Sitting posture at work has become a popular topic recently within rehabilitation. Research has shown the effects of sitting posture on the lumbar spine, cervical spine, shoulders, forearms and wrists, among other areas. Businesses are becoming proactive by bringing in consultants to address the ergonomic needs of their employees, in an attempt to curb workplace injuries secondary to prolonged sitting and increased computer use. Workers are encouraged to get up from sitting frequently to give their bodies a ‘break’, and sit-stand desks are becoming more commonplace. A large percentage of employees complain of chronic musculoskeletal symptoms from sitting at work, and I began looking at postural change with this population and how it differs from people who do not complain of chronic symptoms. Below is my summation of what I commonly see with patients, and I will discuss how I educate patients on postural change and pain at work.

If you observe people closely while they sit, they are frequently making postural corrections. Over the course of ten minutes, for example, they may move five different times (sitting with their right leg crossed, then switching legs, then sitting up tall, then slouch, etc.). If you asked them what position they were in five minutes ago, they probably won’t be able to tell you. When we are in-tuned to our bodies, there are numerous bodily structures that are continuously telling our brains how we are posturing. Skin, ligaments, joint capsules and joints, and muscles all have sensors that are telling our brains where our body is in space. As we sit in a certain position, these structures send input to our brain, and if the body senses that we should move in order to prevent our body from feeling uncomfortable, then we will change position. We may never be aware of this process happening. These are subconscious movements, because our bodies are trained to move after a certain amount of time, knowing that if we stay in that position for too long it will be uncomfortable.

On the other spectrum, if you ask a person who has chronic pain when they make posture corrections, they will answer with statements such as “after 10 minutes my back hurts, so I get up and move” or “10 minutes of computer use begins to hurt my neck, so I pull my shoulder blades back and it feels better. The longer I sit, however, my neck pain worsens and I have to stand up”. The difference with these people, versus people who do not have chronic symptoms, is the point at which they make the postural correction. People with chronic pain wait for pain, because their bodies are focused on the pain. If you wait for pain, however, you are now in a pain cycle that takes time to improve, and you are more likely to resort to an extreme measure to try to curb that pain. After you do the extreme measure (i.e. stand up and bend your low back backwards to stretch, or shove your shoulder blades back) what position do you go back to? Most likely you go back to the posture that started causing the pain in the first place, and you go back/forth from extreme bad to extreme feel-good posture all day until your body cannot take it anymore.

I devised a bell curve description that describes this course of events, which I show to patients to help them understand posture and postural correction:

posture-bell-curve

Posture at work is not meant to be ‘perfect’. It is unreasonable to assume people are going to be perfect throughout the entire day; everyone slouches at least some of the time. It is about being ‘ideal’, at least some of the time, and to have a work environment that allows you to ‘win’ when you get into your posturally-corrected position. Too often people with pain go from extreme bad to extreme ‘feel good’ positions, never hanging out in the ideal position. The body is never learning anything positive when this approach is taken. Rather than waiting for pain, you need to make postural corrections frequently, getting into the ideal region whenever you sense yourself approaching poor postures. You can still do the ‘feel good’ postures and stretch, but take that cue as a reason to then go into the ideal posture. It takes thousands of repetitions for your body to learn body position sense, turning conscious corrections into subconscious postural habits. It is a proactive way to improve pain, decrease injury risk over the long run, and improve overall job satisfaction.

When it comes to postural changes and ergonomic corrections, a lot of a little makes a lot. A lot of small ergonomic changes can go a long way with pain and function, and any employee who is beginning to sense issues with their work condition should have an ergonomic assessment in order to prevent problems from becoming chronic. If you are experiencing pains associated with work, or pains that are worsening with work conditions, contact your physical therapist for an evaluation and start becoming proactive in improving your body’s health and your overall well being.