In industrialized countries, many people sit for most of the time that they are awake. They sit while having breakfast, while going to work in cars or buses, in school classrooms, in meetings, in offices, during dinner, and at home while watching television. Many people also sit at work operating machines which new technology has developed to replace manual work.
Although sitting requires less physical effort than standing or walking, it puts a lot of stress on lumbar area. Combined effects of a sedentary lifestyle, and a job that requires sitting can lead to many health problems. The selection of a suitable chair is a critical step in preventing health problems in people who work in a sitting position. However, you do not have to spend a lot of money to find a proper ergonomic chair.
A good ergonomic chair will have basic adjustability features. The features that should be considered include:
Seat height adjustability: Adjustability is a must – feet should rest comfortably on the floor without pressure on the back of the thighs. When seated, your hips should be slightly higher than your knees. To achieve proper height with respect to your desk or keyboard tray height, you may need a foot rest.
Seat depth adjustability: The depth of the seat is important in order to reduce pressure on the back of your thighs or calves. If the seat puts pressure on the back of the knee, or mid posterior thigh, this will reduce circulation and cause a pooling of blood in the extremities. This can lead to varicose veins, painful conditions, and also blood pressure issues over time. Proper seat depth will allow for a 2-3 finger width distance from the back of the knee to the edge of the chair.
Armrests (height adjustable): To reduce strain on your neck and upper extremities, your armrest height should be as follows: with the arm relaxed and bent while seated, the arm rest should be a 2 finger width higher than the bottom of the bent elbow. Armrests set too high will cause compression of your thoracic outlet. Armrests set too low will cause traction on your neck. The length of the armrests may need to be considered as well so they do not prevent you from pulling in close to your desk or keyboard tray. Armrests set approximately 15cm back from the edge of the chair should be adequate.
Back rest height: A mid back or high back chair offers more support and will reduce lumbar strain. A low back chair is not recommended if you spend a fair amount of time sitting. Regarding shape of the back rest, do not get hung up on molded forms and fancy adjustable parts. The most important factor in reducing back discomfort while sitting is the ability to move around frequently. A chair should not lock you into a position and restrict your movement.
Many of the features described here allow a chair to adjust to a given posture or body size, but it is important to remember the importance of posture change. Adjustability features should allow, rather than inhibit, free posture change. Sitting increases the mechanical force applied on your body.
Stationary postures cause tonic muscle contraction which means they are constantly contracted. This does not allow for the muscles to rest, or allow blood flow. Therefore, by not altering postures or taking short frequent movement breaks, you are at risk of experiencing mechanical pain conditions and excessive muscle tension. Therefore, move around or fidget in your chair frequently, and get up and move around at least every half hour. Your movement breaks do not have to last long, but they do have to be frequent in order to minimize your chances of experiencing discomfort.
How to know when I need some help for my pain:
We trip, hurt our knee. Twist a little too far, your back spasms. That ache in your elbow that used to only be a problem when playing tennis is now bothering you at work and even just reading a book. Checking my blind spot is nearly impossible now without turning my whole body.
When is it ok to just let things heal in their own time and when do you need to get a professional opinion?
The best way to approach this questions is knowing what “acute” versus “chronic” means. Acute injury symptoms are what the body presents in the first 24-48 hours on the initial onset of pain (ranging from pain that can be dull or sharp, redness, swelling, bruising, difficulty moving the affected area, pain-related weakness, avoidance of activity through protective movement mechanisms). Chronic pain is when pain continues well after healing should be complete (3-6 weeks) with similar as well as very different symptoms (less swelling, more dull instead of sharp but perhaps increased pain even a rest, better movement range but perhaps still decreased, weakness in affected and perhaps increased locations, and protective movements can increase creating other areas that become sore). Chronic pain is much more complicated to resolve.
When we get injured, you should remember the rule of “FIDA”, for Frequency, Intensity, and Duration, Activity. If you tripped, twisted your ankle, and immediately have pain, or maybe not much pain until the next day (when your body has had some time to begin the inflammatory response). Pain could be very severe, even at rest, range of motion extremely decreased, and it could hurt just to have your foot on the floor. The normal healing process should see incremental improvements of frequency (how often it hurts as well as how large of an area affected), intensity (how much it hurts), duration (does it recovery quicker with a movement that normally bothers it) and activity (are you starting to go back more normal activity levels and actions required of daily living). My general rule is that if all of these FIDA areas are not incrementally improving within a week, I would get a professional to look at them to make sure that you are doing the right things, avoiding the wrong thing, and that things are not more serious that your originally thought.
With an injury, there are three stages to recovery.
1. Avoid further injury.. Action: avoid repeating the same thing again, cease current movement, make the “danger” stop.
Sometimes there was no specific “injury” and your symptoms just seemed to crop up out of the blue or slowly over time. Interestingly enough, even without the apparent “danger” signal to the brain, our bodies will still follow the same stages of recovery because of some action that we keep repeating (or lack of an important action) that leads to the brain reacting as if there were an injury.
A lot of non-serious injuries will start to heal and have noticeable improvement in pain levels, range of motion, and strength within 4-7 days with proper rest and avoidance of the “danger”, if known. But if things are not improving by that time, there may be more to the issue than you realize. And that is when you may really benefit from a professional to assess it to avoid the problem becoming chronic. Obviously, avoiding an acute injury from turning to chronic is extremely important to anyone. If you are wondering whether you should seek help, as yourself these questions:
Every hour you sit after the age of 25 takes 21.8 minutes off your life.
That’s a pretty eye opening statistic considering the majority of us are sedentary workers and/or enjoy sitting back and watching our TV shows. Suddenly binge watching a Netflix series doesn’t sound so fun (4 seasons of Ray Donovan just took a toll on me). I feel a lot of this comes down to habit and routine.
Most people go to work (sitting), drive home (sitting), eat supper (sitting), then relax (sitting). Sitting is a habit that is now blueprinted into our routine and according to this study is slowly taking time off our life. Breaking habits and routines is central to what physiotherapists do, and it is arguably the hardest part of the job. We need to educate on why it is important to break these habits and form new, healthier ones to not only combat and prevent pain, but to prolong life. So how do we get people to break them?
I recently watched an interesting TEDtalk about how curiosity might be the key to breaking these bad habits.
Although the main focus of this was on smoking and eating, their concept of curiosity, I felt could be translated quite well into time sitting. The gist of it is quite simple; you need to become curious to make you more aware of the impact of your habit. Could I feel better if did more in standing? Would I feel better if I went for a walk instead of watching TV? Do I hurt more after watching TV? Is this worth the 21.8 minutes?
Their success rate was high for smoking, and I am curious to see if it would be similar across the board with most habits. I hope that the statistic alone intrigues your inner Curious George about what it would feel like to go for a walk, get back into the gym or do more work while standing. Life is too short to be subtracting minutes.
Do you ever get dizzy when you turn your head? Light-headed when move too fast getting up or down? Avoid shopping at the grocery store because sometimes it makes you feel nauseated? Do you ever feel like your head is spinning but the room is staying still? Are you afraid of falling because you can’t always tell where your feet are? Do objects look blurry, but your optometrist says your eyes are fine? Do you avoid sitting in the back seat of a car in case you get sick? Does it ever sound like you are underwater or do you ever have ringing in your ears but you haven’t been anywhere with loud noises?
If you have answered YES to any of these questions it may be because of malfunctioning vestibular system. The vestibular system, otherwise known as the “balance center” in our heads, takes information from our movements, or rather where our body is in space, using our eyes, our muscles and joints, and little inner ear sensory organs and combines all that information in the brain. The brain then processes that information and reacts accordingly; either to move your body to keep you upright while the head moves, or vice versa, move your eyes to keep focused on objects, and make your muscles move your joints to where they need to be to keep gravity from taking over so you don’t fall. Here is a diagram to help you understand how these systems work together:
Normally, when the information from your eyes, your body, and your inner ear organs all match up, we are able to move our heads and bodies as we please without getting uncomfortable symptoms such as: dizziness, vertigo (room spinning), light-headedness, disorientation, blurry vision, motion sensitivity, balance loss, ringing in the ears, changes in hearing, or migraines. But when there is one component (or more) of this system that is/are not functioning correctly, the brain is going to rely more on the other senses to keep your body in balance. Sometimes that is enough to keep you functioning at a low level as you adjust your lifestyle to avoid making yourself feel symptomatic. But to do higher level activities, even including quick head turns, focusing on small letters, laying down quickly in bed, it can be too much for the brain to handle and then you get symptoms of dizziness, blurry vision, nausea, etc.
The good news is that our brains are able to learn and change how it reacts so that that even if you have suffered for a few days or many years from vertigo or dizziness you can be treated and get back to a more functional activity level. Imagine being able to take a cruise without the fear of constant nausea, or able to lie down in bed and turn over without your head spinning, or even try to watch a 3-D movie again!
If you or someone you know has had or are still suffering from vertigo, dizziness, risks of falls, etc… then you should talk to physiotherapist that works in vestibular rehabilitation. A physiotherapist can treat inner ear issues sometimes within as little as 1-2 treatments and will give you exercises to “strengthen” your brain and vestibular system so it will work at its full potential. Stop living in fear of the next time you fall, get sick, or have to avoid someplace that you want to go. Make an appointment to see a physiotherapist at One to One Wellness Center and they will help you get back on your feet, and stay there!
“I am not going to fix you”. A powerful, but necessary message for someone who is looking to be “fixed” by their rehabilitation specialist. A study out of Alberta showed that individuals who took a passive coping strategy to their whiplash injury (i.e., relying on others for pain management) had a slower recovery rate than those who took a more active coping strategy1. What I gather from this is if you are depending on your health professional to fix you, you are in for a long road of recovery. The good news is that if you are depending on your health professional to provide you with the tools to fix yourself, the road will be much shorter. A simple but important mindset switch can make all the difference. So instead of asking “Can you fix me?” try “ What do I have to do to fix myself?”.
We don’t have magical hands that can fix; we have knowledge and understanding of how pain mechanisms and the body works. Our job is to provide you with this knowledge in a way that you can understand and provide you with tools that give you the power to fix yourself. Think about this. You get out of bed and your back hurts and you have no idea why. Not a great way to start your day. Well now imagine if you knew the pain mechanisms and the structures that are affected and what they do. The more you know about your condition, the more it normalizes.
Things are not random anymore, they are occurring for a reason; a reason that you now understand. Knowing that already gives you insight and a better sense of control. Now you can wake up in the morning and know if you move a different way you can start your day with less pain. That is what we can do for you; insight, knowledge, and understanding.
Now, how we do this is up to you. You need to be active in your recovery. Ask questions, do your own research, exercise, continue to do your day to day activities, use the advice given to you to empower yourself. Instead of asking ‘what can you do to help me recover’, ask ‘what can I do to help me recover’.
We will give you our best and everything we have to offer, but we will not fix you. We will help you fix you.
Carroll LJ, Ferrari R, Cassidy DJ, Cote P. Coping and recovery in whiplash-associated disorders: Early use of passive strategies is associated with slower recovery of neck pain and pain related disability. Clin J Pain, 2014; 30(1): 1-8.
As health care professionals we have transitioned into a collaborative team with our own specialized areas to help the patient/client become their best self. However, among all the medical jargon and expert advice/opinions, sometimes it is lost in translation that YOU are part of this team, and ultimately the most important member. That means it is best for you to become specialized in knowing your body, because you live in it, we do not.
How do you become that specialist? As Gary Ward, author of ‘What the Foot’ states “don’t change your body, challenge it. Our society is finally coming to the realization that we are not static creatures, we are movers, and in order to move without pain, we need to have a better understanding of our bodies. There are approximately 360 joints and 700 muscles in the human body (among many other things), and you possibly have pain in one or more of them. Simple right? Focus on my knee since my knee hurts. It makes sense because that’s where the pain is, but sometimes you need to take a step back, or even two, to grasp the entire picture. I’ve just started working at One to One and have engulfed myself in reading books that examine this idea of meaningful movement where the entire body is involved. The idea behind this is that when you squat down to pick something up or are taking a leisurely stroll in the park, all 360 joints and 700 muscles have a role to play in helping those movements occur, not one. So if your therapist starts assessing your ankle, or neck for that hip or low back pain, don’t panic, they are beginning to look for those middle pieces of that 1000+ piece puzzle we call our bodies.
I challenge you to start this exploration process to better understand your body as more likely than not this has not occurred since you were first learning these movements as a toddler. Next time you are walking, move slow and try thinking about all the things that are going on to allow you to move forward. How does your ankle move? How does your hip move? Now break it down even further, where are you putting weight through your feet, feel where you are experiencing tension and tightness. Know what your body likes and dislikes, then challenge it. Why are you stopping me here? How come my pain starts when I do this but not this? It goes on and on, but the more you do this, the more you get to know your body, the more control you have over those 360 joints, and the better you will feel.
Ultimately, this post is to encourage you to put the power back into your hands. The best thing you can do is explore your body’s movements, what feels right, what does not and you will become that specialist. As well, this is meant to give you insight to ask your health care professionals to take a look at the entire system, especially if you’ve had multiple treatments with no results, or if you keep going back with the same issue time and time again. Ask them, if they think the way you walk or that stiff foot you’ve had for years is exacerbating your pain. If you ask these type of questions it leads to outside of the box (or joint) thinking and has greater potential for better results. So I end this by saying put the power back in your hands, explore your body, know your body, become your own specialist and begin to see the results you’ve been looking for.
A great article that talks more about body awareness ‘What the Foot’.
Tyler Dillman is a physiotherapist with One to One Wellness. Learn more about Tyler.
Safety tips from Jamie Turnbull, Physiotherapist
Being a physiotherapist in Halifax, Nova Scotia means you see a lot of patients who injure their back shoveling. After experiencing an unusual warm Christmas day, we are now faced with reality… winter is officially here. There is snow on the ground and we will be confronted with having to shovel our driveways on a regular basis.
It is this time of year when we will see many people come in with shoulder or back pain from shoveling. While Physiotherapy is an excellent choice of therapy for these types of problems (and we’re happy to help!), the key message here is that a lot of these issues could be avoided with a little extra care and attention. Likely, a self-propelling snow blower is the best solution, but for most of us this is not an option, nor does it clear all snow-covered areas. Thus we must grab our shovels and be mindful and cautious of our movement. So, here are a few tips to avoid these flare-ups.
If you follow these general guidelines, you are less likely to aggravate something this winter – we’re pretty sure simply having to shovel is aggravating enough!
Is there a connection between what you eat and your pain?
Well here is a potential answer. An in depth look at gut bacteria and its anatomical/physiological connection to the nervous system and the brain.
By Nick Matheson
Once again, the world is reeling from tragic circumstances. Once again, we are faced with the fear brought on by random and senseless attacks. Once again, the world is on high alert. The goal of terrorism is to terrorize and make us change the way we live.
It just so happens that Lori and I are traveling to Paris this week. I cannot say that I have not had second thoughts, though I am inspired by Parisians insisting that they will not be afraid and continuing to celebrate liberty. After all, #parisisaboutlife. Though there will be mourning, I am inspired to bring whatever love I can to and from this great city.
Reading countless news articles and travel advisories over the last couple of days, I was reminded of the counsel I’ve often offered to those struggling to overcome pain: benign vigilance. In other words, pay attention and notice what the body is communicating; however, do not be overwhelmed and immobilized by fear. Ignoring a problem does not make it go away. Facing challenges with awareness, compassion, and intelligence is, in my experience, the best response. This week I will travel with a new vigilance, but I refuse to be afraid.
The world is full of pain. At its best, pain is a means of elevating awareness. My heart goes out to those personally touched by hateful acts, including those that perpetrate them. Once again, the world needs all that la ville de l’amour represents.
Love and Peace.
Does it matter to your body what position you sleep in? Well, yes and no. I would like to give you a short answer, but in order to make sense, I am going to have to take the detour route on this one. Let’s start with a little background and a bit of a review from a prior post (May 2010 “Help Yourself Help Your Neck”).
The musculoskeletal system of our body, meaning the stuff we can actually control in some manner (good luck altering the position of you liver…) is made up of muscles, bones/joints, and nerves. Nerves basically tell our muscles how to move our joints, though this process function is much more complex than that. Muscles are pretty much reactors to what our brain is sending signals through our nerves to do, and since they really only know how to do one thing, and that is to either contract (shorten) or relax (lengthen) to move the joints and nerves that are attached to them, I consider them sort of the “dumb brother” of the three siblings. Here’s why:
Muscles only know how to move (by contracting and relaxing), and when they do, the joints and nerves they are moving are happy. The problem is, when we aren’t moving (most of us aren’t like 2 year olds who are in a constant state of changing position), the muscles still want to contract, and will. And then they get stiff, tighter, and they make you feel stiff and tighter, along with not allowing the joints to get the lubrication they need because of the lack of movement and the nerves may even get a little sensitized because you have been sort of ignoring them.
Now imagine your daily routine. You go to work, you sit at a desk, you look straight ahead most of the day and your back gets slumped until the 5 o’clock bell sounds. You go home, make some dinner, watch some tv or read a book, and then maybe go for a light walk if it’s a nice evening. How much do you think your neck and back muscles have actually moved through their full range of motion (meaning flexing, extending, rotating, and side bending)? My guess (from hearing the history of seeing many clients) is not much. That being said, do you think your body is stiff before you even go to bed? Yup.
So that brings you to the end of your day when you are going to be in a mostly static position for another 8 hours. I’m thinking you shouldn’t be looking for a “looseness miracle” in the morning to make you feel like you are 15 years old again. Proper positioning during night is helpful (see below) but even more importantly is having a good, quality sleep. That means your are rested and relaxed and you have a better chance of waking up without pain. But you need to go to bed a lot more mobile so you don’t stiffen up further during the night or you have no hope of waking up looser! Just talk to a physiotherapist on ways to get yourself looser throughout the day and my bet is your sleep will improve lots.
Specifically speaking though, and keeping in mind the above, I am most often going to recommend side sleeping (possibly with a pillow between your knees if you like that) or on your back (also possibly with a pillow below your knees if you arch a lot in your lower back in this position). Stomach sleeping can lead to a bit of neck problems because you have to breathe and so your head has to be turned one way or the other most of the night, which can stiffen your neck over time. For proper pillow information, check out my other blog (July 2011, “Can You Recommend A Pillow?”) which can affect sleep comfort as well as position.