Transcription:

Melanie Cole (Host):  So many people are working at home and most schools are holding classes online. Many of us don't have desks and chairs at home that are really set up for prolonged periods of use. We're just not used to this. So, what steps can we take to help make our home, work and learning environments healthier and help us to avoid back pain, neck discomfort, and all kinds of other maladies? Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And today I invite you to listen as we discuss home ergonomics, how to set up your home office or classroom. Joining me is Julie Barker. She's a Physical Therapist at Henry Mayo Fitness and Health.

Julie, I'm so glad to have you back on the show with us. And this is such an important topic. Probably one of the most important topics we can do right now, since everybody is working from home. So, many people, not everybody, but so many people are working and they're really not set up. So, first of all, tell us what the word ergonomics means and why it's important that we know this.

Julie Barker, PT, CEAS (Guest): Excellent. Thank you, Melanie. First, I want to thank you so much for having me on your show. I do think ergonomics is so important and as a physical therapist, yes, I'm seeing a lot of people coming into the clinic was postural and neck and back pain things like that are really due to their current work situations.

So, ergonomics is the science of basically fitting the work tasks and the environment to the individual worker, as opposed to the individual trying to conform to a work setting that's awkward or a workflow that's stressful to the worker, which is kind of exactly what's happening in today's world. Workers and students are trying to conform their bodies to the couch or the bed with their laptops balanced on their knees.

Or maybe at the kitchen table where your wrists and your elbows are just taking a beating, resting on the sharp edges. So, a good ergonomic setup can reduce your muscle fatigue and soreness prevent serious work injuries like disc bulge or carpal tunnel. And it certainly makes your job and your life more efficient and easier, which ultimately makes you faster and more productive. So, your brain is more focused on your task and not on your achy back.

Host: Well, that's certainly true. I can attest to that. Sitting behind a microphone all day, it really does take its toll. So, you said you've seen people in the clinic. So, what is a repetitive strain injury? What are some of the most common injuries that people are coming to you with?

Julie: Sure. A repetitive strain injury is basically a microtrauma or really excessive stress that's being placed on part of the musculoskeletal or the nervous system by kind of repetitive repeated overuse or just compression for long periods of time in a fixed position. So tissue stress is really just load over time.

So, even a small increase in load or pressure over a sustained period of time will result in tissue stress. And now tissue stress is cumulative. So, the tissue is deprived of circulation and nutrients, and it starts to begin to actually change its resiliency and eventually even its structure. So, some of the most common things I'm seeing in the clinic now are neck and back strains, disc injuries from poor posture, such as sitting slumped.

I'm seeing some wrist and elbow compression injuries from that contact stress or incorrect elbow angles. We're also seeing something we call double crush, and this is an injury where the neck is basically being stressed in a forward head posture. And the nerves in the arm are being pulled due to over reaching for the mouse.

So, that nervous system is basically getting it on both ends. And of course, we're now seeing a lot of text neck. Now this is a postural syndrome which is due to the forward head position of repetitively looking down at like a phone or a tablet or another device. So, those are probably the most popular, if you will, strains and injuries that are coming into the clinic now due to home situations.

Host: So, tell us then before we get into fixing up that workspace, what are the symptoms that we would start to notice? Because people don't even really notice. And when you just said that, I sat up just a little bit straighter, make sure my feet are flat, but what symptoms? I mean, because we all get little aches and pains now and then, but what are some red flags that would say this is what this is, and you need to either change it or figure this out?

Julie: So, typically it begins with kind of a stiffness and achiness, a tenderness that is intermittent kind of comes and goes. But then you'll start to see it progress to a throbbing, numbness, tingling, and even weakness that doesn't to go away. Commonly I'll say pay attention to the tension. So, you're right, we all have little aches and pains, but when these things are coming consistently, or when they're worsening, that's an indication that you may be developing one of these syndromes.

Host: Well, then let's get into the most important part of this episode. Good body position. Tell us a little bit about desk height. You mentioned that we're reaching for the mouse, chairs, keyboards. What are we doing? What can we change? So, start with the chair and move all around and tell us how to set it up for ourselves so that it really does work for us so we can do our work.

Julie: Right. So the first thing is we try to position individuals, workers, in what we call the neutral position. Now this is the position in which the body is well-balanced and there's the least amount of stress to any one area. Now, generally, if we're looking at the body from the side view, what we want to see is that the ear is lining up directly over the shoulder and the shoulder is directly over the hip.

Now, let me just say here, that it's nearly impossible to achieve this on a couch or in a bed with a laptop and not for an adult and not for a student. So, to set up a workstation. The first thing I do is position the worker in the chair. So, as you sit all the way back in the chair, you should have about three fingers in length of space between the back of your knees and the forward edge of the seat.

So now, if the seat is too deep, you can add a pillow behind you. Next you may need to add a lumbar support. Now, one of my favorite home tricks is to take a rolled up towel with a belt in the center of it, and then belt that onto your chair. It doesn't work very well in your office, but it works great in your home.

Now your knees should be at, or slightly below the level of your hips. Yeah, if not, you may need to add a little flat pillow or something across the back half of the chair where your buttocks are. So, this will cause a slight forward tilt and a person's natural inclination will be to sit up straighter. Next, I bring the seated worker up to the desk surface. Now a typical office desk is 29 to 30 inches tall. Dining room table can typically be between 28 and 32 inches tall. And a TV tray is about 26 inches tall. So I'm short. I'm about 5'3" on a good day. So, the TV tray works better for me, but if you're tall, like my husband who's 6'2", he does much better at the dining room table.

So again, finding the right surface can be important. Once you have that surface, the keyboard should be positioned at the edge of your desk. With a palm rest to support your wrist, to prevent you pivoting off a hard edge, then the hands and the wrists should be straight. So, in line and roughly parallel to the floor.

The elbows should be resting comfortably at your side with a bend of about 90 to 110 degrees. Now, if you have to reach up to access your keyboard, then you're going to need to raise your chair up so that you have that correct arm angle. If your home chair doesn't raise, well, then you can use a pillow also while keeping your elbows should stay close to the side of your body, you should not be reaching forward for your keyboard or your mouse.

That can cause that double crush injury I was talking about. Now your mouse should be placed right next to the end of your keyboard and at the same surface. So I wouldn't want your keyboard in your lap and your mouse on your desktop. They both should be on the same surface. Also, if the mouse is placed too far out to the side, that unnecessarily loads the shoulders.

So, we want to keep that mouse kind of tucked in as close as we can to the keyboard. Now if your chair, if you needed to raise your chair so that your arms are in the correct position and your feet don't touch the floor, then you're going to need to add a foot stool or maybe a sturdy Amazon box or something like that can work well. Now the monitor can also have a large impact on your neck and back. So, you want to position the monitor so that it's centered directly in front of you. It's about an arm's distance away. And the top of the monitor should be at your eye level. That's kind of a new recommendation. We used to say about two inches or so, but it really should be at your eye level.

If you're using dual monitors, you want to be sure to place them close together at the same level and kind of in a V shape so that you avoid turning your head a lot. And that would require a lot of refocusing. Now, if your laptop is your primary computer, this is super important. It should be raised to your eye level, maybe on some books or reams of paper, something like that. And used as a monitor only. You should have an external mouse and keyboard, and those are probably the most important accessories that you can get. So, those should be on the writing surface that you're on and your laptop raised up. Don't try to use the laptop keyboard. If your hands are positioned correctly, then you have to round over to see the monitor.

And again, this is probably the biggest ergonomic mistake I've seen by far. Lighting is also important. So, if your monitor is near a window you need to place it at about a right angle to that window. And you can also adjust your tilt to decrease any glare that you might have. I would say if there's only one purchase that you can make for your home office, then I would strongly recommend that you use an adjustable chair with a tilt feature. Lack of the ability to tilt and kind of adjust your pressure is one thing that leads to static loads and this musculoskeletal stress that we're seeing.

One other thing to be mindful of, is your head position while you're using a phone or a tablet. And we're seeing a lot of this with students the pressure on the spine can increase dramatically when that head is tilted forward to look down. It's much better to lift the phone or the tablet up to your eye level, or they're even making these great tablet risers. Or if you don't want to go through that expense, you can use a cookbook rest that'll hold your tablet up. So, those are probably my top recommendations.

Host: Wow. That was outstanding, Julie. Absolutely outstanding. As an exercise physiologist, I concur with all of those things. And as a fellow short person, I got you beat there because I'm just about 4'10" on a good day. And shrinking I'm sure. Everything you've said is spot on. And I also just want to add the mouse situation.

I had to switch to one of these penguin mouses where it's more vertical than horizontal because I was starting to get elbow pain from that tilt of the wrist for those mouses, because you know, when your hand is pointed down. So, you know, people, if you are getting that these mouses are much more helpful in some ways.

So, as we move along in this episode. And before we wrap up, what else would you like to recommend? You've just given us all these changes to our workstation. Great ideas. What about things that can help our posture, stretching, strengthening? What do you want us to know about not sitting here all day?

Julie: Well, yeah, that's a good question. So, some of the things that I really wanted to point out is you're right. It's about moving. We have to keep moving. So, it's not just making sure you're in the best possible position. You've got to move. Now, normally we recommend about three minutes, every 30 minutes, you should be getting up and moving.

The other thing for vision. We want to be sure that you're looking, we call it the 20, 20, 20 rule. So looking 20 feet away for 20 seconds, every 20 minutes I think is really important. The other thing is you can perform some of your tasks while in standing. Maybe you can do some reading or phone calls or meetings, things like that in standing, just moving around. One of my favorite things is to stretch, lying down, literally take the load of your head and your body off your spine. Typically about 15 minutes is enough, really. The other thing that I think is important is diaphragmatic breathing. It reduces stress, it improves your posture, and it also improves your core stabilization.

Mindfulness, a lot of people are doing mindfulness now. Many studies have been shown that the emotional and physiological benefit of mindfulness training. They found that individuals who practice mindfulness actually saw a 50% reduction in their pain. And the great thing was that mindfulness and reduction lasted for years afterwards. There are also some great little gadgets on the market right now. There's an inclinometer on your phone. It's called posture correction. It's a free app that you can get, and you basically can use your phone to tell you if you've moved out of position. Now the iPhone makes a little wearable called the lumbo, L-U-M-B-O. And they even have an ergonomic coaching app called the Minder. So, those are things I call them the posture police that can really help you. If you don't have an iPhone and you don't want to go through that expense, you can go old school. And I use little stickers, little happy face stickers, and I put them all over.

I put them on my keyboard, on my phone, on my monitor. And when I see those little stickers, it reminds me to kind of sit up tall. So, those are some recommendations that I have.

Host: Well, I love the advice about taking the load off our spine and lying down. Sounds like a great nap to me and probably something we can all use. As we wrap up, Julie, if we're just starting to feel these pains, we can make the changes that you've recommended. When is it time to seek help from a physical therapist? Give us your best advice for ergonomics and wrap it all up for us.

Julie: Great. I would say if you're feeling discomfort, you should reach out to your home office and see if they have in our ergonomist on staff who can help you modify your workstation. If you don't have an ergonomist, have a family member take a picture of you from the side view and also overhead view and see if you're correctly lined up in neutral.

Oftentimes you can pick it out yourself. Some other great things are self-massage with massage tools, alternating hot and cold packs can be very helpful, but I would recommend seeking care from a professional if you're having like increases in headaches, numbness, tingling, or weakness.

Host: All great advice. Listeners definitely share this show with your friends and family, on your social media and social channels, because we are learning from the experts at Henry Mayo Newhall Hospital together. And we all need to learn about ergonomics for home and school and work because everything is different now.

So, take heed of this advice. Listen to it a few times. So, you can write down your list. And if you need a physical therapy consultation, please call (661) 200-1550, or you can visit our This email address is being protected from spambots. You need JavaScript enabled to view it. for more information. That concludes this excellent episode of It's Your Health Radio with Henry Mayo Newhall Hospital. Please remember to subscribe, rate and review this podcast and all the other Henry Mayo Newhall Hospital podcasts. This is Melanie Cole.