The Technology Revolution was supposed to make work easier and faster. By reducing strenuous labor jobs so prevalent in the Industrial Age, which often resulted in injury, it was thought we would also improve our population's wellness and lifestyle.
But it appears the opposite has happened. As a nation we've become more sedentary and more susceptible to repetitive stress injuries, and obesity and associated diseases are skyrocketing.
While we can't change the momentum of today's technology-oriented world, we can begin to change its negative results by focusing on deeper ergonomic causes. The solution involves striking a balance between three components: our patient's physiology, their workspace, and their behavior.
Physical therapists are often the first ones to see patients with pain and musculoskeletal disorders associated with keyboards, mice and screens. Physical therapists and their patients can influence workplaces to see these phenomena from a holistic view. This can have great consequences for the nation's productivity and a company's bottom line.
The U.S. Dept. of Labor estimates the cost of repetitive motion injuries to be over $100 billion in this country alone. Add to that the remarkable rise in obesity, and the makings of a health crisis are imminent.
Both of these ailments saw a marked increase with the dawn of the personal computer in 1980. A sedentary work day can also lead to increased risk of diabetes, high blood pressure, heart disease, and musculoskeletal disorders. Men who sit more than six hours total a day are up to 65% more susceptible to heart disease.1 And according to the American Cancer Society, for people who do not smoke, excess weight and lack of physical activity may be among the most important risk factors for cancer.
In an agrarian economy, people perform physical work throughout the day. In an industrial economy, people typically work on their feet and constantly use their upper extremities. In an information economy, people sit and use their forearms, orienting their upper torso toward a stationary screen at least 6 to 8 hours every day. This limited, repetitive activity wreaks havoc on the body.
The Not-so-Changing Workspace
Recent data clearly show that our workspaces are creating a sedentary work force - complete with corresponding metabolic and physical changes.
Why have workplace designs been so slow to change? Like most manufacturing-related industries, the office furniture industry has consolidated into a few large companies. These giants are encouraged to move cautiously by their boards and shareholders. By the time their designs are researched, approved and shipped, they are several steps behind the technology curve. In truth, there has been no compelling innovation in the office space since the cubicle debuted in 1966.
The companies that employ the millions of workers who suffer most from these issues are also large companies. They buy the least expensive, stylish and functional furniture they can negotiate. These same companies offer guidance through wellness programs, but also demand short-term productivity. Their employees, contractors and vendors hesitate to get up and walk away from their work to stretch when they feel under pressure to deliver.
While most of our workspaces don't permit change, this change is beneficial to workplace wellness. Keyboard trays and monitor arms are a good start, but they need to be easily adjustable, withstand physical use, and make sense within the overall workspace layout. "Ergonomic" mice and keyboards are often advised, but if you can't vary their angle and position, they become repetitive too
Move It or Lose It
There are two origins of repetitive workplace injury: stillness and repetition. We are shackled to our workspaces. We use computers, telephones and other equipment in the same way, repeatedly, until our bodies tell us to stop and get help. We maintain the same static posture to create output on our technology, thus becoming sedentary and overweight.
But humans are not made to sit still. We have over 600 muscles and over 200 joints in our bodies - we're made to move. The answer to repetitive stress injuries and the obesity trend is change. Not one position, but many. Not resting our frame, but making it support itself. Not just big movements, but lots of small ones with our legs, torso and upper body.
We need to relearn the basics of activity and exercise. It isn't enough to be weekend warriors, since that pattern can have negative consequences as well. Daily workouts at the gym are great, but they don't offset the damage from repetitive, stagnant hours spent in the workspace. Frequent movement is natural and necessary.
Get Up, Stand Up
Sit some, recline some, stand more. Essential kinetic change raises the body's metabolism while alleviating the effects of sedentary positions.
Today's physical therapist has a complete arsenal of manual therapy, modalities, and stretching and strengthening interventions that can successfully rehabilitate people with musculoskeletal disorders. But what about prevention? That responsibility rests on the patient to perform their stretches and exercises, and to adopt a more healthy work style going forward.
It also requires a workspace that encourages healthy positioning and kinetic change. Without this, the best a worker can do is to get up and get away from their work periodically. However, the cumulative trauma disorders and sedentary habits will be waiting for them when they return. Treatment must be holistic.
Successful intervention must address the employee's physiology, their workspace, and their behavior. The physical therapist is at a unique crossroads of all three disciplines and can have a significant positive impact on quality of life - and perhaps on a company's bottom line as well. This could add great value to a therapist or practice that partners with local large employers.
While immediate treatment will improve the patient's condition, the PT can help prevent these conditions from arising again. The first step is pain relief through manual therapy and/or movement, along with identification and correction of biomechanical imbalances with manual therapy, modalities and stretching.
But to attain long-term carry-over, strengthening and education is needed. A big part of education is getting the patient to understand why they have symptoms, and that changing positions during the day is a large contributor to relief. This includes home exercises to continue rehab away from the practice.
Change: The One Constant
Without some change in the workspace that created the condition, a patient with repetitive injury and chronic pain is likely to relapse. Note that the quantity and type of work is not necessarily the issue, as it was in the Industrial Age. It's not our work that is killing us; it's our workspaces.
The one constant to treating these issues is change. Change in the patient's current physiology. Change in the patient's computer workspace. Change in their work style choices and behavior in the future. Change is the only constant.
We naturally seek flexibility and variety as part of our day. There is no one "correct" position - the best position is the next one. So in the interest of wellness and more productive work, get your clients moving.
1. Warren, T.Y., Barry, V., Hooker, S.P., et al. (2010). Sedentary behaviors increase risk of cardiovascular disease mortality in men. Medicine and Science in Sports and Exercise, 42(5), 879-885.
Craig Dye is founder of XTension and inventor of the XTensionDesk. Visit xtensiondesk.com. Harrison Vaughan is a physical therapist at In Touch Therapy in South Hill, Va. He is board certified in orthopedics and certified in spinal manipulative therapy and dry needling. Contact: firstname.lastname@example.org