Maintaining Optimal Posture at Work – No Matter the Workplace!

An important part of my dialogue with patients is how to optimize their ergonomic set ups at work.  Creating an ergonomically sound set up is very important for spinal integrity, especially for people who suffer from neck and back pain.  There are a lot of ergonomic products out there that can aid in creating proper posture at work.  Below are descriptions of best ergonomic practices specific to different types of offices, as well as suggested products.

If You Work in a Cubicle

Ergotron Desk Mount Monitor Arm

Ergotron Desk Mount Monitor Arm

I get it.  If you work among a sea of cubicles, you may not want to be the one person standing at a sit-stand desk. However, even with the confines of a cubicle, you can still optimize the space.  First, make sure you are using a desktop monitor as your primary monitor.  Then, make sure that the top of the screen is level with the top of your head.  Try not to strain your head too far forward; try to keep your head back enough so that your ears are over your shoulders.  If you mount the device above to your desk, it will allow you to pull the screen closer to your face so that you don’t have to strain your neck forward.

Ergoguys Arm-stand Computer Armrest

Ergoguys Arm-stand Computer Armrest

Also, try putting your keyboard on your lap so that your shoulders and trapezius muscles don’t tighten and inch up towards your ears. If you mouse a lot, consider the forearm support so that your shoulder doesn’t get tight while mousing for extended periods of time.

Finally, sitting on a stability ball for part of the day forces your back and core muscles to activate.

Private office 

If you’re fortunate enough to have a private office, the ergonomic possibilities really open up.  For one, you can use a sit-stand desk.  Sitting for a full work day, day after day, leads to a vortex of mechanical wear and tear to your spine, which will ultimately result in pain.  Extended sitting causes your low back and hip muscles to get weaker and, thus, fatigue faster.  Once your muscles have fatigued, the passive structures of your spine—the ligaments and intervertebral discs—become the primary source of support.  This will cause them to degenerate faster and also to become tighter in an attempt to provide more support.

This pain-inducing mechanism has become so prevalent that the mantra—“sitting is the new smoking”—has become common place.  “Sitting is the new smoking” implies that sitting is simply bad for your health and the effects of it cannot be reversed through exercise.  Thus, we simply need to sit less.

Fortunately, various sit-stand desks have flooded the market at more economic price points than their predecessors.  IKEA offers a budget desk at less than $500 and I also stumbled upon a $22 hack made with IKEA spare parts.  Heck, even just putting your monitor on a cardboard box and using an external keyboard will be sufficient.

In the field

It wasn’t until I moved to LA that I appreciated the sheer number of people working within the motion picture industry.  Many of them work in pop-up type workplaces—they are shooting on location and set up a card table or, worse, use their lap—as a desk.  Over time, this can create the dreadful head down posture.  If you’re in this predicament, at a minimum, try to use an external keyboard so you can keep your shoulders relaxed.  And if there are any cardboard boxes laying around, you can rig a sit stand desk by putting your laptop on the box.  Unfortunately, there are a lot of ergonomic limitations to this temporary work environment.  Thus, the best thing you can do is to take micro breaks.  This means that every 20 minutes, you should change your position, stretch, or go for a 1-2 minute walk.

Indeed, movement (even if only for a few seconds) is just as important to your spine as maintaining good ergonomic position.  The nerves, arteries, and veins that pass through your spine rely on movement to aid in the transport of nutrition.  Moreover, ligamentous creep (the elongation of tissue from a constant load over time) takes place in as little as 20 minutes.  Creep can have a detrimental effect on your spine as it makes the ligaments lax and, therefore, less able to protect your spine from injury.

iGadgets and Neck Pain

cell_phone_imgOver the last 5 years, I have seen a surge in young adults visiting my office with neck pain. What’s interesting is that most of these patients have not been in serious car accidents or suffered any sort of whiplash injury, nor do they have arthritis. Rather, they have full neck mobility and are generally healthy people. However, they complain of neck pain, headaches, and sometimes numbness, tingling, or pain down an arm. Why the sudden increase in neck morbidity?

The answer is the “head down posture” our necks assume when looking at an iGadget or laptop. The “head down posture” has not only increased the incidence of neck pain but caused earlier onset of neck pain as well.


How “head down posture” causes neck pain

When your neck is upright, the vertebrae in your neck support the bulk of the weight of your head. This is the most stable position for your neck. Once you look down to use your iGadget, your neck flexes forward and the vertebrae aren’t able to bear as much of your head weight. Instead, your neck’s muscles, tendons, ligaments, and intervertebral discs—the “soft tissue”— have to bear the brunt of the weight. Over time, the muscles in the front of your neck will tighten as a result of being overworked from having to hold the head in the “head down” position. Also, your spinal cord is pulled more taut, putting tension on the nerve roots which can create “pinched nerve” symptoms. The “head down posture” places abnormal mechanical stress on the joints resulting in more wear and tear and, ultimately, pain.

Patients often say that their neck feels “weak” and that it’s difficult to hold up their head. This leads them to slouch, which exacerbates the problem.


Treatment for neck pain caused by “head down posture”

Ergonomic education is an important part of my patients’ treatment plans. I instruct all patients in the following practices: to sleep with only one pillow under their necks; to hold their iGadgets at eye level when reading or texting; to drive with their heads against the headrest; to raise their monitor high enough so that the top of the monitor is level with the top of the heads; and, finally, to never ever use a laptop as their primary computer. If the laptop is the primary computer, it’s important for patients to raise it up high enough so that their necks will be upright in a neutral position and to add an external keyboard so that they can type with their shoulders relaxed. Also, always go for the biggest screen you can. I was deeply saddened to learn that Apple discontinued their 17-inch MacBook Pros. Yes, they were bulky. However, those extra 2 inches allowed the neck to be 10-15 degrees closer to neutral. In contrast, the 11-13 inch Macs are disastrous for neck structural stability especially when used for longer periods of time.

I also teach patients how to strengthen their deep cervical neck muscles; these are the muscles that run like a sleeve around your spine and are important stabilizers. There are many excellent YouTube videos that walk patients through such exercises. In-office tractions can also be utilized to correct structural problems that have resulted from chronic “head down posture.” At home, try lying flat on your back on your bed and then slowly let your head hang off the edge of the bed. This should feel good as it slightly decompresses your neck and stretches out the muscles in the front of your neck. If this is painful or challenging, your muscles have adaptively shortened to the point that they are restricting normal neck motion—correcting your posture should be top of mind.