Lower Back Pain Sitting Problem? Here’s What’s Really Going On

Introduction

If you’ve ever asked “Why do I get lower back pain when sitting?”, you’re certainly not alone. That dull ache or sharp twinge when you sit at your desk, in the car or after waking up can feel like your body is betraying you. At Unpain Clinic we see many people experiencing lower back pain on sides, waking up with lower back pain, or even seeking a “lower back pain cure” after trialing countless treatments.

In this post we’ll explore why sitting triggers or worsens back pain, what the research says about root causes and effective treatments (including for issues like slipped disc, muscle spasms, and persistent discomfort), how we approach it at Unpain Clinic, and what you can safely do at home. Results vary per person — always consult a qualified healthcare provider.

What’s Going On With Sitting & Your Lower Back

Why sitting hurts your lower back.
When you sit, especially for long periods, your lumbar spine (the lower back) is subject to mechanical stress, reduced muscle activation, and altered posture. Even more so when you sit with slouched posture, asymmetrically (side-leaning) or without breaks.
Here are key factors:

Disc loading and muscle fatigue – Research shows that prolonged sitting increases intradiscal pressure and lumbar stiffness.
Poor posture and side-leaning/sitting on sides – Sitting asymmetrically (for example, shifting to one hip) can load one side more than the other, potentially resulting in “lower back pain on sides.” Although the research is mixed regarding posture and causation.

Reduced movement & muscle inactivity – Sitting deprives gluteal, hip-flexor and lumbar stabiliser muscles of their usual activation. Over time this can allow muscular imbalances and “weak links” in your chain, leading to pain episodes or spasms.

Underlying structural issues – Conditions such as a herniated (or “slipped”) disc, facet-joint degeneration, or muscle spasm/sprain may not cause pain until sitting adds stress and triggers symptoms.

Waking up with lower back pain – Often this occurs because of overnight stiffness, reduced circulation, or even a “poor sleeping position” combined with already compromised lumbar mechanics — the body is less primed for sitting after sleep.

Why the pain persists or keeps returning:

The body is trying to protect an underlying dysfunction (e.g., scar tissue, prior injury, muscular imbalance) by guarding the lumbar area. Unless the root cause is addressed, the cycle of sitting→pain→less movement→more weakness continues (this idea is explained in our podcast).

Frequent short breaks are often missing (i.e., continuous sitting). Evidence suggests breaks help.
Many treatments focus only on symptom relief (e.g., massage, pain meds) rather than whole-body movement dysfunction or scar / muscle chain issues.

What Research Says

Here we summarise what the peer-reviewed literature reveals about the relation between sitting/sedentary behaviour and lower back pain, and about therapies such as extracorporeal shockwave therapy (ESWT) which we use at Unpain Clinic.

Sitting, sedentariness & lower back pain
A systematic review of studies with objectively-measured sitting found that prolonged sitting increases immediate reports of low back pain (LBP) in adults, but no firm conclusion could be drawn regarding sitting leading to clinical episodes of LBP.

A review of sedentary behaviour and LBP found inconsistent association: in some studies sitting time alone was not independently related to LBP, unless combined with other factors (awkward posture, vibration).
A recent study found that sitting posture, static sitting and fewer breaks had stronger association with LBP than sitting time alone.

What this means: sitting can contribute to lower back pain — especially when combined with poor posture, muscle weakness, static loading, and prior dysfunction — but sitting alone is not guaranteed to cause pain. This aligns with your experiences of “it hurts more when I sit” but not “sitting caused it overnight”.

Extracorporeal Shockwave Therapy (ESWT) & lower back pain treatment

Given your interest in advanced therapies (and our use of shockwave/EMTT at Unpain Clinic), here’s what the evidence shows:

A systematic review and meta-analysis (2023) found ESWT provided better pain relief and improved lumbar dysfunction compared with control interventions in chronic low back pain.
A 2024 review of focused ESWT found that treatment significantly reduced pain and improved function in low back pain, although the number of high-quality studies remains small.

A randomized controlled trial combining ESWT + exercise + medication vs sham found statistically significant pain reduction but disability scores were similar between groups in one trial.
Overall: ESWT appears safe and promising as part of a multi-modal approach to chronic lower back pain. More large-scale, longer-term trials are still needed.

Key takeaway: The research supports multi-factorial assessment (muscle, posture, movement, scar tissue, sitting behaviour) and targeted therapies (including shockwave) rather than “just rest and pills”.

Treatment Options at Unpain Clinic

At Unpain Clinic our approach to someone experiencing lower back pain when sitting or on sides or waking up with lower back pain is comprehensive and evidence-informed. We combine modern modalities with manual therapy, exercise and education.

1. The Initial Assessment
This is our intake service where we assess posture, full range of motion, heart-rate variability, movement patterns, sitting posture, muscular strength/activation, and relevant imaging if required. We aim to identify the “why” behind your pain rather than just “where” it hurts.

2. Shockwave Therapy / Electromagnetic Therapies (EMTT)
We utilise ESWT/radial therapy/focused shockwave to treat muscles, fascia and scar tissue that may be contributing to your lower back pain. As noted in our blog “The Science Behind Shockwave Therapy for Lower Back Pain” (Aug 22 2025) we use protocols aligned with the literature.
In our podcast “#7 – How to Relieve Back Pain When Nothing Else Works” (18 November 2021) we discussed how shockwave penetrates dense scar tissue and restores movement patterns in the lumbar region.
While research supports its use, we always combine it with movement and manual therapies for best effect.

3. Manual Therapy & Neuromodulation
Manual techniques (mobilisations, soft-tissue work, neuromuscular re-education) help restore movement, reduce muscular guarding, release scar adhesions, and promote normal lumbar mechanics.
Neuromodulation (e.g., electrical stimulation or deeper muscle activation) may also be used as part of the adjunctive strategy.

4. Movement-Based Rehabilitation + Exercise
Restoring strength and endurance in key regions (glutes, hip-flexors, lumbar extensors), improving core stability, and training correct sitting/standing transitions is critical. We teach safe exercises and movement patterns that aim to reduce pain, prevent muscle spasms (e.g., lower back pain muscle, lower back pain spasms), and improve functional sitting.

5. Ergonomics & Behaviour Modification
Because we know that sitting posture and behaviour are associated with LBP, we also include ergonomic coaching (desk set-up, sitting breaks, side-lean avoidance, symmetrical seating) and movement prescription: mini-breaks, posture changes, and activation of hips during sitting.

Patient Story

“Mark”, a 45-year-old office worker, complained of lower back pain when sitting, worse on the left side (“lower back pain on sides”), and he woke up stiff with back pain several mornings a week. He had a mild disc bulge on imaging but had been told there was nothing to be done but pain meds. After our 100 Metrics Functional Assessment we found left glute and hip-flexor weakness, scar tissue from an old appendectomy restricting pelvic motion, and prolonged static sitting without breaks. Over 8 sessions combining shockwave therapy (targeting the scar region and lumbar fascia), manual therapy and a tailored exercise programme, Mark’s sitting pain reduced by ~60 %, he no longer woke up stiff and had returned to his gym routine. Results may vary; this is illustrative, not a guarantee.

At-Home Guidance

Here are simple, safe exercises and tips you can do between visits to help reduce lower back pain when sitting, stiffness on waking, and muscle-related symptoms.

Quick Tips
Take a mini-break every 30-40 minutes of sitting: stand, walk 30 seconds, gently twist your torso.
Adjust your chair so both feet are flat, knees at ~90°, hips slightly above knees if possible. Avoid side-shifting to one hip.
Use lumbar support or a rolled towel behind your lower back to maintain natural curve.
When you wake up with lower back pain, spend 1-2 minutes in one of these positions: supine with knees bent & feet flat, or side lying with pillow between knees, then transition slowly to sitting.

Exercise Examples (Start gently, stop if pain worsens)
Glute Bridge – Lie on back, knees bent, feet flat. Press through heels, lift hips while keeping pelvis level. Hold 2 seconds at top, repeat 10–12 times.
Seated Hip March – Sit upright, feet flat. Lift one foot slightly off the floor, hold~2 seconds, lower. Alternate for 10 reps each side. Helps activate hip stabilisers for sitting dynamics.
Thoracic Rotation on Chair – Sit upright, arms crossed or hands behind head. Rotate upper body to one side slowly, hold 2 seconds; repeat each side for 8-10 reps. Helps reduce lumbar “twist” compensation on sides.
Bird Dog (on hands & knees) – Lift opposite arm and leg, hold 2 seconds, switch sides. Builds lumbar-hip connectivity. Start with 6-8 reps each side.
Hip Flexor Stretch – From half-kneeling position (one knee down, other foot forward), gently shift hips forward until you feel stretch in front of hip. Hold 20-30 seconds each side. Tight hip-flexors often contribute to lower back stress when sitting.

Behaviour Habit
Before you sit down for >20 minutes, set a timer or alarm to remind you to move or stretch.
When you sit, check your posture: are you slouched? Leaning to one side? Both feet grounded?
Keep a subtle “soft activation” of your core (imagine drawing your navel slightly towards your spine) while sitting to keep muscles engaged rather than passive.

Disclaimer: These exercises are general and may not be appropriate for everyone. If you have significant disc herniation, nerve symptoms, or red-flags (e.g., numbness, bowel/bladder changes), stop exercise and consult your healthcare provider.