Submitted Successfully!
To reward your contribution, here is a gift for you: A free trial for our video production service.
Thank you for your contribution! You can also upload a video entry or images related to this topic.
Version Summary Created by Modification Content Size Created at Operation
1 -- 1058 2022-04-27 14:29:47 |
2 Reference format revised. -5 word(s) 1053 2022-04-28 15:51:25 |

Video Upload Options

Do you have a full video?


Are you sure to Delete?
If you have any further questions, please contact Encyclopedia Editorial Office.
Kwong, P.; , .; Chan, Y.L.; Kawabata, M. In Vivo Intradiscal Pressure between Sitting and Standing. Encyclopedia. Available online: (accessed on 16 April 2024).
Kwong P,  , Chan YL, Kawabata M. In Vivo Intradiscal Pressure between Sitting and Standing. Encyclopedia. Available at: Accessed April 16, 2024.
Kwong, Patrick, , Yuk Lam Chan, Masato Kawabata. "In Vivo Intradiscal Pressure between Sitting and Standing" Encyclopedia, (accessed April 16, 2024).
Kwong, P., , ., Chan, Y.L., & Kawabata, M. (2022, April 27). In Vivo Intradiscal Pressure between Sitting and Standing. In Encyclopedia.
Kwong, Patrick, et al. "In Vivo Intradiscal Pressure between Sitting and Standing." Encyclopedia. Web. 27 April, 2022.
In Vivo Intradiscal Pressure between Sitting and Standing

Non-specific low back pain (LBP) is highly prevalent today. Disc degeneration could be one of the causes of non-specific LBP, and increased intradiscal pressure (IDP) can potentially induce disc degeneration. Sitting causes higher loads on the lumbar spine than standing in the normal discs, but recent studies do not support this conclusion. Furthermore, the degenerated discs showed no difference in IDP in both postures.

low back pain intradiscal pressure in vivo measure posture

1. Introduction

Low back pain (LBP) has become the leading cause of disabilities and absenteeism worldwide [1][2]. More than 500 million people globally suffer from this symptom and are affected by concurrent comorbidities such as depression, diabetes, and other musculoskeletal disorders [3][4]. These problems, when chronic, put heavy economic and psychological burdens on patients. For example, in the US, approximately $784 million was spent on surgery and $1.8 billion on conservative treatments in 12-month care in 2018–2019 [5][6][7].
Intradiscal pressure (IDP) is the hydrostatic pressure measured in the nucleus pulposus of the intervertebral disc (IVD). As the innervated structure of the IVD [8][9], it is recognized as one of the potential causes of LBP. Studies have discovered that an increased IDP may accelerate the process of disc degeneration [10][11][12]. In the degenerated disc, the amount of incompressible fluid decreases, and the nucleus pulposus cannot maintain even pressure on the adjacent annulus fibrosus and endplates, which could be a mechanical cause of LBP [13]. Thus, understanding the factors that could affect the IDP could help clinicians and scientists to develop and modify the strategy for managing LBP.

2. In Vivo Intradiscal Pressure between Sitting and Standing 

2.1. Effect of Posture Variety in IDP Measurement

Sitting induces a higher load on the lumbar spine than standing, which is consistent with earlier recommendations to avoid long sitting times in daily life [14]. However, most results were based on data from more than 30 years ago. In 2001, Wilke et al. [15] found that sitting and standing have similar effects on the lumbar spine IDP. They used a new implant transducer, a smaller apparatus, and their findings highly agreed with anthropometric data in many finite models. This improved equipment could stay securely in the IVD, thus ensuring that the measure is highly accurate and reliable. Rohlmann et al. [16] used internal spinal fixators and reported similar results in 1999. The implant of the vertebral body could restore normal load-bearing in the spine and collect the three degree-of-freedom force and moment data. Their results revealed that there is a higher load on the lumbar spine in standing because the upright position increases axial loads. The increase in lumbar lordosis in standing also raises the concave-sided compression force. These findings indicated that the improvement in measurement technique may lead to a dramatic difference in the observed in vivo IDP.
The subgroup analysis that separated studies before and after the 1990s showed that there is no difference between the sitting and standing postures in more recent studies. However, only three studies [16][17][18] conducted in vivo IDP measurements after the 1990s and only 21 participants were involved. Therefore, these results should be interpreted with caution.

2.2. Effect of Disc Conditions and Levels on IDP Measurement

Because the measurements are of the pressure of the nucleus pulposus [19], according to previous studies, degenerative changes may affect the measure outcomes [20][21]. The bulging lamellae are squeezed by compressive load, and a disrupted disc partially loses the function of weight-bearing, thus showing higher stress in the annulus while reducing the nucleus pressure [22]. Considering the potential effects of pathological conditions in the disc, scholars performed a subgroup meta-analysis of the normal and the degenerated discs. Possibly, there is no difference of IDP between sitting and standing, and the degenerative changes do not change the comparison result, as both demonstrated the decreased measured value in general. Referring to the differences between disc levels, the results show no significant change in the effect size estimation, and indicated that the effect of posture could be similar on the two spinal segments.

2.3. Large Variation in Outcomes

The variability of the IDP measure is high, even in similar disc conditions and in the same study, possibly because of the various types of transducers used. The earliest measurement [23] used a polyethylene-tipped liquid-filled transducer and obtained data nearly twice that of later measurements [18][24], 11 atmospheres compared with 5~6 atmospheres. Measurements using a piezoresistive needle and implanted transducers obtained similar outcomes, although confounding factors such as muscle activation and ligament responses still existed. Another possible source of error is the measurement process. The sequence of sitting and standing changes the body height, and prolonged standing reduces the disc height, thus lowering the spine loads [25] and eventually impacting the results.
Moreover, considering individual factors, people with a higher weight will put more upper limb pressure on the same disc. Females with small nucleus pulposus areas along the spine will possibly have relatively lower IDPs. Thus, the variability of the IDP can be high if the participants have diverse body builds.
There is also some variation in the VBR measurement [16][17][26][27]. The location of each patient’s surgery level is varied, resulting in different outcomes. Moreover, in the early stages after surgery, patients may suffer from pain and psychological factors that restrict motion; therefore, the outcome difference may appear on the left and right sides and existing regional variations sometimes. Considering the implants in different spine levels and surgery setups within patients, sintered cancellous bone and bridged intact disc induce relatively high loads, while slight compression for implant mounting shows relatively lower loads [28].

2.4. Clinical Implication

The previous viewpoint may not be correct, given the inconsistent findings of the more recent studies. Knowledge regarding the lumbar spinal loads in daily life is essential in LBP management [29]. Well recognized factors such as flexion and lifting weights result in a high spinal load [17][30][31]. The ‘postural perturbations’ strategy proposed recently can induce a high IDP, which interacts with the degenerated disc [32]. Existing conclusions are still controversial regarding the effect of the sitting and standing postures on IDP. Regardless of which posture induces a higher IDP, any prolonged posture is not recommended [33].

3. Conclusions

In conclusion, sitting induces higher loads on the lumbar spine than standing. Furthermore, degenerated discs have a smaller IDP, and they show no difference in IDP in the sitting and standing postures may possibly result from the evenly distributed structures being ruptured. Furthermore, to maintain the well-functioning of the lumbar spine and manage LBP symptoms, any prolonged posture should be prohibited.


  1. Bigos, S. Acute Low Back Problems in Adults. Clinical Practice Guideline No 14; Agency for Health Care Policy and Research, Public Health Service: Rockville, MD, USA, 1994.
  2. Maher, C.; Underwood, M.; Buchbinder, R. Non-specific low back pain. Lancet 2017, 389, 736–747.
  3. Collaborators, G.B.D. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018, 392, 1789–1858.
  4. Weiner, S.S.; Nordin, M. Prevention and management of chronic back pain. Best Pract. Res. Clin. Rheumatol. 2010, 24, 267–279.
  5. Stevans, J.M.; Delitto, A.; Khoja, S.S.; Patterson, C.G.; Smith, C.N.; Schneider, M.J.; Freburger, J.K.; Greco, C.M.; Freel, J.A.; Sowa, G.A.; et al. Risk factors associated with transition from acute to chronic low back pain in US patients seeking primary care. JAMA Netw. Open 2021, 4, e2037371.
  6. Anema, J.R.; Schellart, A.J.; Cassidy, J.; Loisel, P.; Veerman, T.; Van der Beek, A. Can cross country differences in return-to-work after chronic occupational back pain be explained? An exploratory analysis on disability policies in a six country cohort study. J. Occup. Rehabil. 2009, 19, 419.
  7. Kim, L.H.; Vail, D.; Azad, T.D.; Bentley, J.P.; Zhang, Y.; Ho, A.L.; Fatemi, P.; Feng, A.; Varshneya, K.; Desai, M.; et al. Expenditures and Health Care Utilization Among Adults With Newly Diagnosed Low Back and Lower Extremity Pain. JAMA Netw. Open 2019, 2, e193676.
  8. Bogduk, N.; Tynan, W.; Wilson, A. The nerve supply to the human lumbar intervertebral discs. J. Anat. 1981, 132, 39.
  9. Yoshizawa, H.; O'Brien, J.P.; Smith, W.T.; Trumper, M. The neuropathology of intervertebral discs removed for low-back pain. J. Pathol. 1980, 132, 95–104.
  10. Luoma, K.; Riihimäki, H.; Luukkonen, R.; Raininko, R.; Viikari-Juntura, E.; Lamminen, A. Low back pain in relation to lumbar disc degeneration. Spine 2000, 25, 487–492.
  11. Freemont, A.; Peacock, T.; Goupille, P.; Hoyland, J.; O'brien, J.; Jayson, M. Nerve ingrowth into diseased intervertebral disc in chronic back pain. Lancet 1997, 350, 178–181.
  12. Zhang, S.; Hu, B.; Liu, W.; Wang, P.; Lv, X.; Chen, S.; Shao, Z. The role of structure and function changes of sensory nervous system in intervertebral disc-related low back pain. Osteoarthr. Cartil. 2021, 29, 17–27.
  13. Adams, M.A.; Roughley, P.J. What is intervertebral disc degeneration, and what causes it? Spine 2006, 31, 2151–2161.
  14. Majeske, C.; Buchanan, C. Quantitative description of two sitting postures: With and without a lumbar support pillow. Phys. Ther. 1984, 64, 1531–1533.
  15. Wilke, H.-J.; Neef, P.; Hinz, B.; Seidel, H.; Claes, L. Intradiscal pressure together with anthropometric data–a data set for the validation of models. Clin. Biomech. 2001, 16, S111–S126.
  16. Rohlmann, A.; Bergmann, G.; Graichen, F. Loads on internal spinal fixators measured in different body positions. Eur. Spine J. 1999, 8, 354–359.
  17. Rohlmann, A.; Zander, T.; Graichen, F.; Bergmann, G. Lifting up and laying down a weight causes high spinal loads. J. Biomech. 2013, 46, 511–514.
  18. Sato, K.; Kikuchi, S.; Yonezawa, T. In vivo intradiscal pressure measurement in healthy individuals and in patients with ongoing back problems. Spine 1999, 24, 2468.
  19. Nachemson, A.L. Disc pressure measurements. Spine 1981, 6, 93–97.
  20. Adams, M.; Dolan, P.; Hutton, W. The stages of disc degeneration as revealed by discograms. J. Bone Jt. Surg. 1986, 68, 36–41.
  21. Panjabi, M.; Brown, M.; Lindahl, S.; Irstam, L.; Hermens, M. Intrinsic disc pressure as a measure of integrity of the lumbar spine. Spine 1988, 13, 913–917.
  22. Ishihara, H.; McNally, D.S.; Urban, J.; Hall, A.C. Effects of hydrostatic pressure on matrix synthesis in different regions of the intervertebral disk. J. Appl. Physiol. 1996, 80, 839–846.
  23. Nachemson, A. The effect of forward leaning on lumbar intradiscal pressure. Acta Orthop. Scand. 1965, 35, 314–328.
  24. Wilke, H.J.; Neef, P.; Caimi, M.; Hoogland, T.; Claes, L.E. New in vivo measurements of pressures in the intervertebral disc in daily life. Spine 1999, 24, 755–762.
  25. Althoff, I.; Brinckmann, P.; Frobin, W.; Sandover, J.; Burton, K. An improved method of stature measurement for quantitative determination of spinal loading. Application to sitting postures and whole body vibration. Spine 1992, 17, 682–693.
  26. Rohlmann, A.; Graichen, F.; Bender, A.; Kayser, R.; Bergmann, G. Loads on a telemeterized vertebral body replacement measured in three patients within the first postoperative month. Clin. Biomech. 2008, 23, 147–158.
  27. Dreischarf, M.; Bergmann, G.; Wilke, H.-J.; Rohlmann, A. Different arm positions and the shape of the thoracic spine can explain contradictory results in the literature about spinal loads for sitting and standing. Spine 2010, 35, 2015–2021.
  28. Rohlmann, A.; Bergmann, G.; Graichen, F.; Weber, U. Comparison of loads on internal spinal fixation devices measured in vitro and in vivo. Med. Eng. Phys. 1997, 19, 539–546.
  29. Dreischarf, M.; Rohlmann, A.; Zhu, R.; Schmidt, H.; Zander, T. Is it possible to estimate the compressive force in the lumbar spine from intradiscal pressure measurements? A finite element evaluation. Med. Eng. Phys. 2013, 35, 1385–1390.
  30. Claus, A.; Hides, J.; Moseley, G.L.; Hodges, P. Sitting versus standing: Does the intradiscal pressure cause disc degeneration or low back pain? J. Electromyogr. Kinesiol. 2008, 18, 550–558.
  31. Dolan, K.J.; Green, A. Lumbar spine reposition sense: The effect of a ‘slouched’posture. Man. Ther. 2006, 11, 202–207.
  32. Deane, J.A.; Lim, A.K.; McGregor, A.H.; Strutton, P.H. Understanding the impact of lumbar disc degeneration and chronic low back pain: A cross-sectional electromyographic analysis of postural strategy during predicted and unpredicted postural perturbations. PLoS ONE 2021, 16, e0249308.
  33. Beach, T.A.; Parkinson, R.J.; Stothart, J.P.; Callaghan, J.P. Effects of prolonged sitting on the passive flexion stiffness of the in vivo lumbar spine. Spine J. 2005, 5, 145–154.
Subjects: Rehabilitation
Contributors MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to : , , ,
View Times: 608
Revisions: 2 times (View History)
Update Date: 28 Apr 2022