The Deleterious Effects of Sitting

*Update as of 12/25/13 – This article was written several years ago. Since then, I’ve learned a lot more about both spinal biomechanics and the topic of pain. I’ve come to realize that sitting isn’t as bad for back pain as it’s made out to be. Please read some of the more up to date articles on this blog in the “low back reconditioning” category. Nevertheless, there is still some very good information in this article. 

Although we’ve known since a study was published by Kelsey in 1975 that those who spend over half their day sitting experience higher incidences of herniated discs, time spent sitting continues to rise over the years. It’s a byproduct of the technological age and will most likely keep getting worse as time passes..

Devolution

Our species put forth a lot of time and effort toward promoting adaptations that allowed us to exhibit upright postures and use our glutei maximi to powerfully propel the hips rearward via hip extension. Although there are at least twelve distinct hypotheses as to why and how bipedalism evolved in humans (postural feeding hypothesis, provisioning model, threat display, vigilance against predators, sexual selection, male phallic display, thermoregulatory model, carrying models, wading models, changes in climate/habitat, etc.), suffice to say that bipedalism appears to be a critical component to our survival as a species.

According to Wikipedia, “Devolution”, “de-evolution”, or “backward evolution” is the notion that a species can change into a more “primitive” form. It is associated with the idea that evolution is supposed to make species more advanced, and that some modern species have lost functions or complexity and seem to be degenerate forms of their ancestors. This view is rejected by modern evolutionary theory, in which adaptation arises from natural selection of forms best suited to the environment, and so can lead to loss of features when these features are costly to maintain.

Devolution presumes that there is somehow a preferred hierarchy of structure and function, and that evolution must mean “progress” to “more advanced” organisms. For example, it could be said that “feet are better than hooves” or “lungs are better than gills”, so that change to the “less advanced” structure would be called “devolution”. A modern biologist sees all such changes as evolution, since for the organisms possessing the changed structures, each is a useful adaptation to their circumstances.

So even though there may be no such thing as “devolution,” it appears that we are indeed reverting back to our ancestral roots, as an upright posture may no longer be necessary in today’s sedentary world. Perhaps it’s too cost effective and we will continue evolving into creatures whose natural postures are more akin to the fetal position to allow for more efficiency in sitting. Unfortunately, until our skeletal structures adapt to these adaptations, our low backs pay a price for the alarming amounts of stooping, hunching over, and sitting that we undergo in today’s society.

Some Facts About Low Back Pain

• Back pain is the second most common reason for visits to the doctor’s office, second to upper respiratory infections

• Americans spend over $100 billion annually on medical bills, disability, and lost productivity related to lower back pain

• At least 85% of the American population will experience back pain at some point in their lives

• At least 85% of the American population will develop disc degeneration disease by the age of 50 years old

• At any given time, around 25% of the American population is experiencing low back pain

• Low back pain is the most common reason for lost playing time in sports

• Some evidence indicates that at least 94% of low back disorders is mechanical in nature (Waddell)

Now let’s break down the biomechanics and physiological repercussions of sitting

How Much are We Sitting and What are Some Physiological Concerns Associated With Too Much Sitting?

• A 2003 and 2004 U.S. Census showed that Americans spend an average of 56 hours per week sitting. This equates to half of one’s waking hours (8 hours per day). Another study showed that the British spend 15 hours per day sitting when totaling up the hours spent sitting at work, in transit, watching television, working on a computer, eating dinner, and reading. Finally, another study showed that Australians workers spend around 9.5 hours sitting. Researchers have dubbed this epidemic “The Sitting Disease.”

• When sitting, the large postural muscles of the back and legs are shut off which reduces fat-burning enzymes by 50%. Sitting also decreases the HDL:LDL cholesterol ratio, increases the risk of contracting diabetes by 7% for every 2 hours of sitting per day, increases the risk of heart disease, increases the incidents of depression, increases the risk of acquiring metabolic syndrome by 26% for every hour spent sitting irrespective of the quantity of moderate exercise performed (as shown by Australian researchers) and decreases lifespan (as shown by Canadian researchers involving a twelve-year, 17,000 person study as well as by Australian researchers involving a six-year, 8,800 person study). In addition, prolonged sitting increases incidences of discomfort (including back pain, muscle tenderness and aches, stiff necks, and numbness in the legs, chronic disorders, arthritis, inflamed tendons, chronic joint degeneration, impaired circulation, varicose veins, hypertension, obesity, cancer, high blood triglycerides, high blood sugar, osteoporosis, and herniated discs (Graf et al. 1993 and 1995, Grandjean 1987, Kelsey 1975).

• According to Missouri microbiologist Marc Hamilton, “If you’re standing around and puttering, you recruit specialized muscles designed for postural support that never tire. They’re unique in that the nervous system recruits them for low-intensity activity and they’re very rich in enzymes.” One enzyme, lipoprotein lipase, grabs fat and cholesterol from the blood, burning the fat into energy while shifting the cholesterol from LDL (the bad kind) to HDL (the healthy kind). When you sit, the muscles are relaxed, and enzyme activity drops by 90% to 95%, leaving fat to camp out in the bloodstream. Within a couple hours of sitting, healthy cholesterol plummets by 20%.”

• According to Galen Cranz, a professor at the University of California at Berkeley, “Short of sitting on a spike, you can’t do much worse than a standard office chair. The spine wasn’t meant to stay for long periods in a seated position. Generally speaking, the slight S-shape of the spine serves us well. “If you think about a heavy weight on a C or S, which is going to collapse more easily? The C,” she says. But when you sit, the lower lumbar curve collapses, turning the spine’s natural S-shape into a C, hampering the abdominal and back musculature that support the body. The body is left to slouch, and the lateral and oblique muscles grow weak and unable to support it.”

• Some researchers have created a new model or paradigm called “inactivity physiology”. It establishes that sitting and non-muscular activity may independently boost the risk of ill health, and that sedentary behavior is a separate class of behavior with specific consequences for ill health. These are different than those caused by taking too little exercise.

A Cascade of Biomechanical Repercussions from Sitting

• Sitting is static stretching for the back

• What gets stretched? All the soft tissue from the center of the discs to the back of the body. This means all of the muscle, fascia, tendons, ligaments, and disc material/cartilage that lies posterior to the center of the lumbar discs

• This leads to joint laxity and ligamentous instability of the lumbar spine as the ligaments are no longer taut enough to correctly perform their job

• This also causes the posterior wall (annulus) of the disc to stretch, thin, and weaken, in addition to causing the disc nuclei to migrate posteriorly and exert pressure upon the weakened annulus, which creates disc bulges and herniations that protrude into the spinal column and can ultimately lead to extreme levels of pain. Tears and herniations are almost always posterior-ipsilateral in nature

• Pain leads to muscular inhibition and altered motor programming

• Sitting can force the body’s natural posture to exhibit lumbar flexion and posterior pelvic tilt, which is akin to a constant flexion moment on the lumbar discs and constant strain on the soft-tissue at the back of the spinal column

• This posterior pelvic tilt is the number one cause of mechanical dysfunction in the lumbar spine

• What else shortens? The hip flexor and hamstring muscles. This is known as “Adaptive Shortening.” Shortened muscles become dominant muscles

• An overactive psoas creates strong compressive forces upon the lumbar spine every time it contracts

• A tight psoas leads to decreased hip extension range of motion and therefore decreased glute activation from a mechanical perspective

• A tight psoas leads to what’s known as “Reciprocal Inhibition” which leads to decreased glute activation from a neural perspective, which is pronounced by the inhibition due to low back pain

• Compression of the glutes incurred while sitting also inhibits the glutes

• Decreased glute activation leads to what’s been coined, “Gluteal Amnesia”

• Gluteal Amnesia leads to flat (atrophied) and weak buttocks

• Weak glutes lead to what’s known as “Synergistic Dominance.” Synergists are “helpers” of the glutes which include the erector spinae, hamstrings, quads, and adductors depending on the movement

• Since the glutes aren’t functioning optimally and the hips “lock up” due to tight muscles, movement patters erode – more forward knee bend and lumbar rounding and less hip extension during squatting and standing from a chair, less hip extension and glute “pushing” and more hamstring “pulling” during gait, more lumbar extension and less hip extension when picking something up from off the ground, doing yard work, and deadlifting, etc. The erector spinae become prime movers rather than stabilizers in most movement patterns

• Synergistic Dominance leads to “Pattern Overload” which creates more pain

• Pattern Overload leads to tissue trauma, inflammation, spasm, trigger points, adhesions, altered motor patterns, and more muscular imbalance

• Spasms, trigger points, and adhesions lead to less movement and more sitting

• More sitting and less activity leads to detrimental postural adaptations in the form of flattened lumbar curve, kyphosis, posterior pelvic tilt, forward head posture, diminished mobility at the ankles, hips, thoracic spine, and shoulders, inflexibility of the hamstrings, hip flexors, and hip rotators, and weak glutes and core musculature

• Any attempts to exercise with considerable intensity or duration in this state leads to pain and possibly injury, especially at the hamstrings, groin, low back, knees, and shoulders

• Problems in one area of the body lead to problems in other areas of the body. If a misalignment exists in one segment of the kinetic chain, predictable patterns of dysfunction known as “Serial Distortion Patterns” throughout the entire kinetic chain will ensue, which compromise the body’s structural integrity both above and below the misaligned segment. For example weak upper glutes cause knee pain due to their inability to control the femur from being pulled into valgus (inward) when squatting, climbing, and jumping

• Dormant and weak muscles atrophy, which decreases the metabolic rate

• Decreases in metabolism leads to increases in body weight and body fat, which puts more stress on the joints and leads to increased pain and muscular inhibition

• The cycle repeats itself and the individual’s physique, movement patterns, posture, and performance capabilities enter into a continuous downward spiral

• In short, sitting changes the way we move and changes the way our bodies function

The Lumbar Spine – The Ultimate Compensator

As alluded to earlier, the lumbar spine is an amazing segment. It can and will compensate for lack of mobility found in many of the body’s major joints including the ankles, hips, thoracic spine, scapulae, and shoulders.

Let’s look at the hip. If your hip flexors are too tight and you can’t extend your hips (think of gait, hip thrusts, or back extensions), don’t worry; the lumbar spine will extend to pick up the slack. If your hamstrings are too tight and you can’t flex the hips (think of bending over in a deadlift or back extension), don’t worry; the lumbar spine will flex to make up the difference. In fact, the lumbar spine will compensate for any of the six actions of the hip; extension, flexion, external rotation, internal rotation, abduction, and adduction. If you have poor hip rotation and you play golf, where do you think you’ll get the extra range of motion when you swing the club and your hip mobility “runs out”? You’ll get it from the lumbar spine!

At the ankle joint, inadequate ankle dorsiflexion (toe to shin mobility) causes excessive forward lean and low back rounding in a squat. At the thoracic spine, inadequate thoracic extension can force the low back to extend during any exercise where you have to “keep the chest up,” including bent over rows, deadlifts, good mornings, squats, front squats, and overhead squats. Poor upward rotation of the scapulae will cause the low back to extend during overhead pressing. Insufficient external rotation at the shoulder joint will cause the low back to extend while holding onto the bar during a squat. These are just some of the movements that are performed by the lumbar spine that should be performed by other joints. If you lack mobility in key joints, the lumbar spine will contort to get you from point A to point B.

It should be mentioned that the low back musculature including the erector spinae, quadratus lumborum, multifidi, as well as the lats, glutes, rectus abdominis, external and internal obliques, transverse abdominis, diaphragm, and pelvic floor muscles should contract to keep the core tight, produce intra-abdominal pressure (IAP), efficiently transfer energy from one half of the body to the other, and prevent energy leaks during strength training and high-velocity sporting movement. However, the core should usually be braced isometrically and should not move much concentrically or eccentrically in any direction (flexion, extension, lateral flexion, rotation, etc.). While a standard “arch” is a good thing during heavy compressive loading, there’s a fine line between arching and hyperextending the lumbar spine. Contracting the erector spinae is wise, but overarching is unwise as it places the posterior elements of the spine under too much stress and will likely lead to damage and injury over time.

So we know that inflexible muscles (which can be either short or stiff due to excessive tone) can cause the low back to come into play as a “substitute.” But weak muscles can also cause the low back to move, even in the presence of perfect flexibility and mobility. Weak glutes will force an individual to lift with their low back, run with their hamstrings, and squat with their quads. A weak core will cause the low back to collapse and “leak” energy.

What’s the big deal, you might say? Who cares how someone gets from point A to point B as long as they make it? Due to their larger structure and the fact that they support much of the body’s weight, they take a serious beating when they move around at high velocities, under high load, or for sustained periods of time. So you need substantial flexibility, mobility, stability, and strength at the hips in addition to adequate core stability in order to spare your lumbar spine.

In summary, healthy, mobile, and stabile joints spare the lumbar spine. But it takes more than just mechanical efficiency. You also need neural efficiency. Sometimes sparing the spine is a simple matter of motor reprogramming. Many individuals possess adequate joint mobility and stability, yet they still move too much in their lumbar spines and too little in their hips and thoracic spines. These folks need to be taught proper movement mechanics and exercise form.

After working with beginners for an entire session many times they can learn how to stabilize their spine through bracing and move solely at the hips during various exercises and movement patterns such as hip abduction and external rotation movements, quadruped hip extension movements, supine bridging movements, squatting movements, deadlifting movements, lunging movements, and back extension movements. Upon learning proper form many of these individuals will remark that they “finally feel the exercise working the right muscles.” The body wants to take the path of least resistance. It is more cost effective physiologically to stoop rather than squat (Garg and Herrin 1979). You must override your brain’s default signals and teach it to automatically resort to proper motor programs.

How to Reverse and Bulletproof Against the Negative Adaptations Imposed by Sitting

Stop Bad Adaptations

• Less sitting, more standing, more movement. Motion is good (Holm and Nachemson 1983). Sitting is evil (Videman et al. 1990). Sitting has been proven to increase intradiscal pressure over standing (Nachemson, 1966), increase posterior annulus strain (Pope et al. 1977), cause tissue creep in posterior passive structures which decreases anteroposterior stiffness and increases shearing movement (McGill and Brown 1992, Schultz et al. 1979), and cause a posterior migration of the mechanical fulcrum which reduces the mechanical advantage of the extensor muscles and increases compressive load (Wilder et al. 1988)

• Take mini-breaks from sitting, as sitting or stooping severely compromises lumbar stability (McGill 1999). Don’t set for more than 50 minutes at a time. Even standing for 10-20 seconds in a relaxed posture and then stretching overhead (lumbar extension) and then perhaps some neck rolls and windmills briefly and some walking helps a lot as it allows time for the disc nuclei to redistribute which reduces annular stress and to allow for some recovery of ligament stiffness. Athletes on the bench should sit on taller benches to reduce lumbar flexion, stand and pace every 20 minutes. If your work requires standing, dynamic effort, take frequent breaks to relax and possibly stretch. Too much of any single activity is undesirable and dangerous. Opposite loading is key (Krismer et al. 2001)

• Consider your spinal posture at all times (sitting, standing, sleeping, etc.) and know when you are extending, flexing, rotating, laterally flexing, and combining movements. Even pelvic tilting during sexual intercourse is associated with lumbar flexion! Learn the different spinal movements and how they feel. Knowledge is power (Preuss et al. 2005)

• Switch posture frequently to prevent tissue creep and injury (Liira et al. 1996, Callaghan and McGill 2001) and to avoid diminished disc nutrition which can lead to herniations (Buckwalter 1995). Don’t sit in one posture for more than 10 minutes at a time

• For the majority of time spent sitting (not all the time as it’s important to alter posture every so often), try to maintain a normal lordotic position since such a posture helps to balance the loads on various spinal structures. A good idea is to have 90 degree angles at the ankles, knees, and hips with an erect torso. A 1997 study by Hedman and Ferney subjected 12 lumbar spines to constant loading while in flexed and extended seated postures for 30 minutes with 500 N. Forces on the anterior column and the facets were measured. Forces on the posterior ligaments, the disc shear and the facet impingement forces were computed via a quasi-static analysis from the data. The authors of this study concluded that the “minimization of disc shear, tolerable levels of ligamentous tension, lower disc loads and a balancing of facet impingement and articular fact forces were found to be characteristics of prolonged erect sitting in this study. Based on these results, one would expect that the extended seated posture would reduce exasperation of tissues as compared to flexed postures.” They also concluded that the increased load on the tissues of the lumbar intervertebral joints in the flexed seated posture would likely result in increased degenerative changes. The results of this study were as follows:

1. Mean facet force in the L4/5 joints was greater in the extended seated posture (50.7 +/- 32.2 N) than in the flexed posture (5.6+/- 7.5N).
2. Mean anterior disc compressive force was greater in the flexed posture (165+/-133N) than in the extended posture 53.0+/-46.9N).
3. There was no significant difference between the two postures in posterior disc force (flexed=165 / extended=127N).
4. Vertical creep was increased in the extended posture (3.22mm) as compared with the flexed posture (2.11mm).
5. Disc shear and ligamental forces were higher in the flexed posture than in the extended posture.
6. Anterior column force increased 32% in the flexed posture and 28% in the extended posture over the 30 minute experiment.
7. An increase in facet force (65%) in the extended posture after 30 minutes was offset by a decrease in facet impingement force (27%) such that the net increase in facet force was only 1%.
8. The ligament tension in both postures increased substantially (183% in extension and 153% in flexion) due to creep loading. The posterior ligament force in the flexed posture, however, remained roughly 3 times the anterior ligament force in the extended posture over the period of the experiment.
9. Disc shear force increased 9% in the flexed posture and decreased 75% in the extended posture.

• Refrain from conducting any activities, exercises, or postures that cause low back pain to flare-up. If your low back acts up, cease the aggravating activity immediately

• Avoid prolonged stooping and deviated postures as they increase the risk of injury (Adams, Hutton, and Stout, 1980, Prunett et al. 1991, McGill and Brown, 1992, Marras et al. 1993, McGill 1997, Wilder et al. 1988)

• Avoid repetitive lumbar flexion as it has been shown to be the damaging mechanism leading to herniations as the nucleus inside the disc breaches the annulus layer by layer with progressive delamination of the layers (Callaghan and McGill 2001, McGill et al. 2007, Tampier 2007). In fact, McGill’s labs have repeatedly shown that under low compressive loading around 18,000 – 25,000 flexion/extension cycles usually lead to disc herniations (and 5,000 cycles with high loading)

• Avoid frequently bending and twisting the low back (U.S. Dept of Labor 1982, Andersson 1981, Marras et al. 1995, Punnet et a. 1991, Snook 1982, Aultman et al. 2004)

• Avoid stretching the low back; chances are it already has too much ROM and increased lumbar mobility puts people at greater risk for low back injury (Battie et al. 1990, Biering-Sorenson 1984, Burton, Tillotson, and Troup, 1989, Parks et al. 2003)

• Do not practice abdominal hollowing while lifting as it has been shown to reduce spinal stability (McGill 2009) and reduce training efficacy (Koumantakis 2005). Instead, learn the bracing technique

• Avoid lumbar hyperextension under high load or velocity as it may increase the incidents of damage to the posterior elements (pedicles, laminae, spinous processes, and facet joints) of the low back (Hardcastle et al. 1992, Bono 2004)

• Avoid round-back lifting, according to Zatsiorsky round-back deadlifting imposed 66% more compression than arched-back deadlifting. Learn to hinge at the hips. McGill has noted that weightlifters “lock up the lumbar spine close to neutral and rotate almost entirely about the hips,” whereas most normal people bend over by flexing a combination of their hips and low back. Lumbar flexion is most likely more dangerous when standing and bending forward as in a heavy deadlift than it is when lying supine and bending upward as in a crunch as there is a “flexion-relaxation phenomenon” that occurs when standing and bending over where the lumbar erectors shut down near full flexion. The erectors contract eccentrically to allow the bending and then relax completely at end-range flexion which shunts the load to the passive structures which includes the discs (although myoelectrically silent, the lumbar erectors still contribute some elastic stability through the stretching of their tissues according to McGill). Internal pressure on the lumbar discs is 15 psi when lying supine and 334 psi when lifting 20 kg with a rounded back (Wilke et al. 1999)

• Avoid combined spinal movements especially under load. Disc prolapses were produced in human cadaver lumbar spines by combining lumbar flexion and lateral bending with sudden compressive loading (White & Panjabi) as well as with lumbar flexion and torsion (Gordon et al. 1991). When just supporting in the extension axis, supporting 50 Nm was shown to impose 800 N of spinal compression. Supporting 50 Nm in the lateral bend axis was shown to impose 1,400 N of spinal compression. But supporting 50 Nm in the axial twist axis would impose over 3,000 N of spinal compression if induced while extending during lifting (McGill 1997). Since there are no muscles specifically designed for axial twisting, a bunch of muscles contract to help out which increases compression

• Don’t train in the early morning when discs are hyper-hydrated as disc bending stresses increase by 300% and ligaments by 80% due to the increased disc-height (Adams et al. 1987). After just 30 minutes of waking discs lose 54% of the loss of daily disc height/water content (Reilly et al. 1984) and 90% within the first hour. Early spinal motion is unsafe (Adams and Dolan 1995). Avoiding lumbar flexion in the morning has been shown to reduce back pain symptoms (Snook et al. 1998). Play it safe and train 2 hours after waking

• Make sure the abdominals and obliques are strong, not just the erector spinae. Imbalance is problematic (McGill et al. 2003)

• Learn how to breathe properly while stabilizing a load (McGill et al. 1995)

• When picking something up from off the ground, place the load as close to the body as possible to reduce the reaction moment, reduce the subsequent extensor forces and resultant compressive joint loading, and prevent entering into lumbar flexion/spinal buckling

• Learn how to brace the core, engage the inner core unit (transverse abdominis, multifidus, diaphragm, and pelvic floor) and outer core unit (glutes, lats, LDF, rectus abdominis, internal and external obliques, quadratus lumborum, etc.) via integrated movement, and properly develop intra-abdominal pressure (IAP). The beliefs regarding IAP are all over the place, with Zatsiorsky stating that IAP can reduce pressure on the discs by an average of 20% and up to 40% in extreme cases, McGill believing this data is greatly overexaggerated (although he sees merit in IAP for increased trunk stiffness, decreased tissue strain, and failure from buckling), and Bogduk stating that our beliefs about IAP are flawed as research shows that 1) IAP doesn’t correlate well with the magnitude of the load being lifted or the applied stress on the vertebral column as measured by intradiscal pressure, 2) The Valsalva maneuver has been shown to increase loading on the lumbar spine, as has raising IAP 3) Abdominal strength and IAP is poorly correlated, and 4) Strengthening of the abdominals has not shown to increase IAP during lifting. Although the research on IAP seems pretty dismal, Siff states that the lungs should be filled to about 75% of their maximum capacity for the interval when muscle tension is highest. This jives with what most powerlifters believe.

• Always use proper form! Failure to do so is not only dangerous but it reinforces bad technique (Cholewicki and McGill 1996). Practice doesn’t make perfect, it makes permanent. Learn to use the legs and hips while keeping the back stiff while lifting. Learn how to sit back and keep the knees out and chest up in a squat. Learn how to hinge at the hips while keeping the chest up in a deadlift. Learn how to take long strides while staying upright in a lunge. Learn how to move at the hips and not the lumbar spine in a hip thrust. Learn how to rotate at the thoracic spine and not the lumbar spine in a cable chop or lift. Get strong everywhere to eliminate energy links. According to Siff, “Spinal flexion during heavy lifts from the ground can damage the intervertebral discs, so competent lifters strive to diminish the flattening of the lumbar spine by actively concentration on increasing erector spinae tension. If this is overdone, the various spinal ligaments become slack and most of the load is borne by the muscles. Conversely, if the muscles are inadequately contracted, then excessive stress is placed on the ligaments. The skilled lifter is able to optimize the required balance between the spinal muscles and ligaments, thereby enhancing lifting efficiency and diminishing the likelihood of injury.”

Reverse Bad Adaptations

• A multi-pronged approach consisting of varying types of drills, stretches, and strengthening exercises is an effective route to improved back health (Saal and Saal 1989). Proper exercise selection is critical (Linton and van Tulder 2001)

• Get a FMS or similar evaluation – a Functional Movement Screen can identify asymmetries and limitations in fundamental movement patterns which can lead to a specialized corrective exercise plan tailored to the individual

• Engage in SMR or body work – this is important as it can reduce excessive tone, alleviate trigger points, break up adhesions, and reduce spasms

• Engage in static stretching for the hip, shoulder, and ankle musculature – this is important as it can prevent and reverse the effects of adaptive shortening. It is usually not necessary to stretch the spinal column which can sometimes do more harm than good as it can diminish the stretch reflex and lead to spasm (Solomonow et al. 2002)

• Engage in mobility drills for the ankle, hip, t-spine, shoulders, and scapulae – this is important as it can prevent losses in mobility and restore the body to it’s natural state of mobility

• Engage in activation work for the glutes, psoas, serratus anterior, and low traps – this is important as it can “wake-up” dormant muscles and teach them to contract more easily which can then be coordinated into more integrated movement

• Engage in core stability work – this has been shown to be more effective than traditional abdominal full range movement (Hides, Jull, Richardson 2001, Saal and Saal 1989, Koumantakis et al. 2005). Learn to stabilize the core from all directionl load vectors including axial, anteroposterior, mediolateral, torsional. Hernations occur at full end range-of-motion so it’s important to be able to prevent forces from taking you into those extreme ROM’s (Adams and Hutton, 1982). Muscles that attach to the spine are like guy-wires that form the rigging on a ship’s mast which brace the spine and prevent it from buckling, There are many torso and core muscles are well-suited for lumbar stabilization (Crisco and Panjabi 1990, Cholewicki and McGill 1996, Cholewicki, Juluru, and McGill 1999, Gardner-Morse, Stokes, and Laible 1995, Macintosh and Bogduk 1987, McGill and Norman 1987). Spine stability is greatly enhanced by co-contraction or co-activation of antagonistic trunk muscles (Cholewicki and McGill, 1996). Co-contractions increase spinal compressive load as much as 12–18% or 440 N, but they increase spinal stability even more by 36–64% or 2925 N (Granata and Marras, 2000)

• Learn to apply the appropriate level of bracing for the task at hand. For menial tasks, usually co-contraction in the amount of 5-10% of MVC for the supporting core musculature is sufficient in stabilizing the spine and enhancing spinal stiffness. Contracting too hard is unnecessary. Remember, contracting the core muscles via bracing imposes a penalty on the spine via increased compression. This penalty is worth it in order to resist buckling and prevent unstable behavior. The level of co-contraction depends on the task

• Look into the McKenzie method as it is possible to reverse some of the negative adaptations of sitting and to allow the discs’ nuclei to “equilibriate” (Scannell and McGill, 2005)

Bulletproof Against Bad Adaptations

• Increase back endurance; people with back pain have stronger than normal backs, but they need more back endurance (Biering-Sorenson 1984, Nicolaisen and Jorgenson 1985, Holmstrom and Moritz 1992, Alaranta et al. 1994, Luoto et al. 1995, McGill et al. 2003)

• Get strong glutes! It is this author’s opinion that if you get strong glutes, the body uses those glutes for lifting and the low back is used as a stiffened transducer to transfer energy. Strong, properly functioning glutes may be the most important facet of lower back health as the glutes are the ultimate sparers of the spine

• Get strong in a variety of load vectors. Wolff’s and Davis’ laws state that tissue conforms to the lines of stress it receives. We want our tissue to be strong and prepared for all directions of force. We know that bone (Carter 1985), ligament (Woo, Gomez, and Akeson 1985), disc (Porter 1992), and vertebrae (Brinckman, Biggemann, and Hilweg 1989) in addition to tendon and fascia remodel themselves according to the directions and magnitude of stress to which they’re subjected

• Lose bodyfat. Most people are muscularly-skinny and weak yet they are forced to carry around a giant sack of fat with them everywhere they go. This weighs them down, puts more pressure on their joints, and causes fatigue which leads to breakdowns in posture and mechanics. According to the CDC, 67% of Americans are either overweight or obese

• Master simple drills, postures, and exercises, then gradually progression to more advanced drill, postures, and exercises. This might mean to advance from static to dynamic, isolative to integrative, and bodyweight resistance to external resistance. Gradually increase range of motion, duration, number of repetitions, volume, intensity, loading, etc. Too much axial loading too quick can result in endplate fractures and damaged vertebrae. Too much anteroposterior loading too quickly can lead to damages in the posterior elements of the spine or endplate avulsion. Inability to prevent the spine from buckling during heavy lifting can result in damages to discs, ligaments, disc annulus, and disc nucleus

Stop the Madness!

Hopefully this article has inspired you to stop sitting so much, start moving more, and start engaging in back-friendly practices.

51 Comments

  • dan conway says:

    Really great stuff Brett, but you should lose the puppy intro.

  • Thanks Dan. Is it that bad? I was trying to think of something that would get people to pay attention.

    • dan conway says:

      It certainly is an attention getter and it did not stop me from reading and enjoying the article. However, I hesitate to share the article with some of my more sensitive friends and relatives who I’m pretty sure would stop reading part way into the puppy intro.

  • MissMoxx says:

    It’s pretty twisted, even for me! …and I’m pretty twisted.
    Visions of puppy torture aside, it’s a GREAT post!
    While slightly traumatic, it commanded my attention, and is officially burned into my skull!
    The informative parts that is…in addition to the traumatic bits.

  • Zach says:

    wtf, did that actually happen? what kind of sick freak would do that to puppies? i really hope that was just a fictional metaphor, otherwise i hope they fry the bastard

  • Flo says:

    I think the puppy intro is pretty good for drawing attention. The sitting posture is one of the most damaging, yet common, habit in our day life. And it is a slow killer, indeed.

    Although I got lost at the end of the post in so many references, it was a good reading and thumbs up to your dedication, Bret, to document it so thoroughly.

    One question (or hypothesis), what one can do to correct the situation when he/she has the average sitting_9hrs_in_front_of_a_PC job? I’m trying to take breaks now and then and do some stretching around, but it really doesn’t do much…And oh ok, quitting the job for becoming a fitness trainer is not an option yet. 😛

  • Thanks Flo! Here’s the answer to your question:

    1. Change your posture often when you sit but most of the time sit with a normal lumbar curve with 90 degrees at ankles, knees, and hips and upright posture

    2. Take frequent breaks to stand, stretch, and walk around, never sit for over 50 minutes straight without breaking

    3. Make sure you exercise and move around regularly

    4. Begin each workout with a ten minute dynamic warm-up consisting of some mobility drills, activation drills, stretches, and movement prep

    5. Make sure you know how to keep the core tight and move at the hips

    6. Get strong glutes

    Taking breaks and stretching might do a lot for you but you just don’t realize it. Perhaps if you stopped you’d start experiencing more back pain. To reverse bad posture, inflexibility, and weak muscles, it takes dedication and patience. Just be consistent and gradually progress and you’ll be fine.

  • Ronald Berkamp says:

    Bret,

    One question…….

    In the quote “Most people are muscularly-skinny and weak yet they are forced to carry around a giant sack of fat with them everywhere they go”, what is muscularly skinny? I’m certain that you likely made a very clear point and I am just being dense, but I’d appreciate it if you’d humor me and clarify this for me.

    As always thanks for the time and the knowledge.

    • Thanks Ronald! That was a pretty poorly-worded phrase on my part. What I meant was this:

      Most people carry around a ton of bodyfat and if you stripped it all off of them, their level of muscularity wouldn’t be very impressive. So you’ve got a weak muscular system hauling around a huge sack of fat. Posture can erode pretty quickly in this scenario during intense workouts. Their energy systems may be able to hold up, but not their movement quality.

      Hope that makes sense!

  • Daniel says:

    Good info, not a bad metaphor, but it was unpleasant to read about the puppies.

    I have tried several chair and desks, also a standup desk and a threadmill desk. I made them myself, but I have deconstructed them.

    The best way to sit in my opinion is on the floor. I am now sitting on a boxing bag on the floor with a desk made of a plank and two blocks.

    I can easily switch postures and keep my lumbar spine straight. I can also easily do some yoga and stretches while working.

    I have had a herniation in my cervical spine, my physical therapists adviced me to work on my sitting posture. Instead of buying expensive equipment to work with, I have found a low tech solution that’s working for me.

    • Daniel, I sit on the floor a lot too and have found it beneficial. Some folks who have tight hip flexors or hammies might actually experience more low back pain in that position. A lot of times you can just have people sit up higher and it pulls them out of lumbar extension. For this reason, I switch around my posture, seat height, etc.

  • Daniel says:

    On your last point on progression from simple to advanced, Mike Robertson wrote an article how to progress on deadlifts, from pull throughs to RDLs etc.

    How would you do this on the other major exercises like squats, bend over rows, bench presses, overhead presses, pull ups?

    • Daniel, here are some of my progressions:

      Squat – high box squat, low box squat, free parallel squat, free full squat, goblet squat, back squat

      Deadlift – pull through, high rack pull, low rack pull, deadlift

      Pull up – band assisted pull up, eccentric pull up, pull up

      As far as bench press, overhead press, and bent over rows, you just start out light and work your way up (some folks have to start with dumbbells because the bar is too heavy for them).

  • nisha roady says:

    I wouldn’t have read the article but for the intro… and it tied into your point quickly and well. I would have thought… Yeah, yeah.. back pain, posture… I’ve heard it. and skipped right over your article. But I won’t forget this now and it is worth sharing with other people I know who spend too much time sitting at a computer.

  • rebecca says:

    ack! could not read the post because of the puppies.

    • Sorry Rebecca! I feel like a jerk. I’m a puppy lover, I promise. Anyway I urge you to continue reading because the rest of the article has some really good information.

  • Amazing post Bret – As usual!

  • Pjn says:

    What is the reason that fluid accumulates in the spine when sleeping? When I watch a movie, I always lie down on bed/sofa for couple of hours, I take it I shouldn’t go lifting straight after that? Do you have the titles of those research studies regarding fluid and spine?

  • Hi Bret.
    What a great article. I liked the intro because it did get my attention! It really hammers in how important it is to move. I have several back injuries and have had a long battle with back pain. Doctors usually want to give me drugs and say lay still, but I have learned over the years that this is a horrible downward spiral! I no longer have fear when my back hurts and find movement the cure! Just walking realigns me when I’m having trouble. I also use a swiss ball as my computer chair. It helps me to keep some movement when I am sitting..just bouncing a little and swiveling the hips has become a habit.
    I never really thought about the compression to my glutes and how that contributes, your article makes me want to immediately drop to the floor and do some weighted bridges!

  • Mark Young says:

    Great analogy Bret! The puppy stuff got my attention. Besides, in light of a local news story I read this morning, that was actually pretty tame. How sad is that?

    Anyway, super informative post man!

  • PolyisTCOandbanned says:

    1. Why are you against glute isolation machines. You just said they are for women. But some of your exercises look very similar to them. And if the person is not maxing the machine out, what’s wrong?

    2. Did the puppies go the the bathroom? Can this be tied into the analogy somehow?

    • I’m not so anti-glute isolation machines. As a matter of fact, I love the pendulum quadruped hip extension even for athletes and it is indeed a machine (pendulum). The problems with machines are that they aren’t always built for various heights and anthropometries and sometimes the weight stacks are too light to accommodate a stronger male. But if it fits the individual and they aren’t maxing out the machine, there’s nothing wrong with it as long as the individual isn’t relying solely on machines.

      As for the puppies going to the bathroom; I could have definitely tied that into the analogy and stirred up even more emotion. Glad I didn’t think of that.

      • PolyisTCOandbanned says:

        Very cool response. Like your articles. Keep after it. This stuff is really fascinating to learn about.

        On machines, my experience agrees. I have worked up to have to put 20 pounds on top of the entire stack. Even pre-exhusted from DL and doing 2 by 10, switching legs straight through. Eventually will run out of cable room (and am 5-8 and medium build). I have also noticed definite differences with different glute machines in terms of the “action” you get.

        I have added a few little things to help above the machines. I am going to try the hip extensions next. Have issues with quad dominant movement (squats, deadlifts) on my patella (missing cartilage). So really some of this stuff where you don’t use the quads (especially at 90 degrees) is appealing to me, from the “can’t squat, what to do instead perspecitve”

  • seanskahan says:

    Great post Bret- as usual. Great stuff.

  • Brendon says:

    Great stuff Brett and awesome facts all throughout the post. You do some amazing reading and research for your posts. And I just noticed, Thanks for adding me to your Blog Roll!

  • Pjn says:

    There has been research indicating that sitting on swiss balls is not that good… One article even claims it leads to spondolysis.

  • Hi there Bret! Puppies in vices, you are so cruel. Oh wait, that was not actually you that did it. ha! I thought the intro was fine, but you may have to add a disclaimer to it that “no real puppies were hurt and I made the whole story up” in nice big letters.

    Kudos to you for doing actual research into the literature on it. For uber geeks like myself, I still like to see the actual references at the end since I am lazy and can find them easily.

    If I were to sum up my thoughts on this, it appears that the lumbar spine is too stiff, except for a few hypermobile sections. This is what I normally see. The lumbar area only “hinges” at one point (L4/L5 area it seems) and this causes all sorts of issue.

    Ironically, although I will probably get tarred and feathered for this, I find that very low load lumbar FLEXION helps many with low back issues!

    I am not talking about tons of reps here, but a few to reverse the low back fixed position from sitting seems to help. The goal is to get some mobility in the other sections that are moving well.

    If the low back does not move all day, the body just goes “hey, I don’t need to move this area” and it gets stiff—just adaptation as you pointed out.

    I am sure we could find some cavemen bent over stone tablets too if we looked hard enough. Heck, I could argue that it is worse since the process is slow and requires much longer hours! ha!

    This along with optimizing their overall movement. If you look at the back force transmission line, you will see it crosses sides right at the SI joint; so screwed up movement anywhere in the body may lead to issues there around the low back.

    Like all things, there are studies to show that sitting is NOT the cause too

    Claus A, Hides J, Moseley GL, & Hodges P (2008). Sitting versus standing: does the intradiscal pressure cause disc degeneration or low back pain? Journal of electromyography and kinesiology, 18 (4), 550-8 PMID: 17346987

    Claus AP, Hides JA, Moseley GL, & Hodges PW (2009). Is ‘ideal’ sitting posture real? Measurement of spinal curves in four sitting postures. Manual therapy, 14 (4), 404-8 PMID: 18793867

    Roffey DM, Wai EK, Bishop P, Kwon BK, & Dagenais S (2010). Causal assessment of occupational sitting and low back pain: results of a systematic review. The spine journal , 10 (3), 252-61 PMID: 20097618

    Roffey DM, Wai EK, Bishop P, Kwon BK, & Dagenais S (2010). Causal assessment of occupational standing or walking and low back pain: results of a systematic review. The spine journal , 10 (3), 262-72 PMID: 20207335

    Hat tip to Dr. Moseley on the studies.

    Keep the great investigative fitness writing and I am interested more in your conclusions too!

    Rock on!
    Mike T Nelson PhD(c)
    http://extremehumanperformance.com

    • Hey Mike, I definitely should have added in the disclaimer! I intended on adding in the references at the end but I was too lazy! 🙁 Great thoughts on low back pain, sitting, etc. I need to read the articles you referenced. I appreciate the fact that you’re always out there (often sticking your neck out and going against the grain) standing up for what you believe in. You’ve got courage and I respect that. And it’s always good to have a PhD keeping us all in check. Thanks!

  • Tristan says:

    That was a great article. I have dealt and still somewhat still do deal with lower back problems to a degree. Everything in this article is spot on from my experience over the past year. In you training do you deal with a large amount of individuals with back issues and how do you go about working with them, especially post rehab/transitional?

    • I don’t train too many folks who suffer from chronic back pain, although some of them experience pain in certain situations. I always start by doing an FMS screening and then I get them up to par with mobility and stability through SMR, stretching, mobility drills, activation work, core stabilization, and general strength training. We just plug them into movement patterns at the level in which they belong and then gradually progress with ROM, repetitions, and resistance. Hope that helps!

  • Amir Siddiqui says:

    Hi Bret. Amir from Pakistan here. Just found your blog. Man, you go into DETAIL, don’t you? 🙂

    Really enjoy it though. Don’t stop.

    Amir

  • Great info Bret. I hope no puppies were injured in the making of this blog post;-)

  • Rob says:

    Great article Bret!

  • Thank you Amir, Robbie, and Rob! Much appreciated.

  • Tyciol says:

    This has a lot of useful tips.

  • Guinea Pig-Dave says:

    wow, what a great post. I know that I do too much sitting for work and other activities.

  • Brian says:

    Hey Bret,

    I just read the article and I was wondering if the sitting posture also negatively affects the ability for your glutes to recovery. After doing hip thrusts and other glute exercises it seems as though sitting on your butt would prevent those muscles from growing. Just wanted to know your thoughts on what you recommend for glute recovery.

  • Juan Rivera says:

    I respectfully inform you that you misspelled “vise”, the bench tool for “vice” the moral or character flaw.

    According to the Merriam-Webster dictionary:
    http://www.merriam-webster.com/dictionary/vise
    http://www.merriam-webster.com/dictionary/vice
    http://bretcontreras.com/2010/06/puppies-in-vices/

  • Chris W says:

    Bret, Thank you for the article. Very informative of causes, but no help for possible solutions. You regularly mention strengthening your core by mastering basic core movements and excercises. I was hoping for some links, vids, stretching or exercise advice. I am plagued with tight hips, but have plateaued, and work daily to try and free them. I read your entire article and, thought wonderful, another article of why this is happening, but now what do I do. We all no sitting is not good for us, what can you do to help us??????????????
    Thanks Chris

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