Joe Nimble

Is your standing desk giving you a bad back?

“A compromised foot structure is a major perpetuating factor in chronic musculoskeletal pain throughout the body.” (Janet Travell, 1993)

Prolonged sitting at a desk is linked to negative health effects including heart disease and metabolic syndrome (Healy et al., 2011; Gardiner et al., 2011) prompting scientists to advocate performing tasks while standing (Plotnikoff and Karunamuni, 2012). Prolonged standing at work has, however, been shown to increase lower back pain (Tissot et al., 2009). 40-70% of people who have never had a lower-back injury reported lower back pain with static standing (Nelson-Wong et al., 2008), prompting recommendations for regular sitting breaks! (Gallagher et al., 2014). Why does the simple task of standing cause so many to experience back pain?

Anunstable foot: the missing link in standing-related back pain.

The ideal standing posture can be defined as optimal alignment of the body in relation to gravity and the base of support (feet), that can be maintained with minimal energy expenditure. In standing, the foot must be a compliant but stable base of support, providing maximalground contact and stability in all directions. The spread and function of the toes (especially the big toe) is crucial in this regard. Studies examining the determinants of standing balance show the engagement of the big toe with the ground to be the most important determinant of postural control (Tanaka et al.,1996). Morton (1935) showed a valgus (squashed in) position of the big toe impaired postural control, and Chou et al. (2009) showed that removing the big toe from the ground dramatically impaired static balance. Quite simply, a compromised foot results in instability leading to postural compensations and pain (Bird and Pain, 1999). Sadly, deformity of the big toe is a common disorder affecting 23% of 18-65 year olds, over 36% of over 65 year olds (Nix et al., 2010), and results from years of wearing shoes with restricted toe boxes (Munteanuet al., 2017).

Fixing your feet for pain-free standing.

For a stable foot, forefoot structure and natural spread of the toes must be restored. Fortunately, the plasticity that permitted development of compromised feet in response to narrow, symmetrically-shaped shoes, also permits restoration of foot structure and function in response to shoes with the freedom for toes to spread back into a natural-anatomical configuration (Knowles, 1953). Protect your health and move towards pain-free standing by:

  1. wearing foot-shaped (functional) shoes with space for the toes to spread and the foot to widen and flatten and;
  2. standing up to load the feet with body weight, creating the force to stimulate restoration of foot shape and function.

Let standing be the cure rather than the cause of your pain!

References

  • Bird AR and Pain CB. Foot function and low back pain.The Foot. 1999; 9: 175-180.
  • Gallagher KM, Campbell T and Callaghan JP. The influence of a seated break on prolonged standing-induced low back pain development.Ergonomics. 2014; 57: 555-562.
  • Gardiner PA, Healy GN, Eakin EG, Clark BK, Dunstan DW, Shaw JE, Zimmet PZ and Owen N. Associations between television viewing time and overall sitting time with the metabolic syndrome in older men and women: The Australian Diabetes Obesity and Lifestyle Study. Journal of the American Geriatric Society.2011; 59: 788-796.
  • Healy GN, Matthews CE, Dunstan DW, Winkler EAH and Owen N. Sedentary time and cardio-metabolic biomarkers in US adults: NHANES 2003-06. European Heart Journal. 2011; 32: 590-597.
  • Knowles FW. Effects of shoes on foot form: An anatomical experiment. Medical Journal of Australia. 1953; 1: 579-581.
  • Morton, D.J. The Human Foot: its evolution, physiology and functional disorders. New York: Columbia University Press; 1935.
  • Munteanu SE, Menz HB, Wark JD, Christie JJ, Scurrah KJ, Bui M, Erbas B, Hopper JL, Wluka AE: Hallux valgus, by nature or nurture? A twin study. Arthritis Care & Research. 2010; 69: 1421-1428.
  • Nelson-Wong E, Gregory DE, Winter DA and Callaghan JP. Gluteus medius muscle activation patterns as a predictor of low back pain during standing. Clinical Biomechanics. 2008; 23: 545–553.
  • Nix S, Smith M, Vicenzino B. Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. Journal of Foot & Ankle Research. 2010; 3: 21.
  • Plotnikoff R and Karunamuni N. Reducing Sitting Time: The New Workplace Health Priority.Archives of Environmental & Occupational Health. 2012; 67: 125–127.
  • Tanaka T, Hashimoto N, Nakata M, Ito T, Ino S, Ifukube T. Analysis of toe pressures under the foot while dynamic standing on one foot in healthy subjects. Journal of Orthopedic & Sports Physical Therapy. 1996; 23: 188-193.
  • Tissot F, Messing K and Stock S. Studying the relationship between low Back Pain and Working Postures Among Those Who Stand and Those Who Sit Most of the Working Day. Ergonomics. 2009; 52: 1402–1418.
Tags: pain, science, back, foot function