Pain Management Specialist, Mount Sinai Hospital
|
Q: What is ergonomics? It is a very important concept and a good way to prevent or decrease many pain conditions, including back pain, that often happens with prolonged office work in a injury-proned environment, and repetitive stress activities like clicking a mouse or typing on a keyboard. Q: What is the proper sitting position? Proper posture is sitting straight and trying to distribute the stresses of the spine onto the back of the seat. You want to decrease the vertical stresses on your spine. A higher back chair is recommended vs. sitting on a stool, which will increase the stresses on your spine There's a rule of 90's. Everything should approximate 90 degrees, the angles of your knees and elbows. Injuries like carpal tunnel, elbow tendonitis and joint and muscle-skeletal pain are also associated with occupational type problems. The forward posture of sitting puts the most pressure on the disks, which can increase your chances of degenerative disks or herniated disks. Studies have shown that offices that incorporate both sitting and standing work-stations dramatically decreases the incidences of back pain. If you put your feet on top of a footstool about 3-6 inches high, this will change your biomechanics and lessen the stresses on the spine. I recommend that you get up every hour or so, stretch, walk around the office. Q: What about chair lumbar supports. Can they help in some way? The supports are trying to mimic the s-curve of the spine. They are helpful to spread out the forces on the spine. But not all spines are the same when it comes to the degree of these curves. I recommend that you first try an over-the counter lumbar support. (Figure 1) You should not feel a giant mass on your back, but gently sense the cushion on your lumbar helping to maintain the normal curve of your spine. Try it. If it does not help your pain while sitting, consider having a support custom made for you.
Q: What about lumbar support belts? Do they help support the spine? You see power lifters and sanitation workers use these belts, but some studies show it doesn't make a difference in preventing injuries. It might be a good idea. In a sense it serves as a reminder that your should use proper movements of your spine. (Figure 2) Belts and braces can be helpful and support your spine, but prolonged uses of braces will lead to de-conditioning as your body relies on outside support of your structures. Your joints lose range of motion, muscles start to shrink and it becomes a vicious cycle. I recommend that you use the belt only for the time you are lifting heavy objects. Not for use in continuous periods. Q: What is the proper way to lift objects? The proper way is to keep the object as close to your body as possible. That way, you are keeping the least amount of forces and stresses on your spine. You are fighting against forces that want to bend your spine, putting pressure on disks and causing the onset of back pain. One of the most common things I see is an acute disk herniation caused by an episode the patient usually can recall. An example: they might be lifting their toddler and hear a pop or feel a pop sensation in the back, and then feel shooting or burning sensations that travel down the leg. Dr. Kim demonstrates the proper way to lift objects in the video below.
That's your classic herniated disk. Injuries like that can be avoided by practicing ergonomics - utilizing the the science of body mechanics to decrease stresses to prevent injury or re-injury at the workplace setting. Any motion that produces bending or forward motions will put the most pressure on a disk. Think of a herniated disk is like a jelly donut or a tire. The more pressure you put on it, the more likely its going to pop, or squirt out. The vast majority of patients will lift objects very far from your body. The farther objects are away from the body, the more stresses on the spine. This is the worst scenario. Not using your legs and trying to lift the objects with the spine forces the body to want to fall forward. You're putting more stresses on the disk and can really injury yourself that way. The proper way is the keep loads close to the body, between the knees if possible. Standing straight and erect and lifting with your legs. This keeps minimal forces on the spine. Try not to exert yourself. Practicing these techniques can prevent injuries and re-injuries to your spine. Q: How should we sit at the computer desk? The monitor is level with my head. I should not have to bend forward or look up too much to see the monitor. My back is placed evenly against the seat. This promotes a very neutral position. Try and maintain a 90 degrees position on the elbows. Ergonomic chairs can help make sitting easier. The wrists should be neutral to avoid carpal tunnel pain. The mouse should be within easy grasp, not elevated above or below. The feet are planted firmly on the ground. The knees are at 90 degrees. If your feet do not touch the ground, you can use a foot stool which may alleviate your back pain.
Q: Could my years of prolonged sitting at my computer desk contributed to my bad back? Absolutely. Sitting forward promotes the most pressure on your disks. Your body starts to get muscle memory, you begin to stoop and get poor posture even when you're walking. You have to balance the muscles and tissues that promote flexion and extension. This is a concept of balancing forces. By sitting 8 to 10 hours a day without any breaks you will likely experience stiffness, soreness of the back. The human body is not designed to be sitting for those long periods. By sitting, you are not using the other muscles of the spine that are combining to help stabilize the spine and give you proper support. Without the supportive spine you are more prone to injury and back pains. By changing your office design, you can prevent these problems. Sitting is part of our culture, we can't get away from it. Some cultures prefer squatting or even laying on the side in formal and work settings. You have to stretch and strengthen your back and abdominal muscles to achieve the best spine health. The most important thing it to use frequent rest breaks. Walk around, stretch the spine. Use a variety of different muscles. Get the blood flowing to those areas. Something as simple as getting an ergonomic chair to dissipate the forces on the spine, can make a difference. I've seen patients with neck pain, even headaches that can be attributed to their work space. You need proper back support. I recommend a high-back chair above or up to the scapula. For more information about ergonomics... |
