Standing on your feet all day? Aching legs a common concern

Infographic Data on Standing for Work

Infographic and article by Patricia Bouweraerts

The challenge of sore legs after long sessions spent rewiring lighting, conducting rehearsals, assisting in surgeries, or preparing cuisine is not getting that much press in relation to the scale and impact these extended periods of standing has on working people.

News stories in 2017 called out sitting all day as the “new smoking,” harmful to your health — but other research showing equally bad effects from standing for job shifts was not as widely reported. A study led by researchers at the Institute for Work and Health in Toronto, Ontario was released that year examining wellness of more than 7,300 Canadians across a 12-year period, with scientists finding a significantly higher incidence of heart disease for those who mostly stand for work. More on that later….

It is more than the circulatory system that suffers from long periods standing still, said physician Dale Mericle, M.D.

“Hyaline cartilage, the stuff that lines the joints, has no blood supply,” he said. “Its nutrition depends upon the movement of the synovial fluid in the joint. Continuous compression of the knees sounds like knee problems in the future, to me.”

Working people typically put on a brave face and troubleshoot ways to ease aching legs and feet, because standing for their job is expected and there aren’t many other options for them. Some find helpful techniques to prevent or ease pain, or are employed at companies that recognize risks and options.

Sarah Miller, who works at a specialty grocery store in Southern California, said that the most important factors for her are comfortable, supportive footwear, and regular stretching sessions.

“Stretching before, during, and after a long shift on your feet can help with leg pain, as well as back strain from standing,” she said. “Trader Joe’s encourages us to take ‘micro-breaks’ to stretch throughout the shift during lulls in customer traffic, since our job can stress legs, backs, shoulders, and our joints with all the bending, twisting, and heavy lifting involved in this field.”
Infographic 33 Percent of U.S. Worker Illnesses or Injuries are Musculoskeletal Disorders

Sarah’s mother Suzanne worked for many years at a retail book store in product display design and customer service.

“Concerning supportive shoes, I found that taking an extra pair to change into halfway through my shift was extremely beneficial,” she added. “Some types of orthotics and/or ankle supports are important as well.”

Individuals working in careers that involve prolonged standing share tips they have found to ease strain on legs and feet, and physicians and therapists offer guidance for prevention and management of musculoskeletal pain.

Risks from standing too long are real

Arteries move oxygenated blood away from the heart to the body. Veins move blood back to the heart. Dr. Mericle said that inactive standing leads to blood stagnation in veins.

“They (veins) depend upon rhythmic muscular contractions to move the blood,” he said. “I see varicose veins resulting from long periods of standing without walking or moving.”

The Canadian researchers who released the 2017 study connecting standing to heart disease risk are Peter Smith, Huiting Ma, Richard H. Glazier, Mahée Gilbert-Ouimet, and Cameron Mustard. Individuals in the study worked 15 hours a week or more and were free from heart disease at the beginning of the research period.

“Occupations involving predominantly standing were associated with an approximately two-fold risk of heart disease compared with occupations involving predominantly sitting,” wrote the researchers in the American Journal of Epidemiology. “This association was robust to adjustment for other health, sociodemographic, and work variables.”

The heart has to work harder to pump blood from the feet back up to the chest.

They wrote that the causes for increased risk are most likely blood pooling in the legs, raised pressure in veins, and greater oxidative stress. The study listed common occupations where individuals most often stand for long periods are: retail sales; culinary arts and food and beverage service; machine tool operation; metal and plastics production and processing; and customer service.

The research sample was 50 percent male, 50 percent female. Researchers were surprised to find a difference in cardiovascular health between men and women in careers that include a blend of standing, sitting, and walking.

“While occupations that involved combinations of sitting, standing, and walking were associated with a decreased risk of heart disease among men, they were associated with an increased risk of heart disease among women,” they wrote.

The reasons for this may include that occupational titles with a mixture of sitting, standing, and movement differ for men and women — such as motor vehicle assemblers, inspectors and testers for men, and Registered Nurses for women. The psychosocial aspects of occupations may also be amplified more in careers that include a mixture of standing, sitting, and walking, more than in jobs that are mostly sitting or standing, the researchers theorized.

The U.S. Department of Labor, Bureau of Labor Statistics (BLS) reported in 2016 that each occupation involves a combination of standing, walking, and sitting.
Infographic Two of Three Canadian Workers May Suffer From Foot Problem

“For example, waiters and waitresses spent 96.3 percent of their workday standing or walking and just 3.7 percent sitting,” according to the BLS.

The Bureau lists jobs requiring prolonged standing, including the following:

  • Welders, cutters, and welder fitters
  • Retail salespersons
  • Electricians
  • Pharmacists
  • Elementary school teachers, except special education
  • Physical therapists
  • Child care workers

How many experience pain from prolonged standing?

The U.S. Occupational Safety and Health Administration (OSHA) describes musculoskeletal disorders (MSDs) as injuries to the blood vessels, muscles, ligaments, tendons, and nerves. Included are problems such as muscle strains, pain, swelling, numbness, and other health issues.

OSHA reports that work-related musculoskeletal disorders are some of most often reported causes of lost work time, and that according to the BLS in 2013, MSDs represented about 33 percent of all workplace illness or injuries.

The Bureau conducts an Injuries, Illnesses, and Fatalities (IIF) program, posting data on work-related injuries and illnesses. Information is collected with the annual Survey of Occupational Injuries and Illnesses (SOII).

The IIF provides data for musculoskeletal difficulties according to part of the body. In 2016, the national private employer-reported cases of musculoskeletal disorders for the “Lower extremities” totaled 41,480. This resulted in a rate of 4.3 incidences per 10K full-time equivalent (FTE) workers, and a median of 13 days away from work (DAFW).

In addition, the IIF lists totals of work-related injuries and illnesses for state and local government employees. It also posts information about injuries and illnesses by industry sector. Retail; health care and social assistance; accommodation and food service; and manufacturing were the four industries with the highest distribution of nonfatal occupational injuries and illnesses.

Ipsos Public Affairs, a non-partisan, survey-based research practice that conducts polls for organizations such as The McClatchy Company and Thomson Reuters, released a study in 2010 of more than 1,000 Americans who work at large companies with 1,000 or more employees.

“A quarter (24 percent) report they have sought holistic or professional medical care (such as a doctor, chiropractor, physical therapist, etc.) to alleviate discomfort related to their work environment,” according to an Ipsos press release.

Tips for working when prolonged standing is required

Dr. Mericle recommends supportive stockings for those who need to be in a stationary standing position for their occupation.

“Moving breaks every half hour — even for just two minutes,” he said. “Stretching the lower back muscles, as well.”

Many working people, including Sarah Miller practice yoga.

“Lately I’ve been trying to do yoga regularly after work because I find that a lot of the inversion poses help take some pressure off my lower body, as opposed to just sitting on the couch which continues to put more pressure on the hips,” she said.

Massage gets a thumbs-up.

“Also massaging your feet and legs helps promote better circulation, so that’s helpful once your feet are up,” Miller added.

It is vital to know best lifting techniques.

“To avoid back injury it’s important to avoid lifting and twisting,” Miller said. “Square your body up and lift with your legs and a straight back.”

Suzanne agreed.

“In training … it should be taught how to lift heavy objects correctly — so important,” she added. “So many employees have gotten unnecessary back injuries from not knowing how to do this simple task.”

Infographic Showing Musculoskeletal Disorders By Part of BodyIn addition, paying attention to nutrition and maintaining a healthful weight help take the pressure off of feet.

“A good diet helps so much … expending so much energy (at work) is taxing on your body,” Suzanne said. “Making the right food choices is very important. I found out the hard way that carrying around too much extra weight made my job much harder. But, once I started losing the pounds, my days at work got much more manageable.”

Other tips from therapists and researchers

An adjustable desk that lets a worker change between sitting and standing is one solution. This alternative is not always available, though.

“Rather, find ways to move while you’re sitting and standing,” wrote Anna Medaris Miller, senior health editor on USNews.com. “On your feet, for example, use a foot rest to take the weight off of one foot and then the other.”

The Mayo Clinic posts helpful slides and directions for basic stretches, and those specific to some common leg and foot problems.

Knee pain often results from one or more of several causes and may be addressed by strengthening the leg and thigh, wrote Shawn Bishop, senior communications specialist, Mayo Clinic.

“Work with your doctor for a definitive diagnosis,” Bishop wrote. “Once you know the cause, I strongly advise seeing a physical therapist to learn how to do the exercises recommended for your condition. Learning proper technique from a handout alone can be very difficult.”

The post “Eight Ankle Stretches to Try at Home,” on Healthline.com, was written by Ashley Marcin and medically reviewed by Daniel Bubnis, a nationally certified personal trainer.

Before stretching the ankle, warm up the area for five to 10 minutes with gentle walking or bike riding, she wrote. Marcin also advises to seek the advice of a physician if there is more than slight soreness — actual pain — while stretching. The eight stretches include ankle circles, an Achilles tendon stretch, calf and soleus muscle stretches, and a pose from yoga called Chair Pose, or Utkatasana.

Many sources recommend stretching regularly, about three–five days each week.

What ratio of standing to sitting is more beneficial?

We sit for some types of jobs because it helps with concentration.

“Sitting uses less energy than standing and it helps to stabilize the body, so we sit to perform fine motor tasks like driving, computer work, creating detailed drawings, or fine micro-surgery,” according to Cornell University’s Ergonomics Web, (CUErgo).

The reason that sitting all day at work received such a bad rap is because it is found to affect metabolism.

“Sitting for more than one hour has been shown to induce biochemical changes in lipoprotein lipase activity (an enzyme involved in fat metabolism) and in glucose metabolism that leads to the deposit of fats in adipose tissue rather than these being metabolized by muscle, and extensive sitting also relates to heart disease risks, so people are advocating standing to work because this uses more muscle activity (burns about 20 percent more calories),” CUErgo posted. “These changes happen in both fit people who regularly aerobically work out and also unfit and obese people, and regular exercise doesn’t necessarily address this.”

But standing still for the day isn’t the answer either.

“Ergonomists have long recognized that standing to work is more tiring than sitting to work,” according to CUErgo. Standing requires ~20 percent more energy than sitting. Standing puts greater strain on the circulatory system and on the legs and feet.”

Infographic on Optimal Ratio for Sitting Standing and MovingA combination of positions appears to be the best for health.

“Sit using a height-adjustable, downward tilting keyboard tray for the best work posture, then every 20 minutes stand for eight minutes and move for two minutes,” CUErgo wrote. “The absolute time isn’t critical but about every 20–30 minutes take a posture break and stand and move for a couple of minutes. Simply standing is insufficient. Movement is important to get blood circulation through the muscles.”

It doesn’t have to be vigorous, no need for jogging or jumping jacks.

“So build in a pattern of creating greater movement variety in the workplace (e.g. walk to a printer, water fountain, stand for a meeting, take the stairs, walk around the floor, park a bit further away from the building each day),” according to CUErgo.

Evidence for an adjustable work station

Those polled in the Ipsos Public Affairs survey would rather have options for choosing their work position.

“Two thirds (67 percent) agree — including 25 percent who strongly agree — that they wish their employer offered workstations or desks that could be adjusted so that they could work either seated or standing,” according to the release.

The employees thought a choice of working positions would improve the quality of their work, as well.

“Additionally, six in ten full-time workers surveyed (60 percent) feel that they would be more productive if they had the option to work seated or standing,” according to the release.

OSHA posts on its site that MSDs can be prevented using ergonomics, the process of adjusting the physical position of the job to a person’s natural and most efficient movements. The agency adds that the most effective approach to reducing musculoskeletal injuries is to engage employees in a workplace ergonomics process.

“A participatory ergonomic approach, where workers are directly involved in worksite assessments, solution development and implementation is the essence of a successful ergonomic process,” according to OSHA.

A concern worth attention

Most of us either sit all day, or stand all day in the workplace — the risks to our health from static postures are reported in the research and are something for which we need to pay attention.

Working people are sharing techniques to vary postures on the job, and physicians and therapists have recommendations for helpful stretches. A variety of positions and activities may both increase productivity in the workplace and improve peoples’ health.

These are an endorsement to “use the brain and body for work” … and not to “work to use the brain and body.”

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