Irish physiotherapists are reporting a surge in younger people with back pain since the start of widespread working-from-home arrangements in recent years.
However, they are warning it is not necessarily linked to poorer posture or home workspaces, but more likely to workers taking less exercise and experiencing increased stress during the pandemic.
Esther Mary D’Arcy, of the Irish Society of Chartered Physiotherapists, who is also European chair of World Physiotherapy, which represents 685,000 practitioners across the globe, said there has “definitely been an increase” in people aged in their 20s and 30s seeking help for back pain.
“Increasing back pain is another silent impact of the pandemic and it is going to cause more health issues,” she said.
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While hard figures are not yet available in Ireland, a study in the UK has claimed six in 10 young adults aged between 18 to 29 years are suffering from what one organisation dubbed “Covid back”.
The national survey suggested almost half of respondents did not have access to a table and supportive chair while working from home. A fifth were working from a sofa or bed.
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But experts in Ireland say back pain has less to do with sitting positions than previously believed, and more to do with how long people sit as well as exercise, diet, weight and mental health.
“It used to be that the emphasis was on straight posture and getting the right angles with sitting positions in the workplace, but that is no longer the case,” said Ms D’Arcy.
“Research indicates that you no longer focus just on the relationship of the chair to the workplace, but that it is what is most comfortable and that you get up and move regularly.
“It is not so much posture, it is about not sitting for prolonged periods and getting up and moving around the house that is important.”
Ms D’Arcy said younger workers increasingly seeking help with back pain are typically complaining about “gradual-onset lower back pain” and as a result they move less when the advice is to “move through the pain”.
“Not moving during back pain leads to a cycle of decreased movement, increased weight and a decreased desire to move, which can spiral into chronic back pain and immobility,” she added.
“Certainly, what I’m hearing is that so many younger people who always worked at office desks, probably walking in and out to the office, up blocks of stairs, are now working at a kitchen desk where they might not be moving for hours.
“For that reason, physiotherapists are seeing a lot more people and a lot more younger people than they would have before.”
But Dr Kieran O’Sullivan, a University of Limerick expert in lower back pain, cautioned against firm conclusions on the exact causes of the rising numbers with back pain problems.
“We are seeing loads of people with back pain, including young people, but it is probably too early to say this is all about working from home,” he said.
“There is always a risk that we can scare people but there are definitely loads of people with back pain, including young, relatively healthy people.”
Dr O’Sullivan said one of the reasons working from home is “quite a concern” is the assumption that people are getting back pain “only because of ergonomic issues.”
“There is a belief out there that if I get back pain when I’m working from home it is only because I don’t have an ergonomic chair or desk, whereas the evidence tells us there is a lot more going on in back pain,” he said.
Most workplaces have a specific idea of the “correct way to sit but most of that is based on aesthetics — like, this is the elegant, attractive, sophisticated way to sit. There are these stereotypes that if you slouch you are lazy or disinterested.
“But all the evidence tells us that whether we slouch or sit upright, we are equally likely to get back pain and that the real drivers are other factors, some of them including mental health, poor sleep, high work stress — all the more complicated stuff.
“If you think about how long those ergonomic guidelines and advice have been around — for decades — and yet we are seeing more and more back pain than ever.”
While posture has a role, the “big-picture health issues” are more important.
“It is about your overall physical and mental fitness, sleep, diet, stress levels, even strength of social circles, quality of relationships, especially with your employer.
“If you have a poor relationship with your employer that is a much bigger factor than the angle of your desk or chair. A manager causing distress for you or the workplace is a much bigger red flag than your backrest.”
‘People were coming in who are normally fit and healthy, with sore backs and necks’
The winter after the pandemic arrived in Ireland, Jenny Branigan noticed something unusual at her physiotherapy practice.
“We were starting to see people of all ages, working-age people in their 20s, 30s and 40s. Particularly people with younger children,” she says.
“People were coming in who never presented before, who are normally fit and healthy, with sore backs and necks. Physios were talking about it.”
Branigan, who runs Total Physio in Sandyford, Co Dublin, says new, younger clients were typically “developing stiffness from not changing position regularly”.
“They were more tired than usual. They were working longer hours, with their heads tilted to screens,” she says.
“And people were more anxious during Covid. That stress was being held in the trapezius muscle [at the base of the neck, stretching across the shoulders and down the back].
“There were also repetitive strain injuries, stiffness from a lack of mobility for people sitting at a chair for three or four hours at a time, and not breaking that cycle.”
Those having to juggle managing children at home with their usual workload were over-represented.
“When we looked at the pandemic, there were phases,” she adds.
“In the first phase people were enthusiastic, there was a great explosion in people looking after themselves. But then as it went on, and people got fed up with it, they were doing less and less.
“There was great anxiety because it was going on more than anyone expected.
“People who could run 5k before couldn’t manage it. They were not as active, not as supple or mobile. People were not going out for a coffee, taking a stroll at lunchtime. Some had difficulties lifting their kids or a shopping bag.
“Everything was being emailed or instant messaged, and then after work they were just sitting on the couch watching Netflix. Everything was sitting-based. People were getting in a rut.”
Branigan tells clients working from home to “get up every half an hour and change your position. If your body is in the same position for too long, it stiffens. That might mean just getting up to get a glass of water, or move the bin to the other side of the room and walk to it.”
Squats and press-ups on the kitchen counter also help.
“We advise patients not about their best posture but about changing position frequently. The key thing is moving and changing position. No matter how good the position you are in, if it is for too long, the body doesn’t like that.”