In this episode of the Morley Physiotherapy Centre Podcast, owner Tony talks about back pain in the workplace.
Sitting and standing debates in the workplace have been going on for years – but which is better? Listen now or read on to understand the real cause for back pain in the workplace and how to prevent and treat it as it occurs.
Full transcript below!
Tony: Good morning. This is Tony Pullella speaking. I’m a musculoskeletal Physiotherapist from Morley Physiotherapy Centre and I like discussing with people aspects of their health, particularly their spinal health and ways of overcoming them.
This morning I’m going to talk about back pain in the workplace, particularly related to sitting.
Most people understand that the lower back area has many causes and that most of those causes can be associated with injuries, but often, the problem with backs is that they develop postural problems that come from prolonged standing or prolonged sitting. Sitting and standing debates have been going on for quite a few years now, which is better?
From my point of view, I think it’s important to know that there’s many problems encountered in the workplace related to desk work and sitting and if you have a back pain, most people will complain that it’s worse while you are sitting or getting out of the chair. How can we understand some of these factors that affect our workplace, our backs, and how can we overcome these problems?
The cause
What do we know? The workplace has changed a lot in the last 20 or 30 years. The body hasn’t really changed for thousands of years. So, how is the body in the workplace relating to one another?
In the modern lifestyle today, we’ve seen there’s been a genuine decrease in physical activity over the years. Since the 1950s with the advance of technology, our work has become less physical and more static. Our body is made to move and be dynamic. But what’s happening in the latest trends that we’ve seen, is that the workplace is becoming less dynamic, less active, and more static, which means there is no movement.
I sometimes joke with my patients the difference between a live person and a dead person is that a dead person doesn’t move. So, if that’s the definition of life, there’s a lot of dead people at work no moving much.
Let’s look at some of the research. Sedentary jobs, which are seated, have increased 83% since the 1950s and physically active jobs have decreased to make up approximately 25% of our workforce, which is 50% less than 1950. So, that tends to confirm that we are moving less at work, the body dynamics, which causes less activity, creates weakness, muscle imbalances and postural imbalances.
We need more variety. We need to be more mobile and less static. Some of the research has also confirmed that people that sit the most, also are more likely to sit more outside of work. The office worker today, on an average, sits about five hours and 45 minutes a day at work. Of course, on top of our work postures, there’s more sedentary loading occurring outside of work time.
Traveling, commuting, you could say you could spend an hour or two per day in a bus or a car traveling to and from work. How many hours a day do you watch TV? They say about 4.3 hours a day spent watching TV, using computers, screens, or gaming systems. So, in a day, we could be sitting anywhere from 10 to 15 hours. That makes our day pretty much loaded in the sitting department.
The risk of sitting
So, how does sitting affect the back then? How does it affect general health? We know that sitting for longer periods is associated with physical inactivity, and physical inactivity we know are associated more with diseases that affect the heart and our general health. But from a back’s perspective, we know very, very clearly from studies that have measured disc pressure in different body positions, that sitting is not as good as other positions for the lower back.
Intradiscal pressure is lowest when you’re lying down. It is a medium pressure when you’re standing, and there’s a higher level when it’s sitting. Particularly higher still when we slump forwards, which is the worst position. What does this mean? This means that pressure inside the discs of the lower back and tension on the ligaments and the muscles in the spine and the pelvis are much higher in sitting than other positions.
And of course, this correlates with why pain is experienced more in these positions. Forward sitting, particularly with desk work, writing or reading, and computer operation, also has effects on the neck and shoulders, and the mid-back. So, it’s isn’t just the lower back that’s affected. And of course with the arms and the shoulders forwards, we have also seen problems in the workplace to do with elbow injuries, wrist and finger injuries.
How bad is sitting and how long should we do it for? Well, sitting is obviously a posture that we can sit for 20 minutes before we should move. That means that we can get out of the chair and move around and do a stretch. If we can do this, we can actually realign our spines into a better alignment, and we can get ourselves into a more comfortable position when we sit down again.
The ideal sitting position obviously involves maintaining the spine’s natural S-curve. The head and neck and pelvis is aligned while we’re sitting. What affects this, is the type of chair we’re sitting in and the office desk that we’re using. We’ll discuss this a bit later on when we talk about ergonomics.
Prolonged sitting also affects the legs, hips, and thighs, so we know that it affects circulation. It weakness trunk and core support muscles and causes a lot of pressure in the feet as well. Back pain is a complex condition, and as a physiotherapist, we analyze the causes that are focused on these back problems by taking a very thorough clinical history and during a clinical examination to identify the triggers or factors that cause it. We try to assess the client’s physical condition and capacity, so we know the person’s capacity to sit for long periods of time.
Ergonomics – Is it the cure?
Ergonomic assessment is also important for back pain related to the workplace. What is ergonomics? It’s an applied science of equipment design and work systems intended to maximize productivity and minimize operator fatigue and discomfort. And the fatigue and discomfort can also be physical and mental.
So, what sort of ergonomic advice would you give someone that works in an office that’s complaining of back pain? Well, first of all, you’d ask about the chair they’ve selected to sit on. Has the chair got a degree of adjustability in it? There are usually three types of adjustability in a chair: height, tilt, and back support.
The height, obviously, is depending on how tall you are, and the chair should be adjusted for your particular height, so that your knees are bent to 90 degrees and your feet just touch the floor. The seat tilt is also a good thing to adjust, because as the seat tilts forward, it changes the pelvic angle and this tends to change the lumbar curve in the lower back area. That lumber curve can be supported by adjusting the adjustment in your back support area, and that’s also something that’s important for comfortable sitting for long periods of time.
The other area that is looked at is the desk selected by the person to work at. Of course we know that the desk would have a height adjustment. And recently, the trend has been to having a much higher degree of height adjustability in a desk to allow a variety of of sit-to-stand work postures. So, it’s important now for some people with back pain with sitting, they’re able to stand at their desk. Having a desk that can be able to be adjusted for this is a really big advantage.
Many of my clients have changed to a sit/stand desk, and it’s made a big improvement in their condition. What does it mean? Some of the research that’s emerging now of the benefits of the standing versus a sitting desk posture is actually quite interesting. Any activity that can be done in a sit, can be done standing up. If we can change our position for varying periods throughout the day, it creates a more dynamic work environment.
Benefits of a standing desk
Some of the benefits of standing at the desk improve circulation and posture loads that improves muscular balance. Also, because we are standing, it activates the muscles in the legs and in the pelvis and along the stabilizing muscles of the spine to improve musculus balance. Some of the other benefits of the claim seem to be positive of standing at a desk, is it improves productivity by changing energy levels by improved circulation and also creativity and mood.
Some people say that they can lose weight if they stand at a desk with them burning up calories. Well, that’s actually true. In just sitting, you use between 50 and 75 calories per hour, and when we stand it’s between 85 and 110 calories per hour. So over a period of time, you can burn up some calories and you can get some blood sugar levels down, that may be marginal.
The extreme of developing a physical activity at a desk is now being suggested by the use of dynamic desks that are standing. The concept of a treadmill desk or a walking desk has come out now. Some of these studies are showing that people are able to walk while they’re at their desk working, which is quite interesting. If you can multitask and not fall off, that’s actually quite a good thing. And of course, integrated desks are … check it out on the net. They’re quite interesting to look at. I haven’t seen one in operation, and I haven’t recommended any clients to get one.
What are some of the important things to look at posture chips for standing desks. Well, let’s look at what we should look at. The most important thing to look at is the height of the desk. The desk should be … height so that way our elbows are close to our sides and they’re bent between 90 and 120 degrees. This allows the shoulders to sit nicely and the head and neck are balanced, in line with the torso.
The top of the monitor is at or just below the eye level so the user does not have to tilt their head up or down to see the monitor. The wrists and hands are straight and in-line roughly parallel to the floor, and there should be adequate room for the keyboard and mouse to be used at that height. A document holder is recommended to keep all our papers at a level they’re easy to view.
Some desks have also got a keyboard tray, which is a device installed beneath the desktop to hold the keyboard and the mouse. This can slide under the desk when not in use, and when in use, it can be pulled forwards, and also it allows a tilt of the keyboard, an adjustment independently from the desk surface to allow optimal wrist and forearm position.
So, if you are experiencing back pain while sitting for long periods, I encourage you to look at getting an in-house consultant at your workplace to assess your workstation to check whether you need a desk, chair, or work position review and have that adjusted. If you have your workstation ergonomically improved, that should help improve your back pain. Also regular standing and stretching out of the chair is a good way of relieving the normal back strain that occurs after long periods of sitting.
If pain is persisting, get help from your local physiotherapists. Ask him or her to identify your problem scientifically and correct any faulty joint mechanics, and also prescribe suitable exercise to improve your muscle balance and posture.
If you have the ability to try a sit/stand desk, by all means, give it a go and see how that feels.
In the meantime, if you need any more specific advice or treatment or home care strategies, please call us at Morley Physiotherapy and remember – Feel well, Move well, Live well!
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