Causes of Lower Back Pain When Sitting, Standing, and Walking

Lower back pain is a widespread condition affecting over half of all adults at some point in their lives. Some of these adults find sitting, standing and/or walking painfully difficult. While lower back pain is common and at times debilitating, there remains no consensus on the optimal way to diagnose and treat patients with this condition. There are a variety of causes for lower back pain and it can be difficult to identify the specific anatomical structure that is causing the pain. Fortunately, successful treatment is not always predicated on finding the specific pain generator.

woman experiences lower back pain standing at bathroom sinkLower back pain is very common and can make standing at the bathroom sink a painful experience. Photo Source: subdividing patients with lower back pain into more homogenous groups based on factors that aggravate and alleviate the pain, a more specific treatment regimen can be prescribed. A focused approach to treatment rather than the “one size fits all” method leads to better results. Many patients find that certain positions and activities make their back pain better or worse. These are important clues that can help in lower back pain diagnosis and treatment.

Given that most people will sit, stand, and walk on any given day, a lot of research has been conducted on how these specific activities relate to the spine and lower back pain. The remainder of this article will discuss why sitting, standing, and walking can change the severity of lower back pain and how it can be helpful in diagnosis.

Spinal Anatomy — Lower Back Pain

For the purpose of this article, it is helpful to envision the lumbar spine as a tube with supporting structures in front (anterior) of and behind (posterior) it. The tube represents the spinal canal that contains the cerebrospinal fluid and nerve roots. At each lumbar level, a pair of nerve roots exit the “tube” through small openings called the neural foramen (neuroforamen). Behind the neural foramen are the facet joints that allow for motion at each lumbar segment. The paraspinal muscles attach to the back of the bony spinal column and help stabilize and extend the spine. In front of the “tube” are the bony vertebral bodies separated by the intervertebral discs that act as shock absorbers.

The alignment of the spinal column, from the skull to the pelvis, is S shaped. The cervical and lumbar spinal segments are lordotic (curving towards the front of your body) while the thoracic spine is kyphotic (curving towards the back of your body). The amount of lordosis or curvature is not static and can change based on body position. Compared to standing, sitting decreases your lumbar lordosis by approximately 50%.

  • Changes in lumbar lordosis will alleviate certain forms of back pain and will aggravate others as will be described below.

spinal columnThe alignment of the spinal column is S shaped beginning at the base of skull and through the pelvis. Photo Source: you are holding a segment of rubber tubing, a garden hose for example, in a vertical orientation in front of you. Again, the hollow segment of the tube represents the spinal canal, the segment of hose facing you represents the posterior spinal column, and the segment of hose facing away from you represents the anterior spinal column. Now try bending the tubing in half. The tubing on the convexity or outward facing side of the curve will be tensioned or stretched out, while the tubing on the concavity or inward facing side of the tube will be compressed.

This mental exercise helps to reinforce the principle that objects that are being bent will experience two forces—compression and tension. An increase in lumbar lordosis will compress the posterior column (paraspinal muscles, facet joints, neural foramen) and stretch out the anterior column (vertebral body and discs). Similarly, a decrease in lumbar lordosis will stretch out the posterior column and compress the anterior column. This forms the basis of why certain positions can alleviate back pain symptoms in some people and make it worse in others.

  • Paraspinal Muscles: Prolonged sitting, especially if slouching, can cause overstretching of the paraspinal muscles. Imagine how sore your hamstrings would be if you tried to touch your toes for an hour!
  • Facet Joints: Like most joints in our body, arthritis can affect the facet joints. Given that the facet joints are posteriorly based structures, they become compressed with increased lordosis. When facet joints are the primary pain generator, pain tends to improve with sitting and worsen with prolonged standing and walking.
  • Vertebral Disc (Intervertebral Disc): When the vertebral disc is the pain generator, sitting tends to aggravate the pain as more compression is occurring across the injured tissue. In certain types of disc herniations, sitting may compress the disc to a point where the herniated tissue presses against a nerve root causing radicular pain (pain radiating to the lower extremity, such as the thigh). Walking tends to alleviate discogenic pain.

3 Lower Back Pain Provoking Conditions

Lumbar Spinal Stenosis: Pain due to spinal stenosis—narrowing of the spinal canal—tends to be improved with sitting, especially when leaning forward. This posture increases the size of the lumbar spinal canal and neural foramen, decreasing the amount of nerve root compression. The size of the spinal canal and neural foramen decrease when standing and walking. Walking with flexed posture, such as leaning on a shopping cart, tends to be more comfortable then walking upright.

Spondylolisthesis: Pain that occurs immediately when sitting and is at least partially relieved by standing has been associated with lumbar spinal instability or spondylolisthesis. Standing in a neutral position for short periods of time tends to improve pain compared to walking and bending where the movement of the vertebral bodies provoke pain.

Sacroiliac Joint Dysfunction: Sacroiliac joint pain can be aggravated by sitting, particularly if more weight is placed on the affected side. As in the case of spondylolisthesis, pain can occur when transitioning from standing from a sitting position.

Lower Back “Pain Generator” Important to Treatment Selection

Sitting, standing, and walking can worsen or improve the severity of lower back pain. These symptoms can help identify the anatomic culprit or “pain generator.” This knowledge aids in selecting the optimal treatment regimen for a painful lower back.

Updated on: 10/22/19
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