Prolonged Standing

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In this continuing education course, health issues such as knee pain, shin splints, achilles tendinitis, and plantar fasciitis are reviewed. The learner will discover that varicose veins can be prevented. Even if you do have to stand for long periods of time, there are steps you can take to make sure the veins in your legs stay healthy. Also, your posture during prolonged standing can go a long way towards preventing the development of health complications. Many preventative measures are revealed in this course so that massage therapists can present this information to clients through their therapeutic practices.

Prolonged Standing Course Outline (5 CEUs):
  • Chapter One: Overview

Prolonged standing can have a number of negative effects on your health and well-being. Massage therapists should be aware of these effects and how to prevent them- your clients aren’t the only ones whose health you should be concerned about!

What is prolonged standing? Studies generally define it as “spending over 50% of total working hours during a full work shift in the standing position.”i Prolonged standing isn’t just generally uncomfortable- it can lead to long-term health problems.

  • Chapter Two: Lower Back Pain

Studies have shown that people start to experience lower back pain after just two hours of prolonged standing.ii Lower back pain (lumbar pain) is one of the leading causes of disability and sick leave, and can also be one of the most common complaints you’ll hear as a massage therapist. Lower back pain is also one of the most common complaints in emergency rooms, with over 6 million annual cases presenting each year. Only cancer and heart disease cost Americans more in health care costs.iii

  • Chapter Three: Flat Feet

Adult Acquired Flatfoot Deformity is “a condition that results in a fallen arch with the foot pointed outward,” and is one of the risks of prolonged standing.iv While one-fourth of Americans have flat feet (with only 10 percent being born that way and the rest having acquired it through injury)v and live with it without issues, others can develop further complications, such as “knee pain, shin splints, Achilles tendinitis, and plantar fasciitis.”vi

  • Chapter Four: Plantar Fasciitis

Plantar fasciitis is one of the most common causes of foot pain among both athletes and workers who are on their feet all day. Approximately 2 million people undergo treatment for the condition every year in the U.S. Plantar fasciitis is a “syndrome of inflammation of the band of tissue that runs from the heel along the arch of the foot.”vii

  • Chapter Five: Achilles Tendonitis

Achilles tendonitis is “a condition of irritation and inflammation of the large tendon in the back of the ankle.”viii It is a common injury in those who experience prolonged standing, as well as long-distance runners.ix The Achilles tendon is the largest in your body. It “connects your calf muscle to your heel bone and is used when you walk, run, and jump...and is prone to tendinitis, a condition associated with overuse and degeneration.”x

  • Chapter Six: Other Foot Issues Associated With Prolonged Standing

Achilles tendonitis and plantar fasciitis are common foot issues among those who experience prolonged standing. There are also a number of other issues that can affect the feet and heels amongst this population of workers. Among other injuries, bunions, heel spurs and hammer toe are discussed in this chapter.

  • Chapter Seven: Varicose Veins

According to the U.S. National Library of Medicine, varicose veins are “Varicose veins are swollen, twisted, and sometimes painful veins that have filled with an abnormal collection of blood.”xi Any veins in your body can become twisted in this way, but the most common are in the feet and the legs. In cases of prolonged standing, the pressure that the body puts on the veins in the lower body increase the chances of the varicose veins developing.xii

  • Chapter Eight: Other Issues With Prolonged Standing

Studies show that prolonged standing when pregnant can result in a number of complications, including “premature birth, birth defects, low birth weight, and still-birth.”xiii An Occupational and Environmental Medicine study followed 4,680 pregnant women through their pregnancy. The study showed that women who experienced prolonged standing had babies “whose heads were on average 1cm smaller than average at birth, suggesting that they grow at a slower rate.”xiv

  • Chapter Nine: Posture

Your posture during prolonged standing can go a long way toward preventing the development of health complications. When you stand with good posture, your spine is strong and there is no strain on the muscles and connective tissues.

  • Chapter Ten: Footwear

Wearing proper footwear is one of the most important things you can do if your work requires prolonged standing. This chapter contains information on do’s and don’ts for footwear when standing. For example, two good tips are not to wear flat shoes and wear shoes with heels higher than 5 cm.

  • Chapter Eleven: Other Things You Can Do

Along with correcting your posture and using proper footwear, there are other steps you can take to prevent injury from prolonged standing. Workplace design, although normally up to the employer, can have downsides on prolonged standing. This chapter explains some of the steps you can take to make the workplace more friendly to your legs and back.




i Isa Halim, Abdul Rahman Omar, Alias Mohd Saman, Ibrahim Othman, Saf Health Work, “Assessment of Workplace Fatigue Associated With Prolonged Standing in the Workplace,” March 3, 2012, p. 31-42,


ii Danik Lafond, Annick Champagne, Martin Descarreaux, Jean-Daneil Dubois, Janina M. Prado, Marcos Duarte, Elsevier, “Postural Control During Prolonged Standing in Persons With Chronic Low Back Pain,” June 16, 2008,


iii Medscape Reference, “Mechanical Back Pain,”


iv American Academy of Orthopaedic Surgeons, “Adult Acquired Flatfoot,”


v Foot Science International, “What Are Treatments For Flat Feet?” February 6, 2011,


vi Marian Anne Eure, Senior Health, “Arch Enemy,”


vii Jonathan Cluett, M.D., Orthopedics, August 20, 2008, “Plantar Fasciitis,”


viii Jonathan Cluett, Orthopedics, December 20, 2014, “Achilles Tendonitis,”


ix Huntington Foot and Ankle Clinic, “Achilles Tendonitis,”


x American Academy of Orthopedic Surgeons, “Achilles Tendinitis,”


xi U.S. National Library of Medicine, “Varicose Veins,” June 25, 2012,


xii Mayo Clinic, “Varicose Veins,”


xiii Medical News Today, “Prolonged Standing During Pregnancy May Result in Stunted Fetal Growth,”


xiv Ibid.


Continuing education units (CEUs) are provided via electronic download in PDF format. Review the course work at your own pace and then take the included test online. You can print your certificate immediately after passing each test! All coursework is NCBTMB approved (NCBTMB # 451897-12). NOTE: Each state has different requirements. Please be sure to check our state requirements page and contact your state to verify your requirements.