At-Home Employees Tend to Sit in Ways That Promote Back Pain

Heidi Splete

June 03, 2022

SAN DIEGO — Persons who work remotely are at increased risk for low back pain (LBP) because of poor ergonomics and extended time spent sitting, according to a study that involved 45 individuals who worked at sedentary desk jobs during COVID-19.

Dr Katie Thralls Butte

The impact of working from home on the development of LBP in terms of postural risk factors and time spent sitting has not been well studied, noted Katie Thralls Butte, PhD, and colleagues at Seattle Pacific University in a poster presented at the American College of Sports Medicine (ACSM) 2022 Annual Meeting.

"We found significant differences in the behaviors of those working from home and those working in the office," Thralls Butte told Medscape Medical News.

The study population included administrative assistants, insurance agents, lawyers, and business/finance advisors. All were adults working full-time in desk jobs, Thralls Butte said in an interview. Participants completed surveys about demographics, LBP, and work environment. Data were collected between February and September 2021.

Sitting time was assessed using activePAL devices that the participants wore for at least 10 hours per day for 4 days. Thralls Butte and colleagues assessed the participants for posture and hip flexion at a single visit in their clinic using Sagittal standing posture assessment and the Thomas Test. Approximately half of the employees had returned to work and daily commuting.

Overall, employees who worked from home sat approximately 1 hour more per day than those who returned to the office (553 min/day vs 490 min/day; P < .03).

"Interestingly, those that worked from home had about 1300 more steps per day than those that worked from an office," Thralls Butte told Medscape. "Further, both groups self-reported they did similar levels of physical activity. Thus, we hypothesized those at home have more steps around their house, perhaps doing chores or caretaking, but then sit more as well for work, now that they don't commute."

Another important finding was with regard to posture, said Thralls Butte. The data from the study population overall "show high amounts of poor hip flexion, demonstrating possible anterior pelvic tilt. This shift in the pelvis is a precursor to low back pain," she explained. Greater sitting time overall was significantly associated with excessive hip flexion as well as postural deviations at the knee.

The findings have implications for practicing clinicians with respect to "awareness and education of the behaviors and ergonomics of home work environments"; recommendations for activity should be specific to the environment, Thralls Butte said. These factors also should be considered for office workers, although office ergonomics have improved immensely in recent years, she noted.

The take-home message for clinicians is that they should discuss the importance of sitting and standing with good posture with individuals in sedentary jobs and ask people who complain of back pain about their ergonomic setup at home.

As for future research, Thralls Butte would like to pursue behavioral interventions to educate people who work in sedentary jobs on how to incorporate factors such as standing breaks, stretching, proper posture, and optimal ergonomics for sitting and working at home and in the office.

"It's about developing good habits," she said. "Work is something people spend 10, 12, 14 hours doing, so it is something we can target for behavior change to improve health," she added.

"The impact of large amounts of time spent sitting on bodily pain is a new field of research, and the available evidence currently is somewhat equivocal; this study provides helpful early insights," Neville Owen, PhD, a scientist at the Baker Heart and Diabetes Institute, Swinburn University, told Medscape in an interview.

"Although the study has a modest number of participants, the use of objective, device-based measurement of sitting time and standardized functional assessments of study participants are considered real strengths. These strengths give me confidence in the findings," said Owen, who attended the meeting but was not involved in the study.

"Given everything else we know about the adverse health consequences of sitting, including inflammation-related effects, together with the study's careful examination of postural and skeletal anomalies, these are findings that do not surprise me," Owen said.

The take-home message for clinicians is to educate patients with lower back problems that too much sitting is as much of a risk factor as too little exercise, he said.

"Not only encouraging patients with lower-back issues to be more physically active and to do the relevant strengthening and stretching exercises, but also encouraging them to cut down the amount of time that they spent sitting as realistically as possible, and especially to include regular physically active interruptions to time spent sitting, will be beneficial," Owen emphasized.

He added, "Studies with larger samples and with a broader variety of study participants, so that gender, adiposity-related, and job-related variations can be examined would be helpful."

The study was supported by an internal faculty research grant at Seattle Pacific University. Thralls Butte has disclosed no relevant financial relationships. Owen has received funding from the National Health and Medical Research Council of Australia for studies on the health consequences of sedentary behavior.

American College of Sports Medicine (ACSM) 2022 Annual Meeting: Abstract 595. Presented June 1, 2022

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