Fundamental aspects of sitting and standing

Anatomy of standing:

The pelvis is held in an anteriorly tilted position by the iliopsoas muscles and the hip
joint is free to extend as happens during the stance phase of gait. The trunk and head
are rotated until they are vertically above the legs. This is achieved by extension of
the lumbar and cervical spines and is why the vertically held spine is ‘S’ shaped in
humans whereas in quadrupeds it is ‘C’ shaped and held horizontal to the ground.
Bones and joints In the erect posture, the line of gravity of superincumbent body
parts passes through the lumbar, sacral and hip joints and in front of the knee and
ankle joints. This places an extension torque around the knee joint, which is resisted
because the joint is already fully extended. The flexion torque around the ankle is
resisted by the plantar flexors.
Muscles and ligaments A person standing erect under the influence of gravity is
never in a state of passive equilibrium. The body can be conceived of as a pillar of
segments stacked one on top of the other and linked by joints. It is momentarily
balanced when the resultant of all forces acting on it is zero. The system is designed
to minimise any displacement of the line of action beyond the base of support
described by the position of the feet. Compensatory mechanisms come into play to
maintain balance immediately this happens.
Muscles and ligaments play a stabilising role by means of the active and passive
torques they exert around joints to correct small, fleeting displacements of the lines
of action away from the joints. A ‘good’ posture may be defined as one in which
destabilising moments are minimised and the posture is maintained by the resistance
of the relatively incompressible bones (as well as interleaved soft tissues such as the
intervertebral discs).
When the body is pulled ‘off-balance’ by the requirements of badly designed
jobs or workspaces, the anti-gravity muscles come into play and a new equilibrium
position is established but with the associated cost of isometric muscle activity.

The erector spinae muscles These are the main extensors of the trunk. They are also
used to control flexion. In relaxed standing, very little muscle activity occurs since the
lumbar lordosis minimises the trunk flexion moment. When the trunk is flexed even
slightly forwards or when a weight is held in front of the body, the erector spinae muscles
come into play. Work situations that set up static loading of these muscles include
• Working with the hands and arms held away from the body
• Holding a tool or a weight
• Standing with the trunk flexed to reach for work objects placed too far away or
inaccessible owing to a lack of foot space

The leg muscles The soleus and gastrocnemius muscles are true postural muscles in
the sense that they are always ‘switched on’ when standing. When a person is leaning
forward, the activity of the gastrocnemius muscle increases. Prolonged standing causes
significant localised leg muscle fatigue and is one of the causes of leg discomfort.
The abdominal muscles There is very little abdominal muscle activity in standing
and even less in sitting (Burdorf et al., 1993). These muscles may help to maintain a
proper relationship between the thorax and pelvis by preventing excessive anterior
pelvic tilt and hyperlordosis. The abdominals can prevent trunk extension, caused,
for example, by loads placed high on the back (or when putting on a backpack, for
example) or when walking down steep hills.

The hamstring and gluteal muscles The hamstring and gluteal muscles are hip
extensors. The gluteal muscles exhibit hypertrophy in humans and their function is
to stop the trunk from ‘jack-knifing’ forwards over the legs, unlike in quadrupeds
where the trunk is already ‘jack-knifed’ and the gluteals are used for locomotion. The
gluteals are, however, used for locomotion in climbing ladders or stairs. Activity in
the hamstrings is slight in the standing position but increases when the stander leans
forward, holds a weight or pulls.
The iliopsoas muscles Psoas major and iliacus are hip flexors and are constantly
active in normal standing as they prevent extension of the hip joint (the trunk ‘jackknifing’
backwards over the legs, or loss of lumbar lordosis if the head position is
maintained). The iliopsoas muscles act against the hip extensors.
The adductors and abductors of the hip When a person is standing on two feet,
these muscles provide lateral stability, preventing translation of the pelvis in the
frontal plane. When a person standing on one foot (and also during the stance phase
of gait) the pelvis tends to tilt in the direction of the unsupported side. The hip
abductors on the side of the supporting leg contract to keep the pelvis level.

Physiology of standing:

The increase in energy expenditure when a person changes from a supine to a standing
position is only about 8% (Grandjean, 1980). However, erect standing imposes a
hydrostatic handicap that makes humans liable to peripheral circulatory collapse.
Peak plantar (foot) pressures of 137 (kilopascals) kPa exceed the normal systolic
pressure of 17 kPa, resulting in occlusion of blood flow through the foot (Cavanagh
et al., 1987). Walking and fidgeting temporarily reduce the pressure, allowing fresh
blood to pervade the tissues. Venous and circulatory insufficiencies in the lower limbs
also contribute to the discomfort that results from prolonged standing. It has been
shown that venous reflux is more common in symptom-free surgeons (who stand for
long periods) than in a comparison group who experience discomfort in standing.
Prolonged standing causes physiological changes including peripheral pooling of
blood, a decrease in stroke volume and increases in heart rate, diastolic and mean
arterial pressure, peripheral resistance and thoracic impedance. Standing up from a
supine position is accompanied by an increase in the dimensions of the nasal passages

Constrained standing is particularly troublesome for older workers or for those

with peripheral vascular disease because the ‘venous muscle pump’ that returns
blood to the heart ceases to function. Fidgeting is a pre-conscious defence against
the postural stresses of constrained standing or sitting. Its purpose is to redistribute
and relieve loading on bones and soft tissues and to rest muscles.