"THE HEART OF THE MATTER"
a special program of the National Emergency Medicine Association (NEMA)


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Week: 592.7  

Guest: Sandra Hall  

Topic: Posture and positioning at work  

Host/Producer: Steve Girard  

NEMA: Do you have good posture? How about at work? If you’re not sitting correctly in a well set up work environment, you might eventually have to see someone like Sandra Hall, a physical therapist with the University of Texas Southwestern Medical Center in Dallas.  

Hall: A lot of the things we see now are from repetitive stress injuries or poor prolonged positioning because the work environment has become so centralized and you sit in the same position all day long because the computer. We’re seeing more and more problems because of people having like chronic neck strains from overusing their muscles and static positions for longer periods of time. We also see a lot of discomfort between the shoulder blades but people will complain of knife-like feelings like I’ve got a knife going into my back when I’ve been sitting at the computer for a long time. And you also run into things like the Carpal Tunnel Syndrome from not having the wrist in the proper position. Just a lot of different problems and the majority of them all come from staying in the same position for prolonged periods of time.  

NEMA: What are some of the things that we can do? First of all with the seat itself...what can we look for? What are some of the things that would help us avoid some of these problems?  

Hall: When you’re looking for a chair a lot of things you want to look for especially with the seat is to get a seat that can be, where you can adjust the seat hiked up to accommodate for your position or for the persons height so that your feet are flat on the floor when you’re working. Another thing that you want to do is have the seat its called the waterfall front so that. The front of the seat kind of curves down away from your thigh and that way you don’t end up with like circulation problems in the back of your thighs from sitting for a prolonged periods of time. Other things you want to look for are seats where the seat and the backrest are two separate pieces. So that the backrest, depending on how long you are from the back of your knees to your buttocks, then you can adjust the back to come in for shorter people or out further away from for longer, longer legged people so that you can have a good position in that chair. Your able to utilize the backrest by getting all the way back in the chair and take advantage of the curves...that are built into the backrest.  

NEMA: And then sometimes I’ll sit in it and I’ll try to, try to actually do work like that and that doesn’t last very long...  

Hall: No because that puts your shoulders and your upper arms at a disadvantage because then if you’re leaning back and you’re trying to work in that position then you’re not working to your biomechanical advantage. The tilt in the backrest is just strictly to give you the ability to lean back periodically and provide relief for your lower back. Because it just helps you to take a break and relieve some of your back strain.  

NEMA: Now continuing on with the sheer aspects. Now some people get a chair they don’t like the armrest thing. I like the armrest. I guess that’s helpful too.  

Hall: You want to have an armrest and you want to have an adjustable armrest again just to accommodate for the difference in people’s heights. You know if you’ve got different people working out of the same chair like on different shifts, and that allows them to to move the armrest up or down because when you work, you want to have your forearm supported. And having your forearm supported takes a lot of stress off of your neck and your upper back.  

NEMA: Now there are a lot of people out there that won’t be able to go out and get a new chair that fits all these specs. Because if you’ve gone out and priced chairs recently it’s it gets really expensive but to buy the chair that you really want. Some people have to settle for less, some people have to deal with their old chair you know maybe their employer won’t replace. What can somebody do to kind of adjust the chair that they have to help themselves maybe something you can add. Can you put a cushion or a pillow in a certain way that might help, do something to help you out?    

Hall: You can. The bad thing about pillows and if you’re going to add anything to the chair you want to remember that the chair should be firm so that it supports your body. So you don’t want to add a lot of real soft accommodations. But a lot of people will take like a pillow or a towel roll and roll and place it in the back of their chair to support their lumbar curve. And the other thing that you can do as far as chair heights are concerned because you want to have your hips and your knees at a 90 degree angle is a lot of people will put like a 3-ring binder on the floor with the narrow edge toward them and the binder edge away from them and put their feet on that and that will also kind of bring their hips and knees in to proper alignment, and that takes stress off the low back also. As far as armrests are concerned in my opinion there’s really no, there’s no way to accommodate for that. You just really need, if you can’t do any other feature in your chair to be able to have adjustable armrest would be very, that’s the only one you can’t accommodate any other way so this is very important that your forearms are supported because that’s where a lot of your neck and back strain are going to kick in from.  

NEMA: Now I find that a lot of the fatigue that I have is when I’m working so intensely that I forget that I’m, where I’m sitting, what I’m doing, I’m just into the computer or the writing whatever it might be and I kind of tend to forget, I forget to get up and shake out and to kind of walk around, take a little break because then when I come back I usually find that I’m able to assume the better position for longer periods of time. If I’m just sitting there for hours on end I’ll find I’m starting to slouch or I’m starting to dip or you know my arms are out of position and all that and then I get some problems. So I guess the best thing would be to make sure you take breaks if you can and shake out.  

Hall: We recommend at least every 30 minutes if you could, if you could at least do some things with your neck and shoulders just to reposition yourself. Do some real gentle stretching exercises and then at least every hour get up and move around for the benefit of your lower back. But you know there are a lot of computer programs now that will, that will kick in every 30 minutes and give you little reminders you know it’s time to stretch your back or it’s time to move around or just getting in the habit. Or you know start noticing the first signs that you start to notice that you’re getting uncomfortable in that chair. Don’t sit there and think well I’ll do something about it later. That’s your body signaling yourself that your muscles are getting tired and they need a break. And so begin to kind of tune in and listen to your body and read the signals that it’s giving you and give it that advantage of getting a little rest or you’re going to be in to more you know problems. You’re going to end up with more discomfort and it’s going to be harder to overcome that later on. So a lot of education you know listen to your body and become in tune with what its telling you.  

NEMA: Now Sandra, you have another important factor in working healthy....  

Hall: Yeah. I think we need to talk about the set up of the work station because having the correct chair is good but if the station that you’re working at, if you don’t have it set up properly then the chair is going to defeat its purpose. You know making sure, if you work at a computer terminal that the computer screen is the right height. You know it should be just about eye level, the top of the screen should be just about eye level. The screen height, the top of the monitor should be at or just below eye level, and if it isn’t you need to raise or lower your monitor until its at the proper viewing height. You can do that either by raising your monitor by putting it on a phonebook if you need to, or whatever it is. If you need to lower it sometimes just tilting the screen will give you enough. Lower is not usually the problem. Normally they’re too low and need to be brought up a little bit. The distance from the screen, from your eyes to the screen, should be anywhere from 18 to 30 inches or about an arms length away. So you want to make sure that’s set up properly and that your monitor is directly in front of you. You shouldn’t have your keyboard in front of you and your monitor off to either side because then you’re keeping your neck turned and you’re gonna get that’s not the way your muscles are set up to work in a static position so you’re gonna end up with a lot of neck strain. Make sure there’s not a glare on the screen because if there is you’ll usually tilt your head to one side or another or change your body position to try and alleviate that glare. And so again you’re not sitting in a balanced position so you may need to rearrange the office or the lighting somehow in your office to take care of that also. So those are just some other things that really need to be considered when you’re setting up your work station.  

NEMA: These are all things to help avoid health problems down the road...a point that shouldn’t be missed by employers....  

HALL: You know, talking about the chairs, if you can get some information together and did a little bit of research...like on the internet - and there’s a lot of stuff out there about proper chairs and positioning and all that stuff on the internet...and present that to your employer, and if you can make them understand that if you run into neck and back and carpal tunnel problems and all that, it’s going to cost them more money in the long run by you being off work to take care of those problems, than it is if they’re going to invest in a good chair now. So, a lot of education of employers also plays a big role in cutting down on the chronic sprain and strain type injuries.  

NEMA: Let’s add one more thing...the computer mouse...  

Hall: If you’re at a computer and doing a lot of work like in CAD type programs where you’re using the mouse a lot and so you’re constantly keeping your arm outstretched to the mouse. There are a lot of office supply companies now that carry... they’re called mouse trays, and they attach to the armrest on your chair so that you actually work with your mouse with your forearm supported. And again you’re not reaching way out to your desk to do that all day long with that arm being supported. So that’s another thing to look into. They’re called mouse trays.  

NEMA: What about getting comfortable and avoiding problems in our cars, where we can also sit nearly motionless for hours on end?  

Hall: If you have the kind of car that you can tilt your seat, you actually want to have the back of the seat tilted back a little bit and that just relieves some of the stress on the structures in your lower back. Then you want to slide the seat forward so that you don’t have to reach for the pedals or the steering wheel. And what we tell a lot of people also is that if you’ll instead of grasping for the steering wheel at the top of the steering wheel because when you do that you’re usually having to pull your shoulders and round yourself out a little bit. To do that hold the steering wheel toward the bottom and the gives you the ability to rest your forearms on you know the door handle or your thighs or whatever and that supports the upper body. And then also the same thing you can use a rolled up towel or a small pillow to support that normal curve in your back. The other thing to, if at all possible if you’re not driving in high traffic situations, is to use the cruise control. And when you use the cruise control that allows you to readjust your posture more readily you know then when you’re having to keep your foot you know right on the accelerator all the time also. And then, I know a lot of people are going to want to do it, the same things hold....is taking frequent breaks when you’re in the car or you know if you’re going to be driving for 3 or 4 hours stop every 30 to 45 minutes and move around a little. Stretch your back, you know...do some, like stand up kind of tilt your back backwards and arch your back to relieve some of the stress on that. And then just change, just change positions as frequently as you can.  

NEMA: If you use your computer intensely at work...or at home...it’s important to keep your body from rebelling by making sure your workstation and chair are right for you. Thanks to Sandra Hall, a physical therapist from the University of Texas Southwestern Medical Center at Dallas.  

SPOT: 15 years in the prevention of heart disease, stroke and trauma - The National Emergency Medicine Association. This show is just part of what NEMA does. We send out millions of pieces of prevention information to people around the country, give grants to organizations in research, public information and emergency services, and have been instrumental in the creation and expansion of the Chest Pain Emergency Room movement. To play a role, call 800-332-6362.  

NEMA: Thanks for joining us for today’s program. If you have any comments or suggestions, contact this station. Or visit our home page at: www.nemahealth.org/...for a look at transcripts of this or past programs, or to find out more about the National Emergency Medicine Association. I’m Steve Girard at The Heart of the Matter.