Associations of prolonged standing with musculoskeletal symptoms—A systematic review of laboratory studies

Abstract

While prolonged standing has shown to be detrimentally associated with musculoskeletal symptoms, exposure limits and underlying mechanisms are not well understood. We systematically reviewed evidence from laboratory studies on musculoskeletal symptom development during prolonged (≥20min) uninterrupted standing, quantified acute dose-response associations and described underlying mechanisms. Peer-reviewed articles were systematically searched for. Data from included articles were tabulated, and dose-response associations were statistically pooled. A linear interpolation of pooled dose-response associations was performed to estimate the duration of prolonged standing associated with musculoskeletal symptoms with a clinically relevant intensity of ≥9 (out of 100). We included 26 articles (from 25 studies with 591 participants), of which the majority examined associations of prolonged standing with low back and lower extremity symptoms. Evidence on other (e.g., upper limb) symptoms was limited and inconsistent. Pooled dose-response associations showed that clinically relevant levels of low back symptoms were reached after 71min of prolonged standing, with this shortened to 42min in those considered pain developers. Regarding standing-related low back symptoms, consistent evidence was found for postural mechanisms (i.e., trunk flexion and lumbar curvature), but not for mechanisms of muscle fatigue and/or variation in movement. Blood pooling was the most consistently reported mechanism for standing-related lower extremity symptoms. Evidence suggests a detrimental association of prolonged standing with low back and lower extremity symptoms. To avoid musculoskeletal symptoms (without having a-priori knowledge on whether someone will develop symptoms or not), dose-response evidence from this study suggests a recommendation to refrain from standing for prolonged periods >40min. Interventions should also focus on underlying pain mechanisms.

Effects of Interrupting Prolonged Sitting with Physical Activity Breaks on Blood Glucose, Insulin and Triacylglycerol Measures: A Systematic Review and Meta-analysis

“…Conversely, leg muscle activity was higher in overweight adults during standing [31]. However, standing might confer positive [157] or negative [158,159] physiological effects beyond simply EE, and thus a future meta-analysis should evaluate the effects of using standing to break up sitting.…”

Prolonged occupational standing: the impact of time and footwear

“…Discomfort measures of the feet, lower limb and lower back as well as feelings of fatigue are consistently shown to increase with time (King, 2002;Antle, Vezina, Messing, & Côté, 2013;Orlando and King, 2004;Coenen et al 2017;Zander, King, & Ezenwa, 2004). A systematic review identified blood pooling, measured through blood flow, skin temperature and leg circumference/volume, was frequently reported to increase with time standing (Coenen et al, 2017), with strong correlations to discomfort in the measured regions (Antle et al, 2013).…”

“…A systematic review identified blood pooling, measured through blood flow, skin temperature and leg circumference/volume, was frequently reported to increase with time standing (Coenen et al, 2017), with strong correlations to discomfort in the measured regions (Antle et al, 2013). The combination of gravity and the lack of muscle contraction contribute to an increased venous pressure, venous stasis and an increased foot/calf volume (Tüchsen, Hannerz, Burr & Krause, 2005), which is thought to cause a build-up of paininducing metabolites and place stress on passive structures (Coenen et al, 2017;Edwards, 1988).…”

“…Although muscular factors are thought to impact discomfort, results from studies assessing lower limb fatigue using electromyography (EMG) are inconsistent (Antle et al, 2013;Coenen et al, 2017;Gregory & Callaghan, 2008;Brownie & Martin, 2015;Garcia, Laubli, & Martin, 2015). There is some evidence to suggest a role of co-contraction of bilateral lower back muscles in the development of lower back pain (Nelson-Wong, Gregory, Winter, & Callaghan, 2008;) but this is still limited (Coenen et al, 2017).…”

Evidence to design ‘just right’ work using active workstations is currently limited

“…For example, the risk of back pain with prolonged standing, as shown in recent reviews of laboratory10 and field11 evidence.…”