With lots of folks now working from home, I had some requests for tips to stay healthy and pain free…so here you go!
In addition to the info I sent out previously, here’s some suggestions especially for folks who are sitting and working at the computer, which is probably many of you. One reason I write these articles is to organize the research I read so I can find it later. In an effort to minimize many readers’ boredom, while still providing the key points of my ramblings, I’m adding the box below with the 14 most important tips. Don’t worry about everything being perfect. Even small changes can make a big difference.
I’m breaking this information into two posts. The second part will be focused on specific exercise options to help prevent pain and other health-related problems that can coincide with jobs that require a lot of sitting and computer work. Avoiding sedentary behavior is likely the most important recommendation for preventing pain and health issues, so try to change positions every 20-30 minutes. This can mean switching between sitting and standing or taking 2-5 minutes to perform some light stretching or mobility exercises, which I’ll talk more about in part 2.3,26-28 Sit-stand desks and computer prompting, or just a simple alarm, have been shown to decrease prolonged bouts of sitting significantly.28
Alignment and Posture – “Ergonomics is the relationship between a person and their environment.”1
I was expecting to find plenty of easy answers with lots of supporting research regarding an ideal sitting posture for everyone. There are lots of classic recommendations, but seemed to be minimal concrete and consistent evidence backing them up. Theory doesn’t always transfer over to real life, which is why we do research. Some studies showed it made no or minimal difference in people’s symptoms with changes to their seating arrangements.2-4 This was commonly due to small numbers of subjects, a lack of separating people with different reasons for their pain, and too much variation across the board with types of interventions and outcome measurements between studies. As with many other areas of life, scratching just a bit below the surface tends to create more confusion. But with continued digging, things eventually become clearer.
Fortunately, there are some common themes and helpful information that shined through, even though there’s much more research that needs to be done. Every body is different, so you may have to fine tune these suggestions to fit your situation and I’ll talk more below about why certain recommendations might fit some folks but not others. Most of our home and workplace set ups are of course less than ideal, and I’ll talk about some great, simple hacks to make the most of what you’ve got.
1. Looking at yourself from the side, if you drop a string from the top of your head to the floor, your ear, shoulder, and hip should all be in 1 line. See item 4 below for a more in-depth discussion of the importance of spinal alignment. Using a chair with adjustable height, backrests, and armrests has been shown to decrease muscle activity in the neck, back, and shoulders as well as to decrease spinal disk pressure and pain.1,5,6,8-10 A forward head posture is correlated with increased neck pain, so below are some questions to ponder if you find yourself in that position.6
If your ear is in front of that line (forward head), determine why that is happening.
Is your monitor high enough? This is tricky with a laptop. The key is to find the balance between raising the laptop up as close to within eye level as possible without creating an awkward positioning of your wrists and elbows.
Is your monitor big enough and is the prescription for your glasses or contact lenses up to date so you aren’t straining to see the screen?
2. Sit all the way to the back of the chair – using a backrest was a commonly agreed upon way of decreasing low back discomfort and excessive low back muscle activation.1,3,8,11-13
4. Hip angle (having the knees and hips at the same height versus having your knees lower than your hips) is a bit confusing and somewhat controversial in the literature. Bottom line for knees versus hip height (see below for reasoning) – If you have no low back pain or flexion-related low back pain (meaning that pain increases when bending forward and with sitting, while pain decreases with bending backwards and standing/walking), your knees should be slightly (10 degrees) lower than your hips. If you have extension-related low back pain (meaning that pain increases when bending backwards and standing/walking, while pain decreases with bending forward and sitting), your knees and hips should be even. Your torso should be upright or slightly reclined.1
Can you adjust your chair by either raising the seat height or tipping the front of your seat down to position your hips higher than your knees? If not, try putting one or more towels under your “sits” bones to raise your hips.
Consider placing a small rolled up towel in the small of your back to create a gentle curve if your low back is flat or slouched.
For most people (aside from folks with extension-related low back pain – see below), your hips should be slightly higher than your knees. This helps you to maintain a neutral spine position (gentle curve in your low back), which is the ideal position for your spine to be in.11,14 Sitting in this “neutral position”, as opposed to a slouched posture, creates better activation of your core muscles (transverse abdominis in the front and pelvic floor on the bottom) which helps to stabilize and support your trunk, as well as encouraging proper use of your diaphragm during breathing since your diaphragm and pelvic floor work together.15-17 These core muscles are your “base” and turn on prior to all other movements in order to support your trunk and the rest of your body.19-22 It also allows your upper back to rest against the backrest, which decreases activation of your low back paraspinal muscles as well as decreases compressive forces on the discs in your low back.6,8 Forward head posture is also decreased with this positioning.6
Aside from the theories of why this should be helpful, having your knees slightly lower than your hips (10 degrees), has been shown to decrease low back and neck/shoulder discomfort (or provide a feeling of greater comfort in general) for people with no pain and those with flexion-related low back pain.8,11,14,23 Additionally, people with flexion-related low back pain typically sit in a more flexed (slouched) posture.4,24,25 Lowering your knees more than 10 degrees in relation to your hips correlated with increased low back discomfort.11,14
For folks with extension-related low back pain, sitting with the knees lower than the hips correlated with increased pain. This is largely attributed to these folks already sitting with too much of a curve in their low back, their low back muscles (multifidus) being overly active, and they have a decreased ability to relax these muscles. So, creating more of curve in their low back by lowering their knees just makes things worse.4,14,24
The benefits of good quality and quantity of sleep can’t be overstated for all aspects of our well being (including the immune system, which is crucial for fighting things like COVID-19). Check out my review of lots of fascinating sleep research here as well as my evidenced-based sleep hygiene tips. Feel free to pass it along and note the contact info for Trish McGuire at NIH, just above the references list, who provides cognitive behavioral therapy for insomnia.
Diet modifications can be helpful for preventing a range of health issues, especially if your job entails a significant amount of sedentary time. Nutrition is highly individualized and I recommend consulting with one of the highly qualified nutritionists found in our community. Their contact info can be found under the nutrition section of my evidence-based general wellness recommendations handout.
Check out Beyond Tape: The Guide to Climbing Injury Prevention and Treatment for more information about warming up, stretching, and other climbing (and non-climbing) injury related topics. Like my Facebook page and follow me on Instagram for updates and more information and rate/review Beyond Tape on my website or here. My primary motivations for Beyond Tape and any of the posts are to: 1. Check out the most relevant and up-to-date research for each topic in order to dispel myths, sift out conflicting views, and help people to prevent or heal from injuries – letting me know about new research or opposing views is helpful and greatly appreciated 2. Contribute to the local and global communities by donating 100% of my net profits from Beyond Tape to service-based non-profit organizations, such as Rotary International, Doctor’s Without Borders, Access Fund, etc.
1Eggleston ST1. Mouse with your arm™: Facilitating forearm support using the chair armrest to prevent and mitigate musculoskeletal disorders. Work. 2020;65(3):483-495.
2Driessen MT1, Proper KI, van Tulder MW, Anema JR, Bongers PM, van der Beek AJ. The effectiveness of physical and organisational ergonomic interventions on low back pain and neck pain: a systematic review. Occup Environ Med. 2010 Apr;67(4):277-85.
3O’Sullivan K1, O’Sullivan P, et al. What do physiotherapists consider to be the best sitting spinal posture? Man Ther. 2012 Oct;17(5):432-7.
4Dankaerts W1, O’Sullivan P, et al. Differences in sitting postures are associated with nonspecific chronic low back pain disorders when patients are subclassified. Spine (Phila Pa 1976). 2006 Mar 15;31(6):698-704.
5van Niekerk SM1, Louw QA, Hillier S. The effectiveness of a chair intervention in the workplace to reduce musculoskeletal symptoms. A systematic review. BMC Musculoskelet Disord. 2012 Aug 13;13:145.
6Harrison DD1, Harrison SO, et al. Sitting biomechanics part I: review of the literature. J Manipulative Physiol Ther. 1999 Nov-Dec;22(9):594-609.
7Harrison DD1, Harrison SO, et al. Sitting biomechanics, part II: optimal car driver’s seat and optimal driver’s spinal model. J Manipulative Physiol Ther. 2000 Jan;23(1):37-47.
8O’Keeffe M1, Dankaerts W, et al. Specific flexion-related low back pain and sitting: comparison of seated discomfort on two different chairs. Ergonomics. 2013;56(4):650-8.
9Amick BC, Robertson MM, et al. Effect of office ergonomics intervention on reducing musculoskeletal symptoms. Spine (Phila Pa 1976). 2003 Dec 15;28(24):2706-11.
10Van Eerd D1, Munhall C2, et al. Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence. Occup Environ Med. 2016 Jan;73(1):62-70.
11Curran M1, O’Sullivan L2, O’Sullivan P3, Dankaerts W4, O’Sullivan K5. Does Using a Chair Backrest or Reducing Seated Hip Flexion Influence Trunk Muscle Activity and Discomfort? A Systematic Review. Hum Factors. 2015 Nov;57(7):1115-48.
12O’Sullivan K1, O’Keeffe M, O’Sullivan L, O’Sullivan P, Dankaerts W. The effect of dynamic sitting on the prevention and management of low back pain and low back discomfort: a systematic review. Ergonomics. 2012;55(8):898-908.
13Pillastrini P1, Mugnai R, et al. Effectiveness of an ergonomic intervention on work-related posture and low back pain in video display terminal operators: a 3 year cross-over trial. Appl Ergon. 2010 May;41(3):436-43.
14Curran M1, Dankaerts W, O’Sullivan P, O’Sullivan L, O’Sullivan K. The effect of a backrest and seatpan inclination on sitting discomfort and trunk muscle activation in subjects with extension-related low back pain. Ergonomics. 2014;57(5):733-43.
15Claus AP, Hides JA, et al. Different Ways to Balance the Spine: Subtle Changes in Sagittal Spinal Curves Affect Regional Muscle Activity. Spine (Phila Pa 1976). 2009 Mar 15;34(6):E208-14.
16Wong AYL1, Chan TPM2, Chau AWM2, Tung Cheung H2, Kwan KCK2, Lam AKH2, Wong PYC2, De Carvalho D3. Do different sitting postures affect spinal biomechanics of asymptomatic individuals? Gait Posture. 2019 Jan;67:230-235.
17Talasz H, Kremser C, et al. Phase-locked Parallel Movement of Diaphragm and Pelvic Floor During Breathing and Coughing-A Dynamic MRI Investigation in Healthy Females. Int Urogynecol J. 2011 Jan;22(1):61-8.
18Hodges PW, Gandevia SC. Changes in Intra-Abdominal Pressure During Postural and Respiratory Activation of the Human Diaphragm. J Appl Physiol (1985). 2000 Sep;89(3):967-76.
19Hodges PW1, Richardson CA. Contraction of the abdominal muscles associated with movement of the lower limb. Phys Ther. 1997 Feb;77(2):132-42; discussion 142-4.
20Hodges PW, Richardson CA. Feedforward contraction of tranversus abdominis is not influenced by the direction of arm movement. April 1997Experimental Brain Research 114(2):362-70.
21Sjödahl J, Kvist J, et al. The Postural Response of the Pelvic Floor Muscles During Limb Movements: A Methodological Electromyography Study in Parous Women Without Lumbopelvic Pain. Clin Biomech (Bristol, Avon). 2009 Feb;24(2):183-9.
22Luginbuehl H, Greter C, et al. Intra-session Test-Retest Reliability of Pelvic Floor Muscle Electromyography During Running. Int Urogynecol J. 2013 Sep;24(9):1515-22.
23Koskelo R1, Vuorikari K, et al. Sitting and standing postures are corrected by adjustable furniture with lowered muscle tension in high-school students. Ergonomics. 2007 Oct;50(10):1643-56.
24Sheeran L1, van Deursen R, et al. Classification-guided versus generalized postural intervention in subgroups of nonspecific chronic low back pain: a pragmatic randomized controlled study. Spine (Phila Pa 1976). 2013 Sep 1;38(19):1613-25.
25Womersley L1, May S. Sitting posture of subjects with postural backache. J Manipulative Physiol Ther. 2006 Mar-Apr;29(3):213-8.
26Straker LM, Dunstan DW, et al. Sedentary work. Evidence on an emergent work health and safety issue. Final Report, Canberra: Safe Work Australia. Safe Work Australia’s Emerging Issues Programme. March 2016.
27Sheahan PJ1, Diesbourg TL1, et al. The effect of rest break schedule on acute low back pain development in pain and non-pain developers during seated work. Appl Ergon. 2016 Mar;53 Pt A:64-70.
28Shrestha N1, Kukkonen-Harjula KT, et al. Workplace interventions for reducing sitting at work. Cochrane Database Syst Rev. 2018 Dec 17;12:CD010912.