Remote work has shrunk the office down to a corner of the living room, but the hours logged in front of a screen have only grown longer. An improvised desk, a laptop propped below eye level, a phone within constant reach and back-to-back video calls with no walking in between have created a routine in which the body barely moves for hours at a stretch. The consequences are showing up in clinics as lower back pain, neck stiffness, shoulder tension and headaches.
Why the pain is not just "bad posture"
The scale of the problem is national. According to Brazil's Ministry of Social Security, dorsalgia, or back pain, was the leading individual cause of temporary disability benefits granted in the country in 2025, accounting for 237,113 approvals. Disorders of the intervertebral discs ranked second. The figures illustrate how much spinal health is costing workers and employers.
It would be simplistic to blame poor posture alone, according to João Douglas Gil, a physiotherapist and Head of Physiotherapy at Brazil Healt who wrote the analysis. He said back pain rarely stems from a single cause, and that prolonged sitting, little variation in position, sedentary lifestyles, weak muscles, insufficient sleep and stress tend to combine and compound one another.
A systematic review published in 2025, covering 25 studies and more than 43,000 people, found an association between sedentary behaviour and a higher likelihood of neck pain, particularly among workers and as the hours of exposure increased. Gil said this does not mean sitting inevitably causes pain, since the body tolerates a range of positions. What tends to cause harm, he said, is staying in the same position for too long without recovery or physical conditioning.
Ergonomics helps, but movement is what matters
Ergonomics can help, but it is not a substitute for movement, Gil said. No chair compensates for eight hours of immobility. He recommended positioning the monitor directly ahead and close to eye level, keeping the feet supported, and setting up the keyboard and mouse so the shoulders can stay relaxed. A laptop used for long stretches, he added, should be paired with a stand and an external keyboard and mouse.
More important than any single piece of equipment, according to Gil, is varying position regularly: standing up, walking for a few minutes, switching tasks and changing posture before discomfort builds up. Stretching can ease stiffness, he said, but the most reliable prevention comes from building strength and capacity. Strength exercises targeting the trunk, hips and shoulder girdle, combined with aerobic activity, increase the body's tolerance for the physical demands of work. He said any exercise programme should be progressive and tailored to the individual rather than a generic list of "corrective" moves.
For persistent pain, clinical guidelines recommend education, keeping up whatever activity remains possible, and supervised exercise. Gil pointed to a clinical trial published in The Lancet, which found that an individualised programme combining walking and education extended the time patients went without a recurrence of low back pain.
When an MRI actually makes sense
Gil said imaging is often requested too early. In most cases of recent lower back or neck pain without warning signs, an MRI scan should not be the first step. Disc protrusions, wear and arthrosis are also common findings in people who have no pain at all, he said, so detecting them does not prove they are the source of a patient's symptoms. Early scans rarely change initial treatment and can instead cause unnecessary worry and treatment, according to Gil.
Imaging becomes more important, he said, when there is suspicion of a fracture, infection, tumour or inflammatory disease; after significant trauma; or in the presence of fever, unexplained weight loss, a history of cancer, immunosuppression or prolonged corticosteroid use. It is also warranted when there is progressive loss of strength, changes in bladder or bowel function, loss of sensation in the perineal area, or other neurological deficits, as well as when radiating pain and limited movement persist despite treatment and the result could change the course of care.
Building movement back into the routine
Gil said the best workstation is not one where the body stays perfectly aligned, but one that allows for both comfort and change. The spine was not built to stay still, he said, and should not be treated as fragile. Ergonomics organises the environment, breaks interrupt overload, and exercise builds capacity, he said, adding that protecting the spine while working remotely means restoring movement to the daily routine and giving people back a sense of control over their own bodies. He suggested workers carry out a self-assessment of their habits, saying that small changes could lead to a healthier, more active daily life.
