Published on September 29, 2014
Ergonomics and postural adaptations is a common topic of discussion among researchers. Many studies have been conducted on the ways people should have their workstations set up in order to avoid injury. Discogenic low back pain is a common injury that is seen by therapists. This injury becomes worse with flexion of the spine or bending forward which further can push the disc out, causing severe pain. Sitting for long periods of time has been shown to be one of the primary causes of discogenic low back pain along with a decline in overall health. Therefore, standing workstations have become the best option for many to prevent and treat discogenic low back pain along with prolonging health and well-being.
It is likely that patients can have on-going treatment with various therapists and the injury is never fully healed. Daily work habits need to be considered as part of the treatment plan in order for one to fully recover. As medical practitioners and therapists, we only control the movement of our patients for 30 to 60 minutes during an appointment. This leaves another 23 hours where the patient is out of our control, either enhancing the results of their treatment and recovery, or diminishing any gains they have made, by going back to their old habits.
Standing Workstations Can Help Reduce Low Back Pain
Through practice, I have learned to make specific recommendations to my patients about what should be done once they leave our office. One of the very first things I suggest for patients with discogenic low back pain is to try and stand at work more often than they sit. In my opinion, the key to a successful recovery is to prevent flexion based movements of the spine throughout the day. This involves teaching the patient how to hinge from their hips versus bending from their low back. Bending from the low back increases spinal compression and the disc bulges posteriorly into the spinal canal where the nerve roots are located. This can cause impingement of the nerve root, which is responsible for sharp shooting pains that patients with low back pain and sciatica problems experience.
The Problem With Sitting:
Most people tend to sit in a hunched position at their workstation, which results in flexion of the lower spine. Sitting for hours on end causes the connective tissue to be elongated, which makes it weaker, not being able to return to its original length causing long-term tissue damage and pain. Many patients I have seen do not follow the standing protocol at their workplace which delays recovery and prevents quickly healing, quickly re-aggravating the condition. This causes a perpetual state of compression and inflammation.
Stand-Up Desks Are A Solution:
A simple solution to avoid sitting in a hunched position is a standing workstation, which has increased in popularity, as a result of the sitting epidemic plaguing our society. Not everyone has an opportunity to drastically change their workstations with a standing option, therefore; it is recommended that you stand-up and stretch, opening up your arms to the sky, every 20 minutes. Taking this micro-break helps prevent the tissue damage that can cause discogenic low back pain.
Standing electrical and hydraulic workstations can be expensive. Simple ways to create a standing workstation are the following:
- Take two filing cabinets and place wooden plank across it.
- If you work from home use your kitchen counter or island as your workstation.
- Look for open concept book shelves and place your computer or laptop on one of the shelves that is the right height for you and remove other shelving to create an open space.
- Use one filing cabinet for your laptop.
- Find a drafting table to use.
Standing posture is also very important to consider. In order to check if your posture is correct, you can use a dowel along your spine, which will help you stay aligned. You should be able to maintain a 3 point contact along the dowel, ensuring that your head, mid-back and sacrum-tailbone all touch the dowel. You can unscrew a broom-stick, use a hockey stick or golf club in order to create a dowel. You can practice moving with the dowel on your back, by doing squats onto a chair, lunging and walking without any movement of the dowel off your spine. This is crucial in your rehabilitation to ensure that the spine is not bending forward.
Sitting in a Car:
Sitting in a car is very important to consider if you have discogenic low back pain. This is another area that is often overlooked with people who are in pain. I always remember treating a patient with discogenic low back pain who came into my office hunched over and hanging onto the wall for dear life. I provided manual treatment and an exercise program for him which made him feel a lot better, allowing him to stand up-right without the walls assistance. He left my office, and 5 minutes later he was back hunched over again. I remember asking what happened, and he said: “I really messed up all the good things you had done getting back into my sports car.”
From that day forward, I always speak to my patients about getting back into their cars and driving. If the patient is driving a low sports car, it is best for them to leave their keys and take public transport or wait for a family member to pick them up. If the car is a truck or slightly higher, it is important the patient knows to recline the seat to ensure they are not sitting straight up or forward, which can increase spinal compressive forces.
Sleeping flat on your back is also very important to consider. Side sleeping with your knees in a bent position will also place your spine into flexion. Although changing patients sleeping patterns is very difficult, it is an important one to do. Meditating on your back and breathing properly prior to falling asleep is a great way to relax and find comfort in this position.