Ask the Expert: The Sitting Disease

In this week’s Ask the Expert, Dr. Alice Chen, Physiatrist, answers questions on the sitting disease.

Q1. What is the sitting disease?

The sitting disease is a coined phrase for the physiological effects of prolonged sitting. It is the effects on the body on a cellular level as well as on a whole body system. Recent research has validated what we as physiatrists have been advising our patients all along. There is good sitting posture and bad sitting posture and these also impact how your core and gluteal muscles work or don’t work. The interesting thing is that even the recommended 30 minutes of exercise daily that we as physicians have been recommending is not enough to offset the physiologic changes at the cellular level on the body with the prolonged inactivity. The sitting and how we are sitting is the problem.

Q2. What health risks are possible?

Prolonged periods of inactivity causes muscular atrophy (shrinking muscles), a predilection toward obesity (lower caloric output), insulin resistance, and increases in cardiovascular risks. Poor sitting can lead to inactive muscles and all the physiological processes highlighted above, but the poor posture and inactive muscles can also lead to neck and back pain, which has become an epidemic problem in our culture.

Q3. Who is at high risk?

People who have jobs or hobbies that have them sitting for prolonged periods of time are at risk. These are your office workers and drivers, but it can also include anyone who finds themselves sitting at their desktop or laptop for several hours a day. People who have workspaces that are cramped may be at risk as well. Our reliance in the workplace on the computer has encouraged many of us to sit in a single position for longer periods of time.

Q4. What are your recommendations for prevention?

I recommend getting out of the sitting position once an hour, even if it is only for a 2 minute stretch/walk. Take the memo by hand to your colleague. Get your own coffee or water. Take a real lunch break (not in your cubby). I suggest setting a timer once an hour to remind you to move. Even standing and marching in place while you are on a phone call counts! Phone calls can be done on a wireless headset and that frees you to pace or move about your space. The 30 minute daily aerobic exercise is still recommended for cardiovascular health, but it alone is not enough. There are also dynamic sitting balls that encourage the muscles of the gluteals and abdomen to engage even while sitting. I call this sitting with intention.

Q5. What can you do when you sit at work for extended periods of time?

An ergonomic desk evaluation, which can be performed by a skilled physical therapist or occupational therapist, is helpful for those that sit at a desk for most of the day. Sometimes, just the proper positioning of desk equipment (phone, keyboard, monitor, etc.) can encourage better sitting posture when you are sitting.

Dr. Alice Chen, Physiatrist, treats disorders and injuries of the neck, back, muscles, and joints in a minimally invasively manner using techniques including epidural injections, blocks, radiofrequency ablation, joint injections, and medical acupuncture. She employs techniques using ultrasound guidance and fluoroscopic guidance to enable accurate treatment of deeper structures.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.


  1. I have intense pain in my lower back. Nothing has helped it yet and I will not go back on painkillers ever! Going to give this a try. Have nothing to lose. Thanks for your post!

    1. Hi Tens, we wish you the best! Remember that if pain persists, do not hesitate to consult with a physician or physical therapist!

  2. hello what can you tell me re what they all “theater knees” only when i sit in a stationary position for over a hour car /show computer both knees at the same time surt getting sore on a scale of one to ten its about four does not infer with sleeping i also play rb once a week i am 74 years old and been playing for about forty years i weight 182 /six foot please advise thank you bob

    1. Hi Robert, thank you for reaching out. Dr. Alice Chen, Physiatrist, says: “‘Theater knees’ or ‘moviegoers sign’ is a pain in the knees with prolonged sitting. These patients will often request aisle seats and extend their legs if possible to relieve the knee pain along the knee caps. This can occur when the knee cap (the patella) is not tracking properly along the knee (tibia). This can occur due to improper muscle mechanics across the knee pulling the kneecap away from the normal track causing grinding and pain. This condition, sometimes referred to as patellofemoral syndrome, responds well to physical therapy focusing on retaining the uspporting muscles of the knee. Physical therapy may also try taping to “coax” the knee back into a normal motion. NSAID (eg ibuprofen, Naprosyn, etc.) medications may help to reduce the pain temporarily. These symptoms may also be caused by cartilage damage on the undersurface of the knee joint (chondromalacia patellae), which can occur from longstanding mis-tracking of the knee cap or degenerative arthritis. Sometimes, a corticosteroid injection can reduce the inflammation in the knee causing the pain.” It is best for you to consult with your treating physician so they can better advise. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

  3. First of all, thanks and I will be sharing this on FB. I just need to point out that the word “psychological” is used in the first sentence of the first answer. I think it should read “physiological”. Or my glasses need cleaning.

  4. Hiya Dr. Chen!
    I’m in a predicament with respect to this. My business and work (medical transcription) require me to not only sit so long, but I am also restricted in positional changes due to necessary use of a foot pedal. I had exceptional ergos and posture while working past 15+ years (also former pro horse trainer/instructor/equestrian) but have developed a combo of spinal issues that include nerve root and cord compression that include sciatic nerve and some ischial tuberosity bursitis, all of which, but especially the latter, make proper sitting very painful. I have failed injections and ablations and only find relief with Pilates, stretching and a TENS unit. I have found no relief from a wheelchair gel cushion also. Are there any additional recommendations you might have? I am seriously considering a trip to see the wonderful physicians and integrated specialists at HSS (insurance allowing) as the doctors in Florida have “given up”, only offer medications and/or suggest I visit “smarter doctors” (their words) at Mayo or Shands.
    Most Gratefully,
    Janet W.

    1. Hi Janet, thank you for reaching out. Dr. Alice Chen, Physiatrist, says: “A standing desk may be a good solution to keep good postural control while doing your job. They can be difficult to tolerate for an entire day, but one can develop strength and endurance by gradually increasing the time standing by having an adjustable work station. I am glad to hear that you have found a core strengthening program to be relieving for your pain. Have your back condition evaluated by a physiatrist. Hopefully, they can reevaluate you from a functional and comprehensive perspective. Consider having a good physical therapist evaluate your work station for other hints to optimize your posture and pain control during your work day. Good luck!” It is best for you to consult with your treating physician. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

If you’d like to consider HSS for treatment, please contact our Patient Referral Service at 888-720-1982. For general questions and comments, reach us on Facebook or Twitter.