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UnityPoint Clinic Urgent Care - Sunnybrook

5885 Sunnybrook Drive
Sioux City, IA 51106

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Cross out lower back, hip or knee pain

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Man and woman bike riding

How many of you spend most of your day crossing your legs, sitting on your feet or sitting with one leg crossed? Men, do you stand with one or both of your feet toed out when standing? A very common standing posture for men is to stand with both feet pointed to the outside. As we become overweight, this toe out posture habit becomes even more common in both men and women. Ladies also tend to stand in what I call “sexy pose,” with one foot pointed forward and the other foot pointed ninety degrees to the side with a hip shift.

Over time, these awkward posture habits can lead to increased musculoskeletal disorder (MSD) and pain risks including lower back pain, sciatica, hip or knee pain.

Why is this and how does this occur?

What can I do daily at work and at home to reduce my MSD risks of having lower back, sciatica, hip or knee pain? This month’s article is all about becoming more aware of the primary postures we use daily and how to reduce the risks of pain and injury while improving your quality of life.

The more time you spend sitting with your legs crossed, sitting on your feet or standing with your toes pointed out, the more you tighten your hips’ powerful external rotator muscles such as your piriformis.

This piriformis muscle becomes shortened or tighter the longer you sit with your legs crossed, spread apart or stand in toe out postures. These awkward postures externally rotate the hip and compress the large sciatic nerve that runs just below the piriformis muscle. Nerves don’t like compression forces, but they love freedom and flowing movement of the body and a good blood flow to stay healthy and avoid irritation. As the sciatic nerve gets compressed by your tight piriformis muscle, you may feel sciatic nerve pain or numbness and tingling down the back of your leg. This significantly increases the biomechanical risks for lower back, sciatica, hip and knee pain or MSD injuries such as a sprain or strain.

The tighter your piriformis muscle and hip external rotators become, the more your hips may lack proper hip internal rotation with everyday movements. This lack of proper hip internal rotation is one of the most common biomechanical problems leading to lower back muscle strains and ligament or joint sprains, lower back pain, hip or knee sprains and strains. This hip internal rotation is needed every time we go from sitting to standing, squat down to pick something up, lunge in any direction or go up and down stairs throughout the workday. When we lack this proper loading of the hip with hip internal rotation, our lower back, knees and hips take the added biomechanical stress. As we age, this becomes one of the leading risk factors and reasons why total joint replacements of the knees and hips are so common.

How can we reduce our risks of sciatica or lower back, hip and knee pain as we age?

When sitting, it is best to keep both of your feet flat on the floor or on a footrest if needed and to keep both of your hips slightly spread apart, ideally with your hips being slightly higher than your knees. You may extend one leg or the other, even occasionally crossing your legs for a short period of time. Try to limit your time spent crossing your legs, sitting on your feet or sitting with both legs spread wide apart to slow the aging process and greatly reduce the daily wear and tear to your joints.

Perform the “Sitting Piriformis Stretch” one to two times per day with a three to five second hold for one to two repititions. This WorkSmart stretch will reverse and help counteract these awkward sitting and standing posture habits, reducing sciatic nerve compression and greatly reducing the risks for pain and stiffness.

This stretch is performed by sitting up tall and crossing your right leg over your left knee to stretch the right side. Turn your body to the right and gently pull your right knee up towards your left shoulder (opposite side) and hold for three to five seconds, repeating one to two times. Then, repeat other side. You will want to perform this WorkSmart stretch more often daily to the side that you find to be tighter while performing this stretch.

When you are sitting, try to sit with both feet flat on the floor or on a footrest, sitting up tall with your back against the back support of your chair and knees slightly apart. When standing, spend more time in a staggered stance posture with one foot in front of the other, feet slightly wider than shoulder width and with your feet slightly toed out improving your balance and reducing your risk of injury.

Here’s to slowing the aging process of your body and the improved daily energy and vitality of your lower back, hips and knees.

  1. Attending four Gray Institute “Chain Reaction” courses from 99’ to 07’ led by Gary Gray PT, FAFS and FVDS “Functional Flexibility Enhancing Life 2.11” 8/20/04
  2. The Work Injury Consulting Practice “Chapter 7 – Stretching programs for the workplace” by Lauren Hebert DPT, OCS 1998.
  3. Des Moines University Orthopedic lectures by Steven Clark MHS, PT, and Tim Zipple MHS, PT 1996 to 1998.
  4. 4. Atlas of Human Anatomy by Frank H. Netter, MD Plate 473 Hip and Thigh, Nerves of the Hip and Buttock, Ciba 1995 8th Edition.
  5. St. Luke’s Industrial Athlete WorkSmart Stretching Plan poster #16 Sitting Piriformis Stretch by Erik Nieuwenhuis MS, PT 4th version June 2011, St. Luke’s Health System Sioux City, IA.

About UnityPoint Health – Sioux City:

As part of UnityPoint Health – Sioux City which includes UnityPoint Clinic and UnityPoint at Home, UnityPoint Health – St. Luke’s offers a vast network of doctors, nurses and other health care professionals committed to coordinating care to meet the individual needs of our patients. UnityPoint Health – St. Luke’s is one of the region’s most patient and family-centered hospitals, delivering innovative care to communities in the tri-state area including Iowa, Nebraska and South Dakota. St. Luke’s treats more than 77,000 patients annually, coordinating care from the doctor’s office to the hospital and back home through St. Luke’s, UnityPoint Clinic and UnityPoint at Home.

Using a team approach, the physicians and specialists of UnityPoint Clinic are committed to helping patients manage their health. Through more than 48,000 patient visits annually and with services including family practice, general and vascular surgery, pulmonary and critical care, occupational medicine, nephrology and cardiology, UnityPoint Clinic is focused on getting patients healthy sooner and keeping them healthy.

For patients who need additional care at home, UnityPoint at Home provides services and equipment including nursing care, infusion therapy, respiratory therapy, rehabilitation, home medical equipment and supplies. The UnityPoint at Home team, which includes registered nurses certified in chronic care management, work with each patient to find the right home care solution based on their unique needs.

Through our mission to improve the lives of the people of Siouxland, UnityPoint Health– St. Luke’s, UnityPoint Clinic and UnityPoint at Home work together to ensure the best outcome for every patient, every time.

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