Why do I get low back pain when sitting?
Even though it’s uncomfortable to sit for a long time, that pain doesn’t mean that you’re being hurt or damaged by the position.
The truth is that when we sit still, especially for a long time, our body doesn’t get the movement it needs.
When your sitting position puts our muscles and other tissues into stretch or compresses them, they can get reduced blood flow and reduced oxygen.
Our body and its beautiful design has nerves that detect this lack of oxygen in the tissues and send danger messages to your brain to alert you that the tissues are getting thirsty for oxygen.
We often unconsciously react by wiggling a bit in our chair, or feeling uncomfortable, which tells us to move, and get more circulation moving around your body.
If you have tissues that are sensitive, either after an injury or due to a persistent issue, they will send the “need to move” signal much earlier, so you might have a reduced capacity for sitting.
Should I wear a back brace?
If we understand pain as a protective response it should give us pause to think about the purpose of using a back brace. The experts across the world have scoured the research and found that braces or back belts are not effective for adults to significantly improve their function or reduce pain.
If you have strained your back, it’s likely you have experienced significant tightness and maybe even painful muscle spasms around your back. These are your body’s natural defense mechanisms working to prevent you from moving this sensitive area.
This is a very helpful response immediately after an injury, but if it continues past a few weeks, it becomes a problem. Persisting pain happens when your body continues to try to protect itself, with spasm and pain, long after the injured or irritated tissues have recovered.
Studies of people with back pain show that they are already tensing and bracing themselves and not moving their backs. Adding a brace to this protection can cause people to move with even more stiffness. It can be a cue that makes you more aware of your painful back, and make you excessively careful when moving.
A healthy back doesn’t need to tense and brace for normal daily movements, like simply bending to pick up light objects from the floor. These movements should be done freely and in a relaxed manner and WITHOUT a brace. If you have trouble doing this, then finding a good coach or therapist to help you progress back towards doing this movement comfortably is the way to go!
A possible exception to this rule would be in heavy load situations. If you are in a job or have a lifestyle that requires the lifting of heavy loads repeatedly then a brace may be helpful to give you reminders to use the most efficient movement patterns possible to lift. This goes for heavy load situations only. Otherwise, the most up-to-date studies show that use of a back brace does not speed up recovery from back pain.
Why do I have more pain in the morning?
Often after long periods of a lack of movement (like having a good night’s sleep) your tissues have been a bit squashed under pressure, which can squeeze out some of their fluid content.
This can change the pH balance in your tissues, making them more acidic. This causes the nerves in your tissues to become more sensitive, which can make them stiffer and more sensitive to pain.
It’s a normal thing and nothing to be alarmed about. Moving around helps to flush out the acidity from the tissues, restoring their normal pH and helping you feel better.
When you already have sensitivity due to an injury or ongoing pain, this response gets amplified.
This makes it difficult to move first thing in the morning. This sounds scary, but there is a simple fix……movement. This will help the painful and stiff tissues receive blood flow, restore their fluid balance and make them less acidic and sensitive.
Is sitting too much damaging my back?
No, sitting is not damaging your back, even if it feels painful. There’s a cute saying physical therapists often tell to their patients, “your best posture is your next posture”.
What does that mean? It means that varied postures, and moving regularly are healthy and feel good. There’s no such thing as a perfect posture, so no one position is good for extended periods of time. Our bodies thrive on movement for health. We are made to move regularly and in many different directions.
Unfortunately, we live in a world where many of us have to sit for prolonged periods for work, travel and everyday activities. This creates tissues that are repeatedly starved of oxygen, which makes them cranky. This process can create responses in the tissues that cause changes to the sensitivity of nerves. These nerves are how your brain gets all the information it needs from your body to determine if you’re safe.
Continued sitting (or being in any position for too long!) keeps sending signals to your brain that certain tissues are being held tight or put under stress for too long or aren’t receiving enough blood flow. This can increase pain or discomfort to try to keep you safe.
When you think about it, this usually works quite well! You start wiggling and jittering in your seat, or even stand up and move around. This restores blood flow and oxygen to your tissues, which is what caused the sense of discomfort in the first place.
If you don’t have much sensitivity or an ongoing pain condition, then a simple way to address this problem is to build in movement breaks throughout your day to avoid prolonged periods of tissue strain and reduced blood flow that can create sensitivity in you back.
However, once your back has gotten sensitive, then the problem becomes more complex. Telling someone that has developed ongoing pain that you need to “move more and exercise” is a part of the solution, but it requires a more nuanced approach.
Pain is a danger signal. You can think of it as a sort of “alarm“. The settings of this alarm can be much too sensitive. Think of a car alarm that gets triggered when a car drives by instead of when a burglar is trying to break in.
When the sensitivity of your body’s alarm system increases in this way, there are many things you can do. The first thing is to understand what pain is and the way that changes in your body can increase sensitivity.
High quality information on this very topic is one of the main goals of PainChats (link to mission statement), so you’ll find lots of resources to get you on the right path here (some relevant links about sensitization).
Dr Mark Kargela is based at Midwestern University’s Physical Therapy Institute, a university-based clinic setting, where he practices general orthopedics with special interest in spine and persistent pain conditions and mentors students in the clinic. Mark is a regular lecturer at Phoenix-area universities and he owns his own continuing education company where he teaches coursework in modern pain neuroscience and its incorporation into daily patient care. His company’s mission is bringing the patient voice back to healthcare and helping clinicians better understand and help people in pain.