Chained to the Chair

Although many healthcare jobs require constant motion and are physically demanding (e.g., floor nursing), other jobs have staff "chained to the chair" throughout most of the day. Technology has changed the work environment so drastically that approximately 75% of workers in industrialized countries sit for long periods of time (Reinecke, in Advances in Industrial Ergonomics and Safety IV, 2002). Despite, or possibly because of technology, back pain continues to hit US companies in the bottom line, with approximately 40% of all workers' compensation claims coming from low back pain (LBP) diagnoses (Lis, 2006).

Does sitting for long periods at work contribute to back pain?

Yes and maybe. According to a 2006 literature review, sitting alone does not directly contribute to LBP, unless it is accompanied by whole body vibrations (e.g., as experienced when driving heavy equipment) or awkward postures (Lis, 2006). The awkward postures affect healthcare workers. Many charting stations are "one size fits all," and so promote poor postures while documenting. Also, during medical procedures, clinicians often contort their bodies to work on their patients. For example, dental professionals have struggled for years to find positions that do not lead to musculoskeletal pain (Dylla et al., 2006).

For those in an office, the work station may lead you toward, or away from proper posture. Seating levels, computer screen levels, telephone handsets versus headsets, mouse positions, etc., all contribute to ergonomics and potential injuries. Even using bifocal glasses can result in constant tilting the head to look through the appropriate half of the lenses, and may lead to neck pain or headaches.

What happens if I don't sit properly?

There are several physiologic and biomechanical changes that occur during prolonged sitting. The pressure in the vertebral discs greatly increases from 140% with fairly good posture to 275% with slumped, forward head posture (Nachemson, 1976). These constant pressure increase can contribute to disc bulging and herniation. Also, musculoskeletal pain often results from poor sitting postures.

The forward head position (when your ears align in front of your shoulders) causes constant muscular contractions of the long spinal muscles and cervicothoracic/shoulder girdle musculature. Imagine how tired your arms would be holding a bowling ball away from your body; this is analogous with what your trunk muscles are doing to support your head during forward head postures.

It is no secret that prolonged sitting contributes to musculoskeletal tightness. Muscles and tendons will accommodate to their static positions, thus decreasing the overall tissue ability to stretch and elongate. Risks for injury may increase even after just one hour of sitting in static postures (Tyson, 2006).

What can I do to avoid problems?

Three basic principles will help decrease your risk for problems while "sitting down on the job."

1. Maintain a Proper Posture

Your mom was almost right when she told you to sit up straight. During sitting, the best position is a neutral spine position. In the 2006 article, "Fit to Sit™ – Strategies to maximize function and minimize occupational pain," Dylla et al. recommend the following:

2. Move! Engage in Active Sitting

We know you cannot sit in the perfect posture for hours on end, so move frequently. This means stand up often and walk around. If this is not feasible, gently perform the following movements while sitting:

Attempt to perform some or all of these motions every 15 to 30 minutes. Another way to keep moving is to bring an exercise ball to work and spend some time on the ball while at your work station.

3. Ergonomic Work Stations

A proper work station is vital to decreasing the risks of musculoskeletal injury/pain during sitting. The Centers for Disease Control has an excellent page that provides detailed instructions. Interestingly, one study of ergonomics chairs suggested that aesthetics and comfort "may be more important than ergonomics." Participants could distinguish between comfort properties, but not ergonomic properties of different chairs (Helander, 2003), so make sure that you are comfortable.

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