Low Back Pain and Sitting: Is Sitting the New Smoking? by Bill Kelly APA Physiotherapist
In recent years, a bold comparison has made headlines: “Sitting is the new smoking.” This phrase, though provocative, has drawn attention to the health consequences of prolonged sedentary behaviour — particularly on our spines. As physiotherapists, we frequently see the effects of excessive sitting on low back health, and it's time to unpack what this phrase really means.
The Modern Sedentary Lifestyle
Most adults now spend more than half their waking hours seated — whether at desks, in cars, or on couches. This shift towards sedentary behavior is linked with numerous health concerns, including cardiovascular disease, obesity, diabetes, and musculoskeletal pain. Of all these, low back pain remains one of the most common complaints in clinical practice.
Prolonged sitting places sustained pressure on the lumbar discs and reduces blood flow to the spinal tissues. Additionally, slouched or poor postural habits often accompany extended sitting, leading to increased stress on the paraspinal muscles and spinal ligaments. According to Dunne et al. (2021), these factors contribute to increased postural strain and potential development of chronic musculoskeletal conditions.
Is Sitting Really the New Smoking?
While it’s an attention-grabbing phrase, "sitting is the new smoking" may oversimplify a complex issue. Smoking is a direct, modifiable risk factor for multiple fatal diseases, whereas sitting is a behavior that varies in context and can be mitigated with movement. However, the comparison does highlight the risks of sustained inactivity.
Waongenngarm et al. (2020) found that individuals who sit for long periods without breaks are significantly more likely to experience discomfort and pain in the lower back. Furthermore, sitting for more than eight hours a day — even in physically active people — is associated with increased mortality risk (Ekelund et al., 2019), making the broader health consequences of sitting a major concern.
Strategies to Combat Sitting-Related Back Pain
The good news? The negative impact of sitting is largely preventable. Here are some practical tips:
Frequent movement breaks: Aim to stand or move every 30 minutes.
Ergonomic setups: Adjust your desk, chair, and monitor to support a neutral spine.
Core strengthening: Engage in regular exercises that build spinal stability and support.
Posture awareness: Practice upright sitting with lumbar support when necessary.
Conclusion
While sitting may not be the exact equivalent of smoking in terms of health impact, it’s clear that prolonged sedentary behaviour poses serious risks — particularly to the lower back. As physiotherapists, we encourage clients to stay active, incorporate movement into daily routines, and take a proactive role in protecting spinal health.
Remember: Your best posture is your next posture — so keep moving.
References:
Dunne et al. (2021) Thralls KB, Cannavan D, Hossler J, Travis C, Geiger J. The relationship between objectively measured sitting time, posture, and low back pain in sedentary employees during COVID‑19. Sport Sciences for Health. 2023;19:259–266.
Waongenngarm P, Areerak K, Janwantanakul P. The effects of active break and postural shift interventions on new onset of neck and low‑back pain in high‑risk office workers: a 6‑month follow‑up cluster randomized trial. Musculoskeletal Science & Practice. 2021.
Waongenngarm P, Janwantanakul P, et al. (2023) Breaks and postural shifts reduce discomfort and LBP during prolonged sitting. Peer J.
Ekelund U, Tarp J, Steene‑Johannessen J, et al. (2019) Dose‑Response associations between accelerometry measured physical activity and sedentary time and all‑cause mortality: systematic review and harmonised meta‑analysis. BMJ.