Lower Back Pain & Exercise
Low Back Pain is a huge burden on the community. The impacts are felt in the healthcare system, lost days at work & obviously the psychosocial impacts on the sufferer. But what are the different types of back pain & does exercise help?
According to the AIHW (2020), About 4.1 million, or 16% of Australians have a self-reported lower back pain (LBP). Individuals with LBP often experience limitations on their day to day functions. In addition, LBP is associated with increased absence from work, medical expenditure, and a poorer quality of life.
What Are The Different Types Of Lower Back Pain?
LBP is often grouped into 3 categories:
Specific Spinal Pathology
Radicular (Nerve Root) Pain
Non-Specific Lower Back Pain (NSLBP)
Acute Low Back Pain
Serious Spinal Pathology
Cancer
Age > 50 years
History of cancer
Unexplained weight loss
Failure to improve with conservative surgery
Vertebral Fracture
Age > 50 years
Female
Major trauma
Pain & tenderness
Distracting painful injury
Nerve Root Pain
Pain in the leg (+/- pins and needles or numbness) in a dermatomal distribution
Leg pain worse than back pain
Neurological exam reveals sensory, motor, and reflex changes of the same spinal level
Non-Specific Low Back Pain
Pain in the lumbosacral area
Pain may radiate diffusely into buttock or thigh, but not below knee crease
Patient is generally well
Age 20-55 years
Pain is mechanical in nature
Diagnostic triage (Hush & Nicholas, 2011)
Most LBP fits into the 3rd category, being non-specific low back pain. It has been said that up to 85% of all LBP cases have an unknown cause (Gordon et al, 2021). There is a wide range of evidence for exercise therapy in the treatment of LBP. Its us is to address impairments that are thought to be contributing factors.
Exercise & Low Back Pain
Exercise is thought to reduce the severity of pain compared to no treatment (Hayden et al, 2021). One possible reason might be due to the fact that exercise promotes blood flow to the tissues around the back, which is an important process in healing (Benjamin, 2014). The Dutch Physiotherapy Guidlines (2002) recommend that patients with non-specific low back pain engage in general exercise, as remaining inactive for long periods can negatively impact recovery. This is due to the difficulty in localising a specific source of injury, making the prescription of specific exercises hard. As a result, physiotherapists treat impairments identified in assessments that are known to be predictors of LBP. This can range from poor muscle recruitment, muscle weaknesses or biomechanic strategies.
One popular method for treating low back pain is the Pilates method. Pilates encourages the activation of stability muscles during movement. Cueing relating to the Multifidus, Transverse Abdominus, Diaphragm & Pelvic Floor are common features of the Pilates method. Pilates equipment such as a Reformer, Wanda Chair, and Trapeze have been demonstrated to improve the development of Transverse Abdominus compared to mate-based pilates work (Eliks et al, 2019).
The Summary
Low Back Pain is a prevalent condition that has been documented and studied across the globe for decades. it leads to losses in productivity, decreases in functional ability, and reduced work performance.
While there are many known causes of LBP, most fall into the non-specific category.
Exercises such as clinical Pilates can lead to improved outcomes by improving blood flow, promoting healing, and strengthening muscles in the affected areas.
References
Thoracic Outlet Syndrome
Thoracic outlet syndrome, commonly abbreviated to TOS, may very well be one of the most difficult and controversial diagnosis in clinical medicine.
The goal of this Blog is to breakdown this condition and to better understand what we as musculoskeletal type practitioners can do to provide the best care for patients presenting with possible symptoms of TOS. Whether that be assessing the condition, providing hands on or exercise based treatment or even knowing when best to refer on a patient that may need further investigation or even surgical intervention.
Thoracic outlet syndrome, commonly abbreviated to TOS, may very well be one of the most difficult and controversial diagnosis in clinical medicine.
The goal of this Blog is to breakdown this condition and to better understand what we as musculoskeletal type practitioners can do to provide the best care for patients presenting with possible symptoms of TOS. Whether that be assessing the condition, providing hands on or exercise based treatment or even knowing when best to refer on a patient that may need further investigation or even surgical intervention.
To understand the condition you first must understand the area, consisting of a group of three spaces between the clavicle, the first rib to the axilla which several important neuro-vascular structures pass. Structures of which include the brachial plexus, subclavian artery, and subclavian vein as seen in image 1 below.
Compression will primarily occur either in the inter-scalene triangle, the costo- clavicular space or the sub-coracoid space.
Inter-scalene Triangle
The first and most medial area created by the borders of the anterior scalene muscle, middle scalene and the first rib. This is where the brachial plexus and subclavian artery pass through the inter-scalene triangle.
Costco-clavicular Space
The second area is bordered by the subclavius muscle, clavicle, the first rib and anterior scalene muscle, this is where the brachial plexus, subclavian artery and subclavian vein all pass through.
Image 1
Subcoracoid Space
The pectoralis minor muscle forms the anterior border and the ribs form the posterior boundary. The brachial plexus passes through this space, and the subclavian artery and vein continue through it as the axillary artery and vein.
We also need to take into account the muscles that border these areas that the neurovascular structures pass through, as muscle hypertrophy and overuse can contribute to the compression of these structures.
Types
TOS is widely known to consist of 3 main types, which come with differing symptoms, diagnostic criteria and standard treatment strategies.
Neurogenic TOS
A presentation within the clinic where the Brachial Plexus is compressed
See image 1
Vascular TOS
A less common presentation but one that needs considerable treatment due to the compression of the subclavian artery +/or vein
Within this type, there are four sub-categories
1. Acute Thrombosis
A sudden blockage or clot
2. Chronic Stenosis
Long term narrowing
3. Intermittent obstruction without Thrombosis
Closing & opening of the vein or artery due to obstruction that isn’t a blood clot
4. Complete Obstruction
The vein or after is completely blocked & is not allowing blood to flow through
Non-specific TOS
When objective tests can’t differentiate between Vascular or Neurogenic, the presentation is termed as Non-specific.
(Povlsen, Hansson, Povlsen, 2014)
Movements
People with the shoulder flexed for majority of the work day (e.g. over head actions)
Have repeated trauma to the shoulder joint
Extended duration in compromising shoulder positions, those who exhibit abnormal posture, including positions required to play bowed instruments.
Repeated trauma to the head or neck
Postural dysfunction
Pregnancy, oedema, anatomical deviations, hypertrophied muscles, boney growths, and muscle weakness are all theorised to be contributing factors to TOS.
The most commonly presented cause of TOS appears to be caused by a whiplash motion that can result in instability at the atlantoaxial joint (C1-C2), causing the surrounding musculature such as the sternocleidomastoid and scalenes to shorten and alter their function to compensate for the laxity in the joint. This can lead to an entrapment of the brachial plexus, subclavian artery, subclavian vein, or a combination of these vessels and tissues (Levine & Rigby, 2018).
Symptoms
As mentioned previously the symptoms you may present with will indicate whether you have either definitive Neurogenic, Vascular or be a symptom of both.
Due to compression you may experience localised pain in the neck or shoulder, or alternatively in the upper arm or even referred down to the hand due to the structures that are compressed extending and branching down into the hand and fingers.
This may also illicit weakness in the corresponding limb as these nerve branches control the muscle contractions of the arm and hand.
A true symptom of Neurogenic TOS is the decrease in muscle mass of a muscle in the base of the thumb (Abductor Pollicis Brevis) or intrinsic muscles in the hand.
In regards to a Vascular specific diagnosis symptoms will usually include swelling, cyanosis (extremity turning blue) or even a decreased and difficult to read pulse (Jones et al. 2019, Povlsen et al. 2014).
Testing
So, if TOS is difficult to diagnose then how exactly do we get to the stage where we believe that is what the patient is presenting with and to then provide a gold standard treatment?
Well if you have seen a Physiotherapist or a Myotherapist at Richmond Rehab or even elsewhere you will be very familiar with how many questions we ask, to get a better understanding of your symptoms and to try and tease out differentiating symptoms to narrow down our testing.
By this stage of a session if you have mentioned any of the previous symptoms your therapist will likely undergo the following objective tests to confirm or count out TOS.
Adsons Test
A manoeuvre where the therapist will find the patient's radial pulse down near their wrist and then proceed to move the patient's arm upright in an arc compressing the subclavian artery. The therapist will gauge whether the patient's pulse diminishes and then compare to the opposing non-symptomatic side.
Roos Test (Elevated Arm Stress Test) - Across
This is a quite easy one for the patient to perform and works well for inter-therapist reliability. The patient stands in with both shoulders and elbows at 90 degrees and externally rotated in the “surrender position”. They will then squeeze their hands for up to 3 minutes or until symptoms occur.
Adson’s test has a 92% sensitivity and Roos a 98%, meaning it has a 92% and 98% chance respectively of identifying a condition within the tissue being tested. However where this gets difficult is the specificity is quite low, documented to be below 80% even as low as 18%, meaning that althought symptoms are present we as therapist cannot definitively say that the patient has TOS. Where this changes however is when combined and both showing positive results the specificity increases to approximately 82% (Jones et al. 2019, Sadeghi-Azandariyani et al. 2009)
Imaging
One of the greatest tools we have as therapists is the referral network, specifically knowing who or when to refer someone on for a condition or set of symptoms that either may need further investigation or more importantly a condition that we are unable to treat.
TOS is a condition that is important in its diagnosis of true neurogenic or vascular types.
Neurogenic
When suspecting neurogenic TOS symptoms a nerve conduction study may be referred by your doctor, neurosurgeon or neurologist, as well as an EMG (Electromyography) to test the nerves that run down your arm branching off the brachial plexus that may be compressed.(Povlsen et al. 2014)
Vascular
If a vascular type of TOS is suspected or even to differentiate a non-specific or disputed type of TOS then imaging is essential.
The three most common tests you will be referred for are either a Chest Radiograph (X-ray), MRI or a CT scan, alternatively an ultrasound has high sensitivity and specificity. These are the preferred non-invasive techniques, however if the patient requires urgent care for an acute vascular TOS then an angiograph may be required (Raptis et al. 2016, Jones et al. 2014).
If you believe you may have symptoms of vascular TOS then a consultation with your GP would be recommended.
Treatment Strategies
The main goal for treating TOS would be to treat any muscle imbalance, decrease muscle tension and increase muscle length of shortened structures improving symptoms of nerve compression.
A range of Myotherapy techniques can be used to assist relaxing the muscles surrounding the area and assist restoring postural faults that could have been contributing to compression of the thoracic outlet. Hands-on treatment may include massage, myofascial release, trigger point therapy and post-isometric relaxation stretching techniques. These treatment techniques are most effective when combined with correct stretching and strengthening exercises.
Co-management of TOS is also fundamental to recovery. A myotherapist can work alongside other allied health or medical practitioners to help manage thoracic outlet syndrome. Management would include improving upper body posture through education, implementing strength exercises, changing movement patterns, sleeping position or recreational activities.
Management
Ok, now you have been to your therapist and you have a working clinical diagnosis of TOS and you’re up to the stage where you need to do something about it!
The options are Operative or Non-operative
One we are well trained to provide and the other unfortunately will have to be done by a trained surgeon...
Treatment and management strategies of neurogenic TOS are recommended for a minimum of four months prior to engaging in surgical intervention.
Rehab is the initial recommended management and should include Physiotherapy based exercises for postural mechanics to decrease the soft tissue compression. Exercise prescription alone is difficult to achieve the desired results and will often work well with activity modification advice and education from your physiotherapist and myotherapist and relaxation techniques mentioned previously best administered by a myotherapist or remedial massage therapist (Jones et al. 2019).
Additional treatment strategies like pharmacological treatments will assist in the improvement of pain symptoms and neurological symptoms and should be discussed with your GP.
With regards to a vascular type of TOS, a surgical intervention is at times undertaken prior to musculoskeletal rehab with a Physio. Post-surgical management will likely involve a comparable rehab strategy as a non-operative Neurogenic TOS (Povlesen et al. 2014).
This condition like a lot of other conditions is not a cookie cutter method, meaning that the treatment largely is based on symptoms and presentation rather than a blanket treatment for all TOS patients. The best thing you can do for treatment of this condition is have a therapist assess you and plan out the treatment strategy or as mentioned previously refer on for further investigative assessment.
References
Injuries in Hairdressing
As a result of prolonged and repeated lockdowns, we have realised how important our hairdresser or favourite barber is to our health and wellbeing, but we rarely think about the injury and occupational burnout that is highly prevalent in this occupation.
As a result of prolonged and repeated lockdowns, we have realised how important our hairdresser or favourite barber is to our health and wellbeing, but we rarely think about the injury and occupational burnout that is highly prevalent in this occupation.
Hairdressing like any repetitive task comes with its strains and stresses.
A 2019 scoping review by Kozak and colleagues looked at a wide range of studies that assessed the bio mechanical disadvantages this occupation group is subject to, such as spending between 9-13% of total working time with their arms elevated to or above 60 degrees (chest height), of which is a clinically relevant factor in shoulder injuries and persistent severe pain.
There are statistics like this for multiple areas of the body in hairdressing, applicable for both male and female workers, so this spurs the question - “How can you reduce the risk of injuries happening and prolong your career?”
Common Hairdressing Injuries:
Let’s hone in on the more common sites of injury and what structures are being overloaded due to repetitive tasks:
Lower Back (76%) and Neck pain (58%) were prevalent in a twelve month period
Shoulder (60%) and Wrist/Hand pain (53%) were prevalent in a twelve month period
Foot (44%) and Knee pain (41%) were prevalent in a twelve month period
(Kozak, et al. 2019)
What Contributes to these Injuries?
Strenuous hand or arm postures and movements (e.g. arms above shoulder, repetition)
Awkward postures and movements of the spine (e.g. bending and twisting the back)
Workload and biomechanical strain (e.g. mechanical workload, overtime, no breaks)
Prolonged standing and sitting
Other factors (e.g. work experience, mental stress and burnout, gender or low support)
Specific hairdressing tasks (e.g. cutting, dying or styling hair)
(Kozak, et al. 2019)
What Can You Do?
It might seem obvious but taking a break between the stressful activities can prevent or alleviate micro injuries of all the above areas
Occupation specific changes: including but not limited to using a chair for lumbar pain, keeping arms near the body for shoulder pain, and cutting with the wrists in a neutral position for wrist pain
Improving ease of access such as asking customers to turn or bend the head and lowering the customer to an appropriate height
Early introduction of education on injury prevention (Kozak et al. 2019) noted a decrease in shoulder pain with when educating student hairdressers about shoulder positioning while cutting hair.
7 Exercises to Help Prevent Injuries:
Where we come into the prolonging of a work lifespan is through exercise, addressing the positions of extended exposure is through physical preparation and exercise.
Some examples to address these are not limited to the list below but they are a great starting point.
Forearm flexor stretch
Wrist Rolls
Scapula (shoulder blade) Squeezes
Thoracic Extension to the wall or a Foam Roller
Standing Extension or Prone Extensions
Standing Rows
Chin Tuck
If you have an injury or significant pain in one of the above areas please consult your physiotherapist prior to attempting the above exercises, an assessment to provide individualised programs is the best way we can help.
Tradies Health Month - August 2016
Tradies National Health Month
Health 'SNAPSHOT'
Prepared by the Australian Physiotherapy Association
This Article Has Been Prepared By The Australian Physiotherapy Association
About The Tradies National Health Month 'Snapshot'
Marcus Dripps, APA National President
The Australian Physiotherapy Association (APA) has compiled the following health snapshot to highlight the need to improve the health, safety and wellbeing of tradies* in Australia.
This snapshot gathers research and insights to highlight the extent of the issue and solutions to create change. While musculoskeletal injuries like back and neck injuries remain among the top health issues facing tradies, other chronic health conditions and disability post risks to this demographic.
Beyond the quality of life impacts these health issues have on the individual and their families, there are significant impacts to business, the health system and the economy. These impacts will grow if we don't improve information and access for tradies to evidence-based care like physiotherapy.
Physiotherapists play a critical role in providing early healthcare intervention support - by diagnosing, treating and preventing disease and disability through physical means. Working in partnership with their patients, physiotherapists can help them recover from injury, reduce pain and stiffness, increase mobility, and prevent injury.
The APA is proud to lead Tradies National Health Month each year to champion awareness and create tools to enable tradies to take control of their health and stay well.
Tradies' health must be everyone's priority. As the national member association of physiotherapists, we believe all Australians should have access to quality physiotherapy, when and where required, to optimise health and wellbeing.
Tradies Have A High Risk Of Serious Injury
Rates of serious claims by occupation (2012-13)
Tradies have among the highest serious injury and disease compensation claims in Australia, according to Safe Work Australia data. Labourers, technicians, and machinery operators and drivers are among the top four occupations when it comes to the number of serious injury claims.
| Occupation | Incidence rate (claims per 1000 employees) | Frequency rate (claims per million hours) |
|---|---|---|
| Labourers | 27.0 | 18.7 |
| Machinery operators and drivers | 24.4 | 12.3 |
| Community and personal service workers | 17.8 | 13.9 |
| Technicians and trade workers | 15.4 | 8.0 |
| Sales workers | 6.0 | 4.8 |
| Professionals | 4.8 | 2.7 |
| Clerical and administrative workers | 4.0 | 2.5 |
| Managers | 4.3 | 2.0 |
| Total | 11.1 | 6.7 |
The Primary Causes Of Serious Claims
Of all occupations
33% Were From Muscular Stress While Lifing Or Handling Objects
22% WERE FROM FALLS, TRIPS AND SLIPS
Watch More Than Just Your Back
The majority of serious claims are from injuries and musculoskeletal disorders, including traumatic joint, ligament, muscle and tendon injuries.
What Is The Issue?
- While musculoskeletal disorders remain high, the number of serious claims fell by 7% between 2000-01 and 2011-12
- However, claims arising from diseases increased by 4% between 2000-01 and 2011-12.
Watch More Than Just Your Back
| Injury & Musculoskeletal Disorders | |
|---|---|
| Traumatic joint/libament & muscle/tendon injury | 44.7% |
| Musculoskeletal & connective tissue diseases | 15.2% |
| Wounds, lacerations, amputations & internal organ damage | 15.2% |
| Fractures | 9.2% |
| Other injuries | 3.0% |
| Burn | 1.7% |
| Intracranial injuries | 0.5% |
| Injury to nerves & spinal cord | 0.2% |
| Total injury & musculoskeletal disorders | 89.80% |
| Diseases | |
| Mental disorders | 5.9% |
| Digestive system diseases | 2.2% |
| Nervous system & sense organ diseases | 1.0% |
| Skin & subcutaneous tissue diseases | 0.5% |
| Infectious & parasitic diseases | 0.2% |
| Respiratory system diseases | 0.2% |
| Circulatory system diseases | 0.1% |
| Other diseases | 0.1% |
| Total diseases | 10.20% |
| Occupation | Frequency rate (serious claims per million hours worked) | Incidence rate (serious claims per 1000 employees) |
|---|---|---|
| Labourers | 18.7 | 25.1 |
| Machinery operators and drivers | 11.2 | 22.3 |
| Technicians and trade workers | 7.4 | 14.4 |
| Occupation | Frequency rate (serious claims per million hours worked) | Incidence rate (serious claims per 1000 employees) |
|---|---|---|
| Labourers | 1.8 | 1.3 |
| Machinery operators and drivers | 2.1 | 1.1 |
| Technicians and trade workers | 1.1 | 0.5 |
What Body Parts Are Affected?
While backs still present the highest proportion of body stress injury claims, other body parts affected include upper limbs, lower legs, hips, the abdomen and the pelvic region.
Falls, trips and slips of a person: serious claims by body part among all occupations
- The back (upper or lower) had the highest claims, yet this fell by 21% between 2000-01 and 2011-12
- The only major physical location group to show an increase in serious claims between 2000-01 and 2011-12 was lower limbs, which was largely driven by a 21% increase in the number of lower leg-related serious claims and a 17% increase in hip-related claims.
|
Older Tradies Could Have Higher Health Risks
Serious claims are increasing among those aged 55+
- Older employees in all occupations had higher frequency rates of serious claims than younger employees over a 12-year period (2000-01 and 2012-13).
- The proportion of all serious claims awarded to employees aged 55 and above rose from (% in 2000-01to 18% in 2011-12.
- This has exceeded the proportion of all serious claims awarded to employees aged 15-24 years since 2007-08
Chronic Health Conditions And Other Long Term Impacts |
|
| 1. Deborah J Schofield. Med J Aust |
| 2. Arndt V1 et al, Occup Environ Med |
What Is The Cost?
The total estimated cost of work-related injuries and diseases is rising.
- In 2008-09 the total estimated cost of work-related injuries and diseases was $60.6 billion among all occupations
- Between 2000-01 and 2011-12, the median time lost from work for a serious claim rose by 29% from 4.2 working weeks to 5.4 working weeks
- Over the same period, the median compensation paid rose by 71% from $5200 to $8900.
| 2000-01 | 2005-06 | 2008-09 | |
|---|---|---|---|
| Total estimated cost | $34.4 billion | $57.5 billion | $60.6 billion |
| Estimated cost as a percentage of GDP | 5% | 5.9% | 4.8% |
| Percentage of cost borne by workers | 44% | 49% | 74% |
| Percentage of cost borne by community | 53% | 47% | 21% |
| Percentage of cost borne by employers | 3% | 4% | 5% |
| Occupation | 2000-01 | 2007-08 | 2008-09 | 2009-10 | 2010-11 | 2011-12 | % change |
|---|---|---|---|---|---|---|---|
| Labourers | 4.1 | 4.5 | 4.8 | 5.0 | 5.2 | 5.2 | 27% |
| Technicians and trade workers | 4.0 | 4.2 | 4.4 | 4.5 | 4.6 | 5.0 | 25% |
| Community and personal service workers | 4.0 | 4.9 | 4.8 | 4.6 | 5.0 | 4.9 | 22% |
| Machinery operators and drivers | 4.4 | 4.9 | 5.2 | 5.0 | 5.6 | 5.8 | 32% |
| Occupation | 2000-01 | 2007-08 | 2008-09 | 2009-10 | 2010-11 | 2011-12 | % change |
|---|---|---|---|---|---|---|---|
| Labourers | $4400 | $5600 | $6500 | $7000 | $7400 | $7800 | 77% |
| Technicians and trade workers | $5000 | $6400 | $7400 | $7900 | $8200 | $8500 | 70% |
| Community and personal service workers | $4600 | $6200 | $6600 | $6500 | $7100 | $7100 | 54% |
| Machinery operators and drivers | $5900 | $7800 | $8600 | $9000 | $10400 | $10400 | 76% |
What Can We Do To Prevent The Issue?
It is vital tradies become more aware and active in improving their health and safety. Early injury intervention and treatment through evidence-based care, including physiotherapy, must be part of the solution to prolong working careers, reduce time away from work and improve general wellbeing.
Employers, peak bodies and government need to acknowledge the significant role they play in ensuring their workers are fit-for-work and offer appropriate support when it comes to preventative health measures.
| While it is essential individuals and employers consult with a physiotherapist for a tailored program, general tips for preventing injury include: |
|
Partner With Physiotherapy For Workplace Change
Visit tradieshealth.com.au to find out how you can get involved.
References
- Bisset LM, Vicenzino B (2015) Physiotherapy management of lateral epicondylalgia. Journal of Physiotherapy 61: 174–181
- Safe Work Australia (2015) Key work Health and Safety Statistics, Australia, viewed at http://www.safeworkaustralia.gov.au/sites/swa/about/publications/pages/key-whs-stats-2015
- Safe Work Australia (2011) Hazardous manual tasks, Code of Practice
- Safe Work Australia (2011) How to manage work health and safety risks, Code of Practice
- Australian Bureau of Statistics (2007) Labour Statistics: Concepts, Sources and Methods, August 2006 Canberra: ABS. http://www.abs.gov.au/ausstats/abs@.nsf/allprimarymainfeatures/5cbef69b3f02291fca2572c100201026?opendocument
- Safe Work Australia. Work-related Traumatic Injury Fatalities. Canberra: Safe Work Australia. http://www.safeworkaustralia.gov.au/sites/swa/statistics/work-related-fatalities/pages/workrelatedtraumaticinjuryfatalities
- Safe Work Australia (2012–13) Australian Workers’ Compensation Statistics, viewed at http://www.safeworkaustralia.gov.au/sites/SWA/about/Publications/Documents/897/australian-workers-compensation-statistics-2012-13.pdf
- Source:http://www.aihw.gov.au/arthritis-and-musculoskeletal-conditions/http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129547134
- Arndt V1 et al, Occup Environ Med. 1996 Oct;53(10):686-91. Older workers in the construction industry: results of a routine health examination and a five year follow up found at http://www.ncbi.nlm.nih.gov/pubmed/8943833?dopt=Abstract
- Hildebrandt VH. Back pain in the working population: prevalence rates in Dutch trades and professions. Ergonomics 1995; 38: 1283-1298.
- Siebert U, Rothenbacher D, Daniel U, Brenner H. Demonstration of the healthy worker survivor effect in a cohort of workers in the construction industry. Occup Environ Med 2001; 58: 774-779.
- Deborah J Schofield, Susan L Fletcher, Arul Earnest, Megan E Passey and Rupendra N Shrestha, Med J Aust 2008; 188 (4): 231-234. Where are older workers with chronic conditions employed? Viewed at https://www.mja.com.au/journal/2008/188/4/where-are-older-workers-chronic-conditions-employed#9
Sit/ Stand Desks
Sit-Stand Desks are becoming increasingly popular in office workplaces with research into these desks providing a lot of benefits with their use. This blog will delve into what exactly a sit-stand desk is, it’s proper use, and what benefits they may provide its user.
Sit-Stand Desks, also known as a Sit/ Stand Workstation or Standing Desk, are becoming increasingly popular in office workplaces and even some schools. Research into these desks claim a whole deal of benefits with their use, but while sitstand desks has plenty of research behind it, there are still many misconceptions about it and even some doubts.
In this post, we will delve into what exactly a sit-stand desk is, it’s proper use, and what benefits they may provide its user.
What is a Sit/Stand Desk?
Note: You should never stand at your desk with your body weight slouched on one leg such as the above image!
A sit-stand desk is a fully adjustable desk. There are many height adjustable desks on the market, but do not confuse a sit-stand desk to a mere height adjustable one, they may be similar but sit-stand desks are able to adjust to full standing height and are relatively easy to adjust because the user will have to change the heights quite frequently throughout the day.
Misconception
The main misconception towards sit-stand desks is that people assume that you are supposed to be standing all the time while using them, where in fact, you are not supposed to. Before the term sit-stand desk, even I only knew it as a standing desk, and therefore in the name it is easy to see where a lot of people thought incorrectly.
Correct Use
As in the example of the misconception, standing for 6-10 hours a day is not a good way to use your sit-stand desk, and sitting down for the same time frame defeats the purpose. The correct way to use a sit-stand desk is to alternate from sitting to standing. Now, when you are first introduced to the desk, your body may not be accustomed to it, therefore a ratio of standing for a minimum of 5 minutes for every 30 minutes of desk use is advised. Over time, you will be able to stand for a longer period of time without excessive fatiguing in the legs. It is also recommended that the user get an antifatigue mat that they can stand on which has been ergonomically engineered to keep you standing longer without any aches or pains.
Benefits
There have been plenty of research papers dedicated to finding out what the benefits sit-stand desks are, some results from the research include:
Decreased sedentary behaviour - Sedentary behaviour refers to any very low energy activities such as sitting or reclining. It is perhaps a very obvious statement that a sit-stand desk will decrease your sitting time, but in the end how you use your own sit-stand desk is entirely up to you. Decreased sedentary behaviour has been proven to decrease weight gain, and prevent the risk of developing type 2 diabetes, heart disease, and even cancer.
Improved Chronic Low Back Pain - Introduction of a sit-stand desk has shown to improve the condition of people suffering from chronic low back pain.
Increased Productivity - Tests in the office workplace and classrooms have revealed that there is users of a sit-stand desk have a more positive behaviour which in turn increases their own productivity.
Enhanced Cognitive Development - This is an important one for kids in school, with increased energy expenditure and productivity, the child’s cognitive development is enhanced which will also help them academically.
Drawbacks
There are obviously pros and cons for everything, the list of drawbacks for use of the sit-stand desk include:
Sore Feet - During those first few weeks of using your sit-stand desk, your feet may feel especially fatigued and sore, the best way to combat this is to get an antifatigue mat mentioned before.
Extra Effort - With a sit-stand desk, you either use it 100% or not at all. The user has to be dedicated to its use to gain the benefits.
Laptop Use - In a office workplace, it is more difficult to use a laptop while standing because the keyboard and monitor is attached and therefore will not be ergonomic as the user adjusts their desk.
Conclusion
The Sit-Stand Desk is paraphernalia that requires very little knowledge to operate but requires effort and a fair bit of understanding on the user's part if they want to reap thbenefits of a sitstand desk.
Julius Principe
MYOTHERAPIST
This article has been prepared by Julius Principe. Please leave your comments below if you have any further questions about standing desks
Neck and Back Pain
Our most common condition we see at our clinic is neck and shoulder issues. Bec has written a short blog on how to avoid pain here through regular movement, exercise and treatment.
People who work long hours driving, sitting at a desk, or hunching over a workbench often suffer from neck and back pain. This may be the result of muscle imbalances from incorrect posture. Muscle imbalances occur due to inactivity in some areas and over activity in the areas that are required to hold you in that same position for long periods of time. The areas that are over active have an increased risk of muscle tension and spasm, which may lead to neck or back pain.
Regular Movement
Set an alarm to get up regularly and walk around, even if it’s just a lap of your desk. This allows your body to have a break from the position it has been in as well as encouraging movement through areas that otherwise remain stationary and increase the risk of muscle tension.
Regular Exercise
Keeping up a regular exercise program can assist with keeping muscles and joints in peak condition. Posture correcting exercises that re-educate the body, like Pilates, can also help prevent neck and back
Regular Massage
Massage treatment is effective for relieving muscle tension and spasm, as well as helping loosen up stiff joints. Your therapist can provide stretches for you to do at home or work and advise on posture correcting techniques that can assist with reducing muscle tension to help prevent neck and back pain.
Rebecca May
MYOTHERAPIST
This article has been prepared by Rebecca May. Please leave your comments below if you have any further questions about neck and back pain
Scoliosis explained
Scoliosis is a common condition where the spine curves laterally loading up one to two aspects of the spine and causes muscles to shorten which can result in spasms. Julius explains about scoliosis, the cause, how to test for and the treatment involved with this type of condition.
About:
Originally being a Greek word that meant curved or bent, the term Scoliosis is now commonly used to describe the condition in which the spine curves laterally (sideways). This curve can present as one curve or two, being called a C-curve and S-curve respectively.
There are two major types of scoliosis: structural and non-structural. Structural scoliosis presents as a curve in the spine with an added rotation, this is your standard type and commonly occurs during adolescence when we go through the growth spurts; we call this Adolescent Idiopathic Scoliosis (AIS) and they make up 90% of all recorded clinical cases of scoliosis. Structural scoliosis cannot be reversed, but it is treatable if spotted in time. Non-structural scoliosis on the other hand presents as a curve in the spine without any rotation and is much more readily treatable.
Cause:
AIS is an idiopathic condition, meaning that there is no known specific cause that can present the scoliosis. In spite of common opinion, structural scoliosis is not a condition of bad posture, though it may cause it. And although there is no medical evidence of a cause, there is a link between scoliosis and genetics. If one or both parents has had scoliosis, then there is a higher percentage chance that their child may also present with scoliosis. There are also studies that show that females have a higher chance of obtaining AIS compared to males.
Non-structural scoliosis on the other hand can be caused by pain or muscle spasms in the back which pushes the spine into a curve, and it can also be caused by a difference in leg length which creates an imbalance of the hip, which in turn creates an imbalance in the spine.
Forward bend test:
The forward bend test (or Adam’s Test) is a simple way to test if the scoliosis is structural or nonstructural. The client takes his or her shirt off so that the back and their spine is visible, then have them bend forward at the hip, hands hanging in front until they pass the knee and that the torso is in a horizontal position. From behind, take note of the curves of the spine and if there is a side of the ribs that sit higher up than the other. An elevated rib hump is indicative of structural scoliosis because of the added rotation.
Other small signs of scoliosis include:
- One shoulder being higher than the other
- One scapula (shoulder blade) may stick out
- The hip is not level / difference in leg length
- Their head is not centred over the centred over their body
Treatment:
For some AIS cases, if the curve of the spine starts to exceed what is acceptable and will soon begin to cause pain, the doctor may suggest a brace to keep the spine within tolerable levels. There are only a few cases where surgical intervention is needed to keep the curve in check.
Massage is another helpful way to treat scoliosis, as both structural and non-structural scoliosis clients can benefit from it. While it is easier to treat non-structural scoliosis, as eliminating the muscle tension or origin of the pain can essentially bring the spine to normal alignment, working on the surrounding structures of structural scoliosis can ease the pain and tension the client feels and also slow the progression.
Julius Principe
MYOTHERAPIST
This article has been prepared by Julius Principe. Please leave your comments below if you have any further questions about scoliosis
Taping for Postural Correction
Taping a clients back is a common tool used at the clinic for postural correction to hold the body in the perfect anatomical position and to create awareness of slouching during day to day living. A huge majority of our cases we see of lower and upper back pain is essentially self inflicted through bad habits of poor posture and can easily be improved to prevent any future and long-term injuries.
Taping a clients back is a common tool used at the clinic for postural correction to hold the body in the perfect anatomical position and to create awareness of slouching during day to day living. A huge majority of our cases we see of lower and upper back pain is essentially self inflicted through bad habits of poor posture and can easily be improved to prevent any future and long-term injuries.
When to tape
The two main conditions we tape the back for are excessive curvatures of the upper and lower back. From a side position, the spine has a ‘S’ curve as seen to the right, and through predisposed factors, lifestyle habits and poor posture the two curves at the upper and lower portion of the spine will develop a larger curve. It’s these excessive curves we affiliate poor posture with, which leads to muscle imbalances that cause your standard musculoskeletal pain affecting muscles and joints.
Ingredients for postural taping
Fixomull white stretch tape is an under-wrap tape that's easier to remove and is hypoallergenic which makes it a lot more skin friendly.
Rigid strapping tape is the standard strapping tape we commonly see used for taping ankles and shoulders.
Scissors, as the fixomull tape doesn't tear off like rigid strapping tape.
Taping for upper back and shoulder correction
First off we tape for poor posture of the upper back area also known as a kyphotic curve or upper crossed syndrome. Taping should always begin with the body in the anatomical position/ position we want to finish in. For upper body we need to keep the shoulders back and upright (with no slouch through the upper spine) with the head kept backwards by drawing your chin in towards the throat.
We begin first by applying the fixomull followed by the rigid strapping tape as the top layer. Taping from the front of your shoulder and pulling the tape back and down and crossing over the spine of the opposite side of the mid back and repeat for both sides. Now to tape for forward head posture correction we use strips of tape from below the base of the hairline and down over the upper curve of the back.
Taping for lower back correction
Taping for lower back correction involves taping the abdomen instead of directly on the lower back. This is because when the lower back will want to shorten the abdomen will want to lengthen and the tape works to prevent the side that’s being lengthened. The type of taping we apply has vertical strips to prevent an anterior pelvic tilt with horizontal taping to anchor down the vertical strips. For extra strength we do an 'X' with the rigid tape and sealed off along the top and bottom with two horizontal strips.
To correct poor posture long term, you’ll need to stretch muscles that are tight and overactive while strengthening weak and lengthened muscles. Examples of this can be seen in this neck exercises blog. Short term, postural taping is really effective as it holds your body in the correct position during work or through daily activities and allows you to become aware of your posture throughout the day and is really effective at off loading muscle/ joints being placed under strain.