Overview
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 people may also feel pain radiating down the legs, or numbness, weakness, or tingling caused by nerve compression. [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] Back pain has many possible causes. This article focuses on the most common causes of back pain that result from, or are made worse by, walking or standing.
Causes
• Muscle strain/sprain: A strain is a pulled or torn muscle, while a sprain is an overstretched ligament. Muscle strains and sprains generally present as acute, shooting pain. The pain is often worse when going from sitting to standing and as activity increases. [3,4,6]
• Muscle fatigue/mechanical issues: When muscles are tired, they cannot support your body weight as well, which places 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 usually appears in people older than 50 because it is typically a result of aging. [7,9]
• Spondylolisthesis: This condition occurs 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: This term refers to degeneration of the facet joints, which 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”. The resulting lower back pain is worse with standing and walking. [12] In children, this may be treated with a corrective back brace. In adults, this condition is generally managed with over-the-counter pain medication and weight management. Surgery may be considered in severe cases. [7]
• Irritation of internal organs: “Flank pain,” or pain in the area between the ribs and hips, can signal many different conditions, including kidney stones, kidney infection, liver disease, or ulcerative colitis. [1,4,13]
Treatments
Because back pain that worsens with standing and walking has many possible causes, treatment depends on your diagnosis. Your physician may recommend physical therapy, medications including NSAIDs, muscle relaxants, and anticonvulsants, and rest or activity modifications. [1,3,5] Several lifestyle changes can also ease back pain when standing and walking. Supporting good posture throughout the day prevents unnecessary strain on the spine. [5,7]
Extra weight around the abdomen also 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 to the affected area may also provide temporary relief and reduce swelling. [1,5,14]
Sources
1. NINDS. Low Back Pain Fact Sheet. National Institutes of Health.
https://www.ninds.nih.gov/health-information/patient-caregiver-education/fact-sheets/low-back-pain-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.spine-health.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/muscle-strains/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/spinal-stenosis#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-flank-pain
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
