Technology and inactivity are causing many of the health issues in the modern age! For many medical practitioners, over half of their patients receive treatment for injuries that are negatively impacted by or created by sedentary working and posture related issues. This slows down rehabilitation and can result in patient dis-satisfaction, even though it is usually out of the medical practitioner’s control. Office workers shouldn’t need to put their health at risk to do their job. By developing better working habits and by tailoring the environment to their needs, there will be less risk of discomfort or recurring injury!
Guidance on ergonomics should be in every medical practitioner’s toolkit to compliment treatment and enhance their patient’s recovery. This article will give you the information needed to guide your patients on good ergonomic practice, working habits, workstation set-up to achieve better patient outcomes.
Managing the increase in reported posture related issues
There has been a gradual increase in posture related issues among the workforce. A combination of high levels of sitting each day, coupled with a generally sedentary lifestyle have caused this.
Medical practitioners are the one’s tasked with resolving all these physical woes. However, their influence can be hampered by the fact they may only interact with those in pain once a week for an hour. Even with the prescribed exercises being carried out a couple of times per week, it can be difficult for a patient to see progress due to poor working habits, a detrimental ergonomic setup in work and generally not understanding risk areas.
At KOS Ergonomics, we work with many of Ireland’s leading medical practitioners, from spinal surgeons, physios, occupational therapists, GPs and many more, so we know this is a major frustration for them. Poor ergonomics impacts treatment and is largely out of the practitioner's control, unless they can go to the patient’s place of work to understand, educate and recommend what is needed. Over the last 28 years we have worked with people who are in pain due to their work set up, we also see first-hand how it is impacting their quality of life as well as their work performance. Our ergonomic consultants are a multi-disciplinary team, that include ergonomists, physiotherapists, consultants with backgrounds in Health & Nutrition, Human Performance and Health & Safety. The diversity of our team brought different perspectives into how to manage injuries as part of a holistic and long-term injury management plan. A multi-faceted approach is needed where different health care professionals work together to achieve what is best for the individual in pain.
Ergonomics is about adapting the work environment to a user’s specific needs
Ergonomics is about designing for people. Defined as the science of fitting the work environment to the user’s needs and educating user’s on correct working habits. Ergonomics aims to increase efficiency and productivity while reducing discomfort. Research indicates four out of five people will suffer from back or neck pain at some stage during their lives (Andersson, 1999).
Many of your patients will spend most of their day seated. Research indicates that the average Irish Person sits for 7.3 hours per day (Irish Heart Foundation, 2018), but for many office workers it can be much more. The sitting cycle begins at breakfast, the commute to work follows and then comes the largest proportion of sitting; the 40+ hour work week. Evenings will tend to vary but usually there’ll be a few nights of TV or Netflix added to the mix that will bump up one’s weekly sitting time.
Sitting in an upright position increases the static load on the intervertebral discs by 40% compared to standing, so even when a neutral posture is maintained while sitting the static load on the spine is increased. As slouching begins to occur this pressure rises substantially and increases by 90% compared to standing. Reclining reduces the load on the spine as the backrest (if positioned correctly) unloads the spine and back muscles and reduces the static load (Nachemson, 1981). Ergonomics aims to reduce the accumulation of regular stresses on the body throughout the day.
Prolonged sitting is not good for us and there is no one correct sitting position. Even though, a reclined position places reduced stress on your body, it is not recommended to maintain that position. Your next position is always, the best position! Ideally, while sitting the chair allows the user to fluidly move between positions and makes the load more dynamic. Adapting or optimising the work environment to an individual’s needs and educating on the risks will help ensure your patients have the best chance of managing current issues and of working to their best ability.
Educating and Empowering Patient on best ergonomic practice
Educating your patient on ergonomic principles and the rationale behind these is vital in managing current issues. A basic understanding will ensure safe working and will also improve productivity. Many office workers sit for a large portion of their week. If this can be done without risk to their health the role of the medical practitioner will become easier.
So where should you focus your efforts?
When it comes to ergonomics complimenting treatment programs there are four key areas medical practitioners should focus on with their patients;
- Guide on healthy working habits.
- Guide on Workstation Set Up
- Guide patients how to access supports themselves or through their employer
- Guide on specialist ergonomic solutions
The influx of work-related injuries and pain among the workforce is worrying, but if people aren’t aware of or care for ergonomic principles like, healthy working habits, how to sit correctly at the workstation or how high to have their screen, then it’s easy to understand how issues can arise.
A couple of hours of treatment can be trumped by weeks of adopting a negative posture or by poor working habits!
Ergonomics is practical. It’s proven to make a significant difference in both comfort and productivity.
- Guide on healthy working habits.
With only a portion of the week accounted for with exercises and treatment, it is vital that your patients develop better working habits. Habits that will complement their rehab process and their newly improved workstation setup.
“People do not decide their futures, they decide their habits and their habits decide their futures.”
― F. M. Alexander
Although good intentions count for something, developing positive habits throughout the working day will help ensure a reduced risk of your patient’s aggravating their injury. Reduced injury risk means improved comfort which will allow for elevated productivity for the user.
6 Tips to become more ACTIVE:
i. Alternate Working Position
If a chair allows for postural variation, then making use of it will be of benefit in managing any back issues or discomfort. If possible, alternate between sitting and standing. Encourage your patients to look for areas in their work environment where they can stand for periods. Studies have shown that introducing a sit stand workstation can reduce sitting time by up to 143 minutes/day at the workplace and by 97 minutes/day during all waking time (Taleb et al 2012). Sit-stand workstations have also been shown to improve productivity substantially, as well as reducing the experience of musculoskeletal discomfort.
ii. Consume More Water
Increased water intake has many health benefits, like improved brain function, elevated energy levels and a reduced risk of headaches. Drinking more water also means more frequent trips to fill the water bottle and to the bathroom, which of course means more short breaks from the sedentary sitting position at the desk.
iii. Try Walking Meetings
Research conducted at Stanford University had people think of new uses for common objects while sitting at a desk and while walking on a treadmill. More than ¾ of the participants came up with more ideas while walking than while sitting. This gives an indication of walking’s effects on improving creativity (Oppezzo and Schwartz, 2014).
iv. Integrate Technology
Although we have identified technology as a factor in increasing sedentary behaviours it can also be part of the solution to many of our problems. Encouraging your patient to Implement reminders to get up and move will get them into the routine of regularly taking micro breaks and moving more throughout their working day.
v. Vary Posture to Improve Productivity
Put a focus on gradually reducing sitting time. 20 min sit, 8 min stand, 2 mins walk, but remember to adapt your guidance to what is acceptable in your patient’s employer, unless it is requirement for rehabilitation or injury management. If the guidance is seen as unrealistic, it is likely to be ignored. Aim to increase overall standing time gradually to include 2 hours of standing and light activity throughout the working day. Research suggests simple changes in posture will not only benefit the user physically but also mentally by improving mood while reducing anxiety and stress (Colzato et al 2013).
vi. Education on Rationale
Possibly the most integral piece in the puzzle. Education on the health risks of sedentary behaviours and the benefits of being more conscious of ergonomics is vital. More knowledge on the benefits of ergonomics for long-term health will encourage individuals to use positive features on a more regular basis.
If employees don’t know the rationale behind why they should be more active, why they should vary their posture, or how to use specialist ergonomic equipment, chances are they won’t make any changes!
Empowering people on how to correctly set themselves up and educating them on positive habits will help the individual with pain to develop a more holistic approach to their recovery.
- Guidance on Workstation Set Up
i. Are the user’s feet flat on the ground?
To start the workstation user should have be able to sit with feet flat on the ground. This stabilises their body and takes pressure off their lower back. If feet can’t firmly sit on the floor source a footrest. This will force the user to sit all the way back into the chair and que them to remain upright. A footrest will also reduce the likelihood of them crossing their legs under the chair.
ii. Is the chair at the correct height?
Set the height of the chair so the user’s hips are just above their knees with their thighs parallel to the ground. Opening the hip angle and having their weight spread evenly across their legs will unload the pressure that would normally build up in their lower back.
iii. If applicable, does the user make use of the recline mechanism?
Our body craves movement, even more-so in this technological age. If the chair is static, the body will look for another (often bad) position. Set the chair’s back angle to one where the user will be comfortable to work. If applicable using the recline mechanism on the chair to unload the lower back periodically is a great habit to get into. Postural variation is key when sitting for long periods to help maintain a healthy spine. ‘Your next position is your best position’. Postural variation will help prevent the build up of waste products in the lower back and keep help discomfort at bay.
iv. Does the back/lumbar support sit into the correct area?
Position the lumbar support to just above the waistband on your trousers. This positioning will provide support to the lumbar region of the spine and unload the spine.
v. Are the user’s workstation items organised by priority?
Arrange the items used most, nearer to the user e.g. keyboard and mouse. (within in the optimum reach zone - half an arm’s length). This step will enable the user to avoid leaning over excessively and repeatedly twist, thus greatly reducing the likelihood of injury. Items used less frequently should be placed slightly further away from the user (within the maximum reach zone – an arm’s length). Again, the goal here is to prioritise the items used most by moving them closest. For example, if the phone is only used a couple of times each day there's no need to have it in in the optimum reach zone.
vi. Is the monitor in the correct position?
The user’s monitor should be placed approximately an arm’s length away. This will help prevent any eye discomfort arising. The top third of the screen should be at eye level. This cues the user to remain in an upright position and reduces the likelihood of leaning forward and looking down.
vii. Are less frequently used items further away from the workstation?
The printer and items used less frequently should be placed away from the workstation completely. This will mean the user must get up and move around intermittently during the day.
- Accessing support themselves or through their employer
For medical practitioners, educating your patient in ergonomic principles and what to look for is key in managing issues. Under Irish Safety, Health and Welfare at Work Regulations, all regular computer users are entitled to an ergonomic assessment called a DSE (Display Screen Equipment) or VDU (Visual Display Unit) Assessment. Both VDU or DSE Assessment are both technically ergonomic assessments but are very basic. An internal DSE Assessor will typically have a one-day training course, generally without any relevant background in ergonomics or a related field. Many companies use this as more of a compliance check, but it should also go through basic set up of existing equipment.
Generally, if a patient has a recurring injury aggravated by their work environment, a detailed ergonomic assessment would be required. The main difference is this will generally be done by an ergonomist or a competent individual with advanced ergonomic training and is done by an external company, usually an ergonomics company or a Health and Safety company and sometimes physios and OTs too. Ergonomics is a relatively niche area, and many people working in the area have limited experience or limited relevant qualifications. If a patient has a reoccurring or acute injury, it is best to recommend an ergonomic assessment performed by an assessor that has competence relevant to the issue. If there is an assessor/company you are aware to be competent, it is best to recommend them or similarly qualified assessors.
- Guidance on Specialist Equipment
In general, within companies the standard furniture may be adequate for 90% of staff. These staff will be comfortable, happy and will have minimal discomfort while working. Providing education on setup and positive habits should help ensure them remain this way.
For the 10% with special requirements like those with chronic low back pain, carpal tunnel and even a taller/heavier user, specialist ergonomic solutions may need to be sourced. These individuals tend to be the ones that end up requiring treatment.
Specialist solutions could vary from a specific orthopedically designed back care chair to an ergonomic mouse that reduces the amount of pronation at the wrist joint. With the variety of furniture available it can be difficult to identify what the best solution will be for your patient.
Avoid patients getting unsuitable equipment
There is often a gap in injury management between the medical profession and employers, both who want to provide suitable equipment for the injured party. The employer generally doesn’t have internal expertise that will know what suitable equipment is needed for a specific medical condition and expects the medical professional to recommend specifically what is needed. While the medical professional understands exactly what is needed but isn’t familiar enough with the specific equipment to know exactly what equipment will work best to achieve what they are looking for. Often in this case a generic recommendation is made, e.g. get an ergonomic chair. What happens in this case, is the purchasing department google “ergonomic chair” and purchase whatever comes up but they have no idea what is required.
This is where it is recommended to consult with an experienced Ergonomic Consultant who can advise on exactly what is required based on the individual’s background, the medical recommendations and of course, on the type of work they carry out. If specialist equipment is purchased e.g. a back care chair, it is important that suitably qualified person that is very familiar with the set up fits the chair to the user.
Making sure the whole ergonomic solution is tailored to the individual’s needs will allow for better management of current issues, improved comfort and elevated productivity.
Working towards a more holistic approach to injury management and recovery
Over time the hours pile up. Days become weeks, weeks become months, months become years, then decades. If people are more conscious of their ergonomic habits and setup, then their ability to manage injuries will dramatically increase.
By combining high quality treatment with tailored ergonomic education or ergonomic solutions medical practitioners can provide a well-rounded service that will help ensure a more positive outcome for their patient.
Where KOS Ergonomics can help medical practitioners:
Arrange a free in-service with one our ergonomic consultant and we will guide you on:
After the in-service session medical professionals report that they are better equipped to help their patients on how to manage posture related issues and the supports available to them.
Arrange one today by emailing ergoclub@kos.ie
References;
Oppezzo, M., & Schwartz, D. L. (2014). Give your ideas some legs: The positive effect of walking on creative thinking. Journal of Experimental Psychology: Learning, Memory, and Cognition, 40(4), 1142-1152.
Taleb A, Alkhajah MIPH, Marina M. Reeves PhD, Elizabeth G. Eakin PhD, Elisabeth A.H. Winkler PhD, Neville Owen PhD, Genevieve N. Healy PhD. (2012) Sit–Stand Workstations: A Pilot Intervention to Reduce Office Sitting Time. American Journal of Preventive Medicine. 43 (3).
Örtengren, R., Andersson, G.B. and Nachemson, A.L., (1981). Studies of relationships between lumbar disc pressure, myoelectric back muscle activity, and intra-abdominal (intragastric) pressure. Spine, 6(1), pp.98-103.
Robertson, M.M., Ciriello, V.M. and Garabet, A.M., (2013). Office ergonomics training and a sit-stand workstation: Effects on musculoskeletal and visual symptoms and performance of office workers. Applied ergonomics, 44(1), pp.73-85.
Colzato, L. S., Szapora, A., Pannekoek, J. N., & Hommel, B. (2013). The impact of physical exercise on convergent and divergent thinking. Frontiers in Human Neuroscience, 7
Nachemson, A.L., 1981. Disc pressure measurements. Spine, 6(1), pp.93-97.
Andersson, G.B., 1999. Epidemiological features of chronic low-back pain. The lancet, 354(9178), pp.581-585.
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