In recent times, there has been a shift away from “optimal” postures, as there is a large degree of anatomical variance between individuals. Rather, the more important factor, which may result in stiffness or pain; is maintaining the same posture for a prolonged period of time without movement.
The studies which have been performed comparing crossed-legged postures are generally of very poor quality, with high levels of bias. This makes it extremely difficult to draw definitive conclusions.
There are generally two typical leg crossed postures (as seen below). With both positions resulting in different angles at the hip and knee joints.
A 2014 study (1) compared individuals who sat in a crossed-legged position for; 0-, 1-, 2- , and 3 or more hours per day. This study reported alterations in posture in individuals who sat crossed-legged for 3-hours or more per day. That is when compared to other subgroups. The results indicate that sitting in a crossed-legged posture for longer than 3 hours per day may cause; shoulder inclination, lateral pelvic tilt and forward head posture. No significant changes were noted in individuals who sat in this posture for 1 or 2 hours daily. This indicates that it may be more so the lack of movement rather than the isolated posture which is problematic.
These may sound like scary anatomical terms, but when they are broken down, is it relevant to pain and function? The answer is likely no. Slight changes in posture are very unlikely to result in pain or disability. The human body is extremely adaptable. One recent study has even hinted that crossed-legged posture may even improve pulmonary function, when compared with other common sitting postures (2).
Crossed-Legged Sitting And Musculoskeletal Pain
Crossed-legged sitting is unlikely to be harmful in individuals who are pain- or injury-free, but there are some subgroups who may need to take caution with certain crossed-legged positions.
- Lateral hip pain – if you are someone who suffers from pain on the outside of your hip, or has been told you have a condition such as; greater trochanteric pain syndrome (GTPS), gluteal tendinopathy or trochanteric bursitis, it is likely that sitting in a crossed-legged position (left image) may be irritable for you. This is due to an increased stretch placed on the muscles and structures on the outside of your hip, which may cause compression on other already-irritated structures.
- Knee pain; – if you have ongoing pain on the inside of your knee, sitting as is shown in the right image may aggravate symptoms. With the change in position of your femur (long thigh bone) and tibia (shin bone), this can result in increased stress placed on your knee and potentially result in discomfort.
If either of these is true for you, it is probably best you find a more comfortable sitting posture.
Crossed-Legged Sitting And Medical Conditions
- Varicose veins – A method of scare mongering in the media over the years has involved claiming that varicose veins may be caused by sitting crossed-legged. This is not true. Although if you are someone who has varicose veins, it is likely that sitting crossed-legged for prolonged periods is probably not a good idea. However, sitting in any one posture for a prolonged time would not be ideal, so it is best you get some movement as often as is feasible.
- Blood pressure – studies have shown that sitting crossed-legged can increase blood pressure temporarily (3). However, this increase is generally small and returns to normal quickly once legs are uncrossed. Sitting crossed-legged has not been shown to elevate blood pressure over prolonged periods. That being said, if you are someone who has uncontrollably high blood pressure, it is probably not an ideal posture to maintain for hours at a time especially if you are at risk of blood clots. Otherwise, it is likely to be perfectly safe.
Key Take Home Messages
- Posture should not be dichotomized into “good” and “bad”. The most important factor is likely to be changing positions often and getting movement where possible. There is no single “optimal” posture.
- Sitting with your legs crossed is unlikely to have a negative effect if you are someone who is otherwise healthy. However, you should probably avoid sitting in this position for over 3 hours per day.
- If you suffer with lower back, hip, or knee pain which you find can be exacerbated by sitting crossed-legged, you should avoid sitting in this position.
- Sitting crossed-legged will not cause varicose veins. However, the same advice applies here. It is likely best to avoid this position for extensive periods without movement.
- Park Y, Bae Y. Comparison of Postures According to Sitting Time with the Leg Crossed. J Phys Ther Sci. 2014;26(11):1749–52.
- Yadav M, Singh GK, Yadav A, Srivastava S, Gupta G. Pulmonary Function Analysis of a Simple Crossed Legs Sitting Posture. In: Muzammil M, Khan AA, Hasan F, editors. Ergonomics for Improved Productivity. Singapore: Springer; 2021. p. 1019–25.
- Adiyaman A, Tosun N, Elving LD, Deinum J, Lenders JWM, Thien T. The effect of crossing legs on blood pressure. Blood Press Monit. 2007 Jun;12(3):189–93.