New Study Does Not Recommend Standing Desks

Picture from CMD

I have written previously on the ill effects of sitting and prolonged sitting. This has also led to the phrase that "sitting is the new smoking". Which subsequently led to standing desks as a 'trendy' option to offer a way to reduce sitting time.

Previously, some of my patients have also asked me to write a memo for them so they can get  their company to pay for a standing desk at work, while other patients have simply asked for my opinion.

My take on standing desks then? I've seen many of my patients go straight from sitting to a standing desk get different problems. Being unaccustomed on their feet all day long posed new risks. It can inhibit proper circulation and add additional pressure to your legs, hips and lower back. Sort of like jumping from the frying pan into the fire if you ask me.

My suggestions for these patients was not to switch to a standing desk for the full work day, especially if they have been sitting all day immediately. To make sure they gradually phase it in.

Like previous ergonomic chairs, desks etc, there hasn't been much evidence supporting the benefits of standing desks. The earlier limited studies did not comprehensively assess long term health consequences.

In a newly published study this month (Ahmadi et al, 2024), 83, 013 participants wore devices for up to 7 years to track their sitting, standing and physical activities. This was more accurate and objective than self reporting by subjects. The researchers found that sitting for more than 10 hours a day was associated with a higher risk of heart disease and stroke.

The researchers also found that standing more did not mitigate this risk of stroke and heart disease. In fact standing for extended periods was linked to a increased risk of circulatory problems. This suggested that simply changing from stationary sitting to standing will not solve the problem since our bodies respond better to movement rather than staying in static positions. Remember motion is lotion.

Workplace interventions that promote movement found that office workers who reduce sitting time by adding light walking and standing had improvements in blood sugar levels.

So, walk to your colleague to talk to them instead of calling or emailing, take the stairs often instead of elevators, walking to the pantry etc all contribute. Better still if you can do 10 bodyweight squats every 45 minutes. All these can make a significant difference.

Reference

Ahmadi MN, Coenen P, Straker L et al (2024). Device-measured Stationary Behaviour And Cardiovascular And Orthostatic Circulatory Disease Incidence.  Int J Epidemiol. 53(60: dyae136. DOI: 10.1093/ije/dyae136

*Note that the study's large population use and the use of devices to measure objective data strengthen the findings. However, observational studies may not totally establish cause and effect. Also since the average age of the subjects was about 61 years, it may not totally apply to younger popuplations.

Is Good Posture Just A Myth?

If 295 physiotherapists (from four countries) cannot even agree on which is the best sitting posture, then how can the average person know what is? 

Other than having the physiotherapists do a back beliefs questionnaire (BBQ), the above mentioned study had a range of nine sitting options ranging from slumped to upright sitting. 85 percent of the physiotherapists surveyed selected one of two postures as 'best', with one posture being selected more significantly than the other. 

However, those two frequently selected postures were very different to say the least. The physiotherapists who selected the more upright posture had more negative low back pain beliefs in the BBQ. The main differences were what constitutes what a 'neutral' spine is and what is the best sitting posture is.

If you are slouching at your desk, almost everyone will tell you to sit up straight and watch your back. This is especially so when bending forward or while lifting. Back in 2019, I first suggested that slouching while sitting is not necessarily bad for you, challenging society beliefs about posture and back pain. 

So many companies have spent money on ergonomic programs to prevent back pain. This would usually involve a health professional/ physiotherapist (trained in ergonomics) checking your office chair/ desk height, screen height/ position with respect to your keyboard/ mouse to ensure everything is lined up in a straight line.

However, there is very little evidence linking back pain to poor posture. Oops, this basically means a huge profitable industry on work place/ home office ergonomics has very little sound evidence. 

All the published research to date has shown that there is no relationship between any postural factors causing back pain. This includes the shape and curves of the back, asymmetries and how we use our backs.

Yes, if you already suffer from back pain, you may feel it more while sitting, especially for long periods. But sitting is not the cause of the back pain.

One of my patients told me that she just bought a two thousand dollar Herman Miller chair due to working from home 'causing' her back pain. It definitely helps with sitting up straight, however, it did not seem to help her back pain. That's why she still came to see me yesterday.

So, if you currently do not have neck/ back pain, you do not need to worry about your posture. If you do have pain, then your posture may affect it. Sitting for a sustained period is best avoided. The best ergonomic chair/ table will still give you pain. It is better to move more. Take breaks. Get advice and/or treatment to move with confidence and less pain.

References

O'Sullivan K, O'Sullivan P et al (2012). What Do Physiotherapists Consider To Be The Best Sitting Spinal Posture? Manual Therapy. 17(5): 432-437. DOI: 10.1016/jmanth.2012.04.007

Slater D, Korakakakis V et al (2019). "Sit Up Straight" : Time To Re-evaluate. JOSPT. 49(8): 562-564. DOI: 10.2519/jospt.2019.0610

Our spines have natural curves. It is not totally straight at all. You can see from the picture above that the neck is slightly concave, the chest area is convex while the lumbar (low back) region is again concave. In an ergonomic assessment, a 'good' posture usually refers to eliminating/ straightening out these curves.

Here are some common myths and facts about low back pain, slipped discs and your core muscles if you're interested in reading more.

Who Says Slouching Is Bad?

 Not all slouching is bad!

How many of you have been told that you have bad sitting or standing posture? Or it is incorrect to bend your back while lifting.

The fitness industry publicly recommends protecting your spine. A lot of personal trainers will often tell you that the "core" muscles of your spine must be consciously activated to maintain a "correct" posture to protect your spine. They also give advice about "good form" during weight training and after as well.

Sit up straight - Nah not for everyone

Well, fret not, as evidence is now suggesting that there is no perfect posture. Or at least there is no one posture that fits everyone.

Despite there being a lack of strong evidence that low back pain is caused by sitting, a huge business that claims to improve posture has grown. Many of these companies provide products and interventions claiming to "correct your posture" and help prevent pain.

In addition, there are fear inducing messages in the media that by avoiding incorrect posture like slouching, pain can be avoided.

Unfortunately, many health care professionals provide advice along this non evidence-based practice too. It is generally agreed by health care professionals that avoiding spinal flexion is the safest way to sit and bend.

Yes, awkward postures and lifting something heavy may indeed cause some episodes of acute low back pain. Indeed, some links between lifting and injury have been reported. Despite all these widespread beliefs about correct posture, research has not shown that avoiding incorrect posture prevents low back pain or that any single curve in your spine is strongly associated with pain.

Even though there is evidence that people with low back pain find certain postures provoke their pain, it cannot be concluded that these postures causes pain (Slater et al, 2019).

There is also no evidence to support posture assessment or screening for pain prevention in the work place (Slater et al, 2019). Ouch! There goes all the "ergonomic" screenings/ assessments done by physiotherapists down the drain. Fortunately, our clinic does not do any of these ergonomic assessments.

People come in many different shapes and sizes, with normal variation in their spine curvature. Depending on how your spine is shaped, you will have your own preferred lifting technique and sitting style.

Advice and suggestions given by physiotherapists and other health professionals can lead to fear and encourage hyper vigilance/ paranoia.

Despite a lack of strong evidence that "sitting up straight" prevents pain, asking our patients to work hard to achieve that may set them up for failure and cause more anxiety when their pain persists.

Prior to reading this article (Slater et al, 2019), I too am guilty of telling patients to sit up straight.

Movement and changing positions can be helpful since sedentary lifestyles are a risk for low back pain. However, we should not perpetuate worry that sitting for more than 30 minutes in one position can be dangerous and should be avoided (Slater et al, 2019).

We should in fact help people to sit, stand and move more easily. Comfortable postures vary among all of us and patients should be encourage to try different postures. A position that hurts now may not hurt in future.

Moving ahead, there will be challenges to change the idea of having one "correct" posture. Evidence does not support this view and "core" beliefs held by physiotherapists, personal trainers, doctors and society.  40 years ago, bed rest was prescribed for low back pain. Evidence now shows that bed rest is definitely not an appropriate recommendation anymore.

Our spine is strong, robust and adaptable. A campaign to change this may encounter resistance even in the physiotherapy and ergonomic professions as their business model may not be in line with what we now know to be best practice for managing low back pain.


Reference

Slater D, Korakakakis V et al (2019). "Sit Up Straight": Time To Re-evaluate. JOSPT. 49(8): 562-564. DOI: 10.2519/jospt.2019.0610

Please email me if you want the article.

Should I Be Using A Standing Desk?

Now, that's a different standing desk. By Liz Henry from Flickr

Sitting kills. That's the headline many of you would have seem or read in the last few years. You've also read or heard that sitting is the new smoking. And if you've been following our blog, I've written before that despite exercising a lot, if you sit too much at work, you can be what is known as an active couch potato. Worse still, all that sitting can negate the benefits of your exercise.

Well fortunately for me, I hardly get to sit much when I'm working in the clinic.

Many of my patients have asked about the benefits of a standing desk. I even found a picture (below) of former British Prime Minister Winston Churchill working on his slanted standing desk.

Kurt Hutton/picture post via Getty

Standing desks have been suggested as an alternative to the ills of sitting. And there's studies to show that working upright (at a standing desk) can help correct your posture and tone your stomach and legs without compromising your focus.

And in kids, standing desks seems to increase their energy levels and reduce hunger.

My take on standing desks? I've seen many of my patients go straight from sitting to a standing desk get different problems. Being unaccustomed on their feet all day long poses new risks. It can inhibit proper circulation and add additional pressure to your legs, hips and lower back. Sort of like jumping from the frying pan into the fire if you ask me.

And unfortunately, research shows that standing once or twice throughout your work day will not offer you enough relief. So don't switch to a standing desk if you've been sitting all day straight away, make sure you gradually phase it in.

What are the alternatives? I prefer the stability ball or better still the saddle stool with adjustable height so that you can perch on it if you're not quite used to standing yet.

Our clinic's saddle stool

There's also the desk cycle, though I definitely haven't tried it yet.

Desk cycle

References

Commiassaris DA, Konemann R et al (2014). Effects Of A Standing And Three Dynamic Workstations On Computer Task Performance And Cognitive Function Tests. Appl Ergon. 45(6): 1570-1578. DOI: 10.1016/j.apergo.2014.05.003.

Garcia MG, Laubil T and Martin BJ (2015). Long-term Muscle Fatigue After Standing Work. Human Ftr and Ergo Society. 57(7): 1162-1173. DOI: 10.1177/0018720815590293.