NYC Subway Commutes and Back Pain: A Connection Worth Examining

For millions of New Yorkers, the workday does not begin at the office. It starts on a subway platform, often with a bag over one shoulder and the question of whether there will be a seat when the train arrives.

Some days you sit for most of the ride. Other days you stand in a crowded car, shift around other passengers, climb several flights of stairs, and walk a few blocks before reaching your destination. If your back already tends to bother you, it is not difficult to notice a pattern: you leave home feeling reasonably comfortable and step off the train feeling stiff, sore, or ready to stretch.

Does that mean the subway is causing your back pain? Not necessarily. But the connection is worth examining.

Does Commuting Actually Cause Back Pain?

Low back pain is rarely explained by one everyday activity alone. It can involve muscles, joints, discs, nerves, previous injuries, age-related changes, physical conditioning, and many other factors. That makes statements such as “sitting causes back pain” or “standing is better for your spine” much too simple.

Research reflects that complexity. A systematic review of objectively measured sitting found that prolonged sitting can increase immediate reports of low back pain in adults, but the researchers could not conclude that sitting causes clinical episodes of low back pain. Another meta-analysis of longitudinal studies found no clear association between sedentary behavior and the development of low back pain, although longer sedentary time was associated with greater low-back-related disability in some analyses. [1][2]

Studies examining commuting have also found associations between longer commute times and back pain, but these studies are observational. They cannot prove that the commute itself caused the problem. [6]

For a New Yorker, a better question may be: does something about your particular commute repeatedly aggravate symptoms that are already there?

Why Your Subway Ride May Make Your Back Feel Worse

A subway commute can involve several different physical demands within a relatively short period. You may sit without much room to reposition, stand in one place for an extended ride, carry a laptop or work bag, climb stairs, and transition quickly between sitting and walking.

None of those activities is inherently bad for your spine. Problems are more likely to arise when one position or activity consistently reproduces symptoms, particularly when you are unable to change it.

Commute Situation	Why It May Matter	What You Can Try
Sitting for most of a long ride	Some people with low back pain report increased symptoms during prolonged sitting. Holding one position may be more aggravating than sitting itself. [1]	Change position periodically when possible and avoid feeling that you must maintain one rigid “perfect” posture.
Standing for a long ride	Prolonged standing can provoke low-back symptoms in some people as well. [3]	Shift your stance, make small position changes, and avoid locking yourself into one position for the entire ride.
Carrying a bag on one shoulder	Asymmetrical carrying can change trunk position and loading. [4]	Reduce unnecessary weight, alternate sides, or use a backpack with both straps when practical.
Crowded train with little room to move	Limited space may prevent the small position changes that normally occur throughout the day.	Use opportunities on the platform, during transfers, or after exiting the train to walk and change position.
Back already hurts before you board	The commute may be exposing you repeatedly to a position that your back currently does not tolerate well.	Pay attention to which positions reproduce symptoms and discuss a recurring pattern with a back specialist or physical therapist.

The common theme is not that everyone should sit, everyone should stand, or everyone needs to find one perfect posture. Your back generally benefits from being able to tolerate multiple positions and move between them.

Sitting Isn’t Automatically the Enemy

Sitting has developed a bad reputation, particularly among people with back pain. Yet the evidence does not support blaming sitting alone for every painful lower back.

For some people, prolonged sitting clearly aggravates existing symptoms. Someone with lower back pain may notice stiffness after a long seated ride, while another person feels significantly better sitting than standing. Certain forms of nerve irritation can also become more noticeable in particular positions.

The problem is often the lack of variation. On a crowded train, you cannot always get up, reposition your legs, or choose a seat that feels best. If you spend another eight hours sitting at work after the commute ends, the train ride may simply be one more block of relatively static time during the day.

That is different from saying sitting damaged your spine.

Standing for the Entire Ride Is Not Necessarily Better

If sitting makes your back sore, standing can seem like the obvious solution. Unfortunately, standing still for an extended period can bother the lower back too.

A systematic review examining prolonged standing found evidence of an association with low-back and lower-extremity symptoms. Research into standing-induced low back pain also suggests that people differ substantially in how their bodies respond to prolonged standing. [3][7]

That helps explain why one commuter may happily stand from Brooklyn to Midtown while another begins looking for a seat after a few stops.

If you stand on the train, think less about holding a textbook-perfect position and more about avoiding unnecessary rigidity. Shift your weight periodically when you safely can. Use a stable handhold rather than forcing your back to remain completely motionless as the train moves. Small, comfortable position changes may be more realistic than trying to maintain one fixed stance.

Your Work Bag May Be Part of the Equation

Then there is everything you bring with you.

A laptop, charger, water bottle, lunch, gym clothes, and whatever else you need for the day can turn an ordinary work bag into a meaningful load. Carrying that weight on one side can change trunk position and the way forces are distributed while you walk and stand. Biomechanical research has found differences in trunk mechanics with asymmetrical bag carrying. [4]

That does not mean a shoulder bag is automatically giving you back pain. As with sitting and standing, the relationship is more complicated than that. But if symptoms consistently develop on the same side you carry a heavy bag, reducing the load or changing how you carry it is a reasonable variable to examine.

A backpack worn with both straps can distribute weight more evenly than carrying a heavy bag on one side. Whatever style you use, removing items you do not actually need is the simplest place to start.

The Commute May Be Exposing an Existing Back Problem

One reason it is easy to blame the subway is that back pain often becomes noticeable during a particular position or activity. The activity that reveals the symptoms, however, is not necessarily the condition causing them.

A muscle strain can make sitting, standing, bending, and walking uncomfortable. A herniated disc may irritate a nerve and produce pain that travels from the lower back into the buttock or leg. Spinal stenosis can produce a different symptom pattern. Arthritis and other musculoskeletal conditions can also cause recurring pain or stiffness.

NYBJ treats a range of back pain and strain conditions, which is why a recurring “my back always hurts on the train” pattern deserves a broader evaluation when it does not improve.

What matters is not just what you are doing when the pain starts. It is where the pain occurs, whether it travels, what makes it better, what other symptoms accompany it, and how your back behaves during the rest of your day.

When Pain Traveling Down Your Leg Changes the Picture

Back pain that stays around the lumbar muscles is different from pain accompanied by neurological symptoms.

Sciatica refers to symptoms associated with irritation or compression of nerve roots that contribute to the sciatic nerve. Pain may travel from the lower back or buttock into the leg and can be accompanied by burning, tingling, numbness, or weakness.

Some people notice these symptoms more while sitting. Others experience them during standing or walking. The position that brings on the pain can be useful information, but it does not tell you by itself which structure is responsible.

If your commute repeatedly produces leg pain, numbness, tingling, or weakness rather than simple back stiffness, it is worth having the symptoms evaluated.

Your Back Doesn’t Need One Perfect Posture

Patients with back pain often become very focused on posture. They try to sit completely upright, pull their shoulders back, brace their abdominal muscles, and hold themselves in one position for the entire ride.

That can become uncomfortable surprisingly quickly.

Research examining posture and low back pain has not established one specific spinal posture as the cause of low back pain. Reviews have repeatedly found that the relationship between posture, physical exposure, and pain is more complicated than the idea that one position is “good” and another is “bad.” [8]

Good posture is better thought of as adaptable posture. You should be able to sit, stand, walk, bend, and change positions without constantly guarding your spine.

That is difficult to achieve when your back is already painful. In those cases, treatment may focus on restoring movement, strength, and tolerance rather than simply instructing you to “sit up straight.”

A Few Changes Can Make the Commute Easier on Your Back

You cannot control train delays, crowding, or whether someone takes the last open seat. You can control some of the variables surrounding your commute.

Consider:

• Lightening a work bag that has gradually accumulated unnecessary items
• Using both straps when carrying a backpack
• Changing positions periodically when space allows
• Avoiding one rigid sitting or standing position for the entire ride
• Using the walking portions of your commute as an opportunity to move
• Paying attention to whether sitting, standing, stairs, or carrying your bag consistently reproduces symptoms
• Maintaining regular exercise outside of your commute

Exercise is particularly important. A 2021 Cochrane review found moderate-certainty evidence that exercise is probably effective for chronic low back pain compared with no treatment, usual care, or placebo. [9]

The goal is not to perform a few stretches so you can tolerate a damaging commute. It is to improve your overall capacity for the ordinary activities your day requires.

Our corresponding All Sports Physical Therapy article, Your Subway Commute Called. Your Spine Would Like a Word, takes a closer look at practical movement and recovery strategies for commuters.

When Subway Back Pain Deserves an Evaluation

An occasional stiff back after an unusually long commute is different from pain that is steadily becoming part of your daily routine.

Consider seeing a back pain specialist in NYC if:

• Back pain repeatedly occurs during or after your commute
• Symptoms are becoming more frequent or intense
• Pain is beginning to interfere with work, sleep, exercise, or everyday activity
• Pain travels into the buttock or leg
• You develop numbness or tingling
• A leg or foot feels weak
• You are changing the way you walk
• Pain persists despite reasonable activity modification

Seek urgent medical care for new bowel or bladder dysfunction, numbness in the saddle or groin area, or significant progressive weakness. These can be warning signs of serious nerve compression and require prompt evaluation. [5]

Significant back pain after a fall or other acute injury may also warrant more immediate care. NYBJ offers orthopedic urgent walk-in care at 1198 Third Avenue for acute musculoskeletal injuries.

Will You Need an MRI?

Not necessarily.

For acute low back pain without red flags, advanced imaging is generally not recommended as an automatic first step. The American College of Radiology rates lumbar MRI and other imaging as usually not appropriate for uncomplicated acute low back pain without concerning features or prior management. [10]

An evaluation usually begins with your history and physical examination. Your doctor may assess strength, sensation, reflexes, spinal and hip movement, walking, and movements that reproduce or relieve your symptoms.

Imaging becomes more relevant when symptoms persist despite appropriate treatment, neurological findings are present, or your medical history and examination raise concern for a specific condition. [10]

For certain nerve-related symptoms, EMG and nerve conduction studies can provide information about how nerves and muscles are functioning. At NYBJ, Michael Y. Mizhiritsky, MD performs EMG and nerve conduction testing as part of the practice’s non-operative spine program.

What Treatment Looks Like When the Commute Isn’t the Whole Problem

The treatment for back pain depends on what is causing it. That is why a recurring commute-related pattern is useful information but not a diagnosis.

NYBJ’s non-operative spine program may include physical therapy, activity modification, medication when appropriate, EMG and nerve testing, and interventional spine procedures for selected patients. Physical therapy is integrated into the spine-care program and can address movement, strength, mobility, and the specific activities that repeatedly provoke symptoms.

The goal is not simply to make one subway ride more comfortable. It is to improve your ability to tolerate sitting, standing, walking, work, exercise, and the rest of your normal day.

Your Commute Can Tell You Something About Your Back

The subway may not be the reason your back hurts, but it can reveal useful patterns.

If you feel fine until you have been sitting for a certain part of the ride, that matters. If standing reliably triggers discomfort but walking feels better, that matters too. If carrying your work bag seems to make symptoms worse on one side or the pain begins traveling into your leg, those details can help your doctor understand what is happening.

Back pain is rarely solved by declaring one posture, one chair, or one commute the problem. A better approach is to identify the positions and activities your back currently struggles to tolerate, determine why they are provoking symptoms, and build a treatment plan around restoring function.

If your daily commute has become a predictable source of back pain, schedule an evaluation with New York Bone & Joint Specialists to determine what may be contributing to your symptoms.

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Frequently Asked Questions

Can riding the subway cause back pain?

There is not strong evidence that riding the subway itself causes back pain. Longer commuting, prolonged sitting, and prolonged standing have each been associated with back symptoms in some research, but these findings do not establish a simple cause-and-effect relationship. A commute may instead aggravate an existing back problem or expose a position that your back currently does not tolerate well. [1][2][3][6]

Is sitting or standing better for lower back pain?

Neither sitting nor standing is universally better for everyone with back pain. Some people find prolonged sitting aggravating, while others develop symptoms during prolonged standing. Changing positions and building tolerance for multiple postures may be more useful than trying to remain in one supposedly ideal position. [1][3]

Why does my back hurt after my commute but not before it?

The positions and activities during your commute may be aggravating a sensitive muscle, joint, disc, or nerve. Sitting, standing, carrying a bag, stairs, and walking can produce different symptom patterns. Where the pain occurs and what relieves it can help a clinician identify the likely source.

Can carrying a work bag contribute to back pain?

A heavy bag carried asymmetrically can alter trunk mechanics and loading, although that does not mean it automatically causes back pain. If symptoms consistently occur on the side where you carry your bag, reducing its weight or distributing the load more evenly is reasonable. [4]

Is bad posture causing my back pain on the subway?

There is no single posture that has been established as the cause of low back pain. Holding any position for a long period can become uncomfortable for some people. Rather than trying to maintain one rigid “perfect” posture, focus on comfortable positioning and changing position when possible. [8]

When should back pain during my commute worry me?

Back pain should be evaluated when it is persistent, worsening, limiting normal activity, or accompanied by pain traveling into the leg, numbness, tingling, or weakness. New bowel or bladder problems, saddle-area numbness, or significant progressive weakness require urgent medical attention. [5]

Do I need an MRI if my back hurts every day after commuting?

Not automatically. Advanced imaging is generally not recommended as the first step for uncomplicated acute low back pain without red flags. Your history and physical examination help determine whether imaging, nerve testing, or another evaluation is appropriate. [10]

Can exercise help commuting-related back pain?

Exercise can be an important part of managing chronic low back pain. Research supports exercise therapy for improving pain in people with chronic low back pain, although the best program depends on the individual and the condition contributing to the symptoms. [9]

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References

[1] De Carvalho DE, de Luca K, Funabashi M, et al. Association of Exposures to Seated Postures With Immediate Increases in Back Pain: A Systematic Review. Journal of Manipulative and Physiological Therapeutics. 2020.

[2] Alzahrani H, Mackey M, Stamatakis E, Pinheiro MB, Wicks M, Shirley D. The Association Between Sedentary Behavior and Low Back Pain: A Systematic Review and Meta-Analysis of Longitudinal Studies. 2022.

[3] Coenen P, Willenberg L, Parry S, et al. Associations of Occupational Standing With Musculoskeletal Symptoms: A Systematic Review With Meta-Analysis. British Journal of Sports Medicine. 2018.

[4] Zhao G, Ren L, Ren L, et al. The Biomechanical Effects of Different Bag-Carrying Styles on the Lumbar Spine. 2022.

[5] Hennessy O, et al. Assessment and Early Investigation of Cauda Equina Syndrome: A Systematic Review of Existing International Guidelines. 2025.

[6] Kim J, et al. Association Between Commuting Time and Work-Related Low Back Pain. 2023.

[7] Khoshroo F, et al. Distinctive Characteristics of Prolonged Standing Low Back Pain Developers and Associated Risk Factors: A Systematic Review and Meta-Analysis. Scientific Reports. 2023.

[8] Swain CTV, Pan F, Owen PJ, Schmidt H, Belavy DL. No Consensus on Causality of Spine Postures or Physical Exposure and Low Back Pain: A Systematic Review of Systematic Reviews. Journal of Biomechanics. 2020.

[9] Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise Therapy for Chronic Low Back Pain. Cochrane Database of Systematic Reviews. 2021.

[10] American College of Radiology. ACR Appropriateness Criteria: Low Back Pain.

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