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All vocations contain some degree of repetition and with repetition comes increased stress on body tissues. Consistent mouse clicking and keyboard punching over an eight hour day increases the repetitive load through the fingers wrist and forearm. Maintaining a perfect head, neck, shoulder and spinal posture throughout this prolonged period seems near impossible and most people who work at a desk exhibit consistently poor postural patterns. So in this hi-tech world is there any hope for our postural prowess?

Similar to a “concreters back” people who work on computers for prolonged periods are susceptible to overload injuries. These injuries can involve various body structures from headaches, neck pain, shoulder/scapula pain, spinal pain, elbow wrist and forearm pain. Persistent headaches in your office worker tend to be referred by stiffness in the cervical spine and often present with a decreased neck range of movement and headache reproduced upon palpation of the upper cervical spine (muscles or joints). These people commonly present with a forward head/ slouched posture and require postural correction and stability retraining of the deep neck stabilising musculature to fix the underlying cause. Shoulder and upper back pain consistently feature together and can be due to the positioning of the scapula on the chest wall. The common postural abnormality here is a lower or what we term a “dumped scapula” (shoulder blade). This puts extra tension through the neck and can cause neck pain, headaches or even neural/vascular symptoms ( pins and needles, temperature changes) into the arm.

Lower back pain is commonplace for office workers and can be purely due to poor sitting posture; ie slouched into flexion with no lumbar support. At times this can be easily fixed with postural awareness and potentially an additional support to maintain the natural lumbar curve. Getting out and taking part in some intense aerobic exercise after an 8 hour bout of sitting can have its own detrimental effects. Sitting causes hip flexors and abs to shorten and gluteal muscles to lengthen. We know that when muscles are in these suboptimal lengths they do not function normally and sometimes this ‘muscle dysfunction’ can carryover from sitting to exercise, rendering the individual a weak core and potentially creating lumbo-pelvic overload injury. In these cases, it is important the individual undertake a core strength/stretching program to maintain the active lifestyle.

Elbow and forearm injuries tend to arise from tendon overuse (ie. tennis elbow) however can manifest into muscle overload and impairment of nerve mobility. Managing these factors involves modifying the tendon load for a period of time, identifying postural abnormalities higher in the chain strengthening the involved musculature, and application of neural mobility exercises.

So how can we facilitate a comfortable, pain free working experience? The bent finger analogy relates nicely to postural syndrome. If you bend your index finger backwards as far as it will go and hold it there for 10 min. Your skin will blanch with the lack of blood supply and it will start to hurt after 30 seconds. This is what is happening to your tissues when in an end of range sitting posture (ie. slouched). Ischaemic (lack of blood supply) pain will ensue. So if we take the stressed tissues away from end of range into a neutral posture all our problems will be solved? Ergonomic assessment and correction is the first port of call in doing this. Current guidelines highlight a monitor that is 15 degrees below eye level, elbows at 90 degrees and with arm rests, feet flat on floor, desk height in line with elbows and all desk equipment within a 45 degree arc of elbow reach. In order to maintain this body position, it is important to optimise function in the deep stabiliser muscles of the neck, shoulder, upper, lower back and forearm. Regular stretching of the upper back and neck can also facilitate a happy body posture. Combining postural awareness with a regular stretching and stabiliser strengthening program into a sound ergonomic workstation set up will go a long way in improving pain and dysfunction associated with prolonged computer use. It may even improve workplace productivity!

Shane O’Sullivan

Sports Physiotherapist
Prahran Sports Medicine Centre