Over 90 % of all office workers use a personal computer. In 1997 the work-related musculoskeletal disorders had reached 275,000 cases. In 2009 that number is expected to reach over 14 million. Musculoskeletal disorders include; neck pain, tension headaches, lower back pain, and carpal tunnel syndrome, just to name a few. Women are more likely to outnumber men 3:1 for sustaining a carpal tunnel syndrome. The affect on the economy is devastating with musculoskeletal disorders accounting for $20 billion in direct cost and over $100 billion related to indirect cost. These cost represent a sobering statistic that America is sitting more and the effects are devastating.
Most companies have activated an ergonomic program that is designed to help reduce the factors associated with musculoskeletal fatigue and injury. Research has shown that workers who are compliant with the direction of proper sitting have demonstrated increased productivity, efficiency, and morale. Companies have noticed a decrease in injury reporting, illnesses, workers compensation cost, absenteeism, and employee turnover. The bottom line is that your company cannot afford for you to slouch in your chair anymore.
Employees come in all shapes and sizes, and many of them require simple changes to the work place to provide for long-term benefit and reduced cost. Instigation of proper sitting policies can begin with a simple distribution of this article in the work place.
One of the most important basic and fundamental principles is related to the position of the keyboard. When you are in a seated position and sitting up straight, the position of the keyboard should be at the height of your elbows or below. Most people will sit with a keyboard height approximately level with their abdomen. This forces the shoulders to remain in an elevated or shrugged position, which activates a large muscle in your back that can result in a great deal of pain if that position is held too long. The trapezius muscle that extends from the back of your skull to an area just above your lower back and it runs laterally from shoulder to shoulder. It is literally the cross that we all bear.
Simple fixes for the level of your keyboard involve raising your chair height. Other situations may require a more aggressive approach that involves and installation of a swing arm that allows for an adjustable positioning of the keyboard. The computer mouse should be at the same appropriate height of the keyboard.
Simple test: Have someone stand behind you as you are seated. Let them poke onto your neck and back muscles with their finger tips, and hold pressure in any area that is sensitive on your neck and across the top of your shoulders. While they are still applying pressure; raise your hands to reach out as you are simulating typing on a keyboard. You are likely to feel an immediate increase in pain at all those points that their finger tips are pressing on you. Now try the same test, but only bend at your elbows and don’t reach out or raise your elbows. Chances are you are going to feel a significantly less amount of pain by keeping your arms down and bending only at the elbow.
Another common problem is the height of your monitor. The top of your monitor should be equal to the level of your eyebrows, or top of your head. Some individuals have to place their monitor on a stack of large books, to maintain the appropriate height. If you are having trouble seeing your monitor, and maintaining a forward position of your head, it is likely that you will be suffering from a poor postural position. Looking down or straining your head forward to see the monitor will likely aggravate your neck and back muscles.
Attempt to be able to maintain a flat-footed placement on the floor to help with overall balance while sitting. For proper sitting technique, referred to the figure 1: Improper and Proper Sitting Technique
Your objective is to maintain proper posture while sitting by allowing as much contact with your body to the chair that is supporting you. It is important to try to sit back in the chair as far as possible and to maintain contact with your shoulders against the back of the chair. The bottom of your legs and your buttocks should all completely contact the base of the chair. It will help a great deal if you learn to sit while holding in your lower abdomen for extended periods of time. This help support the lower back soft tissue that actually is under more strain in a seated position as opposed to you standing.
It is effective to try to change positions from time to time and some employers will allow you to stand up and continue working for a few moments. This is beneficial to allow for proper circulation and only needs to last for about 4 to 5 minutes. Some employers have offered standing workstations as an alternative to sitting for long periods of time. Research has shown that employees to work at a standing workstation for a minimum of 60 minutes per day have 70% less musculoskeletal complaints. There are even workstations that are available complete with a treadmill, where employees will walk while they are working.
Wrist and Hand Pain
Carpal Tunnel Syndrome (CTS) is closely associated with improper sitting according to old research, but current studies are showing a more reliable source of the problem. The most common orthopedic test for CTS is done as a Phalen’s test. The Phalen’s test is done by having the patient flex both wrist fully and place the back of their hands firmly against each other, and the increase of pain in the wrist and/or hand is considered a positive test. An interesting statistic is that most people who sleep in a fetal position often sleep with their wrist in a fully flexed position. The interesting point is that same wrist position is what causes the development of pressure that result in wrist or CTS pain.
Current studies have shown that individuals who sleep with their hands in a wrist flexed position are extremely likely to develop the symptoms of CTS. The wrist and hand pain is usually noticed the next day while typing or doing repetitive jobs. Blame for the condition is usually linked with the repetitive motion, not the sleeping position of the wrist. Individuals who sleep in the fetal position are more likely to curl their wrist and have CTS. The remedy for many CTS conditions is the use of a simple loose fitting wrist splint that is available at most drugstores. When the brace is worn at night during sleep, the typical wrist flexion is stopped and the symptoms are relieved. There is no need to use the brace during the daytime hours.
Another common condition that leads to wrist and hand pain is associated with the neck. The nerves that go to the hand and the arm begin in the neck area. Problems associated with conditions like this are quickly identified by x-ray, MRI, and/or needle EMG. These test will often result in diagnosis, but the actually cause of the CTS may still be a mystery. Make sure you know the actual cause of your CTS prior to having unnecessary surgery.
A neurologist and/or chiropractic physician are usually the best doctors to determine the actual source of pressure on the nerve. Usually a correct diagnosis followed by treatment results in some improvement of symptoms within a two week time period. If symptoms persist without any improvement, get a second opinion or ask for further testing.
It may seem like an oversimplification, but learning to be able to sit up straight, sucking your stomach, and keep your keyboard at the level of your elbows and below, all result in and decreased cost to both you and your employer. In this high tech world of computers, it might be worth your time to consider some common sense approaches to fixing the problem, instead of that $150 new ergonomic keyboard with the fancy angles on it.
Dr. David Ryan is available for corporate consultations related to ergonomic and other safety questions.