Part 1 of 4 in the desk-work neck and shoulder series. Part 2 is the desk and the breaks; part 3 is the air-conditioning; part 4 is when to see a doctor first.

"I know it's from sitting too long, but the job is the job — what am I supposed to do?" It comes up often, usually with a kind of resignation behind it: the posture cannot change, so the aching must be endured.

This part answers one thing: why sitting still aches — and there is a public standard to check it against.

The short version

• The 2024 Seating at Work guidelines from Malaysia's Department of Occupational Safety and Health (DOSH) emphasise seated work with minimal movement for over 30 minutes continuously.
• Sitting still is not the muscles resting — DOSH states that the muscles, tendons and ligaments not supported by the chair or desk counterbalance gravity continuously, and that a static posture restricts blood flow to the vessels supplying the muscles and accelerates fatigue.
• Why the neck and shoulders: DOSH's risk table maps "lack of movement over a prolonged period in a sitting posture" to neck, shoulder, upper back and low back pain.
• TCM theory's side is the Suwen's "prolonged sitting injures the flesh, prolonged looking injures the blood" and "work-rest imbalance" in the WHO standard — one observation, two accounts, not merged here.

First, the things that cannot wait

Chest pain that feels tight or squeezing, or chest pain spreading to your arms, neck or jaw — call 999 now, or go to the nearest hospital emergency department. The NHS heart attack page states a heart attack happens when blood flow to the heart is blocked, and lists both chest pains among its reasons to call 999. This is an emergency, not a consultation booking.

Persistent numbness or weakness in the arm or fingers — get urgent help. The NHS lists "pins and needles that do not go away" and "no feeling in your arm or shoulder" among the reasons to get urgent help.

The full list is in part 4.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

I. The problem is not "sitting", it is "for how long" and "without moving"

Prolonged sitting is not a diagnosis. DOSH's Seating at Work guidelines cover all seated work, with the emphasis on seated work with minimal movement for more than 30 minutes continuously. The same department's Display Screen Equipment guidelines draw another line: a screen used more than 1 hour continuously, or more than 4 hours cumulatively in a day without frequent breaks.

The Display Screen Equipment guidelines' examples of "static posture" are concrete: head still while looking at the monitor, continuously holding a phone or tablet, sitting without making any movements for long periods. The NHS neck-pain page lists "bad posture — for example, when sitting at a desk for a long time" among the common causes of neck pain.

What a practitioner cares about is usually not whether your posture is textbook, but three things: how long one position has been held unchanged; how much accumulates in a day (eight hours at work, two commuting, plus the phone in the evening); and whether any part of the day is spent not leaning forward.

II. Why sitting still aches: DOSH's own explanation

Sitting is still work. The Seating at Work guidelines explain it early on: gravity pulls a seated person down all the time, and the parts not resting on the chair or desk — muscles, tendons and ligaments — exert an upward counterforce against it. So "sitting still" is not "the muscles resting".

The longer one posture is held, the greater the load. The guidelines define a "static and sustained posture" (静态与持续姿势) as the same posture or position held with minimal, restricted or no movement for a prolonged period. Exertions sustained during prolonged sitting put an increased load or force on the muscles and tendons, which contributes to fatigue. The Display Screen Equipment guidelines put it this way: the muscles hold the body in a single position for a long period, which can result in circulation problems and cause muscle tension.

No movement, slower blood supply. DOSH states that a static working position restricts blood flow to certain parts of the body, particularly the vessels supplying the muscles, which can accelerate fatigue and make the muscles prone to injury. It adds that the sedentary nature of sitting (limited mobility) creates less demand on the circulatory system, so heart activity is lower and blood flow slows — and that being static impedes both the blood flow bringing nutrients to the muscles and the transport of metabolic waste away.

Why the neck and shoulders. The Seating at Work risk table lists "lack of movement over a prolonged period in a sitting posture", with neck, shoulder, upper back and low back pain among that group's potential symptoms. The Display Screen Equipment guidelines state that prolonged display-screen work has been associated with musculoskeletal conditions, especially around the neck and shoulder — "associated" is the guideline's word, not "will certainly".

The air-conditioning counts too. DOSH puts environmental factors such as the air-conditioning among its risk factors too — its sentence on cold sits beside TCM theory's "cold" in part 3.

So DOSH gives both the workstation standard and "change position, stand up and move around" — part 2.

III. How TCM theory reads "long": sitting injures the flesh, looking injures the blood

The Suwen chapter 宣明五气篇 says: "The five overstrains injure thus: prolonged looking injures the blood, prolonged lying injures qi, prolonged sitting injures the flesh, prolonged standing injures the bones, prolonged walking injures the sinews". A Beijing University of Chinese Medicine article files it under "overuse of exertion and rest" — doing anything to excess becomes a cause of illness.

In plain terms, the theory holds qi and blood — its own category, not the blood in the vessels — are driven by the body's movement. Hold one posture too long, their circulation slows and the muscles (the "flesh") are under-nourished: "prolonged sitting injures the flesh". Eyes fixed on one spot for hours is "prolonged looking injures the blood". A day at a desk does both.

What the terminology standard says. The WHO's 2022 international standard terminologies on TCM carries the same entry, the "five exhaustions" (五劳), rendering 肉 as "muscles". It also carries "work-rest imbalance" (劳逸失度): a collective term for over-exertion and physical inactivity. The same chapter's "physical inactivity" (过逸) entry states that it leads to imbalances in the flow of qi and blood, weak tendons and bones, and stagnant qi of the spleen and stomach. So "prolonged sitting injures the flesh" is not an old saying urging people to move; it is a defined entry among the causes of illness.

The two accounts side by side. Both start from one observation: a body kept still for a long time. From there they part — DOSH counts load, blood flow, nutrients and waste; the theory counts "prolonged sitting injures the flesh" and "imbalances in the flow of qi and blood". They agree on one sentence: stillness is the problem, changing position is the answer. What differs is the language for "why", and this article does not merge the two.

The same day lands differently on different people. How long the ache has lasted, and whether anything in part 4 applies, is what to say at the consultation.

The words in this part

• Static and sustained posture (静态与持续姿势) — DOSH's term for one posture held with minimal, restricted or no movement for a prolonged period. You meet it in occupational-safety documents.
• The five exhaustions (五劳) — the five kinds of "overuse" the Suwen lists; the WHO standard carries the same entry.
• Work-rest imbalance (劳逸失度) — a WHO-standard entry among the causes of illness: over-exertion and physical inactivity together.
• Physical inactivity (过逸) — same chapter: it leads to imbalances in the flow of qi and blood, weak tendons and bones, and stagnant qi of the spleen and stomach.

The other three parts

• Part 2: Screen height and how often to stand up
• Part 3: What air-conditioning on the neck and shoulders does
• Part 4: When to see a doctor first

👉 If you are not sure "where this desk-work neck and shoulder ache should go next", you are welcome to bring it to an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 can assess it; if anything in the section above or in part 4 applies, see a doctor first. In-person consultations are coming soon.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

Sources

• Department of Occupational Safety and Health Malaysia, Guidelines on Occupational Safety and Health for Seating at Work 2024 — https://dosh.gov.my/wp-content/uploads/2025/12/On-Occupational-Safety-And-Health-For-Seating-At-Work-2024-kecik.pdf
• Department of Occupational Safety and Health Malaysia, Guidelines on Occupational Safety and Health for Working with Display Screen Equipment 2024 — https://dosh.gov.my/wp-content/uploads/2025/01/GUIDELINES-ON-OSH-FOR-DSE_Full_21Nov.pdf
• NHS, Neck pain, page last reviewed 27 April 2023 — https://www.nhs.uk/symptoms/neck-pain-and-stiff-neck/
• NHS, Shoulder pain, page last reviewed 22 May 2023 — https://www.nhs.uk/symptoms/shoulder-pain/
• NHS, Heart attack, page last reviewed 31 March 2026 — https://www.nhs.uk/conditions/heart-attack/
• Beijing University of Chinese Medicine, Zhai Shuangqing, "Why illness begins in overuse", China Traditional Chinese Medicine News 28 March 2012, university reprint 29 March 2012 — https://www.bucm.edu.cn/kxyj/e18614fe5f854061ae134ed91d4661f6.htm
• World Health Organization, WHO international standard terminologies on traditional Chinese medicine, Geneva 2022 — https://www.who.int/publications/i/item/9789240042322

本文是「久坐办公肩颈酸痛」系列的第 1 篇，共 4 篇。第 2 篇讲桌子与休息，第 3 篇讲冷气直吹，第 4 篇讲什么时候要先看医生。

「医师，我知道是坐太久，但工作就是这样，能怎么办？」这是不少读者常说的一句话，背后通常是一种放弃——姿势不能改，所以酸痛只能忍。

这一篇只回答一件事：久坐为什么会酸，而且有公开标准可查。

一分钟看完

• 马来西亚职业安全与卫生局（DOSH）2024 年的《坐姿工作指引》特别关注连续超过 30 分钟、几乎不动的坐姿。
• 坐着不等于肌肉在休息——DOSH 写明，没靠在椅子或桌子上的肌肉、肌腱与韧带要持续出力平衡重力；而静态姿势会限制供应肌肉的血流、加快疲劳。
• 为什么是颈肩：DOSH 的风险表把「坐姿中长时间缺乏活动」对应到颈痛、肩痛、上背痛、下背痛。
• 中医理论那一边是《素问》的「久坐伤肉、久视伤血」与世卫标准的「劳逸失度」——同一个观察，两套说法，本文不合并。

先说不能等的几件事

胸口发紧或疼痛，或胸痛蔓延到手臂、颈部或下巴——请立刻拨打 999，或前往最近的医院急诊部。NHS 的心脏病发作页面写明，心脏病发作是流向心脏的血流被阻断，并把这两种胸痛列为要立刻拨打 999 的情况。这是急症，不要先安排问诊。

手臂或手指持续麻木、无力——请马上求医。NHS 把「持续的麻或刺痛」与「手臂或肩膀失去感觉」列为要马上求医的情况。

完整的清单在第 4 篇。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

一、问题不在「坐」，在「久」和「不动」

久坐本身不是一个诊断。DOSH 的《坐姿工作指引》适用于所有坐着的工作，特别强调的是连续超过 30 分钟、几乎不动的坐姿工作；同一个部门的《显示屏设备工作指引》划的另一条线是连续使用屏幕超过 1 小时，或一天累积超过 4 小时而没有经常休息。

《显示屏设备工作指引》给「静态姿势」的例子很具体：看着屏幕时头部维持不动、长时间握着手机或平板、长时间坐着完全不动。英国 NHS 的颈痛页面也把「坐在桌前太久的不良姿势」列为颈痛的常见原因之一。

医师在意的通常不是姿势标不标准，而是三件事：同一个姿势维持了多久没换；一天累积多少（上班八小时、通勤两小时，再加晚上滑手机）；一整天前倾之后，有没有不前倾的时段。

二、久坐为什么会酸：DOSH 自己的解释

坐着也是在用力。 《坐姿工作指引》开头就说明：坐着的人受地心引力持续向下拉，没有靠在椅子或桌子上的那些部位——肌肉、肌腱和韧带——要持续向上出力来平衡它。所以「坐着不动」不等于「肌肉在休息」。

同一个姿势维持越久，负荷越大。 指引把「静态与持续姿势」（static and sustained posture）定义为：同一个姿势或位置在很长一段时间里几乎不动、受限或完全不动。长时间坐姿下持续的出力，会增加肌肉与肌腱的负荷或受力，造成疲劳。《显示屏设备工作指引》的说法是：肌肉长时间把身体固定在同一个位置，可能造成血液循环的问题，并引起肌肉紧绷。

不动，供血就慢。 DOSH 说，静态的工作姿势会限制身体某些部位的血流，尤其是供应肌肉的血管；这会加快疲劳，让肌肉更容易受伤。DOSH 还说，久坐（活动受限）对循环系统的需求变少，心脏活动降低，血流因此变慢；静止不动不只阻碍把养分送到肌肉的血流，也阻碍把代谢废物运走。

为什么是颈肩。 《坐姿工作指引》的风险表把「坐姿中长时间缺乏活动」单独列为一项，对应的可能症状包括颈痛、肩痛、上背痛、下背痛。《显示屏设备工作指引》则写明，长时间使用显示屏与肌肉骨骼问题有关联，尤其是颈部与肩部一带——「有关联」是指引的用词，不是「一定会」。

冷气也算在内。 DOSH 把冷气这类环境因素也列进风险因素——它那句话和中医理论的「寒」并排来看，在第 3 篇。

所以 DOSH 给的不只是工作站标准，还有「换姿势、站起来、走动」——两样都在第 2 篇。

三、中医理论怎么看「久」：久坐伤肉、久视伤血

《素问·宣明五气篇》：「五劳所伤：久视伤血，久卧伤气，久坐伤肉，久立伤骨，久行伤筋，是谓五劳所伤」。北京中医药大学的文章把这一段归在「劳逸过用」之下——做得太过，就成了病因。

用平常的话说，理论认为气血（理论自己的范畴，不等于血管里的血）要靠身体的活动来推动。同一个姿势维持过久，气血运行减慢，肌肉（「肉」）得不到足够濡养，就是「久坐伤肉」；眼睛长时间盯着一处，是「久视伤血」。办公桌前的一天，两样都占了。

术语标准怎么写。 世界卫生组织 2022 年的中医术语国际标准收了同一条「五劳」，英文把「肉」写作 muscles（肌肉）。标准另有「劳逸失度」一条：过劳与过逸的合称。同一章的「过逸」条目写明：缺乏活动会导致气血运行失调、筋骨软弱、脾胃之气停滞。所以在理论里，「久坐伤肉」不是一句劝人多动的老话，而是有定义的病因条目。

两套说法放在一起。 两边从同一个观察出发：身体长时间不动。往下就分开了——DOSH 数的是负荷、供血、养分与废物，理论数的是「久坐伤肉」与「气血运行失调」。相同的只有一句：不动是问题，换姿势是答案；不同的是解释「为什么」的语言，本文不合并成一句。

同样的一天落在不同的人身上，结果可以完全不同。酸了多久、有没有第 4 篇列的情况，才是看诊时要说的。

这篇出现的几个词

• 静态与持续姿势 static and sustained posture——DOSH 的用词：同一个姿势几乎不动、受限或完全不动地维持很长一段时间。您会在职业安全文件里读到它。
• 五劳 wǔ láo——《素问》列的五种「过用」，世卫标准收了同一条。
• 劳逸失度——世卫标准的一条病因：过劳与过逸的合称。
• 过逸——同一章的条目：缺乏活动会导致气血运行失调、筋骨软弱、脾胃之气停滞。

这个系列的另外三篇

• 第 2 篇：屏幕多高、多久起身一次
• 第 3 篇：冷气直吹肩颈会怎样
• 第 4 篇：什么时候要先看医生

👉 如果您不确定「我这种坐出来的肩颈酸痛，下一步该往哪里走」，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师为您评估；若有本文开头或第 4 篇列出的情况，请先就医。线下亲诊服务即将推出。

无论身在何处，与持证中医师对坐。

汉方现代中医

资料来源

• 马来西亚职业安全与卫生局，《2024 年坐姿工作职业安全与卫生指引》 — https://dosh.gov.my/wp-content/uploads/2025/12/On-Occupational-Safety-And-Health-For-Seating-At-Work-2024-kecik.pdf
• 马来西亚职业安全与卫生局，《2024 年显示屏设备工作职业安全与卫生指引》 — https://dosh.gov.my/wp-content/uploads/2025/01/GUIDELINES-ON-OSH-FOR-DSE_Full_21Nov.pdf
• NHS，Neck pain，页面最后审阅 2023 年 4 月 27 日 — https://www.nhs.uk/symptoms/neck-pain-and-stiff-neck/
• NHS，Shoulder pain，页面最后审阅 2023 年 5 月 22 日 — https://www.nhs.uk/symptoms/shoulder-pain/
• NHS，Heart attack，页面最后审阅 2026 年 3 月 31 日 — https://www.nhs.uk/conditions/heart-attack/
• 北京中医药大学，翟双庆〈生病因何起于过用〉，《中国中医药报》2012 年 3 月 28 日，校网转载 2012 年 3 月 29 日 — https://www.bucm.edu.cn/kxyj/e18614fe5f854061ae134ed91d4661f6.htm
• 世界卫生组织，WHO international standard terminologies on traditional Chinese medicine，2022 — https://www.who.int/publications/i/item/9789240042322