Have you been mulling over what to do about the nagging pain in your [insert pain here: neck/back/shoulder/wrist/thumb/all of the above]? You may be wondering if an ergonomics evaluation may help you. Here’s a list of 10 things to help you decide if an evaluation is right for you:
- Your pain gets worse at work
- If your pain intensifies while you’re at work, it’s a pretty good sign that work is contributing to your pain. Even if your pain was caused by an injury outside of work, your pain can be aggravated by the movements you do at work.
- Your pain subsides over the night and/or weekend
- If you feel better once you stop working for the day, or you feel better on the weekends after not working, this is also indicative work may be causing or aggravating your pain.
- You used to have sporadic pain, but now your pain is constant
- If you had pain that used to come and go, but now does not go away, it’s time to do something about it. Unfortunately, things won’t get better from here and will likely get worse. Intervention through therapy or an ergonomics evaluation is needed.
- Your workstation doesn’t feel “right”
- Maybe when you sit down to work at your computer, you just don’t feel comfortable. Or maybe when you stand at your workstation, things feel off. A lot of the time, it’s because the heights and distances in your workstation are not right for you. For example, the monitor might be too far away, the chair tilted the wrong way, the height of your desk or workstation might be too high, etc. Try changing heights and distances to increase comfort and consider an evaluation if you can’t get it right.
- You spend a lot of time at work doing one thing
- Do you spend all day at the computer? All day standing in an assembly plant? All day walking in a factory? Unfortunately, too much of one posture or movement is not good for your body. It will protest because it’s hard to use the same muscles to do the same thing all the time. Try alternating the tasks you do during the day if you can. Otherwise think about having an evaluation so that you can learn how to make some changes in your work habits.
- Your work involves repetitive motion
- People who spend most of the day keyboarding, mousing, assembling, lifting, or any other type of work that involves the same motion over and over are at risk for pain and injury. When you keyboard all day, the muscles in your hands, wrists, and fingers get overused. When you lift, the muscles in your back are at risk because they keep working with no breaks doing the same thing. Try to eliminate the repetitive motion at work – an evaluation can help you with this as well.
- Your work puts you in awkward postures
- An awkward posture is where your joints are out of neutral and subsequently puts you at risk for injury. For example, if you are typing, it is best to keep your wrists straight as this is neutral posture. If you bend your wrists upward because your keyboard is too high or too slanted, you are now in an awkward posture. Your body does not like this one bit – even very minimal bending in a body joint can cause some people quite a bit of pain. Try to eliminate the awkward postures in your work and have an evaluation if you can’t get them all.
- Your work involves either too much activity or not enough
- Some people don’t get enough activity and are sitting all day. Some people get too much activity walking, bending, and reaching all day. Neither scenario is great and it puts you at a greater risk of injury. See what you can do about increasing or decreasing your activity during your breaks and leisure time. An evaluation can help you target what the problem is and what to do about it.
- You are going for physical/chiropractic/massage therapy and you are not getting better
- Getting therapy for your pain is a great idea, but sometimes it’s all for naught when you go to work. For example, if you are having therapy because of neck pain and you go to work where your monitor is too high; therapy is not going to work as well as it could unless you get that monitor lowered. An evaluation can pinpoint all the areas that could be causing your pain.
- You have tried ergonomics equipment, but it has not helped
- Some people go ahead and get an ergonomic mouse or a split keyboard, only to find that it does not help their pain. I find it’s better to have an evaluation first before spending money on equipment. Many times it’s cheaper to have an evaluation because you might not even need equipment, just a workstation adjustment. And if it’s found that equipment is needed, the right kind with the right features will be recommended for you during the evaluation. Most importantly, an ergonomics evaluation will involve key components that equipment alone won’t provide – help with adjusting your posture, making sure the heights and distances are correct for you, and guidance on how to pace yourself during the day.
With the advent of today’s technology, we are using our hands and arms more than ever and in very different ways. Tablets, smartphones, and computers have changed the way that we work, play, and live. The technology is great, but the pain we experience from it, is not so great. It’s not surprising that we feel pain – there are many ergonomic risk factors associated with our devices:
- Force – from holding our phones and tablets;
- Repetition – the same movements of keyboarding, mousing, swiping, and pointing are performed over and over;
- Awkward posture – how we hold our phones and tablets, as well as incorrect set up at the computer;
- Overuse – the sheer amount of time we use our devices for work and play;
- Static posture – staying in one place while using our devices, as well as holding our devices with one hand position for too long;
- Contact stress – our phones and tablets digging into our hands, desk contact while keyboarding and mousing.
But our devices don’t have to cause us pain if we follow a few simple rules:
- Prop it up – Force from gripping and awkward wrist postures can be greatly reduced by letting go of your tablet or phone. Prop it up on a stand, or a pillow on your lap, or your backpack/briefcase.
- Elbows free – Nerves run through your elbows and can be aggravated with the pressure of leaning. Pain and tingling (“pins and needles”) can start here and travel down to your hands. Keep your elbows free and try not to lean them on anything, no matter how soft.
- Hands free or switch hands – Use your earbuds when speaking on your phone or remember to switch hands and ears often. The same elbow pain can result here from bending your elbow and holding it up for too long.
- Use all your fingers to type – Try to avoid typing with your thumbs only on a tablet. Many tablets are too big for comfortable typing with your thumbs – pressure is placed into your palm and your thumbs really have to reach to type some keys. Place the tablet down flat to type or set it up with an external keyboard.
- Keep it straight – Make sure all your joints are in neutral. Don’t have your thumbs extended down, keep your wrists straight, keep your elbows in-between (not completely straight, and not completely bent).
- Switch it up – Avoid using one set of muscles for too long. If you usually text with your thumbs, switch to typing with one finger to take pressure off your thumbs. If you usually hold your phone or tablet in your left hand and swipe/point with your left, switch it up and hold with your right and swipe/point with your left (it’s easier than it sounds!) If you point with your index finger, use another finger instead. If you use certain keys constantly when typing, try other keyboard shortcuts to take pressure off those fingers. If you use your mouse too much, try replacing some movements with keyboard short cuts.
- Move constantly – Don’t stay in one position for too long. Move around in your chair or on the couch or stand up. Keep moving your phone and tablet around in your hands. Reach your hands to the sky and stretch up, rotate your shoulders and wrists. Perform any movement you can – just keep moving!
- Mini breaks – Incorporate mini breaks into your posture constantly. For example, don’t hover your hand over your mouse when your reading your screen – rest it instead; put your phone or tablet down while it’s loading – look up and give your neck a break from looking down; during breaks in keyboarding – put your hands in your lap.
- Shorter, more frequent is better – If you are using your device for a long period of time, it’s better to use it in short stints with breaks in-between. A good rule of thumb is 15 minutes on, 1-2 minutes off.
- Less is more – Of course the best thing your can do is use your devices less. Spending the day at work on the computer and then spending the rest of your day on your phone or tablet is just too much device time. Ditch the device as often as you can!
I once did an evaluation with a client who was having neck and shoulder pain in her office administration job. At the completion of the assessment, we discussed what type of equipment might be best for her, such as a keyboard tray and a document holder. We also spoke at length about her posture and how it could be improved; about her work habits and how she could be better about rest breaks; about her work procedures and how she needs to relax her neck and shoulders while typing; and about her leisure time and how she could avoid activities in her daily life that were affecting her neck and shoulders (e.g. using the computer at night after using it all day). When I contacted her a few weeks later to see how she was doing and if she had received her equipment yet, she responded that based on changing her posture, her work habits, her work procedures, and daily activities; she felt much better and did not feel she even needed the equipment recommended for her.
I always think of this client when I go over “training” with other clients in office environments. Training is a good catch-all term for all the things I mentioned above plus other things such as exercise, nutrition, and stress reduction techniques. Here is a list of my top 10 training tips for office work:
- Alternate tasks throughout the day – If you can, break up your computer work with other tasks such as attending meetings or reading. If you only do computer work, be vigilant about taking breaks.
- Have good posture – Feet flat on the ground; legs, hips, and elbows at 90 degrees of flexion; elbows close to your torso; wrists straight; shoulders pulled back and relaxed; and head lined up over neck. Be like a puppet – imagine a string at the top of your head pulling you up to the ceiling. Everything will fall into place perfectly.
- Change position frequently – Use the good posture described above, but let’s face it, you won’t be able to maintain that posture all day, nor should you. Your body needs movement and different postures. So sometimes you will slouch and lean forward, and that’s okay for a bit. Just remember to come back to your good posture more often than not. And don’t forget to move around in your chair – that helps too.
- Get up – Get up often and walk – every hour at minimum. Set a timer so you won’t forget. Stretch and move your arms, wrists, and hands at the same time. At the very least, stand at your desk and get your blood moving.
- Relax your shoulders – Everyone has the tendency to hunch their shoulders when working at the computer, especially when they’re on a deadline. Practice relaxing your shoulders as much as possible. Try this: Hunch your shoulders up as high as they will go while inhaling. Hold your breath and your shoulders for three seconds. Relax your shoulders as much as you can and breathe out deeply. You will feel a difference immediately.
- Relax your arms – Don’t extend your arms at all when you are typing. Keep your elbows close to your sides and let your upper arm hang loosely from your shoulder socket. A good way to accomplish this is to pull your chair close to the desk while typing.
- Reduce overtime hours – Your body was not meant to be a computer all day. It will rebel in the form of discomfort and possibly injuries. Try not to work more than an 8-hour day to reduce your risk of injury. If you must work longer, take 5-minute breaks every hour and a 30-minute break every four hours. Your body will thank you.
- Don’t hover – Try not to hover your hands over your keyboard or mouse. When you are not typing or mousing, put your hands in your lap or do light exercises with them. A good exercise is letting your hands fall to your sides and lightly make fists in and out while you are reading your computer screen.
- Eat and drink – Eat small nutritious snacks or meals every 3-4 hours to maintain your blood sugar at a good level. Sip water throughout the day to keep hydrated. Without proper fuel, your body will become sluggish.
- Beat stress – Every so often, sit back in your chair and regroup. Close your eyes and take three big, deep breaths and gain focus and perspective on your work. Feel a sense of power and control over your work and your working habits. Know that you are only one person and can only do so much. Be happy with what you are doing.
Implementing these tips and practicing them often is like training for a marathon. If you run often, run well with good posture, take breaks, and eat and drink well; you will achieve your goal. Training is essential – never overlook it. Good luck!
In 1997, NIOSH (National Institute for Occupational Safety and Health) released a publication called Musculoskeletal Disorders and Workplace Factors, A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back http://www.cdc.gov/niosh/docs/97-141/pdfs/97-141.pdf . Although this report over 20 years old, the valuable information about what causes work-related injuries remains current.
One of the most interesting parts of the report is the evidence of work-relatedness to injuries. From the 40 epidemiologic studies they evaluated, NIOSH judged how strong they felt the evidence was that the injury or musculoskeletal disorder (MSD) was caused by the ergonomic risk factor. Ergonomic risk factors include: force, repetition, awkward postures, and static postures to name a few. The categories they used were:
- Strong Evidence of Work-Relatedness (+++) – a causal relationship
- Evidence of Work-Relatedness (++) – convincing epidemiologic evidence for a causal relationship
- Insufficient Evidence of Work-Relatedness (+/0) – could not conclude the presence or absence of a causal relationship
- Evidence of No Effect of Work Factors (-) – the specific risk factor is not related to MSDs
What they found for the shoulder area was this:
- Evidence of Work-Relatedness (++) between highly repetitive work and shoulder injuries. Repetitive work was defined as activities which involve continuous arm movements which affect the shoulder muscles. It should be noted that the studies also involved awkward postures or static postures along with the repetition.
- Hairstylists and dental hygienists are two professions where there is continuous arm and shoulder movement. They are at risk for shoulder injuries.
- With some professions where the job can’t be changed much, the solution is to change the way the job is done. Proper rest breaks, alternating tasks throughout the day and stretching and strengthening of shoulder muscles will help to prevent injury.
- Evidence of Work-Relatedness (++) between repeated or sustained shoulder postures with greater than 60 degrees of flexion or abduction and shoulder injuries. These are jobs that involve working with the arm above chest level.
- Landscapers and drywallers require lifting the arms above chest level a great deal of the time. This increases their risk for shoulder injuries.
- This also requires a change in the way the job is done. Proper rest breaks, alternating tasks throughout the day and stretching and strengthening of shoulder muscles will help to prevent injury. Both professions would benefit from ergonomic tools with contoured handles and proper angles.
- Insufficient Evidence of Work-Relatedness (++) between both force and shoulder injuries as well as vibration and shoulder injuries. Force means shoulder movement combined with a load and vibration means using a tool that vibrates or being on surface that vibrates.
- It should be noted that the currently available epidemiologic studies did not provide enough evidence at that time. Future studies may prove otherwise.
- I could find only one other study done by the University of Waterloo “Overhead Work: Evidence-Driven Job Design and Evaluation”. It found that by changing the direction of hand force to be in line with gravity, muscular activity lessened in the shoulder. This decreased fatigue and in turn could reduce injuries.
I will continue with further body parts in my next post – identifying further jobs where there may be risks and providing guidelines for ergonomic intervention.