in the small of your back.
- Relax slowly onto the towel – it should support the natural arch of your back.
- Place your hands on your tummy and relax.
- Afterwards, engage your core and roll your body to the side to dismount, do NOT lift your bottom.
Top tip: This can be a little achy or uncomfortable initially as the lower back is gently unloaded. With repetition this becomes more and more pleasant. If you struggle you can always begin with just 20 to 30 seconds at a time.
Drink more water during your day
A great strategy that has two benefits for your general health and back health specifically is to focus on drinking more water during the day. Get a large bottle, say 500ml to 1 litre and be sure to drink this throughout the day. Firstly, this is going to keep you more hydrated which is only going to be a positive for your health. Secondarily, you’ll be forced to get up more regularly to either fill up the bottle or visit the bathroom!
Do away with unnecessary aids
While aids such as footrests and reclining chairs may seem like a good idea at the time, they could actually be making the problem worse by ‘rounding’ a person’s lower back. This will increase the compression at the lower lumbar spine.
Other top tips include:
- Use a desk that can raised from seated to standing and back again. These are good as they provide flexibility and variety for your posture.
- If you regularly wear a shirt and tie to the office, avoid having too tight a shirt collar and this creates a stress point at the lower neck.
- Travel light! Don’t pack your work bag too heavy. A rucksack would be my bag of choice as it evenly distributes the weight across the back and shoulders. If carrying a bag causes you pain, it’s likely there is deeper issue so seek professional advice.
- Avoid wearing high heels for any length of time – while they may look good, they do little to absorb shock as we walk, which in the long-term can cause chronic shortening of the calf muscles and a forward tilting pelvis, which can increase pressure in the lower lumbar spine through altering posture.
Prevent lower back pain from occurring in the first place
Ultimately the best strategy is always prevention. Preventing either the occurrence of back pain or, if it does happen, limiting the severity of episodes as well as creating an environment for optimal recovery is essential. If you’re already incorporating the strategies above, that’s a great first step. The next step is to devote a relatively small amount of time each week to engaging in resistance exercises that build both core and spinal strength – such as squats, lunges and hip hinges. Although things like pilates and yoga are good for core strength and flexibility, these common choices miss the all-important spinal strengthening part, not to mention unhelpful practices like pelvic tucks to flatten your low back during some of the exercises which are bad for your back health long term.
The key is for people to realise how their body is designed to move! It may seem obvious, but many people don’t enough exercise to stimulate their muscles, no matter whether they’re in the office or at home. As a result, back muscles become weak and more prone to stress. We forget how these muscles are needed to support us for 70+ years, so it’s vital we maintain them to enjoy many pain-free years to come, long after we’ve left the office and into retirement.
References
[i] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8315405/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3102055/
[ii] https://www.bhf.org.uk/informationsupport/heart-matters-magazine/activity/sitting-down
Michael Fatica
Michael Fatica is a Consultant Osteopath for The Back in Shape Program (BIS), an online, rehabilitation program for treating back pain. He studied at University College of Osteopathy and has been treating and advising patients for the past 10 years, specialising in the spine and spinal mechanics. Previously at The Mayfair Clinic in London, Michael developed BIS during the pandemic as a means of helping patients who were unable to seek face-to-face expert help for back pain.
