Prolonged Standing: Complications and Preventive Measures

Introduction

Worldwide, half of all working people spend three-quarters of their working time standing. Prolonged standing causes several health problems. Many occupations require prolonged standing, such as doctors during surgeries, teachers, nurses, retail staff, assembly line workers, catering staff, cooking staff, hair stylists, laboratory technicians, store clerks, etc. The causes of health risks on prolonged standing can be described as a physiologic change that happens due to increased pooling of blood in the legs that results in decreased venous return and cardiac output, which ultimately cause hypotension. This fall in blood pressure causes fainting and other symptoms of hypotension. The problems due to prolonged standing not only cause health risks but also affect the person's work performance and productivity.

How Much Time Is Considered Prolonged Standing?

Prolonged standing is said to be standing for more than one hour or more than four hours a day. Researchers believe that standing for two hours or at least four hours is optimal. However, more than four hours of standing daily causes various health risks, such as fatigue and illness. It also causes long-term health problems. There are many effective interventions and preventive ways to eliminate the effects of prolonged standing.

What Are the Complications of Prolonged Standing?

The most common complication of prolonged standing is lower back pain. Some of the major health risks are musculoskeletal problems of feet and lower back pain, sore feet, muscular fatigue, stiffness of the neck and shoulders, varicose veins, swelling of legs, slouched posture, cardiovascular disorders, joint compression, and complications in pregnancy.

Lower Back Pain

• Lower back pain is the most common complication of prolonged standing. It is described as fatigue of the lower back and discomfort.

• Prolonged standing increases the risk of lower back pain due to excessive activation of muscles that are involved in postural stability during standing.

• Prolonged standing increases the coactivation of gluteus medius (muscles that stabilize the pelvis during standing).

• To investigate whether the gluteus medius muscle is overactive during prolonged standing, doctors suggest electromyography (EMG).

Slouched Posture

• A slouched posture is described as hanging down of the head forward.

• It can also cause improper alignment of the spinal cord, especially in the thoracic and cervical regions.

• A slouched posture causes constant strain on the neck muscles and decreases alertness.

• A slouched posture can also cause varicose veins.

Cardiovascular Problems

• Standing for long periods causes certain cardiovascular disorders.

• Cardiovascular problems due to prolonged standing include leg edema, carotid atherosclerosis, increased heart rate, blood pressure, varicose veins, chronic venous insufficiency, chronic venous diseases, and orthostatic symptoms such as dizziness and lightheadedness.

• The combination of age and prolonged standing increases the risk of venous diseases.

• Prolonged standing also changes the distribution of blood to the extremities, which results in the pooling of blood.

• Carotid atherosclerosis caused by prolonged standing may lead to coronary artery disease, aneurysms, carotid artery disease, and peripheral artery disease.

Varicose Vein

• The enlarged and twisted veins are said to be varicose veins. Varicose veins commonly affect the legs, feet, and ankles.

• While standing for long periods, gravity pulls the blood down to the lower parts of the body.

• The body mechanisms like valves of veins and vasoconstriction pump the blood upwards to the body. As the blood is pumped upwards, veins' valves prevent the blood from flowing backwards. In a person who stands for long periods, the valves of the veins become weak and fall, resulting in loss of prevention of blood flow backwards. So gravity will pull the blood to the legs and feet. This causes the veins to expand, resulting in varicose veins.

• The valves of veins also play a role in muscle contraction. Prolonged standing causes the muscles to strain constantly, which results in decreased strength of muscle contraction and weakness of the muscles.

• Varicose veins are associated with chronic heart diseases, hypertension, and complications of pregnancy.

Joint Compression

• Prolonged standing causes increased pressure on the joints of the knees, hips, ankles, and feet without significant mobility.

• This significant pressure decreases the cushioning of synovial joints and normal lubrication, which causes it to tear.

• This increased pressure and wearing away of the joint parts cause the disability to walk or move.

Muscle Fatigue or Discomfort

• Prolonged standing causes constant stress on the muscles that get exhausted, leading to pain and swelling of the lower back, ankles, legs, and feet.

• Some research has shown that muscle fatigue persists for more than 30 minutes after standing for about five hours, and then the fatigue ends.

Complications in Pregnancy

• Prolonged standing of more than six hours a day has been correlated with lower birth weight deliveries, preterm births, spontaneous abortion, and increased blood pressure for pregnant mothers.

• Some researchers believe that working in a standing position for more than 25 hours a week causes decreased fetal growth.

• Working up to 36 weeks into pregnancy does not cause any negative effects.

What Are the Interventions and Preventive Measures for Prolonged Standing?

There is no exact preventive measure for standing, but there are ways to change the unpleasant time spent while standing in the workplace. Healthcare providers suggest the person move or walk around and change their position throughout the day. The person should not stand for more than eight minutes in one place. Workstations should be designed that allow the workers to conduct good health. Some of the interventions used to prevent the effects of prolonged standing are:

• Compression Stockings - The use of support stockings helps to reduce the swelling of legs caused by prolonged standing. They also play a role in reducing the symptoms of chronic venous insufficiency.

• Floor Mats and Shoe Inserts - The use of floor mats, floor surfaces, and shoe inserts reduces symptoms such as muscle discomfort, pain, muscle fatigue, and leg edema.

• Stay Hydrated: Drink plenty of water to stay hydrated and maintain good circulation.

• Adjust the Stance: Stand with feet shoulder-width apart and avoid locking the knees to reduce strain on the joints.

• Sit-Stand Chairs and Workstations - The use of sit-stand chairs with or without foot rails or footrests helps people reduce the effects of prolonged standing.

• Take Breaks: Try to take short breaks to sit down or at least change the posture every 30 minutes if possible.

• Stretch Regularly: Perform simple stretches for the legs, back, and feet throughout the day to relieve tension and improve circulation.

Conclusion

Prolonged standing causes several health risks that can be reduced by lifestyle changes such as doing exercises and stretches, moving, or walking around throughout the day while standing for a longer period. Getting advice from healthcare providers regarding the effects of prolonged standing may be beneficial.