When your lower back hurts more standing than sitting

What follows combines several patients' visits into one composite story. It is not about any one person, and anything that could identify someone has been removed.

How do patients usually come to us?

Patients tell us they thought their back hurt from sitting too long, but it's actually worse when they walk or stand. That detail is the clue.

They also mention the soles of their feet burn and they get tired after walking just a little. They talk about the feet and the back separately, but when we ask, the two come up together.

They've tried pain patches and stretching, but nothing changed.

Why does it hurt more when standing?

While you're standing, your feet carry your body weight. If the arches have collapsed, your center of gravity tips forward, and your body arches the lower back more to keep from falling over.

This arching repeats with every step. When you're sitting, your feet aren't carrying your weight, so it hurts less.

An excessive inward curve of the lower back is called lumbar hyperlordosis.

So no matter how much you loosen the lower back, it arches again as soon as you stand. The cause is below it.

What do we look at?

We measure how weight lands on the soles of your feet. We check whether the whole sole touches the ground and where pressure concentrates.

We also look at how you stand from the side, checking whether your center of gravity is forward and how much your lower back is arched.

We have you walk. Some things don't show while standing but appear during walking.

How do we treat it?

We build the foundation with custom insoles that support the arch, and treat the lower back, already arched and stiff, separately with Chuna (Korean manual therapy).

Supporting the feet alone won't make a stiff lower back straighten out on its own. That's why the two need to be done together.

We also build strength around the abdomen and pelvis. With that strength, the lower back arches less while you stand.

How did things go?

Foot fatigue goes down first. The feeling of less pressure on the lower back while standing comes next.

Many people first notice the difference on slopes or stairs, where weight shifts forward.

What are the limits of this approach?

The cause of lower back pain is not always in the feet. What we look at is one of several possible paths.

If you have numbness running down your leg, weakness, or any change in bladder or bowel function, get checked by an orthopedic surgeon or neurosurgeon first.

To people with the same symptoms

1. Hurting more when standing than when sitting is the clue.
2. When the arch collapses, the body arches the lower back more to keep from falling.
3. Even if you loosen the lower back, it arches again when you stand.
4. Supporting the feet and treating a stiff lower back are separate jobs.
5. If you have leg numbness, weakness, or changes in bladder or bowel function, get those checked first.

We look at the whole chain, from the feet up through the knees and lower back. If you only treat the spot that hurts, it comes back a few days later.

If your first steps in the morning hurt, or nothing changes even after switching shoes, come see us once. We don't look only at the feet; we follow the chain up through the knees and lower back.

There are many possible causes, so the same treatment can lead to different courses for each person.