View source for Complications of prolonged standing

The '''complications of prolonged standing''' are conditions that may arise after standing, walking, or running for prolonged periods. Many of the complications come from prolonged standing (more than 60% of a work day) that is repeated several times a week. Many jobs require prolonged standing, such as "retail staff, baristas, bartenders, assembly line workers, security staff, engineers, catering staff, library assistants, hair stylists and laboratory technicians".<ref name="safeworkers.co.uk">{{cite web|last1=Watson|first1=Kevin|title=MSc|url=http://www.safeworkers.co.uk/standing-for-long-periods.html|website=Standing for Long Periods|accessdate=1 October 2015}}</ref>
The basic physiological change that occurs in the body during prolonged standing or sudden stand from supine position is that there will be increased pooling of blood in the legs. This decreases the venous return, and so there will be decreased cardiac output, which ultimately causes systolic blood pressure to fall (hypotension). This hypotension may lead the subject to faint or to have other symptoms of hypotension.
Standing requires about 10% more energy than sitting.<ref>{{cite web|last1=Cornell University|title=Sitting and Standing at Work|url=http://ergo.human.cornell.edu/CUESitStand.html}}</ref>{{Better source needed|reason=This website appears to be a class website from Cornell. It cites some sources but it's uncertain where this number comes from.|date=January 2019}}
==Prevalence==
There are no exact measures of how prevalent the complications are. However, European studies report that between one third and one half of all workers spend at least four hours per [[Working time]] (for an average workday of eight hours) standing or walking.<ref name=whsc>[http://www.whsc.on.ca/Files/Resources/Hazard-Resource-Lines/Prolonged-Standing-WHSC-Resource-Line Prolonged Standing: taking the load off], Version 2.0. From: Workers Health and Safety Center.</ref> One estimate from the United Kingdom stated that over 11 million people stand for long periods of time without rest.<ref name="safeworkers.co.uk"/>
==Complications==
===Slouching===
{{see also|Kyphosis}}
Proper posture is often referred to as a "[[neutral spine]]"; slouching is an improper posture or a "nonneutral spine".
Slouching is often described as improper posture, movement or rigidity of the spine, especially the cervical and thoracic regions, in relation to other parts of the body.
===Varicose veins===
[[Varicose veins]] are veins that have become enlarged and twisted, especially within the legs, ankles and feet of an affected individual.<ref>{{cite web |url=http://www.mayoclinic.org/diseases-conditions/varicose-veins/basics/definition/con-20043474 |title=Diseases and Conditions: Varicose veins |author=Mayo Clinic Staff |publisher=[[Mayo Clinic]] |accessdate=December 22, 2015}}</ref>
When standing, gravity pulls the blood downwards to the lower part of the body. Body mechanisms, such as [[vasoconstriction]] and valves of the [[veins]], assist in pumping blood upwards.<ref>{{cite web|url=http://www.sirweb.org/patients/varicose-veins/|title=Society of Interventional Radiology- Patient center|author=|date=|work=SIRweb.org|accessdate=23 February 2017}}</ref> As blood is pumped through the body, the valves within the veins prevent the blood from flowing backwards. After extensive, prolonged standing, these valves can become weak and eventually fail. When this happens, blood is no longer being prevented from flowing backward. Gravity will pull the blood back into an individual's legs, ankles and feet. This forces the veins to expand or "balloon" to accommodate this extra blood.
The valves of the [[veins]] work best in concert with accompanying muscle contractions that force the blood to continue moving up the leg. Standing with some muscles constantly strained weakens these muscles and therefore the strength of the contractions. Varicose veins have also been associated with chronic heart and circulatory disorders and hypertension as well as complications related to pregnancy.
Prolonged standing increases the risk for hospitalization from varicose veins.<ref>{{cite journal|last1=Tuchsen|first1=F|title=Prolonged standing at work and hospitalization due to varicose veins: a 12 year prospective study of the Danish population.|journal=Occup Environ Med|date=2005|volume=62|issue=12|pages=847–850|doi=10.1136/oem.2005.020537|pmid=16299093|pmc=1740939}}</ref> Among the working age population one out of five hospitalizations from varicose veins are as a result of prolonged standing. Prolonged standing leads to impeded blood flow and stasis in the veins in the lower limbs, which can cause varicose veins.
===Cardiovascular disorders===
Standing for prolonged periods can lead to certain cardiovascular disorders. In a study by Krause et al. (2000)<ref>{{cite journal|last1=Krause|first1=N|title=Standing at work and progression of carotid atherosclerosis|journal=Scandinavian Journal of Work, Environment & Health|date=2000|pages=227–236|doi=10.5271/sjweh.536|volume=26|issue=3|pmid=10901115|doi-access=free|hdl=2027.42/55329|hdl-access=free}}</ref> the authors examined the relationship between standing at work and the progression of carotid [[atherosclerosis]] in men. Standing for long periods can change the distribution of blood in the extremities. This in turn causes the blood to pool and reduces the circulating blood plasma volume leading to hemodynamic changes that impact the body. The authors reported that long periods of standing at work were significantly associated with atherosclerotic progression. This study provides evidence that hemodynamic changes from standing can influence the progressions of carotid atherosclerosis. The authors also found that men with carotid stenosis or ischemic heart disease were at greater risk for the progression of atherosclerosis . Atherosclerosis can lead to coronary artery disease, carotid artery disease, peripheral artery disease, and aneurysms.<ref>{{Cite web|url=http://www.mayoclinic.org/diseases-conditions/arteriosclerosis-atherosclerosis/basics/complications/con-20026972|title = Arteriosclerosis / Atherosclerosis - Symptoms and causes|website = [[Mayo Clinic]]}}</ref>
===Joint compression===
Standing places significant pressure on the joint of the hips, knees, ankle and feet but without any significant movement of it.<ref>{{cite web|url=http://www.hazards.org/standing/|title=Standing - Hazards Magazine|author=|date=|work=Hazards.org|accessdate=23 February 2017}}</ref> This reduces the normal lubrication and cushioning of synovial joints, causing them to tear. The combined effect of pressure and tearing can cause extensive amounts of pain and make it difficult to move or walk.<ref name=whsc/>
===Muscle fatigue===
Muscles kept in a constant stress position quickly become exhausted and can result in pain and swelling in the lower back, legs, ankles and feet.<ref>{{cite web|url=http://www.safeworkers.co.uk/standing-for-long-periods.html|title=Standing for Long Periods|author=|date=|work=SafeWorkers.co.uk|accessdate=23 February 2017}}</ref><ref>{{cite journal|title=Evidence of Health Risks Associated with Prolonged Standing at Work and Intervention Effectiveness|first1=Thomas R.|last1=Waters|first2=Robert B.|last2=Dick|date=1 May 2015|journal=Rehabil Nurs|volume=40|issue=3|pages=148–165|doi=10.1002/rnj.166|pmid=25041875| pmc=4591921}}</ref>
The Occupational Safety and Health Administration (OSHA) has stated that muscle fatigue and musculoskeletal disorders account for "33% of all worker injury and illness".<ref>{{cite web|url=https://www.osha.gov/SLTC/ergonomics/|title=Safety and Health Topics - Ergonomics - Occupational Safety and Health Administration|author=|date=|work=OSHA.gov|accessdate=23 February 2017}}</ref> Considerable research has been conducted as to the extent of muscle injuries and all have concluded that these are expected but can be reduced with breaks and the availability of chairs.{{Citation needed|date=February 2017}}
Research has shown that the body experiences muscle fatigue after standing for five hours; this fatigue persists for more than 30 minutes after the end of the work day according to electronic measurements of fatigue.<ref>{{cite journal|last1=Garcia|first1=M|title=Longterm muscle fatigue after standing work|journal=Human Factors|date=2015|volume=57|issue=7|pages=1162–1173|doi=10.1177/0018720815590293|pmid=26048874|s2cid=2725600}}</ref> The perception of fatigue is subjective and does not necessarily correlate with the experimental indicators of fatigue.
==Pregnancy==
Walking or standing more than six hours per day has been linked with pre-term births, low birth weights as well as high blood pressure for the mother.<ref>{{cite web|url=http://www.medicalnewstoday.com/articles/247272.php|title=Prolonged Standing During Pregnancy May Result In Stunted Fetal Growth|author=|date=29 June 2012|work=MedicalNewsToday.com|accessdate=23 February 2017}}</ref>
Researchers have found that working more than 25 hours a week has been "associated with slower rates of fetal growth". They also found that, on average, there are no "negative effects of working up to 36 weeks into pregnancy".<ref>{{cite web|url=http://www.livescience.com/36507-pregnancy-working-baby-growth.html|title=Standing for Long Hours During Pregnancy May Slow Babies' Growth|author=|date=30 May 2013|work=LiveScience.com|accessdate=23 February 2017}}</ref>
==Productivity==
A systematic review from Karakolis and Callaghan<ref>{{cite journal|last1=Karakolis|first1=T|title=The impact of sitstand office workstations on worker discomfort and productivity: a review|journal=Applied Ergonomics|volume=45|issue=3|pages=799–806|doi=10.1016/j.apergo.2013.10.001|pmid=24157240|year=2014|s2cid=30170218}}</ref> found that sit-stand workstations did not reduce worker productivity. Three of the reviewed studies found increased productivity when workers used sit stand stations, four reported no impact on the productivity of workers, and one reported mixed results.
==Intervention==
There is no real prevention for standing, but there are ways to mitigate time spent standing in the workplace. Experts suggest to move around and change positions throughout the day. It is best not to sit in one position for more than 20 minutes, or to stand in one position for more than 8 minutes.<ref>{{cite web|url=https://www.bostonglobe.com/lifestyle/health-wellness/2014/11/03/yes-sitting-work-bad-but-standing-actually-better/7ceei6fb0B7QjgAH3FlOrK/story.html|title=Yes sitting at work is bad, but is standing actually better? - The Boston Globe|author=|date=|work=BostonGlobe.com|accessdate=23 February 2017}}</ref>
If prolonged sitting in the workplace is required or desired, individuals should gradually transition to significant periods of standing.<ref>{{cite journal|last1=Buckley|first1=J.P.|title=The sedentary office: a growing case for change toward better health and productivity. Expert statement commissioned by Public Health England and the Active Working Community Interest Company|journal=Br J Sports Med|date=2015|volume=49|issue=21|pages=1357–62|doi=10.1136/bjsports-2015-094618|pmid=26034192|s2cid=131237|url=https://dspace.lboro.ac.uk/2134/19154}}</ref> When transitioning from sitting to standing, individuals might experience musculoskeletal discomfort or fatigue while the body adapts.
Companies should design workstations that are conducive to good health. Workstations should allow workers to choose between several working positions and to move easily between them.<ref name="ccohs.ca">{{cite web|url=http://www.ccohs.ca/oshanswers/ergonomics/standing/standing_basic.html|title=Working in a Standing Position - Basic Information : OSH Answers|first=Government of Canada, Canadian Centre for Occupational Health and|last=Safety|date= 2019-01-23|work=CCOHS.ca|accessdate=23 February 2017}}</ref> Additionally, workers should be able to adjust the height of their workstations to fit their body size. Other helpful aspects of workstations are footrests, elbow rests, and seats so workers can sit when they need to.
==Footwear==
The choice of footwear can change the impact of prolonged standing. Shoes should support the foot, have shock-absorbing cushions, fit the foot well, and be comfortable.<ref name="ccohs.ca"/> Shoes should not be flat, have heels higher than 5&nbsp;cm, or change the shape of the foot. There are also special insoles for shoes that can be used when soft mats or chairs are not available. Additionally the floors in a work area should not be metal or concrete. It is best to have cork or rubber covered floors. Floors should not be slippery.
Training and education are important components of avoiding complications from standing. Employees trained in ergonomics experience less muscle discomfort and more productivity while using sit-stand work stations than workers not trained.<ref>{{cite journal|last1=Robertson|first1=M.M.|title=Office ergonomics training and a sitstand workstation: Effects on musculoskeletal and visual symptoms and performance of office workers|journal=Applied Ergonomics|volume=44|issue=1|pages=73–85|doi=10.1016/j.apergo.2012.05.001|pmid=22727324|date=January 2013}}</ref>
==Floor mats==
Floor mat or anti-fatigue mats are used to prevent the complication associated with prolonged standing. A study by the [[Loughborough University|University of Loughborough]] conducted by George Havenith and Lucy E. Dorman has shown "(dis)comfort sensations did show statistically significant improvements related to mat use."<ref>{{Cite journal|last1=Havenith|first1=George|last2=Dorman|first2=Lucy E.|date=2007-01-01|title=The effect of COBA anti fatigue floor matting on worker comfort during standing work|url=https://repository.lboro.ac.uk/articles/report/The_effect_of_COBA_anti_fatigue_floor_matting_on_worker_comfort_during_standing_work/9353444/1|language=en}}</ref> Proper floor mats can also be used to reduce stress on feet and knees. Anti-fatigue matting is recommended and launderable matting is preferred.{{citation needed|date=June 2018}} A study investigating the effects of 4 different standing conditions on assembly workers showed that using mats and shoes with in-soles was perceived as more comfortable for the workers than without while standing on hard floors.<ref>{{cite journal|pmid=12236657|title=A comparison of the effects of floor mats and shoe in-soles on standing fatigue|journal=Applied Ergonomics|volume=33|issue=5|pages=477–84|year=2002|last1=King|first1=P. M|doi=10.1016/s0003-6870(02)00027-3}}</ref>
==See also==
* [[Neutral spine]]
* [[Ergonomics]]
* [[Sitting#Health risks|Sitting - Health risks]]
==References==
{{reflist}}
{{DEFAULTSORT:Complications of prolonged standing}}
[[Category:Injuries]]
[[Category:Spinal cord]]
[[Category:Physical exercise]]
[[Category:Ergonomics]]