Lifestyle Medicine and Office Ergonomic Strategies for Managing Low Back Pain

Original Editor - Stacy Schiurring based on the course by Ziya Altug
Top Contributors - Stacy Schiurring, Carin Hunter, Jess Bell, Kim Jackson and Lucinda hampton

Introduction[edit | edit source]

Back pain is a common complaint among persons who spend an extended amount of time in any one position. When considering the typical office worker, this is often a seated position. A sedentary lifestyle is becoming more common as an increasing number of people spend an extended amount of time seated for both work and leisure time. A 2019 study published in Applied Ergonomics found an association between chronic low back pain (LBP) and prolonged static sitting posture.[1]

LBP is the third highest cause of self-perceived disability[2] and causes major burdens on individuals, employers and society.[3] Identifying risk factors is of high importance when creating an appropriate prevention plan. For physiotherapists this often involves the use of ergonomics and postural analysis.

Ergonomics and Whole-Person Health[edit | edit source]

Ergonomics: the science concerned with fitting a job to a person’s anatomical, physiological, and psychological characteristics in a way that enhances human efficiency and well-being.”[4][5]

This article will limit the discussion on ergonomics to the office setting, it should be noted that ergonomic assessments can be completed in any setting a person must perform work activities. The term ergonomics is interchangeable with Human Factors or can be combined with Human Factors and Ergonomics (HFE).[6]

The three subtypes of ergonomics .

Physical Ergonomics[edit | edit source]

Physiotherapists are often involved with physical ergonomic assessments of workplace set-ups. They assess and make recommendations to improve a person’s anatomical or physiological functioning by adjusting the positions they hold their body while working to minimise risk for injury, and minimise repetitive motions. The human component of a work system must be considered during the assessment, it is important for the physiotherapist to consider whether:

  • Equipment is usable
  • Tasks are compatible with a person's ability and training
  • The environment is comfortable and appropriate for the assigned task
  • The work system takes a person's need for social and economic needs.[7]


Other factors taken into consideration during a physical ergonomic assessment include:

  • Worker health
  • Working postures
  • Handling materials
  • Repetitive movements
  • Work-related musculoskeletal disorders
  • Workplace layout
  • Equipment design
  • Safety[8]

Ergonomics looks at more than just the physical functioning and user positioning of a work system. According to the International Ergonomics Association, ergonomics is a "multi-disciplinary, user-centric integrating science. The issues HFE addresses are typically systemic in nature; thus HFE uses a holistic, systems approach to apply theory, principles, and data from many relevant disciplines to the design and evaluation of tasks, jobs, products, environments, and systems.  HFE takes into account physical, cognitive, sociotechnical, organizational, environmental and other relevant factors, as well as the complex interactions between the human and other humans, the environment, tools, products, equipment, and technology."[6] Many aspects of the ergonomic assessment are often outside the practice rights of physiotherapists. However, utilising the principles of Integrative Lifestyle Medicine and Whole Person Health can ensure a full and thorough ergonomic assessment with referrals to the proper clinician or healthcare provider.

Cognitive Ergonomics[edit | edit source]

Cognitive ergonomics assesses for work conditions that may be cognitively challenging such as disruptions, interruptions and information overload which can impair a person's work performance and lead to a decreased well-being at work. Disruptions can include office background noise or co-worker's speech. Interruptions have negative consequences on productivity and job performance. Information overload can also hinder job performance via multitasking or excessive input from communication apps or software.[9]

Other factors taken into consideration during a cognitive ergonomic assessment include:

  • Skills training
  • Mental workload
  • Decision-making processes
  • Human-technology interaction
  • Work stress load
  • Social stress load
  • Physical training
  • Education
  • Fatigue[8]

Organisational Ergonomics[edit | edit source]

Organisational ergonomics, or macroergonomics, assesses the larger structures, policies and procedures of an organisation. It also takes the effects of technology on workers, processes, and the greater organisation into consideration.

Examples of organisational ergonomics include:

  • Teamwork
  • Communication
  • Quality management
  • Crew resource management
  • Introduction of new work paradigms
  • Design of working times/duration
  • Work design and flow
  • Telework[8]

Sources of LBP for the Office Worker[edit | edit source]

Office workers

Research supports that both prolonged sitting[10] and standing postures[11] can result in LBP and musculoskeletal discomfort.[5] A 2020 study found that LBP was provoked by poor work station set-up and design, poor lighting causing eye strain, and prolonged sitting of at least 4 hours/day in a group of university office workers in Thailand. The study also found that those with subjective reports of increased LBP had poor preventative behaviour, such as exercise, and a BMI ≤ 25.[12]

Poor ergonomic office setup with prolonged sitting often results in poor posture. The posture most commonly seen will include: forward head posture, rounded flexed spine, rounded shoulders with protracted scapulae, sacral sitting, lower extremities often in poor alignment with hips lower than the knees, and feet possibly poorly supported on the floor.

It is also important to consider eyestrain when assessing for a source of LBP in the office worker.[12] Visual input and orientation is a strong determination of postural alignment. For the office worker, the height and placement of the computer screen is of high importance when setting the worker's posture. For example, if the screen is too low the worker will assume a slouched flexed posture with forward head to be able to properly view the screen. If the screen is too close, the worker's eyes must maintain convergence and pupil constriction to properly read the monitor. Poor lighting will also effect eye muscle functioning. Such examples will cause both postural discomfort and pain, as well has eye muscle strain.[13] Proper ergonomic office setup has also been found to reduce Computer Vision Syndrome, which is a collection of eye and vision problems related to near vision activities such as computer use. Symptoms include: eye strain, dry eye, eye irritation and watering, double vision. blurred vision, slowness of focus, shoulder pain, and neck and back pain.[14]

The following video gives an overview of eye strain with computer use.

[15]

The COVID-19 global pandemic has changed the way many people work, especially those who work in an office setting. According to the US census bureau, more than a third of US households reported a family member was working from home more frequently than before the pandemic.[16] Working from home may contribute to an increase in musculoskeletal discomfort and pain due to a lack of resources for proper ergonomic setup and assessment.[17] A study published in 2020 by Pekyavas[18] found that in the transition to a home office environment, approximately 86% of participants work at a desk set up and 65% of participants spent 3-8 hours/day working in that environment. Approximately half reported LBP as their most painful musculoskeletal complaint, followed by shoulder pain (44.8%), and knee pain (35.6%).[18]

These two short videos provide information on the effect prolonged sitting with improper positioning has on the body:

Prevention of LBP for the Office Worker[edit | edit source]

The human body was designed to move through a wide variety of movements. Musculoskeletal discomfort and injury occur when the body maintains one posture for a prolonged period of time.[10][11][12][17] Low back pain in the office worker, or any sedentary individual, can be improved or eliminated with some simple changes:

  1. Have an appropriate office set-up
  2. Take movement breaks throughout the work day
  3. Perform regular exercise or other physical activity outside of the work day
  4. Proper rest

Please read HERE for more information on sitting posture and its impact on LBP.

Appropriate Office Setup[edit | edit source]

When seated at a workstation, the office worker should have the following alignment for optimal posture and decreased risk of musculoskeletal discomfort and injury.

Office Ergonomics Sitting Posture
  1. Computer monitor should be directly in front of the worker with eyes gazing at top third of the screen straight ahead.
  2. When seated, the worker's body should be approximately one arm length back from the computer screen.
  3. While seated in the chair, the worker's shoulders should be relaxed and down.
  4. Arms should be relaxed at sides with elbows flexed to 90 degrees, wrists comfortably supported on desk surface.
  1. Keyboard and mouse should be easily accessible, directly in front of the worker.
  2. While seated in the chair, hips should be far back into the chair, low back supported against back support with gentle lumbar curve.
  3. Feet should be supported on floor or on foot support to maintain hips slightly above the worker's knees.


Please review the following video of a physiotherapist demonstrating a basic seated office computer assessment.

[21]

Click HERE for a computer workstation ergonomic handout and checklist from the National Institute of Health.[22]

Movement Breaks[edit | edit source]

As movement specialists, physiotherapists can encourage a more active lifestyle for the office worker. Below is a list[5] of clinical choices that can help an office worker manage and/or prevent LBP:

  1. What is the intention of the office break?  Is the break needed for physical and/or mental needs?
    • Physical: The worker may need to move, stretch, or change positions.
    • Mental: The worker may need to step away from the task at hand or change tasks altogether.
  2. What should the worker do during the break?  Rest in place, stand, sit, bend, stretch, move around?
  3. How long should an office microbreak last? 20 seconds to 2 minutes depending on the work and the need of the worker.
  4. How often should the microbreak occur? 20-120 minutes.
  5. What impact does other formal or scheduled breaks have on LBP? Examples: meal breaks
  6. What impact does chronic overwork over the year without taking a vacation break have on LBP and overall health?

Below are lists of simple movement exercises that can be performed as microbreaks during the workday.

[5]
Movements in Sitting Movements in Standing
Change how arms or legs are crossed Heel raises
Tap feet while supported on floor Pinch shoulder blades together
Alternate heel up/toe up while feet supported on floor Gently turn head side-to-side
Turn feet inward/outward Open/close hands
Bend/straighten legs one at a time March in place
Wiggle toes Boxing punches

The following videos are examples of movements that can be performed by office workers. The first video is based on yoga forms for a more integrative medicine approach to movement, the second is a more clinical alternative.

Resources[edit | edit source]

Consider the ideas presented in this TED talk.

Related Physiopedia Pages:

References[edit | edit source]

  1. Bontrup, C., Taylor, W.R., Fliesser, M., Visscher, R., Green, T., Wippert, P.M. and Zemp, R., 2019. Low back pain and its relationship with sitting behaviour among sedentary office workers. Applied Ergonomics, 81, p.102894.
  2. Vos, T., Allen, C., Arora, M., Barber, R.M., Bhutta, Z.A., Brown, A., Carter, A., Casey, D.C., Charlson, F.J., Chen, A.Z. and Coggeshall, M., 2016. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), pp.1545-1602.
  3. Buruck G, Tomaschek A, Wendsche J, Ochsmann E, Dörfel D. Psychosocial areas of worklife and chronic low back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2019;20(1):480.
  4. Venes D. Tabers’s Cyclopedic Medical Dictionary,  23rd ed. Philadelphia, PA: FA Davis Company; 2017.
  5. 5.0 5.1 5.2 5.3 Altug, Z, LifeStyle Medicine and Office Ergonomic Strategies for Managing Low Back Pain. Integrative Lifestyle Medicine for Managing Low Back Pain. Physioplus. December 2021. 
  6. 6.0 6.1 International Ergonomics Association. What is Ergonomics? Available from: https://iea.cc/what-is-ergonomics/#top (accessed 18/12/2021).
  7. Bridger R. Introduction to ergonomics. Crc Press; 2008 Jun 26.
  8. 8.0 8.1 8.2 U.S. Fire Administration. Emergency Services Ergonomics and Wellness. Available from: https://www.usfa.fema.gov/operations/ergonomics/ch1-ergonomics-human-factors-defined.html (accessed 19/12/2021).
  9. Kalakoski V, Selinheimo S, Valtonen T, Turunen J, Käpykangas S, Ylisassi H, Toivio P, Järnefelt H, Hannonen H, Paajanen T. Effects of a cognitive ergonomics workplace intervention (CogErg) on the cognitive strain and well-being: a cluster-randomized controlled trial. A study protocol. BMC psychology. 2020 Dec;8(1):1-6.
  10. 10.0 10.1 Baker R, Coenen P, Howie E, Williamson A, Straker L. The short term musculoskeletal and cognitive effects of prolonged sitting during office computer work. International journal of environmental research and public health. 2018 Aug;15(8):1678.
  11. 11.0 11.1 Coenen P, Parry S, Willenberg L, Shi JW, Romero L, Blackwood DM, Healy GN, Dunstan DW, Straker LM. Associations of prolonged standing with musculoskeletal symptoms—A systematic review of laboratory studies. Gait & posture. 2017 Oct 1;58:310-8.
  12. 12.0 12.1 12.2 Hong S, Shin D. Relationship between pain intensity, disability, exercise time and computer usage time and depression in office workers with non-specific chronic low back pain. Medical hypotheses. 2020 Apr 1;137:109562.
  13. Reddy SC, Low CK, Lim YP, Low LL, Mardina F, Nursaleha MP. Computer vision syndrome: a study of knowledge and practices in university students. Nepalese journal of Ophthalmology. 2013 Sep 23;5(2):161-8.
  14. Ranganatha SC, Jailkhani S. Prevalence and associated risk factors of computer vision syndrome among the computer science students of an engineering college of Bengaluru-a cross-sectional study. Galore Int J Health Sci Res. 2019;4(3):10-5.
  15. YouTube. UC San Diego Health| Relieve Eye Strain with these Expert Tips. Available from: https://www.youtube.com/watch?v=wyVc37ykstU [last accessed 19/12/2021]
  16. United States Census Bureau. Working from home during the pandemic. Available from: https://www.census.gov/library/stories/2021/03/working-from-home-during-the-pandemic.html (accessed 19/12/2021).
  17. 17.0 17.1 Salajar R, Yulianto A. Hazard Identification and Risk Assessment of Human Factors/Ergonomics (HF/E) While Working from Home. American Journal of Engineering Research. 2021;10(2):140-144.
  18. 18.0 18.1 PEKYAVAŞ NÖ, PEKYAVAS E. Investigation of The Pain and Disability Situation of The Individuals Working" Home-Office" At Home At The Covid-19 Isolation Process. International Journal of Disabilities Sports and Health Sciences. 2020;3(2):100-4.
  19. Youtube. Pain from Sitting Too Long? The Anatomy behind Prolonged sitting. Available from: https://www.youtube.com/watch?v=0kU2tNCYTsg (accessed 19/12/2021).
  20. Youtube. TED ED Why sitting is bad for you. Available from: https://www.youtube.com/watch?v=wUEl8KrMz14 (accessed 19/12/2021).
  21. Youtube. Ergonomics self assessment. Available from: https://www.youtube.com/watch?v=Aq1D5Bp3ANo (accessed 18/12/2021).
  22. National Institute of Health. Computer Workstation Ergonomics: Self-Assessment Checklist. Available from: https://ors.od.nih.gov/sr/dohs/Documents/Computer%20Workstation%20Ergonomics%20Self%20Assessment%20Checklist.pdf (accessed 19/12/2021).
  23. YouTube. Yoga with Adriene| Yoga at Your Desk. Available from: https://www.youtube.com/watch?v=tAUf7aajBWE [last accessed 19/12/2021]
  24. YouTube. Ask Doctor Jo| Real Time Exercises & Stretches. Available from: https://www.youtube.com/watch?v=CAq9vV7gkrs [last accessed 19/12/2021]