Changing your chair to an often more expensive 'back friendly' one is a traditional tactic in trying to tackle lower back pain. Chair type and sitting posture is a topic that patients frequently ask us about during consultations. There is no doubt that office based jobs that involve prolonged periods of sitting can be known to commonly aggravate preexisting lower back pain (source). However... interestingly... it seems highly unlikely that occupation roles involving prolonged sitting are actually an independent cause of lower back pain! (source)
Should we recommend special chairs? Are you wasting money? What does the research say?
Use of chairs with lumbar supports
There is mixed opinion on the use of lumbar supports. Some studies have found that chairs with lumbar supports provide relief (source). Others have found that using a back support reduces muscle tension (source). Other authors have reviewed the literature and decided that there is little evidence to support modifying chairs to reduce lower back pain (source).
What about chairs that create tiny movements in your back as you are sitting?
This is generally referred to as dynamic sitting. There is some support for using dynamic sitting (source) to help promote micro movements in the spine while sat e.g using gym balls and also using kneeling stools (source) to promote more extension of your back whilst sat. However... some argue that while these types of seats may reduce back pain they often create symptoms elsewhere in your body. There are also conflicting reports as to whether spinal muscle activity is either increased or decreased.
So.., obviously a mixed bag of opinions and outcomes...
So what do we recommend you should believe and what should you actually do?
Interestingly...if you read the studies mentioned/referenced so far it is clear that they have many limitations! Perhaps the most common criticism we can make is that the researchers seem to only trial the use of one particular chair for all types of back pain. When we assess people's spines in the clinic each one can be very different. Some have flat/straight backed postures, others have over exaggerated curves. We would treat each type of back pain with different types of physiotherapy, so why don’t we apply this same principle to picking chair types? Surely there should be types of chairs that suit certain types of spine!
One of the most recent papers looking at this specifically is by Mary O’Keefe and her team in 2013 (source). They looked at trying two different types of chair on one particular sub group of back pain patients (people whose symptoms were worse with bending and better with straightening). The first chair they trialled was a traditional office chair with supportive back rest keeping you relatively still (type of chair you would get through your occupation heath dept). The second chair however was one that sloped forwards providing a small dynamic element and a straighter spine when sitting. Interestingly... this group of back pain patients experienced significantly less pain when sitting on the sloping chair. This essentially means that those with worse back pain in bending are better sat with a chair tilted forward in order to increase their extension (arching of their spine) and that for those whom have pain that is worse when they extend (arch) their spines will be better sat in a chair promoting a bent/slumped posture.
Perhaps the main lesson we can learn from this is that there may be some value in investing in specifically designed chairs...but...only ones that are matched to your spinal type. the current approach in occupational health departments seems to look only for a generic norm, assuming all spines and symptoms are the same... it is unlikely therefore that this will work .
You may be best to seek a spinal assessment from a physiotherapist or medic that can match your back type to a certain chair type and work out what is best for you. It is also widely acknowledged that lower back pain has a variety of underlying components. Simply addressing the mechanics of sitting on its own is likely to only effect a small proportion of the underlying causes of most people’s back pain. It is therefore likely that looking at sitting postures in isolation will never really be an effective measure.
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Thanks for reading
The Consortium Team