"Sitting is the new smoking." So warned Julie Landis, DPT, president, Ergo Concepts, LLC, Germantown, Md. Sitting for prolonged periods of time has been found to increase risks of diabetes and heart disease, even among people who meet the recommend guidelines for physical activity.1
White-collar workers, those who sit behind a desk at a computer screen for most of their day, frequently complain of a variety of aches and pains. "The most common issues are postural pain in neck and shoulder, back pain from prolonged sitting, shoulder issues from poor work setup, and wrist issues from improper use of mouse and keyboard," explained Rosemarie Trigger, PT, CSHE, physical therapist and certified specialist in health ergonomics, Physical Therapy Associates of Schenectady, New York.
In today's office culture, with the rise of telemeetings and telecommuting, workers are sitting more and walking less. Equipment such as laptops and tablets -- which cause the user's trunk to lean forward and shoulder and neck to hunch -- are not good for posture. "We often allow our bodies to adapt to a fixed environment instead of changing the environment to fit our bodies," noted Trigger. The lack of mobility in workstations can lead to a lack of blood flow.
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It can be difficult to determine whether workers are aggravating pre-existing injuries with poor work posture and poor workstation setups, or whether their office behaviors alone are enough to cause injury. Trigger continued, "Employers need to consider more than just cost." An ergonomic evaluation can have lasting benefits.
Physical therapists believe that investing in ergonomics analyses and improvements are a good bet for employers. By making workers more comfortable, they will be more productive, concentrate better and commit fewer errors. Such employees will not be leaving work for doctor or physical therapy appointments either. Added Landis, "Companies are starting to think about what it means in terms of healthcare dollars."
Landis' practice has gotten requests to perform onsite evaluations from human resources, risk management and health and safety departments. Sometimes the employee has a pain management concern he brings to management, who then seeks out an ergonomics expert to handle it. Physical Therapy Associates of Schenectady works much the same way, receiving referrals for ergonomic evaluations from physicians and insurance companies, as well as workers who seek them directly.
Trigger had developed a "back school" and return-to-work program for her practice. She was frustrated with seeing repeat injuries, so she began working with businesses to reduce risk factors. Out of that, PT Associates of Schenectady's ergonomic consulting program was born.
Landis is a former outpatient orthopedic physical therapist. Her patients brought office-related discomforts to her and she tried to fix them on the fly. Realizing this was a disservice, she proposed an ergonomics division to her supervisor, who rejected the idea. The concept stayed with her until a co-worker suggested they branch out. In 2001, she started Ergo Concepts, LLC.
Physical therapists such as Landis and Trigger are especially qualified among medical professionals to assess ergonomics. Patrice Winter, PT, DPT, MHA, FAAOMPT, assistant professor, George Mason University, Fairfax, Va., and a spokesperson for the APTA, said, "As physical therapists, we are the pros in human movement. Our training is attuned to preventing injury before it happens."
Physical therapists have the knowledge to see where there are movement issues before the worker experiences pain, and can correct them proactively. Poor mechanics can lead to faulty movement patterns, dysfunction and pain. When performing ergonomic assessments, PTs look at the entire body to see how someone sits, stands and moves.
"The number one thing we look for is awkward posture," Landis said. "Ergonomists will observe the person working in the environment and will look for risk factors that could be leading to work-related discomfort, such as repetition, duration, awkward posture, contact pressure and force."
How do they interact with the objects around them? Does the chair have adequate depth and lumbar support? What is the desk height? What is the monitor position? "Small modifications can make huge differences for people who spend their day seated," explained Winter.
The first step is on-the-spot changes and addressing any equipment that causes discomfort. "I do whatever I can to make an immediate fix," Trigger said. That could include adding a footrest, adjusting the keyboard height, adjusting the lumbar support in the chair, moving the mouse, etc. "I try to improve natural sitting posture because that improves neck and shoulder pain."
A petite person who's overreaching could get a shorter keyboard. A wave keyboard or vertical mouse could help eliminate radial and ulnar deviation. Evaluations help workers to re-conceptualize how their desk is set up. "Ergonomics is built on bringing the workstation to the worker," noted Landis.
"Part of the solution of staying healthy is position change," Landis explained. She recommends shifting position every 30 minutes to get the blood flowing. She wants companies to encourage people to stand more often. Maybe they can create a communal environment where people can stand and work, rather than buying individual standing desks for everyone.
Winter concurred. "The body is made to move," she said. When joints are used in small ranges of motion, there tends to be misuse and breakdown over time.
"I would ultimately prefer if a sit-stand option was available," remarked Trigger. She has set up simple docking stations at which employees can use laptops while standing for a portion of their day when adjustable equipment is unavailable. The recommendation for standing desks, for example, comes on a case-by-case basis. Overall, PTs need to know what's available on the market for modifications. "Chairs are especially important," noted Winter.
Physical therapists will give options, ones that require a greater investment and alternatives that are more budget friendly. Landis added, "We always recommend people to get a follow-up visit if they are getting new equipment."
"We try to be proactive and give information to workers on how to set up their workstations," Trigger explained. Software can be used to conduct self-audits, where picture-based questions guide users and offer feedback on improvements. This is ideal for smaller companies, who might not have the resources to pay for a full evaluation.
Along those lines, Ergo Concepts LLC conducts photo evaluations. Telecommuters or those who live further away from the practice send photos of their workstations, showing how they normally use the space, and the physical therapists evaluate. "They work great," said Landis. "We take the same amount of time as we do in the office."
Employee education is paramount. Throughout the process, physical therapists try to attain worker buy-in. Evaluations will only be successful if the worker continues to use the adjustments and does not return to their old style when the physical therapist leaves.
Successful assessments can even begin in the physical therapy clinic. Landis advised clinicians not to ignore ergonomics. "It's part of treatment because most people are working at a computer," she said.
If possible, Winter recommended visiting patients complaining of musculoskeletal pain at their office to see the setup first hand. "I just found that invaluable," she said.
Trigger agreed. "Any time you can get into the community, it's a good marketing resource for other services offered in your clinic."
Offering ergonomic assessments can be a part of any PT's repertoire, if they are so inclined. "Most PTs can do it because they have the expertise in biomechanics," Trigger said. It relies on their existing knowledge of musculoskeletal injuries, and therefore is a relatively easy transition. Physical therapists must take pre-visit research and necessary follow-ups into account when determining how much to charge for these services.
Despite its growing importance, Landis noted that ergonomics is missing from many physical therapy curricula. Interested clinicians must educate themselves and arm their patients with current available information. She suggested the OSHA and CDC websites as resources. Landis concluded, "I would love the PT and OT worlds to be more involved with ergonomics from a professional standpoint.
1. University of Leicester. New study finds that sitting for protracted periods increases the risk of diabetes, heart disease and death. Accessed via www2.le.ac.uk/offices/press/press-releases/2012/october/new-study-finds-that-sitting-for-protracted-periods-increases-the-risk-of-diabetes-heart-disease-and-death July 1, 2014.
Danielle Bullen is on staff at ADVANCE. Contact: firstname.lastname@example.org