Does sitting cause back pain? Following the evidence back to a previously abandoned position
Back in the day … I believed that sitting was a risk factor for back pain.
Why did I think that? Back then, it was entirely based on my “common sense” as a massage therapist, confirmed by observation of my (very skewed) patient data sample. For more than a decade, I warned a great many PainScience.com readers to beware of too much sitting.
Eventually I noticed that the evidence really didn’t back up my common sense. And so, in 2017, I heeded the evidence and officially changed my mind, like any self-respecting science journalist should do! I made a bit of a blogging meal out of confessing my mistake. Mea culpa posts are always popular.
And then I proceeded to cite the evidence, which remains fairly persuasive to this day: many studies all showing no correlation whatsoever between sedentariness and back pain.
And so I switched from warning people about the dangers of sitting to warning people about the dangers of believing that — specifically of believing their back is so fragile that it can be hurt by sitting.
But I had missed a study, a good one, something that was probably better than anything I was citing. And it supported my original bias, and contradicted my new, evidence-based bias. Ruh roh! Flip flop?
Measuring total laziness with accelerometers
Gupta 2015 appears to be the first-ever study of the relationship between back pain severity and objectively measured total sitting time — not just sitting at work, and not just measured by self-report but by accelerometers.
There’s some heavy-duty number crunching in this one, which makes it harder to evaluate. There’s plenty of room for flaws to hide in all that number crunching, but there’s nothing obviously wrong with the study. Seems like good methodology to me, likely to produce more reliable results. Unfortunately, almost a decade later, it is still the only study using this methodology, so it still really needs to be replicated — all the more so because it is reporting results that are at odds with all the other studies, even if their methodology was obviously inferior.
Perhaps this is actually a (rare) case of a new, improved approach finally producing a clearer, better answer than previous research could. Or maybe it’s just more noise. And that is why we (still) need some replication.
| title | Is objectively measured sitting time associated with low back pain? A cross-sectional investigation in the NOMAD study |
|---|---|
| journal | PLoS ONE |
| Volume 10, Number 3, 2015, e0121159 | |
| authors | Nidhi Gupta, Caroline Stordal Christiansen, David M Hallman, Mette Korshøj, Isabella Gomes Carneiro, and Andreas Holtermann |
| links | publisher • PubMed • PainSci bibliography |
I think it’s odd that the risk of having high back pain with occupational-sitting time alone was not statistically significant. Not sure what to make of that, but it seems like confirmation that the signal is hard to separate from the noise. Every dataset has weird subsets, but why would that subset be anomalous like that? If sitting a lot increases the risk of back pain, then any large segment of sitting time should show about the same association, and pretty clearly.
Not saying it’s a deal-breaker, just a bit of a head-scratcher. And another reason replication is (still) needed.
But flip the script and look at high sitting time — the most serious sitters — and the risk of strong back pain was three to five times greater than low sitting time.
That’s compelling overall.
And it continues to annoyingly contradict the shiny new evidence-based position that I conspicuously adopted back in 2017. If these results can eventually be reinforced by other studies, then it will be my first-ever example of following the evidence back to a previously abandoned position — a full flip-flop. Whee! But I’ve been spared that embarrassment by the lack of replication.
It’s not really embarrassing, of course. This is just more of the legendary uncertainties in the pain business. Obviously, the only correct “position” here is to report the uncertainty — rather than overconfidently declaring either that it’s a myth that sitting causes back pain … or that it does.
This study was long ago cited in an update to PainScience.com’s huge science-based guide to back pain, which is like a compilation of twenty years’ worth of blog posts like this, a 200,000-word beast … but more organized than just a pile of posts. It’s written for both patients and professionals, like all my content. Read the large, free introduction