Finding a comfortable way to sit with lower back pain is difficult
There is such a thing as a comfortable way to sit with lower back pain—in other words, sitting with proper posture that places less strain on your lower back. But when you actually try it, you quickly run into a contradiction: maintaining a comfortable sitting posture for a long time is not comfortable. Sitting with proper posture is only possible when your muscles and joints are functioning as they should.
Why is sitting so difficult? Because it usually involves working with your hands.
When we sit in a chair, we rarely spend that time doing nothing. We read, use a computer, and do other tasks with our hands. That means we naturally take a posture with our arms reaching forward, and the moment we start working with our hands, our good posture collapses.
This illustration shows a doll balancing while holding its arms out in front.
If you take that kind of posture, the weight of your arms makes you tip forward, so you have to spread your feet front and back to steady yourself. Even then, you would still fall forward, so you lean your upper body backward to keep your balance.
The same is true for people: we create this forward-reaching posture by shifting the position of the head, back, and hips.
But when you are sitting in a chair, you cannot move your legs to help balance, so instead you round your back or tilt your pelvis.
In other words, it is not really possible to keep perfect posture while working with your hands out in front of you.
You may be able to do it for a short time, but muscles fatigue as time passes. That is why it is difficult to maintain good posture for long periods without giving in to fatigue.
You may already have tried things like consciously keeping your pelvis upright or putting a cushion behind your back. If none of that has fully helped, the problem is not just how you sit. Your body has simply not been prepared well enough to handle the demands of working while seated.
To sit more comfortably with lower back pain, you need to identify which parts of your body are not moving well and stretch the muscles that interfere with proper posture.
- Are often told they have good posture
- Have tried changing their chair or cushions
- Already do stretching, running, or similar activities
- Have received treatments such as massage
The key to solving this is understanding your body’s habits
We have seen that sitting while doing handwork makes people more likely to round their back than simply sitting in a chair doing nothing. So if your body is already stiff and prone to slouching, it is much harder for you to maintain good posture in a chair than it is for someone whose body is not like that.
Knowing whether your body is in a condition that allows good sitting posture is just as important as knowing what good posture looks like. So let’s check whether your everyday physical condition makes you likely to slouch.
This illustration shows a test of neck movement. If you have a rounded back posture, you will not be able to look straight up.
Ideally, your face should become parallel to the ceiling.
There are three reasons why someone cannot look straight up. First, the back may be shifted backward into a hunched posture. Second, poor shoulder blade movement may be limiting movement in the chest and abdomen. Third, the neck itself may not be moving well.
When neck movement is poor, you become more prone to a hunched posture. Because sitting tends to round the back, that tendency becomes even stronger in a seated position.
This illustration shows a flexibility test for the inner thigh muscles (the adductors).
If the adductors are stiff, the knees will not move closer to the floor. Ideally, the gap between the knees and the floor should be about one to two fist-widths.
In particular, if the adductor magnus is tight, the pelvis tilts backward and the back becomes rounded.
Using tests like these to identify distortions helps you understand your body’s habits, and that becomes the starting point for solving the problem.
Treatment record
Let’s look at a treatment record to see the steps through which lower back pain that makes sitting difficult can improve.
- Symptoms: Lower back pain when sitting and when walking for a long time. Pain in the neck and between the shoulder blades.
- Age: In their 30s
- Work: Mainly desk work
- What they had tried: Back cushion, stretching, massage
If we put the events so far in chronological order, the course was roughly as follows:
- They were told that back pain is unavoidable in a job that requires sitting.
- They were told that massage and stretching are effective for relieving muscle fatigue.
- They started stretching.
- They began using a cushion designed to keep the pelvis upright.
- They increased the amount of time they spent walking, but then started to develop lower back pain while walking.
Various tests are performed to identify the cause. Each part of the body has a normal range of motion. If a part cannot move as it should, or if it is harder to move in one direction than the other, that may be contributing to the pain.
Examination results
The examination showed that factors leading to a hunched posture were present across a wide area, including the legs, chest, and neck.
This test checks the tightness of the muscles at the back of the thighs (the hamstrings).
Ideally, both hands should reach the floor, but that was not possible here.
When the backs of the thighs are tight, the pelvis tends to tilt backward, which makes the lower back and mid-back more likely to round while sitting.
It also became clear that the right thigh was tighter.
The thigh muscles are among the most powerful muscles in the body. They can change the position of the pelvis, and those pelvic changes affect all the way down to the feet—in this case creating a 2 cm difference in leg length.
Although the person complains of lower back pain, I do not touch the lower back from the start. There are two reasons for this.
① It can worsen inflammation and increase the number of visits needed
Massaging the lower back certainly improves circulation for a moment, so it feels good. However, the muscles producing the pain are inflamed, and pressing on them can make that inflammation worse. Once that happens, the pain continues constantly, and during treatment it becomes impossible to tell whether the symptoms are improving or not.
In that situation, you cannot tell on the spot whether the symptoms have improved, so you end up saying, “That’s enough for today. Please see how it goes for a while,” which leads to more clinic visits. Increasing the burden on the client is not desirable.
② The cause is often not where the pain is felt
When lower back pain is present, the real cause is often hidden in a distant area such as the neck, shoulders, or legs. Rubbing the lower back may feel pleasant, but it does not address the problem at its root.
Also, the painful muscles may sometimes be muscles that should not be loosened. In that case, more treatment only makes things worse.
For these two reasons, even though the person is complaining of lower back pain, I do not start by touching the lower back.
Treatment details
Here is an example of seitai treatment.
Many people think seitai is only about loosening muscles, but in fact it also involves adjusting joint movement. That is because joints that do not move well can themselves cause muscles to become tight.
In this illustration, the areas where spinal movement is restricted are identified and joint movement is encouraged. When the adjustment is done properly, the pain disappears on the spot.
In this case, the problem created by the back had affected the abdomen on the opposite side of the body, leaving the abdomen unable to expand and contract properly.
On re-examination afterward, the abdominal tension had disappeared, and neck movement while looking up at the ceiling had returned to the normal range.
This leaves the body less likely to become hunched over while sitting.
The person then tries again the movements that were painful during the pre-treatment examination. We ask them to confirm for themselves that none of those movements now cause a problem.
Pain often comes from the way the body is used in daily life—in other words, from lifestyle habits. Sitting restricts blood flow in the lower body, so it not only worsens the condition of the muscles but can also affect lifespan. I explained what to be careful about when sitting for long periods and how daily stretching and training help prevent recurrence. That completed the treatment.
In pain-related statistics, lower back pain ranks second among women and first among men.
When you are in pain, prioritize a position that causes less pain.
The cause of the pain is an imbalance in the muscles. When the balance is poor, even standing posture that is considered good for the body can cause pain. Neither posture will necessarily reduce the pain.
While it's clear that standing puts less strain on your muscles and is better for your health, there are two things you should be aware of.
The first is that staying in the same position for a long period of time is a strain.
Even if you are standing, staying in the same position for a long time puts a strain on your body. If you try working at a desk while standing, you will find that your posture will deteriorate after 10 minutes.
You may not realize it, but your muscles can no longer maintain the same posture, causing you to shift your weight onto one leg or slump one shoulder. This is because humans are not designed to stay in one position for long periods of time. Therefore, it is recommended that you alternate between sitting and standing.
Second, tasks that require you to hold your hands out in front of your body require you to maintain a strained posture.
This is true whether you're standing or sitting, so if you're hoping that standing at your desk will solve your back pain, you might be disappointed.
It is important to stop working at your desk, even if it is just for a short time, and return to a posture that is not straining you. We recommend frequently alternating between sitting and standing.
Here's a summary of whether standing or sitting is better when you have lower back pain:
Unless you correct the muscle imbalance, the problem won't be solved.
- If you stay in the same position for a long time, even if you are standing, you will get back pain.
- Desk work itself puts a lot of strain on the body, and even standing can cause back pain. "}},{"@type":"Question","name":"How often should I stand up?","acceptedAnswer":{"@type":"Answer","text":"
Once every 15 minutes. Don't just stand, move your lower body.
As long as your body is moving, even a little, your muscles are active and your metabolism will not slow down. However, when you sit, the activity of the muscles in your lower body stops completely. This reduces blood flow to the muscles, making them more likely to lose flexibility. This can also lead to chronic inflammation, which can cause various illnesses.
Furthermore, it affects maximal oxygen uptake, the maximum amount of oxygen the body can use. Maximum oxygen uptake affects the amount of energy produced by mitochondria in cells, and is related to the risk of heart disease and death.
A 2003 study found that prolonged sitting reduces VO2 max, with a sedentary 50-year-old's VO2 max being similar to that of an active 80-year-old.
This leads one to wonder if exercising during non-working hours would lower the risk of death, but a 2009 study found that no matter how much exercise one does, there is no change in the risk of death.
Therefore, if you have a habit of sitting continuously, get up from your chair every 15 minutes and do some stretching or other exercise that moves your lower body.
Steps for solving the problem through seitai
The way we use our bodies today has been shaped by everything we have experienced since childhood—play, sports, accidents, childbirth, and many other events.
If you are in pain, it is simply your body’s way of telling you that there has been a problem with how you have been using it up to now.
The first stage in solving the problem is to stop the pain. Once the cause has been identified through examination and treatment is provided accordingly, the pain will ease. Only after the pain has improved is your body ready to learn correct movement patterns.
The second stage is learning how to use your body correctly. This gradually changes both the body and the brain so that you do not return to the way you were before.
Because physical pain is often caused by lifestyle habits, stretching and exercise become necessary. Just like brushing your teeth, steady repetition is important.
If you want to solve pain, the first step is to stop the pain. Stretching and exercise come after that.
