Journal for Research in Sport Rehabilitation

Journal for Research in Sport Rehabilitation

The effect of sitting with legs crossed on rotation and range of motion of the lower back, pelvis, and thigh: A systematic review

Document Type : Review article

Authors
Ali asghar Norasteh 1
Mohammad Yasavoli Sharahi 2
Hamed Zarei 3
1 Professor, Department of Physiotherapy, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
2 PhD Student in sports injury and corrective exercises, Department of Sports Injury and Corrective Exercises, Faculty of Physical Education and Sports Sciences, University of Guilan, Rasht, Iran.
3 Assistant Professor, PhD, Sports Biomechanics Department, Faculty of Physical Education & Sport Sciences, University of Guilan, Rasht, Iran.
10.22084/rsr.2026.31264.1783
Abstract
Background and Aim: Cross-legged sitting is a common daily postural habit, yet its biomechanical effects on the lumbopelvic region and lower extremities remain insufficiently understood. This review aimed to synthesize evidence on the effects of sitting with crossed legs on rotational mobility and range of motion of the lumbar spine, pelvis, and hip joint.
Methods: A systematic search was performed in Google Scholar, PubMed, ScienceDirect, PEDro, and MedLib using the English keywords Leg Crossed, Hip and thigh range of motion, and Hip rotation. Persian databases including Magiran, Irandoc, IranMedex, MedLib, and SID were searched using the keywords legs crossed, range of motion of the pelvis, thigh and lumbar spine. The search covered studies published between September 2000 and September 2024. Studies of any design examining sitting posture effects on hip, pelvic, or lumbar ROM were eligible.
Findings: Ten studies met the inclusion criteria. Most reported that cross-legged sitting induces postural asymmetries, particularly increased external hip rotation and compensatory lumbar changes. Methodological heterogeneity due to variations in measurement tools, sample sizes, and participant ages led to inconsistent outcomes. Only a few studies explored links to low back pain, with inconclusive results.
Conclusion: Current evidence confirms a relationship between cross-legged sitting and altered hip-pelvis-spine kinematics. The proposed mechanism involves adaptive shortening of the hamstring and tensor fascia latae muscles, restricting thigh and back ROM. Although some evidence suggests a potential link to back pain, the scarcity of high-quality studies highlights the need for future prospective research with standardized methods.
Keywords
Sitting Position
Range of Motion
Hip Joint
Lumbar Vertebrae
Subjects
1.         Hosseinimehr SH, Anbarian M, Khosravi3 MT. The Survey of Scapulohumeral Rhythm and Isometric Strength ratio of Shoulder Agonist to Antagonist Muscles in Handball Players and Non-athletes. Studies in Sport Medicine. 2013;5(14):15-30.
2.         Bloomfield SA. Changes in musculoskeletal structure and function with prolonged bed rest. Medicine and science in sports and exercise. 1997;29(2):197-206.
3.         Ro DH, Lee J, Lee J, Park J-Y, Han H-S, Lee MC. Effects of knee osteoarthritis on hip and ankle gait mechanics. Advances in orthopedics. 2019;2019(1):9757369.
4.         Drzaƚ-Grabiec J, Truszczyńska A, Fabjańska M, Trzaskoma Z. Changes of the body posture parameters in the standing versus relaxed sitting and corrected sitting position. Journal of back and musculoskeletal rehabilitation. 2016;29(2):211-7.
5.         Cicolini G, Pizzi C, Palma E, Bucci M, Schioppa F, Mezzetti A, Manzoli L. Differences in blood pressure by body position (supine, Fowler's, and sitting) in hypertensive subjects. American journal of hypertension. 2011;24(10):1073-9.
6.         Woo EH, White P, Lai CW. Musculoskeletal impact of the use of various types of electronic devices on university students in Hong Kong: An evaluation by means of self-reported questionnaire. Manual therapy. 2016;26:47-53.
7.         Pereira S, Silva A, Santos R, Silva CC. Assessing Postural Control From Birth to Adulthood Among Individuals Born Preterm: A Systematic Review. Motor Control. 2024;1(aop):1-29.
8.         Hirano M, Katoh M, Gomi M, Arai S. Validity and reliability of isometric knee extension muscle strength measurements using a belt-stabilized hand-held dynamometer: a comparison with the measurement using an isokinetic dynamometer in a sitting posture. Journal of Physical Therapy Science. 2020;32(2):120-4.
9.         Moon IY, Yi CH, Park IW, Yong JH. Effects of sitting posture and bolus volume on activation of swallowing‐related muscles. Journal of Oral Rehabilitation. 2020;47(5):577-83.
10.       Kendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA. Muscles: testing and function with posture and pain. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2005
11.       Jung K-s, Jung J-h, In T-s. The effects of cross-legged sitting on the trunk and pelvic angles and gluteal pressure in people with and without low back pain. International Journal of Environmental Research and Public Health. 2020;17(13):4621.
12.       Butte KT, Cannavan D, Hossler J, Travis C, Geiger J. The relationship between objectively measured sitting time, posture, and low back pain in sedentary employees during COVID-19. Sport sciences for health. 2023;19(1):259-66.
13.       Davidson JM, Zehr JD, Dominelli PB, Callaghan JP. Traditional versus dynamic sitting: Lumbar spine kinematics and pain during computer work and activity guided tasks. Applied Ergonomics. 2024;119:104310.
14.       Randles R, Finnegan A. Guidelines for writing a systematic review. Nurse education today. 2023;125:105803.
15.       Mozafaripour E, Rajabi R, Minoonejad H. Anatomical alignment of lower extremity in subjects with genu valgum and genu varum deformities. Physical Treatments-Specific Physical Therapy Journal. 2018;8(1):27-36.
16.       Lee K-h, Chon S-c. The relationship between the range of hip rotation and the quadriceps angle in subjects with and without flat foot. Physical Therapy Korea. 2018;25(4):19-26.
17.       hui Shin Y. Effect of Cross-legged Sitting Posture on Joint Range of Motion: Correlation with Musculoskeletal Symptoms and Facial Asymmetry. The Journal of Korean Physical Therapy. 2022;34(5):255-66.
18.       Lee J-H, Yoo W-G. Changes in gluteal pressure and pelvic inclination angles after continuous cross-legged sitting. Work. 2011;40(2):247-52.
19.       Bobowik PŻ, Mańka J, Jaskulski K, Kaczmarczyk K. Hip joint mobility in relation to measurement position, gender and limb dominance. Acta of Bioengineering and Biomechanics. 2022;24(2).
20.       Park Y, Bae Y. Comparison of postures according to sitting time with the leg crossed. Journal of physical therapy science. 2014;26(11):1749-52.
21.       Ahn H-E, Yoon T-L. The effects of sitting in a crossed legs posture on the vertebral angle, chest wall mobility, pulmonary function, and respiratory muscle activity: a preliminary study. Journal of the Korean Society of Physical Medicine. 2019;14(3):13-20.
22.       Karkousha RN, Mohamed AR, Ibrahim AH. Cross‑legged sitting posture effect on lumbar proprioception in young adults: a cross‑sectional study. Bull Fac Phys Ther. 2021;26:1‑5.
23.       Boukabache A, Preece SJ, Brookes N. Prolonged sitting and physical inactivity are associated with limited hip extension: a cross-sectional study. Musculoskeletal Science and Practice. 2021;51:102282.
24.       Alam MM, Ali AM, Rafey M, Sufyaan M, Ahmad I, Zarrin S. Work-Related Risk Factors for Musculoskeletal Disorder among Nurses in Indian Hospitals. Muscles, Ligaments & Tendons Journal (MLTJ). 2023;13(2).
25.       Yanagisawa O, Fukutani A. Muscle recruitment pattern of the hamstring muscles in hip extension and knee flexion exercises. Journal of human kinetics. 2020;72(1):51-9.
26.       Martín-San Agustín R, Benítez-Martínez JC, Castillo-Ballesta L, Gacto-Sánchez M, Medina-Mirapeix F. Validity, reliability, and sensitivity to change of DiCI for the strength measurement of knee and hip muscles. Measurement in Physical Education and Exercise Science. 2020;24(4):303-11.
27.       Kawama R, Takahashi K, Wakahara T. Effect of hip joint position on electromyographic activity of the individual hamstring muscles during stiff-leg deadlift. The Journal of Strength & Conditioning Research. 2021;35:S38-S43.
28.       Yu J-S, An D-H. Differences in lumbar and pelvic angles and gluteal pressure in different sitting postures. Journal of physical therapy science. 2015;27(5):1333-5.
29.       Lee BJ, Cha HG, Lee WH. The effects of sitting with the right leg crossed on the trunk length and pelvic torsion of healthy individuals. Journal of Physical Therapy Science. 2016;28(11):3162-4.
30.       Ahn S, Kim S, Kang S, Jeon H, Kim Y. Asymmetrical change in the pelvis and the spine during cross-legged sitting postures. Journal of Mechanical Science and Technology. 2013;27:3427-32.
31.       Voorn R. Case report: can sacroiliac joint dysfunction cause chronic Achilles tendinitis? J Orthop Sports Phys Ther. 1998;27(6):436-43.
32.       Kang S-y, Kim S-H, Ahn S-J, Kim Y-H, Jeon H-S. A comparison of pelvic, spine angle and buttock pressure in various cross-legged sitting postures. Physical Therapy Korea. 2012;19(1):1-9.