Posture

Now that we can refer to our exercise video library, I can share with you a short exercise sequence to follow at work/in the office that will take you less than 2 minutes to complete.

If performed every couple of hours (say 4 times a day) these exercises would probably largely curtail posture-induced pain and workplace injury. This is something we tend to teach it in our Posture Management Workshops that we deliver to local companies and organisations (found under the Employee Health section of our website).

Refer to the following exercises in the following sequence:

Exercise 1: Chin Tucks

Exercise 2: Neck Mobility

Exercise 4: Shoulder Mobility

Exercise 12: Pelvic Mobility

Exercise 9B: Thoracic Spine Mobility in a Wheely Chair

If you have any feedback or questions regarding these videos, or are interested in our local employee health programme, please contact us on 020 8566 0767 (Ealing) or 01895 2000 50 (Uxbridge), or by email at help@bridgetohealth.co.uk.

Many of our patients blame their aches and pains on their own bad postural habits; the implication is that if only they could maintain good posture in the chair at work, they would not encounter the same problems. Whilst good posture can help, it is part of a wider picture, and in most cases Osteopathic treatment is a very effective part of the solution. Here are ten reasons why:

1. There is no such thing as perfect chair posture; human beings are not designed to sit in chairs all day
2. A degree of objectivity is needed to evaluate the problem; this is very hard to do for yourself, and the trained eye of an Osteopath will quickly focus on the key issues
3. Assessment means that all related health problems may be identified at the same time, and treated appropriately in a structured and integrated manner
4. The result of sitting in chairs from schooldays onwards is that your body will have adapted e.g. certain joints will be stiffer; treatment can identify and modify those factors
5. Personalised exercise prescription can focus your efforts onto the most effective, relieving and restorative exercises for you as an individual
6. The first aim of treatment is to guide you back towards a sustainable state of relative comfort
7. Treatment is also aimed at improving your general health and mobility over the very long term
8. Consideration of lifestyle factors (such as work patterns or dietary habits) means that improvements are more likely to be sustained
9. It is common for patients to express surprise and delight that they are experiencing a state of physical ease and wellbeing they had forgotten was possible
10. The experience can equip you with the understanding and means to tackle similar health issues as and when they arise in the future

We’ve posted a few entries about posture at work – on a wide variety of topics such as

• what sort of bag is best for my back?
• Top tips for good posture at work (in the office)
• It’s just my posture … the slippery slope towards work related injury

I’ll post again in the next day or so some simple 2 minutes exercises that can help with good posture.

This was a question from a patient who was concerned that he might have something seriously wrong with his neck because the clinical treatment alone was not enough to maintain relief of his symptoms. As an osteopath, it is an interesting statement because it points to a fundamental misconception of what constitutes

“doing something to your neck”.

For the patient, sitting in a chair at work 5 days a week was a natural way of life, and not something he expected to result in too many consequences. In terms of biomechanics, that starts to look suspect on many levels, not least in terms of the moulding effect on posture. There is an old saying,

“of all the inventions of Man, nothing is as cruel as the chair”.

What happens to your neck when you sit down is this.

When you sit, you lose the natural inward curve of your low back; the result is that your upper body and head is tilted forward, and therefore you will pull your head back to level your gaze. The modern preference for eye-level screens will exacerbate this unless you maintain the curve in your low back; similarly, leaning forward will exaggerate it. The net effect is that the back of your neck is compressed, much as if you were stood looking at the night sky, or painting a ceiling for hours at a time. The difference in these activities may seem significant to you, but as far as your body is concerned, you are squashing the base of your neck whichever way.

This means that over time, the region around the base of your neck will tighten, and movement will be reduced due to joint compression. Taken over days, weeks, months and years, the effects become more ingrained in the body structure, and you lose the ability to move freely.

Osteopathic treatment can help to counteract the long-term consequences of deskwork, but prescribed exercises will play a big part; without restoring adequate everyday motion to an area, your body will tend to trade off mobility for stability.

The stiffening that my patient was experiencing is a natural economy of needs that your body performs: where motion is used, it will tend to be maintained; where it is not used, it will be discarded. There is truth in that other old saying “use it or lose it”.

I am a registered osteopath in Ealing, and neck pain and back pain are just two complaints/conditions/injuries that we treat. If you have any questions or need some advice, please do contact us. (The Ealing clinic is on The Green, literally a four minute walk from Ealing Broadway).

Most of our office-based patients come to us complaining of a similar set of injuries typically induced by the sedentary lifestyle that goes with working at a desk, and the poor postural habits we acquire in that environment.

Once the pain and other symptoms have been addressed, the focus of patient care switches to the prevention of similar occurences in the future. Ever in quest of the magic bullet, many patients ask us whether acquiring good working posture will address the problem.

Inevitably, the answer is… both yes and no!

Unquestionably, learning and applying the basic components of good desk-based posture – as outlined in an earlier post – Top tips for better posture at work (in the office) – is pivotal to injury prevention.

But we also have to acknowledge some fundamental truths: namely, that we were not designed and equipped to work for hours at a time at a desk (no more than to drive for hours in a car or totter around on 3-inch heels carrying a briefcase crammed with laptops and documents…).

Effective workplace injury prevention involves addressing a much wider range of issues including:

1. desk and office-based exercises at regular intervals during the working day
2. daily home exercise to counter some of the stresses inherent to desk-related postural imbalances
3. nutrition and hydration habits at home and work
4. sound lifting and carrying ergonomics (some advice posted here)
5. regular and effective relaxation/recovery routines
6. good sleeping habits and posture

All of which combine to provide a more comprehensive insurance against posture and stress-related injuries in the future. It is with this in mind that we designed our Workplace Injury Prevention Workshop, which aims to train office workers, increase awareness and reduce the risk and cost of postural and repetitive strain injuries. If we can help your organisation – please get in touch (we are osteopaths based in Ealing and Uxbridge)

At the end of a recent treatment session, a patient asked me what was the best type of bag to get from an osteopathic perspective.

My mouth opened and closed a few times before anything came out, followed by a few embryonic thought bubbles. Since then I have given the question some more thought in order to identify what I see as the salient issues concerning bags and backs.

1. Make sure it is fit for purpose
   If you have any specific equipment you have to carry such as a laptop, camera, etc. Someone else has already worked out some of the ergonomic issues for you, so looking at relevant task-specific bags will help you make an informed choice, even if you subsequently buy something else.
2. Make sure it is appropriate for you
   This is less easy to define as we are all unique individuals, but the sort of issues you should take into account are any specific medical or physical conditions that may be affected by carrying the bag. Beyond that, we all have certain postural tendencies and movement patterns that will be influenced by carrying (see below).
3. Carry as close to your body as possible
   This affects both your choice of bag and how you use it. The further away from your body it is, the harder a bag will be to carry, and the more it will alter your posture and movement. This means that a bag should be as flat as is practical, so that you can position the extra weight around your body rather than away from it (bags that you can fit under your arm are much easier to carry than wide bags that bash against your legs).
4. Consider where in relation to your body the extra weight will be placed
   You will automatically use your body to lean away from a bag in order to maintain balance, and then you will use your neck to restore your head to level, with your eyes looking straight ahead. The more weight you are carrying, the more exaggerated this compensatory pattern will be, and the more worthwhile considering whether a wheelie bag is more appropriate.

5. Chose a bag that allows you as many carrying options as possible
   The more variety of carrying options you have, the less you will exaggerate any one postural tendency, and the easier it will be to relieve any stains that develop in the course of everyday use. A bag with back straps, a shoulder strap and a handle gives you plenty of options for variety; a bag with a single strap may limit you to a single carrying method.
6. The way you use the bag is generally more important than what type of bag it is
   Buying a spanking new bag that you carry in the same old way probably wont make much difference to your posture, health or symptoms. By all means try to find something that suits you, but take the opportunity to increase your awareness of your habit patterns, and if eg. you always carry on one shoulder, try changing shoulders regularly; you may discover something that helps you for free.

Lastly, if it all seems too confusing you can always get in touch with us; we may be able to make some suggestions, although there is no substitute for talking face to face in a treatment session (we are located in Ealing and in Uxbridge).

nb. At the recent back show at Earl’s Court, Mathieu saw something called the healthy back bag. The company are in the process of redesigning their computer carrying bag, and have a wide range of fashionable bags; well worth a browse.

I must admit Peter and I approached our visit to the Back Show with a mixture of wariness and cynicism, expecting to come across an endless array of dubious gadgets, miracle potions, and the-definitive-solution-to-all-back-pain-at-an-almost-affordable-price…

In the event, we spent a really absorbing couple of hours meeting a wide range of enthusiastic professionals, each contributing something specific and positive to the complex patchwork of musculoskeletal pain.

We first met Katie Baylis of Putnams, a family-run firm specialised in an extensive range of orthopaedic products. Having just written a blog post about choosing a pillow, Peter was interested in their pressure relief cushions. You can review the range on their website but Bridge to Health patients can order through us to get a discount.

A short while later, we were sampling the unique footwear concept of Terra Plana, a company that has designed a shoe aiming to deliver the same experience and benefits to foot and body as if you were wandering around… bare foot. We were so bowled over by the experience that we instantly purchased a pair each, and I have scarcely used anything else in clinic since, feeling far less tired than previously by the end of the day.

A Terra Plana shoe using bare foot technology

We then spent ten minutes lounging around in the best office chair I have ever come across, the SwingSeat^TM designed by SmartMotion Technology. Pricy, but if you are going to be chained to a desk all day… it’s the next best thing to a walk in the park – and we can offer discounts, so speak to us first!

We then chanced upon the Healthy Back Bag Company which manufactures an alluring range of stylish bags designed to carry light to moderate weights whilst minimising spinal damage. I was favourably impressed by their laptop bag, as I’m constantly badgering patients to carry theirs more smartly… take a peak at the catalogue.

I also spend a lot of time trying to tempt patients to spend more time swimming, which is why I was happy to come across the Art of Swimming, an organisation led by Steven Shaw that has imported Alexander technique’s postural framework to the swimming pool. Their teaching program sounds very exciting and may well be available in a swimming-pool close to you.

I quickly visited the stand of the National Osteoporosis Society which publishes a set of handy self-help booklets, and our friends and colleagues at the Pilates Foundation and at the Society of Teachers of the Alexander Technique (STAT) as the show began closing.

Time was running out as I passed the Back 2 stand which promotes the MastercareMini^TM, a very practical light “inversion table” (a device allowing you to stretch your back by hanging upside down), which as a back sufferer always makes me drool. The ushers were converging on us by that time, but I will be investigating that contraption in the near future.

We will definitely be returning to the 2010 Back Show next year, scheduled at the Olympia 2 on 24th and 25th September (dates to be confirmed). Indeed, I would recommend you do so yourself!

Tennis elbow – a.k.a. lateral epicondylitis – is one of the most common overuse injuries.

It is usually associated with repetitive finger/wrist movements such as in typing, using a mouse on a computer, wielding a hammer or a racket, or using a screwdriver.

It commonly affects a wide range of office and manual workers: typists, computer operators, carpenters and plumbers, cashiers etc and… yes, racket athletes.

Although there may be no swelling or redness, the condition manifests with pain on the outside of the elbow or in the forearm, worse when gripping a handle or lifting a weight. When it is particularly bad, it may even prevent the sufferer from working.

To the extent that the elbow is an integral part of the upper body at work, tennis elbow is often related to poor working posture, and may be accompanied by wrist, shoulder and/or neck pain as the condition becomes entrenched.

Initially, treatment of tennis elbow involves:

• Resting the joint until the pain subsides, and limiting any aggravating movements of the wrist, elbow or shoulder;
• Applying an ice pack to the elbow for a few minutes at regular intervals to reduce the inflammation
• Light massage therapy of the forearm, and gentle easy movement of the wrist, elbow, shoulder and neck / mid back;
• Increased water intake (not tea or coffee) to facilitate tissue repair.

If the condition has been present for 2-3 months or over, treatment is more involved and diverse:

• More intensive mobilisation of the elbow, but also upper back, neck and other upper limb joints;
• More extensive massage of the elbow and forearm muscles;
• Contact hydrotherapy (application of hot/cold water) to encourage local blood supply and tissue repair;
• Home and workplace exercises emphasising stretching of the wrist muscles and movements of the upper limb and neck;
• Adapting the work station, e.g. bringing the mouse closer to the keyboard, using wrist rests, using larger, shock absorbing handles on work tools.

If you think you are suffering from tennis elbow, please call us on 01895 20 00 50 to discuss your symptoms and seek further advice. Our clinic is located on Uxbridge high street. Bridge to Health also arranges drop-in employee health checks on site at local businesses and organisations as part of its Corporate Services offer, providing busy workers an opportunity to discuss and take action on health issues that might otherwise go unchecked. Do contact us if we can help!

New NHS treatment guidelines have suggested that complementary therapies be used in the treatment of certain conditions: in particular, chronic low back pain sufferers may be referred for osteopathy.

Reactions to this have been mixed. Many welcome these developments, but others have questioned whether there is sufficient evidence to suggest that this approach could be an effective use of precious resources.

For those who are concerned about the effectiveness of osteopathy for low back pain, I would draw your attention to 2 aspects of this issue:

1. Low back Pain is a symptom, not a diagnosis. Many people can have similar symptoms, whilst the causative factors (diagnosis) may be different. Throwing any form of treatment (e.g. massage) at a symptom is rather like throwing darts at a board blindfolded.
2. Osteopathy is a system of healthcare, not a form of treatment. The osteopathic approach strives to understand the symptoms, arrive at an accurate diagnosis, and subsequently deliver appropriate forms of treatment.

Anyone concerned about the appropriateness of osteopathy for the treatment of their symptoms or condition is welcome to talk to us on 01895 20 00 50.

This article aims to provide a rapid, practical checklist of good postural habits for people working at a desk so as to lower the risk of the many postural injuries we routinely see in clinic.

Your Seated Body

• Keep your head up, chin tucked in, shoulders relaxed
• Ensure your elbows are tucked in, your arms and hands broadly horizontal, avoid flexing or extending your wrists
• Ensure your thighs are at around 45 degrees to the top half of the body, and your feet flat on the ground – remove high heals at the desk!

Your Chair

• Edge well back in your chair, sitting tall and maintaining the slightly extended curvature of your lower back
• Adjust your backrest to support the small of your back
• Do away with armrests – which encourage slouching – and ensure that your elbows are at same height as the keyboard

Your Workstation

• Push your keyboard back from the edge of the table to give your hands and wrists the space to remain aligned
• Position your mouse as close as possible to the keyboard, and favour keyboard functions over mouse wherever possible
• Set your screen square on, and the top of it just below eye level – if you have a laptop, ensure you have a separate screen and keyboard
• Adjust your screen to remove any glare
• Have a document holder and position it as close to the screen as possible – use eyes rather than neck for reading and touchtyping
• Remove any clutter from under your desk

Managing Health during the Working Day

• No-one can maintain good posture for long – set your computer timer to remind you every hour to get up and walk about for a bit
• Use that break to do a few simple neck and shoulder movements: head forward/back, rotating right/left, ear to shoulder right/left, roll shoulders backwards and forwards, repeating each 4-6 times
• Keep a 1.5L bottle of water close to hand; sip at regular intervals aiming to finish the bottle in the day
• Leave your desk at lunch – eating and working do not mix well!

If you are looking for a good desk chair, you may want to look at the Bambach saddle seat which was designed by an Australian therapist to maintain optimal posture – but remember that the secret of good posture resides in… not remaining seated too long!

If you have any views or questions, please contact Mathieu or Peter by email or phone (01895 20 00 50). We would love to hear your feedback, and any suggestions for future topics too. You can also leave a comment on our blog here.

Every day of the week, we are visited by patients complaining of lower back pain, neck pain, head-aches, shoulder, elbow or wrist strains.

Many of them are busy professionals from companies and organisations in the Uxbridge and Hillingdon area. As we gather background information relative to the causes of injury, many of these patients will rather insightfully say

“it must be posture-related”.

In a sense, they are right: as office workers sit at their desk all day, increasingly hunched over their computer screen, so their chest and neck muscles tighten, compressing the vertebrae in their neck, straining their mid and lower back muscles, causing their shoulders, elbows and wrists to function at unnatural angles, and to sustain repetitive strain injuries; and as they cross their legs in these interminable meetings, so their pelvis may become twisted, resulting in lower back pain and lower limb complaints. The current prevailing mood of heightened stress is but an extra potential trigger of the injury process…

However, there is a degree of fatalism in incriminating posture, in other words it is often seen as an inevitable fact of life.

As osteopaths, we hope you would expect us to disagree strongly: with a little awareness focussed on understanding the mechanism of injury, altering the layout of work stations, improving working posture and implementing some basic lifestyle and postural exercise routines, the frequency of work-related injuries can be radically altered.

Over the coming weeks and months, Bridge to Health’s osteopaths will be stepping up their campaign to increase public awareness of how to prevent these types of injuries.

Our June health offer to local employees living or working in and around Uxbridge will centre on a postural assessment and osteopathic treatment, coupled with some practical exercises to enhance posture.

We will also be speaking to our corporate clients to encourage them in a pragmatic approach to work-station ergonomic assessments, coupled with employee training in workplace injury prevention practices.

If you believe you’re suffering from the effects of poor posture, feel free to contact your local osteopath on 01895 20 00 50 (the address for our Osteopathic Clinic in Uxbridge is here). If you think that a conversation with your company’s health and safety representative would be helpful, they are welcome to visit our website www.bridgetohealth.co.uk and then to contact us on the same number.