Getting upset at one’s government for not fixing some pet cause is beyond passé, and it usually makes you sound like a crazy person. But I never claimed to be sane, and I was getting annoyed that US government had so little to say about prolonged standing in the workplace.
In this case, I’m the one who has to eat crow. The information was there, I just sucked at finding it. In 2014, authors from The National Institute for Occupational Safety and Health (NIOSH), which makes recommendations for work-related safety and injury prevention, released a thorough review of the dangers of prolonged standing and the effectiveness of various interventions, and it’s actually quite good. (True, the paper comes with a disclaimer that distances the agency from the authors’ opinions…but I’m still going to count it.)
The paper was a review, meaning it looked at many other studies, guidelines, and articles. The authors evaluated the strength of the existing evidence, and came to their own conclusions.
What Health Complaints Were Included?
The authors couldn’t consider every dang health complaint that exists to see if it’s linked to standing. So they made a short list, and evaluated the connections in those areas. They focused on:
- Low Back Pain
- Cardiovascular problems
- Fatigue/Discomfort
- Pregnancy Issues
What Were the Key Takeaways?
The authors carefully sifted through the evidence, and listed the findings and conclusions of each. As might be expected in a scientific paper, their language was cautious, and they showed admirable restraint when stating their conclusions.
I, on the other hand, will cheerfully summarize everything in pat statements, and gloss over those pesky nuances.
Low Back Pain
- People who stand all day have a lot more pain than people who don’t.
- Standing for a long time changes which muscles are activated and how, which may lead to pain.
- Standing on a sloped surface seems to help people avoid low back pain.
- The jury’s still out on why, exactly, standing might cause low back pain.
Cardiovascular Problems
- Prolonged standing and age both increase a person’s risk of developing venous diseases.
- Leg volume is increased with prolonged standing.
- People whose jobs require prolonged standing are more likely to get varicose veins.
- Men whose jobs required a lot of standing had higher carotid intima media thickness than those who didn’t. (The carotid arteries are in the neck, not the legs. Thick carotid artery walls are associated with atherosclerosis, and a higher risk of heart disease and stroke.)
- Standing at work seems to increase leg edema, especially for those with varicose veins.
- Nighttime leg cramps are also more common in workers who stand more than 4 hours per day.
- Objective measure of physiological stress (such as blood pressure, total water in the body, and vein size) increased after 8 hours of standing.
Fatigue/Discomfort
- Prolonged standing increases both objective measures of fatigue and subjective levels of discomfort. (A shocking discovery, I know.)
- Oxidative stress (which is linked to cell and tissue damage, and may lead to any number of nasty diseases) is higher in workers who stand all day.
- Standing and moving around is much better than standing still.
Pregnancy Issues
- The evidence for pregnancy complications was more mixed compared to the evidence for low back pain, cardiovascular problems, and fatigue.
- There is decent evidence to suggest that prolonged standing during pregnancy increases a woman’s risk of preterm deliveries, spontaneous abortion, and stillbirth.
- There is less compelling evidence to suggest that prolonged standing increases the risk of low birth weight and small birth size for gestational age.
- Is there a safety threshold (either hours per day, or hours per week) for standing while pregnant? We don’t know.
What Interventions Help Standing Workers?
According to Captain Obvious, the best way to prevent standing pain is to stand less. Got that?
But if your choice is between standing and working, or laying down and being fired, you may not have the luxury of stopping. And some occupations lend themselves to flexible postures more easily than others. So NIOSH also looked at evidence on various interventions that have been tried to reduce standing pain to see how well they worked.
Compression Stockings
There is pretty clear evidence that compression stockings (also be called compression socks or compression hosiery) do help, up to a point. They are reasonably effective at improving symptoms of venous diseases and reducing leg pain. But they certainly aren’t a cure for anything, and they are no help at all for treating non-venous problems.
Floor Surfaces & Shoes
We can conclusively say that concrete sucks. Every time concrete was tested against other materials, regardless of what those materials were, it was voted dead last in terms of comfort.
Figuring out which material was best was harder, and the authors didn’t even try to make a recommendation. Generally speaking, soft and compressible surfaces are better than hard surfaces.
Both better flooring and better shoes (or shoe insoles) were good at reducing subjective levels of discomfort. But there wasn’t much to suggest they would help with swelling, low back pain, or other health complications. Better flooring combined with better shoes didn’t offer much advantage over a single intervention.
The authors did note that wearing high-heeled shoes might increase the prevalence of varicose veins. But is this information really going to be the main thing that dissuades people from standing in heels for 8+ hours?
Sit/Stand Workstations
Studies on sit/stand workstations vary widely in their particulars, and many are so small that the results are little more than anecdotal. But in some cases, sit/stand workstations clearly had a positive effect. In one study of South African surgeons, 100% reported that sit-stand chairs reduced back pain during long surgeries.
After looking through the results, I concluded that if you want to try a sit/stand workstation, knock yourself out. Users often report less discomfort, and sit/stand workstations are a rare intervention that might benefit both standing and sitting workers.
This article is becoming a list of obvious things, so I’ll add one more. In order for a sit/stand desk to help you, you have to be able to stand and sit. And this is clearly not true for everyone.
Conclusions
I’m still going to gripe about the government. It’s bogus that I have to get my car inspected every two years, even though we all know that for $60, my car will be declared “safe.” Even if the mechanic has to ignore the dead body in the backseat. My city tacks an extra fee on to my property taxes, for the “convenience” of letting me pay them. (To be fair, the city of Newark needs that money for important municipal improvements, like putting lead in our drinking water.)
But at least one federal agency did the right thing with my taxpayer dollars, and provided leadership where needed. True, that leadership is of a scientifically-reserved and non-binding nature, but that is even more encouraging. At least one U.S. federal agency does real science.
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