Lower Back Pain When Standing
Millions of adults experience lower back pain at one time or another, but some people notice the discomfort when standing. The lower portion of the back, known as the lumbar region, provides stability and support for the body when it is in an upright position. Each vertebra or spinal bone is separated by a fluid-filled disc that functions as a shock absorber. The discs can become irritated when an individual stands or sits for too long. Age-related wear and tear can also weaken the discs. Further aggravating weak, inflamed discs by walking or standing for long periods can lead to persistent pain.
Postural stress that develops from prolonged periods of standing is one of the most common reasons for lower back pain. This is because the pelvis tends to tilt forwards when an individual is standing for extended periods of time and this increases the curve in the lower back. The change in posture places excess pressure on the back by tightening the muscles that surround the spine and narrowing the spaces for the nerve roots and spinal chord. As the pressure increases, muscle spasms, nerve irritation, and pain may develop in the lower back when standing or walking. Although the underlying cause is typically postural, it is important to have a Physical Therapist evaluate chronic lower back pain so that a proper treatment plan can be recommended.
Potential Causes of Lower Back Pain
There are a number of reasons why lower back pain may occur when standing, such as a car accident, back injury (e.g., fall, sports injury), a strained tendon, a sprained ligament, or fatigued back muscles. However, the following conditions are also linked to pain while standing or walking:
- Spinal stenosis
- Herniated disc
- Degenerative disc disease
Hyperlordosis refers to excessive spinal curvature that creates a C-shape in the lower region of the back. The symptoms include tight, stiff muscles in the lower back along with mild to severe pain in the lumbar region that worsens with movements such as sitting down and getting up. This condition may arise due to poor posture or prolonged inactivity (e.g., not exercising regularly). Additional issues that are associated with hyperlordosis include obesity and spinal conditions such as discitis (spinal disc infection), spondylolisthesis (disc misalignment), and kyphosis (hunchback).
Poor posture is particularly problematic because when an individual is seated in an improper position, muscles in the lower back may tighten too much in an attempt to support and stabilize the spine. This causes the spine to gradually shift out of alignment, thereby increasing spinal curvature. Subsequently, the back may begin to hurt while sitting down, getting up, or when an individual is walking. Similarly, ligaments in the back may become sprained due to improper lifting or stretching techniques.
Obesity is also linked to spinal misalignment or excessive curvature that leads to lower back pain during movement. Additionally, individuals who do not exercise regularly are at risk for experiencing back problems because inactivity can weaken lumbar muscles that surround the pelvis and trunk. Weak muscles provide poor spinal support and allows the spine to curve excessively. Therefore, posture and lifestyle habits are among the first factors that should be assessed for individuals with chronic lower back pain when standing.
Spinal stenosis refers to pressure that is placed on the spinal cord as well as nerves due to the narrowing of the spine. More specifically, the spaces between the spinal bones gradually become narrower and squeeze the nerves along the spine. This condition often develops in the lumbar region (lower back), where it is known to cause lower back pain when standing or walking. Additional symptoms include:
- Weakness in the legs
- Stabbing pain that extends down the legs when standing and then goes away in sitting
- Tingling or numbness in the lower back, legs, or even the buttocks
Some people experience less pain while they are sitting down, especially when they lean forward. This occurs because bending forwards opens up space for the nerve roots and spinal chord. Spinal stenosis may develop after a spinal injury or due to age as it is common in individuals who are 50 years of age or older. If this condition is not properly treated, it can lead to bladder or bowel problems as well as sexual dysfunction.
Degenerative Disc Disease
Degenerative disc disease is a common condition that may develop as an individual ages. The protective, shock-absorbing discs that are positioned between each vertebra in the spine can gradually shrink, lose their water content and break down (degenerate) over time. This form of degeneration reduces the space between bones and subsequently allows them to rub against each other, thereby causing stiffness as well as pain in the back. The loss of space between the vertebrae irritates spinal nerves as well. The following symptoms are associated with degenerative disc disease:
- Weakness in the legs or feet
- Back pain the frequently changes in terms of duration or severity
- Pain in the lower back that radiates down the thighs and buttocks
- Lower back pain that worsens when sitting, lifting, bending, or twisting
Physical therapy as well as appropriately prescribed exercises are among the first approaches that are recommended to improve the health of the spinal discs and lessen pain.
A herniated disc, which is also known as a ruptured, bulging, or protruding disc, occurs when the jelly-like center of a spinal disc pushes through a tear in the tough outer layer of a disc. This causes back pain by placing the spinal cord and neighboring nerves under excess pressure. The material that is released from the damaged disc also contains chemical irritants that worsen nerve inflammation.
Furthermore, a herniated disc is linked to degenerative disc disease as the protective fluid inside of spinal discs decreases with age, making them more rigid. This loss of flexibility is associated with increased pain during movement. As the fluid content continues to decrease, the discs begin to shrink as well and this causes the space between vertebrae to become narrower. In addition to the aging process, the following factors increase the risk of experiencing a herniated disc:
- Long-distance driving
- A sedentary lifestyle
- Being overweight or obese
- Improper lifting techniques
- Performing repetitive activities that strain the spine
This condition may develop anywhere along the spine, but it typically affects one of the five vertebrae that make up the lumbar (lower) spine. Accordingly, it is one of the most common causes of lower back pain and sciatica. Although a herniated disc may be particularly painful, physical therapy helps most people overcome this issue in a matter of weeks or a few months.
Sciatica refers to pain that is caused by inflammation of the sciatic nerve. In most cases, it is due to nerve compression (squeezing) in the lower region of the spine. The sciatic nerve is the widest and longest nerve in the body. It is found in the lower back, where it extends to the hips, buttocks, and legs. The pain that sciatica causes may range from mild to moderate or severe and is often felt in lower regions of the body due to the length of the sciatic nerve.
Sciatica is not always described as a condition in the medical community, but may instead be referred to as a symptom of sciatic nerve irritation. For instance, a herniated disc is the most common issue that is linked to sciatica due to the pressure a bulging disc can place on the roots of the sciatic nerve. This means that identifying the underlying cause of sciatica is oftentimes the key to properly addressing it. The distinct symptoms include:
- Weakness in the lower back and legs
- A sharp, shooting pain in the lower back, hips, buttocks, or down the legs
- Numbness, tingling, burning, or pins and needles sensations in the legs, feet, or toes
- Pain that varies in severity and worsens when sitting or standing for long periods of time
A number of individuals who have experienced long-term sciatica have reported that it hurts when they walk or that they can’t walk due to the pain. However, therapeutic exercises (e.g., stretching, strength training), hot-cold therapy, and over-the-counter pain relievers help target sciatica. All of these approaches may be recommended by a physical therapist who can monitor the response to pain medication as well as the therapeutic regimen.
There are other conditions such as osteoarthritis, neuropathy (nerve damage), and lumbar radiculopathy (pinched nerves) that are linked to back pain, but the ones that were described are the most common causes of lower back pain that worsens with movement.
A physician will typically recommend taking over-the-counter pain relievers, followed by prescription strength anti-inflammatory medication to reduce lower back pain. Additional forms of treatment depend on the specific cause of the discomfort. If the pain is related to structural or postural issues with the spine as well as a minor back injury, a referral for physical therapy is typically made.
One of the main benefits of physical therapy is the guided instruction of specific exercises, including lumbar stabilization techniques, that help strengthen back muscles, relieve chronic lower back pain, reduce spinal curvature, and improve the flexibility of your spine. Effective lumbar stabilization exercises that a physical therapist may incorporate into the treatment routine include:
- Side plank
- Superman exercise
- Lower body reverse plank
- Upper body forearm plank
- Quadruped arm and leg lift
These types of exercises help relax tense muscles, boost the flow of oxygen and nutrient-rich blood toward the affected region, strengthen weak spinal discs and muscle tissue, and lessen inflammation. This decreases pain while increasing flexibility, mobility, and range of motion. A physical therapist may also discuss how factors such as footwear, orthotics, and ergonomics can help prevent future occurrences of lower back pain when standing.
Wearing well-cushioned shoes or orthotics, which refers to shoe inserts that are designed for enhanced back support, promotes proper spinal alignment and stability of the feet. People who tend to experience lower back pain when standing, sitting down, or getting up should avoid wearing high heels. This particular type of footwear can lead to pain while walking because it changes the curvature of the spine and causes people to stand in unnatural positions when they are at rest. In addition, high heels are linked to the wear and tear of tendons that attach muscles to the spine as well as the weakening of discs between vertebrae (spinal bones) due to the abnormal spinal curvature they cause.
Ergonomic strategies are especially essential for individuals who stand or sit for long periods due to their jobs. Specialized rubber mats or height-adjustable desks are optimal for people whose job duties require them to stand during their work shift. Similarly, ergonomic chairs that support the back are beneficial for those who are in a seated position for several hours at a time.
Overall, the combination of therapeutic exercises, lifestyle changes, and maintenance techniques that can be performed in the office or at home support long-term improvement of lower back pain. These strategies also afford many individuals with little to no discomfort while moving around.
Lower back pain is a common occurrence that resolves on its own for most adults. However, if the pain continues to worsen, especially while sitting down, standing up, or walking, it is best to consult with a Physical Therapist. This is because constant pain with movement can have a negative impact on daily activities. Conversely, targeting back pain early on can help prevent serious issues that make it hard to walk or move freely.
Persistent cases of lower back pain can typically be treated through physical therapy, especially if the issue is linked to postural problems, obesity, or a lack of regular exercise. Physical therapy promotes postural correction, spinal realignment, strong back muscles, and enhanced spinal flexibility that helps alleviate symptoms in most cases. Individuals are also taught how to perform beneficial exercises at home safely as well as ways to reduce back strain by maintaining a healthy weight.
Medical intervention may be necessary if the following symptoms arise:
- Intense muscle spasms
- Bladder or bowel problems
- Numbness or tingling in the arms, back, or legs
- Extensive curving of the lower back while bending forward
These complications may indicate that a more dangerous underlying condition has developed.