Prolonged Standing at Work

The 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.