It’s estimated that as many as four in five workers have developed some form of musculoskeletal pain as a result of poor home working ergonomics. And with hybrid and home working set to continue for the foreseeable future, the long-term health implications could end up costing businesses and the economy millions. So how can something as innocuous as sitting, pose such a serious risk to our health and productivity? We caught up with Kate Molloy, Founder and Practicing Chiropractor of White Therapy, a multi-disciplinary private health clinic specialising in treating muscle, joint and nerve pain, to find out what the risks are and more importantly, what we can do about it.
“It sounds dramatic” explains Kate, “but if done incorrectly, over time the simple act of sitting can be extremely damaging on the body. Over the past two years, we’ve seen a huge increase in the number of musculoskeletal complaints in clinic including hip, back and neck pain. Most of this is directly attributable to people becoming more sedentary, experiencing increased stress and spending hours working at home at makeshift desks and on chairs that simply aren’t designed to support correct posture and alignment.”
Kate explains further: “Physically, when we are in a seated position, our femur (the largest bone in the human body) is placed at 90 degrees to our torso. The problem is that this positioning can shorten the hip flexor and cause tendinopathy and degeneration. When sat we also inflict sustained compression through the discs in our backs.
If we exert these pressures on our backs and hips for hours every day, eventually there will be consequences, ranging from pain and inflammation to restricted or limited movement and in extreme cases, spinal damage”.
Research reveals that the average office worker in the UK spends up to 9 hours a day sitting at their workstation. That’s a whopping 67 days or around 1600 hours a year sat in front of a computer screen. Factor in the amount of additional hours we’ve all spent sitting during lockdowns and you begin to understand the cumulative effect that sitting can have on your musculoskeletal health.
But it isn’t just neck and back niggles that we should be alert to and it isn’t just poor seating that’s the culprit. The type of desk and computer you use can aggravate the problem further. Desks that are too low or too high can cause poor posture and place extra strain on muscles and joints. Studies have also shown that laptops cause more strains and pains than desktops because of the close positioning of the screen and the keyboard and those who’ve done away with surface support altogether are at an even greater risk. If you’re sat with a computer on your lap, constantly hunched overlooking down at a screen, you’ll experience sustained flexion in your neck and your shoulders will round.
Kate continues, “In addition to back and neck complaints we’ve seen a significant increase in lateral epicondylitis (tennis elbow) and temporomandibular joint disorders, symptoms include teeth-grinding and pain or clicking around the jaw. Both conditions are significantly aggravated but incorrect positioning due to the poor ergonomics when people are working from home”
“In an ideal world everyone would work at bigger screens, but the reality is that most people will continue to use laptops as we continue to take a hybrid approach to working switching between home and the office. That being the case, the most important thing to do is to make sure you have a properly designed task chair and a decent working surface at home to encourage correct alignment and adequate postural and lumbar support. There are also some excellent laptop stands on the market which use a separate keyboard and mouse to ensure that your laptop is correctly positioned for your arms to rest comfortably and with the screen at eye level. I’m also a big fan of hydraulic desking which allows you to move between a seated and standing position, reducing spinal loading in the same position. “
The role of HR and Occupational Health and the Mind-Body Connection
Whereas pre-pandemic, HR or occupational health professionals in the office would make sure seating and equipment was fit for purpose, when offices closed overnight, so too did access to that expertise. A whole host of other factors colluded: people stopped going to the gym, the lines between work and home life blurred and the natural break enforced by the daily commute was removed. Big business was commendably quick to respond with many providing allowances for employees, who suddenly found themselves WFH full-time, to buy company-approved and ergonomically designed office equipment for their homes. All businesses were not created equal, however, and for smaller organisations that just wasn’t an option practically or financially.
“While the full impact is yet to be seen”, Kate cautions that “with hybrid working set to stay, it’s a good idea to take stock of our working arrangements and the impact they’re going to have on our health and well-being longer term. As a clinician, as soon as I meet a patient, I try to understand the aetiology – or cause – of the pain to work out the most appropriate treatment plan. Increasingly, it’s poor working practices and inadequate equipment that are to blame. We were designed to move. We are like machines and keeping that machine still for long periods of time won’t do it any good. Over time, low grade pain will turn into permanent injuries and that could end up costing businesses dearly if workers are unable to work and having to take more and more time off.
“Besides the physiological aspect there are other factors to consider. A growing body of research focusses on the mind-body connection and the role poor mental health, fear and stress can play in aggravating an individuals’ experiences and responses to pain. A complex relationship between mind and body is at work, with past experiences, attitudes, perceptions, circumstances, personal relationships and a whole host of other external variants, all contributing to an individual assessment of and response to pain.
Kate explains: “Over the past couple of years, people have experienced increased levels of fear, tension and isolation because of the pandemic. People have had a lot to deal with and even though we can connect via technology, vital human connections have been lost. Increased anxiety, tension and isolation all trigger higher levels of cortisol and that can impact directly on recovery. There is a simple saying that ‘what the mind thinks the body follows’ and lots of evidence that demonstrates how people’s perception of pain increases when they are stressed or under pressure. Consider your own physical response to feeling nervous: dry mouth; clammy palms; an upset stomach; and you get a sense of how the mind-body connection works”.
Several studies have found that psychosocial variables (i.e, attitudes, beliefs, circumstances and psychiatric status) are as, if not more, important than the severity of injury when predicting recovery from injury.
In their paper Psychological Factors in Chronic Pain: Evolution and Revolution, academic researchers Dennis C. Turk Akiko Okifuji state that, “There has been a growing recognition that pain is a complex perceptual experience influenced by a wide range of psychosocial factors, including emotions, social and environmental context, socio-cultural background, the meaning of pain to the person, and beliefs, attitudes, and expectations, as well as biological factors”. The paper goes on to discuss how psychosocial factors play a key role in determining patient outcome such as whether individuals will spontaneously recover or whether fear or anxiety will lead to avoiding physical activity for fear of aggravating the pain.
Kate concurs: “The connection between good mental and physical health cannot be underestimated and there is so much emerging research about the inter-relationship between movement, gut health and sleep on our mental and physical wellbeing. At White Therapy, we moved from being a sole discipline to a multi-disciplinary clinic because we understand the importance of treating mind, body and soul holistically. There is a lot we can do: take regular breaks, drink lots of water, make sure your screen is at the correct level. But its counterproductive if we do all those things and then spend nine hours a day sat on a sofa hunched over a tiny screen. pretty soon were going to run into trouble”
Kate concludes: “like many things no one size fits all but, as we continue to navigate our way through the pandemic and learn to live with covid, it’s vital that we promote the importance of protecting musculoskeletal health. As an absolute minimum, anyone working from home for all or some of their time in the forseeable future, should be investing in a really good ergonomic task chair. When you compare the relatively small cost of initial outlay with the potential long term damage to health and subsequent time off work, it will quite literally be worth its weight in gold.