Prolonged Standing at Work

Posted on by Robert B. Dick, PhD

 

standingThe National Retail Federation forecasts that retailers and merchants will hire between 730,000 and 790,000 seasonal workers this holiday season.[i] Many of these workers, such as sales associates and cashiers, have little, if any, opportunity to sit during their work shift. Increasingly, workers across a variety of occupations are required to stand for long periods of time without being able to walk or sit during their work shift. For example, in operating rooms, nurses and doctors must stand for many hours during surgical procedures. In retail, sales associates spend a considerable amount of their work time standing without the ability to sit down.  Female associates who wear high heel shoes are at increased risk of developing musculoskeletal pain conditions.[ii] [iii]

NIOSH conducted a review of the literature to examine the risks of prolonged standing in the workplace. “Evidence of Health Risks Associated with Prolonged Standing at Work and Intervention Effectiveness” was published in Rehabilitation Nursing earlier in the year.[iv]  Based on the research reviewed, there appears to be ample evidence that prolonged standing in the work place leads to a number of negative health outcomes. The studies consistently reported increased reports of low back pain, physical fatigue, muscle pain, leg swelling, tiredness, and body part discomfort due to prolonged standing. There is significant evidence that prolonged standing at work (primarily in one place) increases risk of low back pain, cardiovascular problems, and pregnancy outcomes.

Interventions such as floor mats, shoe inserts, adjustable chairs, sit–stand workstations, and compression stockings have been used by employees to reduce the pain, discomfort and fatigue from prolonged standing. In reviewing the studies examining the effectiveness of interventions, we concluded that dynamic movement appeared to be the best solution for reducing risk of these health problems due to prolonged standing. The ability for workers to “have movement” during work, such as walking around, or being able to easily shift from standing to sitting or leaning posture during the work shift seemed to be a common suggestion in nearly all of the literature but needs more research.

A reliable characterization of prolonged standing is needed based on a standard workday (i.e continuously standing for over one hour or standing for over 4 hours per day). Various groups, such as the Association for peri-operative Registered Nurses (AORN) and the Dutch researchers, have suggested time limits for prolonged standing, which they believe would be effective. Perhaps the solution can be found in how work is organized. Jobs should be designed to allow the employee to have control over their own bodies, such that they are able to assume different sit/stand postures and move as they need throughout their work shift.

Has your workplace addressed the issue of prolonged standing? What has worked? Please share your experiences in the comment section below.

Robert B. Dick, PhD, Captain USPHS (Ret.)  is a visiting scientist in the NIOSH Division of Applied Research and Technology.

 


This blog is in memory of Thomas Waters, PhD. Dr. Waters, a preeminent scientist who worked at NIOSH for 24 years, passed away in November. He made important contributions to research on work-related musculoskeletal disorders and was a co-author of the study summarized here.

 


 

References

[i] National Retail Federation https://nrf.com/news/retail-industry-adds-22100-jobs-october Accessed 11/21/2014

[ii] Mika A, Clark BC, Oleksy Ł. The influence of high and low heeled shoes on EMG timing characteristics of the lumbar and hip extensor complex during trunk forward flexion and return task.   Man Ther. 2013 Dec;18(6):506-11. doi: 10.1016/j.math.2013.03.004.

 

[iii] Mika A, Oleksy L, Mika P, Marchewka A, Clark BC. The effect of walking in high- and low-heeled shoes on erector spinae activity and pelvis kinematics during gait. Am J Phys Med Rehabil. 2012 May;91(5):425-34. doi: 10.1097/PHM.0b013e3182465e57.

[iv] Waters, T and Dick,R. “Evidence of Health Risks Associated with Prolonged Standing at Work and Intervention Effectiveness “Rehabilitation Nursing 2014, 0, 1–18.

Posted on by Robert B. Dick, PhD

19 comments on “Prolonged Standing at Work”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    The work of Karen Messing and her colleagues has contributed a lot to making this hazard better understood and more recognised. (See the chapter in “Pain and prejudice. What scientists can learn about work from the people who do it.) Thanks for your work, and acknowledging Tom’s contribution. How does one get a copy?

    @Dorothy Wigmore, Yes, Karen Messing’s works have been spectacular. I appreciate Dr. Thomas Water’s contributions to the issue too. His memory and works live on. Kudos, Robert B. Dick, for your works and this article. Thanks.

    I’m wondering how this research and the relatively recent research about prolonged *sitting* mesh together. Being able to move around and neither sitting nor standing in one place seems to be the best, as is alluded to in this article. But workplaces are many and varied. It’s hard to individualize your employees’ work area across an entire facility. “Happy mediums” are extremely hard to find!

    Concerning this research, I’m particularly curious about the notion that standing for too long can lead to cardiovascular problems. Surprising conclusion.

    in my work as occupational medicine doctor, I see daily lots of workplaces where long standing is imposed either by firm policy or the place of work conditions ( lack of space in a store or the necessity to adopt a fixed position in front of a machine).The legislation in my cointry allows me to make reccomendations ( medical or ergonomic) based on the ,anamnesis,psysical exam and suplimentary medical tests. For example ,the employee that presents subjectiv and objectiv modifications in his state of health, that can be atributed to prolonged standing is either exchanged from his workplace (rotation) or he could beneficiate of 10 min every dwo hours of sitting or lying down in Trendelemburg in a separate room. If the disease can be atributed to profession, I signal it to abilitated control organisms and if the case corfirms that employee benefits of 4 to 12 salaries (depending on the disease),pait recuperatory treatment and so on.

    Thank you for the concern and recommendations as doctor what would be a nice impact to add “recuperation” time to many of the workplace diseases/ hazards what able to cause illnesses to workers. I agree to create a policies for standing positions to have every two hours a time to seat/walk/ stretch . For previously injured workers after returning to work to even laying down or take longer brake or lunch hour out if needed. It is not just about rights but needs and so about respect from the employers towards their workers and their health. Working around 32 years in the USA I find very few employment where workers are valued that way. I recommend Labor and Industries visit companies small and large much us they could, surprise visits and check on safety issues more often including what you mention here would be one of the most important part to be able to employ well-trained workers and older or pre-injured knowledgeable staff. If you can collect others around you in your profession to request all this and put in what you believe in it would be a GOD SENT for all workers in our country. ( Injured worker)

    now a days most of the businesses specially in city centre and on the shop floors most of the employees are standing almost all day with out sitting….

    It’s fact but, it’s not all time standing all time. My job is keep on sitting 7 hours but meanwhile we have lunch and so on things we need.

    It will be interesting to conduct a study on the correlation between formation of plantar calcaneal spur and duration and frequency of prolonged standing among workers.

    I am a US Postal mail handler for the past 25 years. My job requires me to stand the entire shift. As an employee, I have requested a sit stand stool and they are refusing. I have developed varicose veins, bone spurs and siatic pain. Can you suggest any recourse? I’m suffering and I have years to go before retirement.

    NIOSH has conducted several Health Hazard Evaluations (HHEs) at the postal service. You can access them by searching “postal service” on this website https://www2a.cdc.gov/hhe/search.asp The following HHEs may be of interest:
    https://www.cdc.gov/niosh/hhe/reports/pdfs/2007-0170-3070.pdf
    https://www.cdc.gov/niosh/hhe/reports/pdfs/2008-0293-3132.pdf https://www.cdc.gov/niosh/hhe/reports/pdfs/1992-0073-2337.pdf

    The issue of prolonged standing has come up during the postal service HHES. The recommendations we have provided to minimize prolonged standing and potential health problems include: Design the work so that the employee can adopt various postures; provide sit/stand work stations for certain postal operations such as when repetitive operations were performed with frequent reaches more than 16 inches forward; provide industrial antifatigue mats for employees who stand for more than 90% or more of their working hours; and rotate employees through jobs with different physical demands to reduce the stress on limbs and body regions.

    You can try sharing this information with your employer and union.

    Tiffany, I am sorry for the hardship you are going through. Your employers are supposed to provide adjustable seats/ stools for you. No one should be required to continuously stand or walk for one hour or for their whole work shift, without available options to sit.
    If only there can be better regulations and enforcement to improve the quality of life of employees in this aspect. Please let us work towards this; setting better examples for the rest of the world. Thanks.

    I am a nurse and our floor has recently removed most of the chairs from our nursing stations. The remaining chairs are utilized by other disciplines which does not allow nursing staff to sit. Managment feels this will increase patient satisfaction and increase use of the computers in the patients’ rooms. There are no anti-fatigue mats in the rooms. The chairs in the patients’ room are not height adjustable they’re just regular chairs. I feel this will increase ill effects to nursing staff and potential cause harm to patients.

    George, that is a terrible condition. You are correct in your assessment and there is available research to support it. Work productivity and patient satisfaction actually decrease with increased prolonged standing and stress on staff; this further leads to workplace accidents and increased spending/ costs of maintenance for employers.
    Please, better education and awareness are needed to both employees and employers. Thanks.

    work in a clinical facility at front door and lobby security is it ok for employer to force us to be on our feet for a complete 8 hr shift?

    What is the age at which an employee of a company would be recommended to stay away from work? Does the CDC recommend that employees aged 65 or older or 70 and older to stay away from work? My type of work (Maintenance Technician/ multifamily housing) requires garbage handling and entering peoples apartments to repair broken or malfunctioning items. During this pandemic time period, we are required to enter apartments of people, with appropriate PPE, for emergency repairs only. I am of good health and will be 68 in September. Should I be concerned?

    Have there been any studies on how long an employee should stand on an ergonomic mat? I found many studies involving four hours. I work 10 hour days. I don’t just stand, there is minimal walking.
    One of the mats that I work on has a tacky surface (like I envision would be used in a ‘clean’ room). We stow items so there is a lot of minimal walking, however there is no ability to pivot your foot on the surface. We must lift our foot to pivot.
    The other mat that is used has half moons all over it. This mat is used to remove heavy items from a conveyor, placed into smaller lots that go into totes and down another conveyor. After 3 hours of working, my plantar fasciitis was back with a vengeance and my employer said it was my shoes and not the unlevel surface. This person is an Athletic Trainer and not an Occ Medicine person. I couldn’t find information on Occ Med websites or Podiatry websites. Any ideas? I truly hate ergonomic mats – I love ergonomic shoes and concrete.

    E.T.P., I think taking a few minutes, about 5 minutes (5 – 10 minutes) to sit, after every hour standing, should be beneficial to your feet as this relieves them from the pressure of standing. Sitting between operations or during operations when possible, can be highly beneficial.

    It saddens me that at this time and age, in the land of the free – the USA, issues of prolonged standing and its detriments to society have not been properly regulated by authorities like the CDC, and OSHA. How many more health injuries, morbidity and mortality need to occur before recommended safety measures are effectively enforced?

    In 2018, I did a research on prolonged standing at restaurant jobs, and I am currently doing another project on policy and enforcement recommendations addressing prolonged standing at work.
    I am however hopeful that the US will catch up to, and even become better in addressing this issue like other Countries – Britain, Sweden, Japan, and Canada, have done.

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