Back Pain While Standing or Walking
Presentation
70-80% of individuals will experience lower back pain in their lifetime. [1-3] Back pain can be acute or chronic, and is often associated with decreased motion and stiffness. [4] Some individuals may experience radiation of pain down the legs, or numbness, weakness, or tingling caused by the compression of nerves. [4] There are several factors that may put you at greater risk for back pain. These include osteoporosis, smoking, and diabetes. [5] Additionally, poor posture, lack of regular exercise, or extra body weight may increase your likelihood of lower back pain. [5] While there are many different etiologies that cause back pain. This article focuses on the most common causes of back pain that result from and/or are exacerbated by walking or standing.
Causes
• Muscle strain/sprain: Muscle strain refers to the pulling or tearing of muscle fibers and muscle sprain refers to overstretched ligaments. Muscle strains and sprains generally present as acute, shooting pain. They are often worse when transitioning from a sitting to standing position and with increasing activity. [3,4,6]
• Muscle fatigue/mechanical issues: If muscles are fatigued, they are unable to sufficiently hold up your body weight, thereby placing more strain on your spine. Overweight individuals are often at greater risk. [7] Additionally, alterations to your mechanics may place undue strain on your spine. For example, your body must absorb force equivalent to 2-3x your body weight each time you take a step. If you have poor foot mobility, this force is transferred to the spine, causing pain over time. [8] Poor hip mobility can cause inflammation of the back over time and compress nearby nerves. [8]
• Lumbar spinal stenosis: Lumbar spinal stenosis describes a narrowing of the spine that places pressure on the spinal cord, causing pain when walking or standing, weakness and tingling, and in severe cases, bowel dysfunction. Spinal stenosis generally presents in persons older than 50, as spinal stenosis is usually a result of aging. [7,9]
• Spondylothesis: Spondylolisthesis refers to instances when one of the vertebrae slips out of place. Pain is generally worse in the leg as compared to the back and is exacerbated by standing and walking. [10,11]
• Spondylosis: Spongylosis refers to the degeneration of the facet joint that can cause leg and back pain. Usually, your back pain is worse in the morning and gradually diminishes throughout the day. This pain is aggravated by standing and walking, and spine flexion. [3,11]
• Hyperlordosis: This condition presents with drastic arching of the lower spine, more commonly known as “swayback”. This lower back pain is exacerbated by standing and walking. [12] In children, this may be treated with a corrective back brace. In adults, this condition is generally managed with OTC pain medications and weight management. Surgery may be considered in severe cases. [7]
• Irritation of internal organs: “Flank pain”, that is, pain in the region between your ribs and your hips, can indicate many different conditions, including kidney stones, kidney infection, liver disease or ulcerative colitis. [1,4,13]
Treatments
Because the onset of back pain that is made worse with standing and walking can be caused by numerous conditions, treatment will vary based on your diagnosis. Your physician may recommend physical therapy, medications including NSAIDs, muscle relaxants, and anticonvulsants, and rest or activity modifications. [1,3,5] There are also several lifestyle modifications you can implement to improve your back pain upon standing and walking. Supporting good posture throughout the day prevents unnecessary strain on the spine. [5,7]
Additionally, extra stomach weight pulls the pelvis forward, contributing to acute back pain while walking. [1,5,14] Maintaining a healthy weight and engaging in regular exercise can also lessen back pain. Applying ice or heat on the affected region of the back may also provide temporary relief and reduce any present swelling. [1,5,14]
Sources
1.NINDS. Low Back Pain Fact Sheet. National Institute of Health
https://www.ninds.nih.gov/health-information/patient-caregiver-education/fact-sheets/low-backpain-fact-sheet
2. McIntosh G, Hall H. Low back pain (acute). BMJ Clin Evid. May 9 2011;2011 3.Patrick N, Emanski E, Knaub MA. Acute and chronic low back pain. Med Clin North Am. Jul 2014;98(4):777-89, xii. doi:10.1016/j.mcna.2014.03.005
4. Bjerke B. What Causes Sharp Lower Back Pain? . Spine Health.
https://www.spinehealth.com/blog/what-causes-sharp-lower-back-pain
5. How do I stop my lower back from hurting when I walk? . The Spine and Rehab Group. https://www.thespineandrehabgroup.com/lower-back-pain-when-walking
6. Muscle Strains Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/musclestrains/symptoms-causes/syc-20450507
7. Causes of Lower Back Pain When Standing or Walking Medical News Today https://www.medicalnewstoday.com/articles/322369#long-term-treatment
8. Molen TV. 5 Reasons Why Your Back Hurts When You Walk. Kinetic Edge Physical Therapy. https://www.kineticedgept.com/5-reasons-why-your-back-hurts-when-you-walk/
9. NIAMS. Spinal Stenosis NIH.
https://www.niams.nih.gov/health-topics/spinalstenosis#tab-risk
10. Spondylolisthesis UK National Health Service
https://www.nhs.uk/conditions/spondylolisthesis/#:~:text=Spondylolisthesis%20is%20where%2 0one%20of,same%20as%20a%20slipped%20disc
11. Casazza BA. Diagnosis and treatment of acute low back pain. Am Fam Physician. Feb 15 2012;85(4):343-50.
12. Casser HR, Seddigh S, Rauschmann M. Acute Lumbar Back Pain. Dtsch Arztebl Int. Apr 1 2016;113(13):223-34. doi:10.3238/arztebl.2016.0223
13. Flank Pain. Cleveland Clinic.
https://my.clevelandclinic.org/health/symptoms/21541-flankpain
14. Frothingham S. What Can I Do About My Lower Back Pain When standing? Healthline https://www.healthline.com/health/lower-back-pain-when-standing#self--care
