Posture and Exercise

Key points for reducing neck and back pain in the sedentary worker

Many people who sit for long periods of time have complaints of neck and back pain. Since gravity is constantly pulling down on our bodies, causing muscle imbalances throughout the neck and back, it's not hard to understand why people complain of discomfort.

Fortunately, there are methods for preventing discomfort in the sedentary working class. Educating your patients on proper sitting technique, simple exercises that can be performed in the workplace, and the correct ergonomic workstation setup can prevent or alleviate the majority of musculoskeletal ailments common for those who sit for long periods at a desk or computer.

Proper Technique

One question I like to ask my patients is, "How many hours a day do you sit?" A common response is, "Most of the day, and especially at work." Since patients with sedentary jobs have to sit and work all day long, we need to focus on the best way to alleviate pain while at work.

One helpful technique is to learn how to sit correctly. By sitting correctly your patients can reduce strain on the neck and low back. I like to use the jelly doughnut analogy with my patients to paint a clear picture of how the disc moves within the spine.

When sitting in a slouched position, a compression force is applied to the front of the disc, which pushes the disc content toward the back of the spine, onto a nerve. This is similar to pushing on the front of a jelly doughnut and having the jelly drip out of the back. This analogy hits home with many of my patients, and once they know why they have pain, they are more compliant with performing the techniques that help them correct their poor posture.

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These guidelines for proper sitting posture have been useful for my patients in reducing neck and back pain in a sitting position.

1. Keep your gaze level (rather than looking up or down) to prevent unwanted stress on your neck;

2. Keep your chest up and out so that your collarbones are level. Doing this moves your shoulders back into their correct position;

3. Keep both feet flat on the floor. Do not cross your legs while in a seated position. Crossing your legs rotates your hips and puts unnecessary pressure on your lower back;

4. When seated in your chair, keep your feet flat on the floor and bend your knees at a 90-degree angle. This will take pressure off your knees and lower back;

5. Keep your rear end flat against your seat. Don't lean to or favor one side more than the other. Leaning to one side will add stress to your lower back and can cause lower-back pain.

Simple Workplace Exercises

Another way to reduce pain is to get out of the chair as much as possible. It makes perfect sense that if the position you are in all day causes pain, it's beneficial to change that position as much as possible. I like to have my patients get up and move around every hour. This will change their sitting position and allow them to reassess their posture when they sit back down.

I have patients perform a series of four workplace-friendly exercises once they are up and out of the chair. These exercises help offset the constant pull of gravity.

Backward shoulder rolls. This exercise will help loosen up the shoulders and upper spine. Begin by raising both shoulders up at the same time, then slowly round them backward. Perform this exercise for three sets of 10, or continue until your shoulders begin to loosen up.

Shoulder blade squeezes. It's all in the name. Sit with your arms relaxed and by your side. Squeeze your shoulder blades together as if you were trying to crack a walnut between your shoulder blades. Perform this exercise at least 20 times, making sure to hold for at least two seconds per squeeze.

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Better Lifting

Active workers must pay strict attention to biomechanics on the job.

Cervical retraction (chin tucks). Sit with your chest up and out. Next, retract or tuck your chin back. Do not bend your chin or neck while performing this movement. Any forward bending will only reinforce forward head posture. Performing a chin tuck correctly involves a strictly horizontal motion. Imagine a metal rod is attached to the top of your head. This rod prevents you from bending up or down. Next, glide your head backward. Perform this movement for three sets of 10 or until your neck begins to feel loose.

Standing back extension. While standing, place your hands behind your back and slowly tilt your back as far as possible. Once you've reached your end range of motion, slowly return to a neutral standing position. Try not to bend your knees or move your hips. Perform this exercise 30 times or until you feel your lower back loosen up. To target specific segments of your spine, place your hands on both sides of the targeted vertebrae, and bend back.

Ergonomically Correct Workstation

The final point to make is the importance of proper workstation setup. With proper setup, your patient will be able to better maintain proper posture. The less-cluttered workstation will lead to more biomechanically correct movements. Here are the primary elements to consider.

Position the computer correctly. Users should be able to look straight ahead and see the computer screen while the neck is upright in the field of vision; line of sight should be horizontal to the middle of the monitor.

Position the body correctly. Workers should not move their neck forward, bend the neck down, or lean from side to side in the chair. If you are in a position that causes you to twist or turn while looking at your computer, this will place increased stress on your joints, which may lead to pain, joint stiffness, and muscular weakness.

Maintain proper wrist control. While typing, make sure the wrists are in a neutral position when resting on the keyboard. Flexing or extending the wrists increases the compressive forces on the joints, which may lead to impairments such as pain, numbness, and tingling - and can result in more serious issues such as tendonitis or carpal tunnel syndrome.

Position the telephone wisely. The telephone is an important tool in the workplace and should be placed in the most strategic position. Position the phone on the side of the user's non-dominant hand so he will have easy access to write messages with the dominant hand. For workers frequently on the phone, I recommend wearing a headset. This will decrease the temptation to hold the phone against the shoulder, which can cause unnecessary cervical strain.

Sit correctly. See the guidelines to proper sitting posture described above.

Remember proper back support. Proper back support should also be attained with the addition of a lumbar roll to increase lumbar extension and prevent posterior compressive disk forces. If you do not have a lumbar roll, roll up a towel to about two inches in thickness and place it between the small of your back and the chair.

Office workers are susceptible to workplace injuries just as much as active employees are. With attention to proper workstation setup, frequent breaks and simple postural exercises, physical therapists can assist these workers in remaining healthy and on the job. 

Jeff LaBianco is a physical therapist at OrthoCare Specialists, Bridgeport, Conn., and author of Defying the Pains of Gravity Using Proper Posture Technique. Visit www.jlftherapy.wix.com/wellness


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