Working from home: why desk ergonomics is only minor in preventing back and neck pain
THE IDEA IN BRIEF
Back pain when working from home is less likely to do with posture and more likely to do with poor trunk muscle endurance and flexibility;
People with back pain do not have different postures than those without pain;
Lack of movement is more likely to increase risk of developing back pain when working at a desk;
Both general exercise and structured trunk muscle endurance exercise programs have been shown to not only reduce back pain when working at a desk, but also prevent it from coming on in the future.
Read on for more details or scroll to end of post for a video with exercises to reduce and prevent back pain
WORKING FROM HOME AND POSTURE-RELATED PAIN
The COVID-19 global pandemic has changed how we conduct our work and still be productive in society. Working from home (WFH) is currently the new ‘normal’ with many companies now considering adopting this change in the future, allowing their staff to WFH more once coronavirus settles down.
As a physio conducting home visits, its pleasing to see everyone adopting good workspace/desk set-up ergonomics. A quick Google search on desk ergonomics will demonstrate this. Yet despite these efforts, people are still experiencing pain or stiffness. The two biggest questions or statements I get from patients experiencing pain from WFH is:
“how do I improve my desk set-up?” and
“I think my posture is contributing to my pain.”
In most cases, neither of these are the issue.
The issue is most likely related to either poor muscular endurance (i.e. the ability to maintain a certain position for a period of time) or poor joint mobility.
Is my posture in sitting or standing related to my pain?
Probably not. Pain when working from a desk is due to a prolonged lack of movement. There are two reasons for this. First, there is no correlation between the curvatures of your back at rest and pain when either standing or sitting. Evidence shows there is no statistical difference in the curvature of the lower back between people with chronic lower back pain and individuals without pain (Laird et al, 2016).
When sitting, it has been shown that the curvatures of the back increase significantly within just 10 minutes, yet no pain develops. Furthermore, correcting your sitting posture to a ‘good’ position causes the back curvatures to be almost the same as those in standing (Claus et al, 2016).
Second, there is no gold standard on what is ‘good’ vs ‘bad’ posture because posture cannot be measured validly and every individual’ posture is different. Studies show that each time we stand, we do it in a different way. And just because someone stands with an increase in their lower back curvature does not increase their risk of developing lower back pain. Plus, the tools used to “assess” standing posture in a clinic setting produce very different results to postures used for everyday activity (Schmidt et al, 2018; Dreischarf et al, 2018).
Can posture ever become problematic?
Yes, but this is due to a lack of movement variability for that certain ‘type’ of posture. Your spine is designed to move, and to move frequently in different ranges of motion. Sitting at a computer for 8 hours per day, five days per week, does not give your spine the mobility it needs to move smoothly and with ease.
This is partly what causes you to feel stiff, and if bad enough, sore. Numerous studies have demonstrated this, where people with lower back pain working at a desk had signficantly reduced mobility, proprioception (i.e. knowing/feeling where your back is in the environment around you) and move much more slowly compared to those with no back pain (Laird et al, 2014). So in many ways, pain can be a driver to adopt a maladaptive posture.
Why is trunk muscle endurance important in preventing back pain when working from home?
Your trunk muscles comprise your abdominals, spinal muscles (e.g. erector spinae, multifidus), and to a lesser extent the diaphragm. Their job is not only move your spine to complete tasks (e.g. squat, lift, pus, pull), but to also to stop it from collapsing forwards or backwards. Muscular endurance is the ability of your muscles to sustain a certain posture or position for a prolonged period of time.
Trunk muscle endurance is important in preventing back pain as it has been demonstrated that those with back pain demonstrate increased levels of back fatigue, which reduces that ability to either sustain positions (e.g. sitting) or reduce the ability to perform repetitive tasks (e.g. lifting objects of the ground) (Moffroid, 1997).
People with poor trunk muscle endurance not only report more incidences of back pain, but also demonstrate adaptive behaviours to try and overcome the pain rather than taking active approaches to fix it (e.g. increased sitting time, tilting their pelvis more forward, increased use of cushions, not allowing time for physical activity) (O’Sullivan et al, 2006).
Finally, people with back pain also showed reduced muscle oxygenation and increased recovery time following and spinal muscle endurance test (Kell and Bhambani, 2006), meaning it was more difficult to perform tasks repeatedly and for longer periods of time.
What are the benefits of exercise in reducing and preventing back pain?
Not only does exercise and general physical activity help reduce and prevent back pain, but it has also shown to have long-term benefits into the future. Those with persistent lower back pain who completed a structured and supervised back exercise program not only showed reduced pain, improved function and overall wellbeing, but they also changed their behaviours towards physical activity and exercise in preventing back pain.
Better yet, this effect was maintained up-to 10 years following the program (Maul et al, 2005). There have also been programs which show improved mobility, flexibility and strength in as little as 4 weeks (Kotolis and Kellis, 2006).
EXERCISES TO HELP WITH WFH POSTURE-RELATED PAIN
Performing 3 sets of 12-15 reps, spread out through your work day, will improve mobility and endurance, and reduce the risk of developing spinal pain from WFH.
Claus AP, Hides JA, Moseley GL, Hodges P (2016). Thoracic and lumbar posture behaviour in sitting tasks and standing: Progressing the biomechanics from observations to measurements, Applied Ergonomics, Vol 53, Part A, 161-168.
Dreischarf M, Pries E, Bashkuev M, Putzier M, Schmidt H (2016). Differences between clinical “snap-shot” and “real-life” assessments of lumbar spine alignment and motion – What is “real” lumbar lordosis of a human being? Journal of Biomechanics, 49:5, 638-644.
Kell RT, Bhambhani Y (2006) Relationship between erector spinae static endurance and muscles oxygenation-blood volume changes in health low back pain subjects, European Journal of Applied Physiology, 96, 241-248.
Kofotolis N, Kellis E (2006), Effects of two 4-week proprioceptive neuromuscular facilitation programs on muscle endurance, flexibility and functional performance in women with chronic low back pain, Physical Therapy, 86:7, 1001-1012.
Laird RA, Gilbert J, Kent P, Keating JL (2014). Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis, BMC Musculoskeletal Disorders, 15:229.
Laird RA, Kent P, Keating JL, (2016). How consistent are lordosis, range of movement and lumbo-pelvic rhythm in people with and without back pain? BMC Musculoskeletal Disorders, 17:403.
Maul I, Läubli T, Oliveri M, Krueger H (2005) Long-term effects of supervised physical training in secondary prevention of low back pain, European Spine Journal, 14, 599-611.
Moffroid M (1997). Endurance of trunks muscles in persons with chronic lower back pain: assessment, performance and training, Journal of Rehabilitation Research and Development, 34:4, 440-447.
O’Sullivan PB, Mitchell T, Bulich P, Wallen R, Holte J (2006) The relationship between posture and back muscle endurance in industrial workers with flexion-related low back pain, Manual Therapy, 11:4, 264-271.
Schmidt H, Bashkuev M, Weerts J, Graichen F, Altenscheidt J, Maier C, Reitmaier S (2018) How do we stand? Variations during repeated standing phases of asymptomatic subjects and low back pain patients, Journal of Biomechanics, 70:21, 67-76.