Posture and Ergonomics

So Was Your Mother Right?

  - Dr. Steven Vollmer

If your mother was like most, she probably, at some point during your childhood, admonished you to sit and stand up straight. (Perhaps she repeated this more than once.) In my years working with patients with back and neck pain, it appears that most of them did not take their mother very seriously, as their consistent poor posture over the years is often a big contributor to their current problem. Unfortunately, if they have been stooping, slouching, etc., their entire lives, the chances of substantially changing those habits are slim, but I always feel it is important to point out the things they are doing that are contributing to their discomfort and make suggestions as to what improvements could be attempted. It isn’t easy changing one’s old ways, but I have never seen someone not benefit from a concerted effort to do so.

What are the benefits gained? Proper posture helps keep joints in better alignment with less abnormal wear placed on joint surfaces. It decreases stress on supporting structures, lessening the chances of developing strain and overuse symptoms such as muscle fatigue and pain. And proper posture contributes positively to one’s appearance. Following are some of the recommendations I share with patients for the home and office that can help them in their efforts to experience some of these benefits. Like with exercise, there are no quick fixes here, and one needs to be consistent with their efforts to improve their posture.

Good posture when sleeping is very important, considering the amount of time one spends in bed. I discourage sleeping on the stomach, because it is obviously difficult to keep the neck in a neutral position while doing so. Sleeping on the back or either side is preferable. I encourage patients to use a pillow that provides the proper support to keep the head/neck in a neutral posture. Proper pillow height is needed so that a person does not end up sleeping on an arm when lying on their side. (One’s pillow, not an arm, should do the job of supporting the head/neck.) Because of the importance of pillow support, I usually discourage feather pillows. Obviously, the support provided by your bedding helps determine whether or not proper posture of the spine is maintained while sleeping. (If the mattress and box springs are 20 years old, I can assure you that proper support is no longer being provided.)

I encourage my younger patients to also avoid stomach sleeping, because the earlier the habit is developed, the better. Just because their necks are more flexible doesn’t mean it is any better for kids to sleep with them twisted to one side or the other. Hopefully, with parents of newborns being advised to not place their babies on their stomachs because of the threat of SIDS, fewer and fewer children/adults will be stomach sleepers in the future.

As for posture in the workplace, the vast majority of my patients spend time in front of a computer, sometimes their entire workday. If their poor posture habits are made even worse due to an improper ergonomic setup, neck and back pain, headaches, etc., will eventually result. Following are several suggestions regarding steps that can be taken to minimize back and neck strain on the job.

Computer position -
The monitor needs to be set so that the user does not have to look up or down to view it. Setting the screen so the top of it is at eye level is recommended. (Laptops obviously present a problem here. They should be positioned, whenever possible, so that the user’s head and neck are held in forward flexion to the least degree possible.)

Chair position –
The seat should be at the proper height so that one’s feet can rest comfortably on the floor. If someone has short legs, placing something under their workstation to rest their feet on is recommended. (Working with one’s feet dangling above the floor will eventually result in pain.) The chair should have adequate back support and armrests. If the only support for the upper extremities being provided is a wrist rest, upper back and shoulder pain will develop much more quickly.

Phone –
Holding the phone receiver between an ear and shoulder while using both hands on a keyboard puts considerable stress on the neck. I encourage all my patients that are doing this to get a headset, if possible, especially if they spend most of their day on the phone while at the computer. (A speaker phone is another option, but it obviously does not provide the level of privacy one has with a headset.)

Document Position –
Looking back and forth all day long between paperwork lying flat on a desk and a computer screen is another habit which hastens the onset of muscle fatigue and pain. I recommend some type of document holder that allows paperwork to be positioned upright beside one’s monitor, so that the bulk of movement between it and the computer screen occurs with the eyes, not the head and neck.

One can have the perfect chair, use a headset, and be sitting at a workstation that is ergonomically correct in every way, and still develop musculoskeletal discomfort if he/she doesn’t make it a habit to take mini-breaks to change positions, stretch, etc. We all often lose track of time when at a computer, as we are focused on the task at hand and are not thinking about the muscle tension that is slowly developing. If possible, periodically getting up and moving away from the workstation is preferable, as this relieves some of the lower back stress that has developed while sitting. The trick is to develop some way of reminding oneself that it is time for a break. Programming something on the computer to do this or setting an alarm of some sort are possible solutions.

There are certainly other times besides when sleeping or at the office when we demonstrate poor posture. How we lift things, whether light or heavy, has a tremendous effect on our backs. I find patients tend to think about their backs when lifting heavy items, such as a piece of furniture, but give little thought to proper posture when bending over to pick up a pencil. The back needs to be protected all the time. (This is especially true when handling children.) When watching TV, if your favorite spot to sit every night is that old sofa or easy chair, neither of which is offering much back support, it is pretty safe to assume that your spine is not in an ideal posture. Just like with your mattress and box springs when sleeping, the level of support provided by what you sit on at home is important as well.

Yes, I submit that our mothers were right when telling us to sit or stand up straight. Unfortunately, the majority of us didn’t take their advice to heart and demonstrate poor posture habits, at home and work, that put us at risk for developing chronic back and neck problems. If our home and work environments are not conducive to maintaining proper posture, we need to evaluate what can be done to improve things. Even if you have never given it much thought before now because you have yet to develop any serious discomfort, any change you can make to reduce stress on your spine by improving your posture will increase the chances of your continuing to do well. Plus, better late than never when it comes to obeying Mom.

Dr. Steven Vollmer is a doctor of chiropractic (DC) and Diplomate of the American Academy of Pain Management (DAAPM) in clinical practice at Cole Pain Therapy Group.