Is sitting-while-at-work associated with low back pain? A systematic, critical literature review

Objectives: To present a critical review and evaluate recent reports investigating sitting-while-at-work as a risk factor for low back pain (LBP). Methods: The Medline, Embase and OSH-ROM databases were searched for articles dealing with sitting at work in relation to low back pain for the years 1985-97. The studies were divided into those dealing with sitting-while-working and those dealing with sedentary occupations. Each article was systematically abstracted for core items. The quality of each article was determined based on the representativeness of the study sample, the definition of LBP, and the statistical analysis. Results: Thirty-five reports were identified, 14 dealing with sitting-while-working and 21 with sedentary occupations. Eight studies were found to have a representative sample, a clear definition of LBP and a clear statistical analysis, Regardless of quality, all but one of the studies failed to find a positive association between sitting-while-working and LBP. High quality studies found a marginally negative association for sitting compared to diverse workplace exposures, e.g, standing, driving, lifting bending, and compared to diverse occupations. One low quality study associated sitting in a poor posture with LBP. Conclusions: The extensive recent epidemiological literature does not support the popular opinion that sitting-while-at-work is associated with LBP.