Monday, August 12, 2019

Patient Can Run 10 Km In An Hour But Can't Stand For 30 Minutes

My patient came in complaining that she can run for an hour with no pain/ problems. However, when she had stand in line at the security checkpoint at the airport for barely 30 minutes, her back started to hurt. So why does standing often feel harder than running?

We all have to queue at some point or other in our life. Especially in Singapore, whether it's waiting in line for your favorite food or lining up for the the Bicentennial 20 dollar note that was launched recently. Or at the airport.
Queuing for the Bicentennial note
When we are walking or running, our muscles contract and relax (or flex and extend). When we stand still in upright position, we are lengthening (or straightening) our hip flexor muscles in a sustained position. After a while in that position the Psoas and Illiacus muscles fatigue. The human body is made to move, it is not made to be in stationary postures.
Psoas and Illiacus muscles
If if you hold your hand straight in front of you, they fatigue quickly. This would be similar if you're standing still.

Some people stand with they knees hyperextended, this can further extend your hip flexors and in some cases makes an arch (in the foot) drop a little (although I personally don't think it is necessarily bad).

You can easily remedy the above by standing with "soft knees". Bend the knees slightly about five degrees or so, just so you don't hyperextend them.This helps to distribute your weight more evenly.

Research shows that nearly 50 percent of people develop some kind of back pain from excessive standing, even if they have never experience back pain previously or had a previous injury.

Taking walking breaks for five minutes every 30 minutes can help alleviate the back pain you get from standing. This is from the small movements your spine gets from walking. (have a look at our previous article on how running can be good for your back). Subjects that walked (faster than  a stroll), but slower than a run had less low back pain after two hours of standing compared to those who just stood.

If you can't take a walking break, other ways to dissipate forces from accumulating in your back include placing your foot on a curb or ledge. Keep alternating legs to reduce load on different sides of your back.

I used to work at the old Raffles Hotel for a couple of months while waiting for my exam results and I did the breakfast shift at the main restaurant and night shifts in the then "Tiger Tavern" and Long Bar.
Foot rest at the Long Bar in Raffles Hotel
There was a foot rest all around the bar counter for patrons to rest their foot. So they can linger in the bar longer. Now you and I know why.


Gallagher KM, Payne M et al (2019). Walking Breaks Can Reduce Prolonged Standing Induced Low Back Pain. Human Movt Sci.  66 : 31-33. DOI: 10.1016/j.humov.2019.03.012

Some history for you readers. The Tiger Tavern was named after a tiger was killed in the old Raffles Hotel.

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