Association of Exposures to Seated Postures With Immediate Increases in Back Pain: A Systematic Review of Studies With Objectively Measured Sitting Time

Abstract

Objective: The purpose of this study was to conduct a systematic review of studies to determine whether sitting time measured objectively (by laboratory controlled time trial, direct observation, or wearable sensor) is associated with the immediate increase in low back pain (LBP) (determined by pain scale rating) in people >18 years of age. Methods: Four databases (PubMed, EMBASE, SPORTDiscus, and Cumulative Index to Nursing and Allied Health Literature) were searched from inception to September 1, 2018. Randomized controlled trials and cohort and crosssectional studies, where objectively measured sitting time was temporally matched with a measure of LBP in adults, were included. Studies without a control session conducted on a separate day were excluded. Screening, full-text review, data extraction, and risk of bias assessment (Quality In Prognosis Studies) of included papers were performed independently by 2 reviewers, with a third available to resolve disagreements. Results: In total, 609 articles were identified, 361 titles/abstracts were screened,75 full-text articles were assessed for eligibility, and 10 met the inclusion criteria. All but 1 reported sitting time to be associated with an immediate increase in LBP. Six of these reported clinically relevant pain levels (n ¼ 330). Half of the included studies were rated as having a low risk of bias and the remaining were rated as having a moderate risk of bias. Conclusion: Prolonged sitting increases immediate reporting of LBP in adults; however, no conclusion between sitting and clinical episodes of LBP can be made. Based upon these findings, we recommend that future prospective studies should match objectively measured sitting with temporally related pain measurements to determine whether prolonged sitting can trigger a clinical episode of LBP. (J Manipulative Physiol Ther 2020;43:1-12) No language restrictions were used, and all articles that met the inclusion criteria for study design and population, exposure, and LBP were included for analysis.Study Design and Population.

Musculoskeletal pain and sedentary behaviour in occupational and non-occupational settings: a systematic review with meta-analysis

“…For instance, increased occupational physical activity is reported to be associated with reduced general MSP symptoms [ 133 , 134 , 136 ]. Also, a review of experimental studies has reported that device-measured continuous uninterrupted sitting is associated with the increased immediate report of LBP in adults [ 25 ]. The evidence from our review also suggests experiments/interventions that reduce total workplace sitting time or sitting bout duration potentially reduce general MSP/discomfort, especially in the lower back and the neck/shoulder.…”

“…There is, however, an inconsistent body of evidence of associations of SB with MSP conditions and related outcomes from high-level evidence-based studies [ 19 , 20 ]. Some previous systematic reviews of studies including higher-level study designs have reported no associations of SB with the prevalence of some MSP conditions [ 19 – 24 ], whereas others have reported either positive [ 20 , 25 ] or negative [ 26 ] associations with some MSP-related outcomes such as pain intensity. Methodological differences and limitations within the individual studies reviewed in these systematic reviews could impact the quality of evidence and comparability of these reviews as some of the studies were based on self-reported and surrogate estimates of SB which increases the risk of bias [ 19 , 21 , 22 , 24 , 27 ].…”

“…Methodological differences and limitations within the individual studies reviewed in these systematic reviews could impact the quality of evidence and comparability of these reviews as some of the studies were based on self-reported and surrogate estimates of SB which increases the risk of bias [ 19 , 21 , 22 , 24 , 27 ]. The emergence of evidence on device-measured SB, especially from studies using the ActiGraph and activPAL devices has improved the quality of SB evidence in recent research outputs [ 25 – 27 ].…”

Core Muscles Endurance in Sedentary Individuals with and without Nonspecific Chronic Low Back: A Cross-Sectional Study

“…Over 70% of physiotherapists considered the upright lordotic sitting posture as the optimal posture (82). Major stakeholders in the healthcare systems around the world commonly agree that prolonged sitting is associated with a higher prevalence of LBP (25,(83)(84)(85)(86)(87)(88). Sustained sitting for more than thirty minutes is considered a common aggravating factor for many people with LBP (81), although there is a lack of evidence in support of this concept (89)(90)(91).…”

What Psychosocial and Physical Characteristics Differentiate Office Workers Who Develop Standing-Induced Low Back Pain? A Cross-Sectional Study

“…Regarding workplace factors and the occurrence of LBP, prolonged sitting is commonly cited in the literature, but the available evidence has not confirmed a consistent association between occupational sitting and LBP [ 3 , 4 ]. Nevertheless, office workers spend over two-thirds of their workday seated and this prolonged and uninterrupted sedentary behaviour [ 5 ] is a recognised public health concern [ 6 ].…”