Lower Back Pain When Sitting But Not Standing

If your lower back hurts, your first instinct may be to take a seat. But, while sitting takes a load off your legs and feet, it can worsen back pain in some circumstances. Lower back pain when sitting but not standing can point to various conditions, including spinal diseases and sciatica. 

Below, we’ll analyze the possible causes of lower back pain when sitting and possible solutions to implement into your wellness routine. 

Why Does My Lower Back Hurt When I Sit But Not When I Stand?

Your lower back may hurt when you sit but not when you stand because sitting places more impact on the lumbar spine. So, sitting may exacerbate conditions affecting the lumbar spine structures, like spinal stenosis, spondylolisthesis, herniated disc, and degenerative disc disease. 

Why Does My Lower Back Hurt Above My Buttocks When I Sit?

If your lower back hurts above your buttocks when you sit, you’re likely dealing with a lumbar spine issue, like a herniated disc, lumbar spinal stenosis, or spondylolisthesis. Sciatica, sacroiliac joint dysfunction, and piriformis syndrome are other possible causes. 

  • Sciatica is a common condition involving pressure on the sciatic nerve, which travels from the lower back through the buttocks and down the legs. This can cause pain, tingling, and numbness that travel along the path of the nerve. Sciatica pain tends to get worse with prolonged sitting because it increases stress on the nerve. 
  • Sacroiliac joint dysfunction, or SI joint dysfunction, affects the joint that attaches the pelvis to the lumbar spine. The joint may be misaligned and/or move abnormally, leading to pain in the lower back, buttocks, and lower extremities. 
  • Piriformis syndrome occurs when the piriformis muscle in the buttocks presses on the sciatic nerve. This can cause pain in the lower back, buttocks, and lower extremities—it often feels similar to sciatica pain. 

Why Does My Lower Back Hurt When I Do a Sit-Up?

Your lower back may hurt when you do a sit-up because of weakened core muscles, tight hip flexors, poor sit-up technique, or an underlying spinal condition. 

The most common cause of pain while doing sit-ups is a weak core and tight hip flexors. The core (AKA abdominal) muscles provide significant support for the spine, but often weaken from a sedentary lifestyle. 

When you try to do a sit-up with a weak core, the core muscles alone can’t facilitate the movement. This forces other tissues, like the spinal joints, discs, and ligaments, to bear the load. As a result, your lumbar spine is subject to increased stress and you may experience lower back pain. 

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Tight or excessively strong hip flexors (the muscles at the front of the hip) can also transfer stress to the lumbar spine when you do sit-ups. Tight hip flexors pull on the lumbar spine, leading to discomfort with each rep. 

Generally speaking, sit-ups aren’t the best core exercise for your back. This may seem like a catch-22, as you can’t strengthen your core without regularly exercising them. Thankfully, other core exercises can bolster this key muscle group without straining your spine, including planks and bridges. 

How to Cure Lower Back Pain When Sitting

To cure lower back pain when sitting, start by improving your sitting posture and taking breaks during long periods of sitting. 

Sitting with poor posture or in a twisted position can lead to lower back pain. So, if you experience back pain when you sit, a good first step is to implement proper sitting posture. Keep your feet flat on the ground without crossing your knees or ankles, relax your shoulders, and look forward. Keep your back straight with your spine aligned, maintaining the natural curve of the lumbar spine. 

Additionally, try to take a break after every 30-minute period of sitting. Stand or take a quick walk to give your back a break. If you work at a computer, a standing desk can make it easier to take regular breaks from sitting. 

Along with these tips, consider the type of chair you’re sitting in. If you have a desk job, it’s worth investing in a high-quality, supportive office chair that’s appropriate for your height. Ensure the chair offers adequate lumbar support, meaning it supports the natural curve of the lumbar spine. 

If you still have lower back pain when sitting after implementing these changes, you may need to try more formal back pain treatments, like physical therapy, pain medications, activity modifications, and weight loss. 

  • Physical therapy can address muscle weaknesses, tension, and imbalances that may be contributing to your lower back pain. Your PT may suggest targeted exercises, stretches, and complementary treatments, like massage, to lower your pain levels. 
  • Pain medications can temporarily relieve pain and inflammation. While they don’t target the underlying cause of back pain when sitting, medications can help you manage your symptoms while your back heals. 
  • Activity modifications like swapping high-impact workouts for low-impact alternatives, like walking or swimming, can help reduce lower back pain over time. Your doctor may also recommend various lifestyle adjustments, like quitting smoking and eating healthier, to promote recovery. 
  • Weight loss may help reduce lower back pain while sitting for individuals who are overweight or obese. Shedding extra pounds helps alleviate stress on the lumbar spine when you sit. If weight loss is advisable for you, talk to your doctor about safe, sustainable weight loss methods that may work for you. 

When these conservative treatments fail to provide lower back pain relief, your doctor may recommend more aggressive treatments, such as epidural steroid injections and even surgery. This usually only occurs in advanced cases of certain spinal conditions, including spinal stenosis, spondylolisthesis, and herniated disc. While these conditions can usually be managed without surgery, severe cases may require surgery to completely resolve your pain. 

If you experience lower back pain when sitting that doesn’t go away after a few weeks of improving your habits, don’t hesitate to contact a doctor for professional support.