Managing Low Back Pain A Challenge for the Next Millennium

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Managing Low Back Pain A Challenge for the Next
Millennium
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OUTLINE

• Incidence of Low Back Pain
• What is Low Back Pain
• Anatomy of Low Back Pain
• Causes of Low Back Pain
• Signs and Symptoms of Low Back Pain
• Diagnosis
• Treatment of Low Back Pain (Surgical/Nonsurgical)
• Back Pain Prevention
• Office Chair Selection

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Incidence of Low Back Pain

• Low back pain is one of the main reasons
  Americans visit their doctor
• 80 of people will have low back pain at some
  point in their lives Each year, back pain costs
  Americans about 100 billion in medical bills,
  disability, and lost productivity.
• It is the most expensive industrial injury,
  affecting 2 to 5 of the workforce and leading
  to 1,000,000 workers' compensation claims
  annually.

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Incidence of Low Back Pain

• Low back pain remains a serious health disorder,
  and, next to the common cold, it remains the most
  common reason why people seek medical care
• During his or her life, about one in five persons
  will have a serious episode of back pain that
  will require medical attention.
• Low back pain is the most expensive health care
  problem for people age 20 to 50 years.

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What is Low Back Pain

• Back pain is actually very commonabout three in
  four adults will experience back pain during
  their lifetime, especially low back pain
• Back pain may be acute or chronic.
• Back pain comes in many forms, it may be sudden
  and sharpor it may be dull.
• Pain may occur with movement, and it may even
  occur with coughing and sneezing. You may also
  have numbness in your arms or legs.
• Its important to treat your back pain properly.
  Seek medical attention if your back pain
  persistsand seek immediate attention if you have
  any of the emergency signs listed below.
• Warning Signs You Need Help
• Pain is getting significantly worse
• Pain affects every day activities
• Severe symptoms
• Groin or leg weakness or numbness
• Arm or hand weakness, tingling, or numbness
• Loss of bowel or bladder control

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Anatomy of Low Back Pain

• Your back, or spine, is made up of many parts
• Your backbone, also called your vertebral
  column, provides support and protection and
  consists of 33 vertebrae (bones)
• There are discs between each of the vertebra that
  act like pads or shock absorbers.
• Together, the vertebrae and the discs provide a
  protective tunnel (the spinal canal) to house the
  spinal cord and spinal nerves
• These nerves run down the center of the vertebrae
  and exit to various parts of the body.

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Anatomy of Low Back Pain
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Anatomy of Low Back Pain

• Your back also has muscles, ligaments, tendons,
  and blood vessels.
• Muscles are strands of tissues that act as the
  source of power for movement.
• Ligaments are the strong, flexible bands of
  fibrous tissue that link the bones together, and
  tendons connect muscles to bones and discs.
• Blood vessels provide nourishment.
• These parts all work together to help you move
  about.

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Anatomy of Low Back Pain

• Back pain may be a result of injury to any or all
  of the previously mentioned body parts
• Injury to the soft tissues (muscles, ligaments,
  tendons) results in sprains or strains, which are
  generally not considered serious
• However, injury to bones, nerves, or blood
  vessels may be more serious
• The outer layers of discs can also get tears or
  cracks, allowing the annulus fibrosus or nucleus
  pulposus to bulge out.
• Any of these injuries can cause inflammation and
  pain.

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Anatomy of Low Back Pain

• The lumbar spine is made up of the lower five
  vertebrae often referred to as L1 to L5.
• These five vertebrae line up to give the low back
  a slight inward curve.
• The lowest vertebra of the lumbar spine, L5,
  connects to the top of the sacrum, a triangular
  bone at the base of the spine that fits between
  the two pelvic bones

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Anatomy of Low Back Pain

• Intervertebral discs separate the vertebrae.
• The discs are made of connective tissue.
• Most connective tissue is made of fibers of a
  material called collagen.
• These fibers help the disc withstand tension and
  pressure.
• Healthy discs work like shock absorbers to
  cushion the spine.
• They protect the spine against the daily pull of
  gravity.
• They also protect it during strenuous activities
  that put strong force on the spine, such as
  jumping, running, and lifting.
• Two spinal nerves exit the sides of each spinal
  segment, one on the left and one on the right.
• As the nerves leave the spinal cord, they pass
  through a small bony tunnel on each side of the
  vertebra, called a neural foramin

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Causes of Low Back Pain

• Back pain has a variety of causes, including poor
  posture and poor body mechanics (ex. standing for
  long periods of time or sitting incorrectly can
  cause back pain)
• Engaging in certain sports often carries a risk
  of back injury.
• Low back pain is often associated with heavy
  physical work, lifting or forceful movement,
  bending or twisting, or awkward positions.
• You may even have a back injury and not know it
  until a stressful movement aggravates the
  condition.
• Dont ignore back pain. Talk to your doctor if
  your pain persists.

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Causes of Low Back Pain

• Common Causes of Low Back Pain Include
• Sprain/Strain
• Obesity
• Aging/Degeneration
• Herniation

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Causes of Low Back Pain

• Sprain or Strain
• A sudden fall, car crash, or sports injury can
  cause a sprain or strainor even just lifting
  something too heavy.
• When a back injury occurs, muscles, ligaments,
  and tendons can become over-stretched, overused,
  or torn.
• Tissues can swell, causing pain, tenderness, and
  stiffness.

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Causes of Low Back Pain

• Obesity
• Your spine caries a large portion of your weight.
  
• Being overweight puts pressure and stress on the
  back, especially the low back.
• In addition, carrying excess weight aggravates
  other health conditions such as osteoporosis
  (weak bones), osteoarthritis (joint pain),
  rheumatoid arthritis (an autoimmune disease),
  degenerative disc disease (described below in the
  aging section), spinal stenosis, and
  spondylolisthesis.

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Causes of Low Back Pain

• Degeneration
• The intervertebral disc changes over time.
• The first change that occurs is that the annulus
  around the nucleus weakens and begins to develop
  small cracks and tears
• The body tries to heal the cracks with scar
  tissue.
• The torn annulus can be a source of pain for two
  reasons. First, there are pain sensors in the
  outer rim of the annulus. They signal a painful
  response when the tear reaches the outer edge of
  the annulus. Second, like injuries to other
  tissues in the body, a tear in the annulus can
  cause pain due to inflammation.
• With time, the disc begins to lose water, causing
  it to lose some of its fullness and height. As a
  result, the vertebrae begin to move closer
  together.

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Causes of Low Back Pain

• Degeneration
• The intervertebral disc changes over time.
• The first change that occurs is that the annulus
  around the nucleus weakens and begins to develop
  small cracks and tears
• The body tries to heal the cracks with scar
  tissue.
• The torn annulus can be a source of pain for two
  reasons. First, there are pain sensors in the
  outer rim of the annulus. They signal a painful
  response when the tear reaches the outer edge of
  the annulus. Second, like injuries to other
  tissues in the body, a tear in the annulus can
  cause pain due to inflammation.
• With time, the disc begins to lose water, causing
  it to lose some of its fullness and height. As a
  result, the vertebrae begin to move closer
  together.

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Causes of Low Back Pain

• Degeneration
• The intervertebral disc changes over time.
• The first change that occurs is that the annulus
  around the nucleus weakens and begins to develop
  small cracks and tears
• The body tries to heal the cracks with scar
  tissue.
• The torn annulus can be a source of pain for two
  reasons. First, there are pain sensors in the
  outer rim of the annulus. They signal a painful
  response when the tear reaches the outer edge of
  the annulus. Second, like injuries to other
  tissues in the body, a tear in the annulus can
  cause pain due to inflammation.
• With time, the disc begins to lose water, causing
  it to lose some of its fullness and height. As a
  result, the vertebrae begin to move closer
  together.

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Causes of Low Back Pain

• Herniations
• Herniation occurs when the nucleus in the center
  of the disc pushes out of its normal space.
• The nucleus presses against the annulus, causing
  the disc to bulge outward.
• Sometimes the nucleus herniates completely
  through the annulus and squeezes out of the disc.
  
• Vigorous, repetitive bending, twisting, and
  lifting can place abnormal pressure on the
  shock-absorbing nucleus of the disc.
• If great enough, this increased pressure can
  injure the annulus, leading to herniation.
• A lumbar disc can also become herniated during an
  acute (sudden) injury

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Causes of Low Back Pain

• Herniation causes pain from a variety of sources.
• Mechanical Pain.
• This is pain that comes from the parts of the
  spine that move during activity, such as the
  discs and ligaments.
• Pain from inflammation occurs when the nucleus
  squeezes through the annulus.
• The nucleus normally does not come in contact
  with the body's blood supply. However, a tear in
  the annulus puts the nucleus at risk for
  contacting this blood supply.
• When the nucleus herniates into the torn annulus,
  the nucleus and blood supply meet, causing a
  reaction of the chemicals inside the nucleus.
• This produces inflammation and pain.
• Neurogenic Pain
• A disc herniation may also put pressure against a
  spinal nerve.
• Pressure on an irritated or damaged nerve can
  produce pain that radiates along the nerve.

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Causes of Low Back Pain
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Signs and Symptoms of Low Back Pain

• Disc herniations produce inflammation when the
  nucleus comes in contact with the body's blood
  supply
• The inflammation can be a source of throbbing
  pain in the low back and may spread into one or
  both hips and buttocks.
• A herniated disc can press against a spinal
  nerve, producing symptoms of nerve compression.
• Nerve pain follows known patterns in the lower
  limbs (It can be felt on the side of the upper
  thigh, in the calf, or even in the foot and toes)
• Pressure on the nerve can also cause sensations
  of pins, needles, and numbness where the nerve
  travels down the lower limbs

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Signs and Symptoms of Low Back Pain

• Back pain is its own symptom.
• Your back pain may be acute or chronic.
• Acute pain lasts four to six weeks, but chronic
  pain is persistent, long-term painsometimes
  lasting throughout life.
• Back pain may be sudden and sharpor it may be
  dull.
• Pain may occur with movement, and it may even
  occur with coughing and sneezing.
• You may also have numbness in your arms or legs.
  (Leg symptoms are often referred to as sciatica
  caused by a pinched nerve.)
• It's important to treat your back pain properly.
• Seek medical attention if your back pain
  persistsand seek immediate attention if you have
  back pain with any of the following emergency
  signs
• Pain is getting significantly worse
• Pain affects every day activities
• Severe symptoms
• Groin or leg weakness or numbness
• Arm or hand weakness, tingling, or numbness
• Loss of bowel or bladder control

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Signs and Symptoms of Low Back Pain

• Rarely, symptoms involve changes in bowel and
  bladder function.
• A large disc herniation that pushes straight back
  into the spinal canal can put pressure on the
  nerves that go to the bowels and bladder.
• The pressure may cause low back pain, pain
  running down the back of both legs, and numbness
  or tingling between the legs in the area you
  would contact if you were seated on a saddle.
• The pressure on the nerves can cause a loss of
  control in the bowels or bladder.
• This is an emergency. If the pressure isn't
  relieved, it can lead to permanent paralysis of
  the bowels and bladder.
• This condition is called cauda equina syndrome
• Doctors recommend immediate surgery to remove
  pressure from the nerves.

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Signs and Symptoms of Low Back Pain
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Signs and Symptoms of Low Back Pain

• In summary, symptoms from low back problems vary.
  
• They depend on a person's condition and which
  structures are affected. Some of the more common
  symptoms of low back problems are
• low back pain
• pain spreading into the buttocks and thighs
• pain radiating from the buttock to the foot
• back stiffness and reduced range of motion
• muscle weakness in the hip, thigh, leg, or foot
• sensory changes (numbness, prickling, or
  tingling) in the leg, foot, or toes

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Diagnosis

• The diagnosis of low back problems begins with a
  thorough history of your condition.
• Your doctor or therapist will ask you questions
  to find out when you first started having
  problems, what makes your symptoms worse or
  better, and how the symptoms affect your daily
  activity.
• Your doctor or therapist will then physically
  examine the muscles and joints of your low back.
• It is important that your doctor or therapist see
  how your back is aligned, how it moves, and
  exactly where it hurts.
• Some simple tests to check the function of the
  nerves are performed.
• These tests are used to measure the strength in
  your lower limbs, check your reflexes, and
  determine whether you have numbness in your legs
  or feet.
• The information from your medical history and
  physical examination will help your doctor or
  therapist decide which further tests to run.
• The tests give different types of information.

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Treatment of Low Back Pain

• Ninety percent of people who experience low back
  pain for the first time get better in two to six
  weeks without any treatment at all.
• Patients often do best when encouraged to stay
  active and to get back to normal activities as
  soon as possible, even if there is still some
  pain.
• The pain may not go away completely.
• One goal of treatment is to help you find ways to
  control the pain and allow you to continue to do
  your normal activities.

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Treatment of Low Back Pain(Nonsurgical)

• Whenever possible, doctors prefer to use
  treatments other than surgery. The first goal of
  these nonsurgical treatments is to ease your pain
  and other symptoms.
• Bed Rest
• In cases of severe pain, doctors may suggest a
  short period of bed rest, usually no more than
  two days. Lying on your back can take pressure
  off sore discs and nerves.
• Most doctors advise against strict bed rest and
  prefer that patients do ordinary activities using
  pain to gauge how much is too much.
• Back Brace
• A back support belt is sometimes recommended when
  back pain first strikes.
• It can help provide support and lower the
  pressure inside a problem disc.
• Patients are encouraged to gradually discontinue
  wearing the support belt over a period of two to
  four days. Otherwise, back muscles begin to rely
  on the belt and start to shrink (atrophy).
• Medications
• Many different types of medications are typically
  prescribed to help gain control of the symptoms
  of low back pain.
• There is no medication that will cure low back
  pain.
• Medications are prescribed to help with sleep
  disturbances and to help control pain,
  inflammation, and muscle spasm.

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Treatment of Low Back Pain(Nonsurgical)

• Physical Therapy and Exercise
• In addition to other nonsurgical treatments,
  doctors often ask their patients to work with a
  physical therapist.
• Therapy treatments focus on relieving pain,
  improving back movement, and fostering healthy
  posture.
• A therapist can design a rehabilitation program
  to address a particular condition and to help the
  patient prevent future problems.
• There is a great deal of scientific proof that
  exercise and increased overall fitness reduce the
  risk of developing back pain and can improve the
  symptoms of back pain once it begins.
• Injections
• Spinal injections are used for both treatment and
  diagnostic purposes. T
• here are several different types of spinal
  injections that your doctor may suggest.
• These injections usually use a mixture of an
  anesthetic and some type of cortisone
  preparation.
• The anesthetic is a medication that numbs the
  area where it is injected.
• If the injection takes away your pain
  immediately, this gives your doctor important
  information suggesting that the injected area is
  indeed the source of your pain.
• The cortisone decreases inflammation and can
  reduce the pain from an inflamed nerve or joint
  for a prolonged period of time.

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Treatment of Low Back Pain(Surgical)

• Only rarely is lumbar spine surgery scheduled
  right away.
• Your doctor may suggest immediate surgery if you
  are losing control of your bowels and bladder or
  if your muscles are becoming weaker very rapidly.
• For other conditions, doctors prefer to try
  nonsurgical treatments for a minimum of three
  months before considering surgery.
• Most people with back pain tend to get better,
  not worse.
• Even people who have degenerative spine changes
  tend to gradually improve with time.
• Only one to three percent of patients with
  degenerative lumbar conditions typically require
  surgery.
• Surgery may be suggested when severe pain is not
  improving.

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Treatment of Low Back Pain(Surgical)

• There are many different operations for back
  pain. The goal of nearly all spine operations is
  to remove pressure from the nerves of the spine,
  stop excessive motion between two or more
  vertebrae, or both. The type of surgery that is
  best depends on that patient's conditions and
  symptoms.
• Laminectomy
• removes part or all of the lamina to release
  pressure on the spinal nerves.
• Discectomy
• operation to remove the portion of the disc that
  is pressing on the nerve roots is called a
  discectomy
• This operation is performed through an incision
  in the low back immediately over the disc that
  has ruptured.
• Lumbar Fusion
• When there is excessive motion between two or
  more vertebrae, the excess motion can cause both
  mechanical pain and irritation of the nerves of
  the lumbar spine.
• In this case some type of spinal fusion is
  usually recommended.
• The goal of a spinal fusion is to force two or
  more vertebrae to grow together, or fuse, into
  one bone.
• The pain is reduced because the fusion reduces
  the constant irritation and inflammation of the
  nerve roots

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Back Pain Prevention 4 Harmful Habits

• 1 - Twisting when Lifting So many people make
  this mistake! We forget to check our body
  mechanics while lifting, yet too much of this
  type of movement can be very damaging to your
  back. When lifting, follow these steps
• Get close to the object
• Bend your knees and grasp the object firmly
• Lift straight up (don't twist!) in one fluid
  motion
• Hold the object close to your body
• Move close to where you want to place the
  object
• Bend you knees when lowering the object
  Wrong!!

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Back Pain Prevention 4 Harmful Habits

• 2 - Bad PostureHow often to you think about
  your posture?
• Bad posture - slouched shoulders, head down,
  knees locked - places an enormous amount of
  stress on the spine.
• Good posture keeps your body in balance and helps
  avoid that stress. Here's what good posture looks
  like when standing
• Feet slightly apart Knees straight Chin
  slightly tucked in Shoulders back
• Be sure to check and correct your posture during
  your everyday activities.
• Soon you will find that you are actually more
  comfortable when your spine is in balance!

Stand tall!
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Back Pain Prevention 4 Harmful Habits

• 3 - Too Little Exercise, Too Much Weight
• A sedentary lifestyle has become all too common
  in our society today.
• Eventually our spines will pay the price.
• Research shows that people who do not exercise
  regularly and are overweight are more likely to
  suffer from back injures and pain.
• To keep that from happening to you, get up and
  get moving! Find a way to put exercise into your
  daily activities. Not only will it help keep your
  spine healthy, it will help you to shed those
  unwanted pounds and feel great too!

Exercise can be fun!!
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Back Pain Prevention 4 Harmful Habits

• 4 - Ignoring the Pain
• None of us like going to the doctor, but
  persistent back pain should not be ignored.
• If you suffer from persistent, chronic, or
  recurring back pain, see your doctor.
• In most cases there is an easy, non-surgical
  treatment that can return you to a pain free
  life.
• However, if left untreated or allowed to
  progress, back pain can lead to serious and
  severe disability.

Don't ignore unresolved pain
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Back Pain Prevention

• Tips to Minimize Stress at the Desk
• Don't lean over the desk for prolonged periods of
  time
• Don't sit too far from the work and/or with the
  back unsupported.
• Raise or lower the chair to the proper height so
  the knees are bent at a 90-degree angle.
• Keep the elbows bent at a 90-degree angle. The
  elbows may rest on the work surface.
• Don't bend or twist the neck to cradle the phone
  against the shoulder.

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Back Pain Prevention

• How To Maintain a Neutral Spine While Standing
• The feet should be placed slightly apart with the
  knees straight and chin tucked in to maintain a
  neutral spine.
• Do not stand in one position for a prolonged
  period of time shift the weight from one foot to
  the other frequently.
• Use a footstool to elevate each foot from time to
  time may be helpful.

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Back Pain Prevention

• Spine Safety Carrying
• First take a look at the object to be moved. If
  it appears to be too heavy or cumbersome, find
  help! Next, consider where the object is going.
  Are there obstacles along the way? If so, move
  them out of the pathway.
• Depending on the shape of the object, try to hold
  it at the side and bottom while keeping it close
  to the body. Remember to keep the back straight.
  Carry the object with the elbows slightly bent.
• An extra tip ... Carry a balanced amount of
  weight in each hand. For example, when carrying
  shopping bags or luggage, split the load in two.
• The shoulders should be held slightly back and
  level.
• Each ear should line up with the shoulders.
• The chin is slightly tucked and the pelvis is
  shifted forward so the hips are aligned with the
  ankles.

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Back Pain Prevention

• Spine Safety Lifting
• First take a look at the object to be moved. If
  it appears to be too heavy or cumbersome, find
  help!
• If there are obstacles in the way, move them
  before lifting the object.
• Maintain good posture and keep the head properly
  aligned. Try to get as close to the object as
  possible and bend at the knees.

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Back Pain Prevention

• Spine Safety - Reaching
• Consider the size, weight, and location of the
  object. Use a sturdy stool or ladder if
  necessary. Don't even think about standing on
  tiptoe!
• Next, directly face the object and get as close
  to it as possible. One hand could be used for
  additional support. Try not to look overhead for
  prolonged periods of time. This could cause
  unnecessary stress to the neck.
• An extra tip ... Store items that are used often
  within easy reach. This may mean rearranging
  shelves and/or closets.
• Don't lift yet! Make sure the feet are slightly
  apart and flat on the floor. To turn, instead of
  twisting the body, pivot with the feet. This will
  help to provide a stable base of support.
• Keep breathing and tighten the stomach muscles.
  Smoothly lift the object using the arms and legs
  ... not the back!
• Remember ...Poor posture and incorrect body
  mechanics are two of the leading causes of neck
  and back pain

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Back Pain Prevention

• What is the correct way to sit?
• Keep your feet flat on the floor.
• Try to avoid sitting in the same position for
  more than 30 minutes.
• At work, adjust your chair height and work
  station so you can sit up close to your work and
  tilt it up at you. Rest your elbows and arms on
  your chair or desk, keeping your shoulders
  relaxed.
• When sitting in a chair that rolls and pivots,
  don't twist at the waist while sitting. Instead,
  turn your whole body.
• When standing up from the sitting position, move
  to the front of the seat of your chair. Stand up
  by straightening your legs. Avoid bending forward
  at your waist. Immediately stretch your back by
  doing 10 standing backbends.
• It is ok to assume other sitting positions for
  short periods of time, but most of your sitting
  time should be spent as described above so there
  is minimal stress on your spine.

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Back Pain Prevention

• What is the correct way to sit? (Contd)
• Sit up with your back straight and your shoulders
  back. Your buttocks should touch the back of your
  chair.
• All three normal back curves should be present
  while sitting. A small, rolled-up towel or a
  lumbar roll can be used to help you maintain the
  normal curves in your back.
• Here's how to find a good sitting position when
  you're not using a back support or lumbar roll
• a. Sit at the end of your chair and slouch
  completely b. Draw yourself up and accentuate
  the curve of your
• back as far as possible. c. Hold
  for a few seconds d. Release the position
  slightly (about 10 degrees). This is a
  good sitting posture.
• Distribute your body weight evenly on both hips.
• Bend your knees at a right angle. Do not sit with
  your knees crossed. Keep your knees even with or
  slightly higher than your hips.

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Back Pain Prevention

• What is the correct way to sit while driving?
• Use a back support (lumbar roll) at the curve of
  your back. Your knees should be at the same level
  or higher than your hips. "
• Move the seat close to the steering wheel to
  support the curve of your back. The seat should
  be close enough to allow your knees to bend and
  your feet to reach the pedals.

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Back Pain Prevention

• What is the best position for sleeping and lying
  down?
• The best lying or sleeping position may vary,
  depending on your symptoms. No matter what
  position you lie in, the pillow should be under
  your head, but not your shoulders, and should be
  a thickness that allows your head to be in a
  normal position. "
• Try to sleep in a position which helps you
  maintain the curve in your back (such as on your
  back with a pillow under your knees or a lumbar
  roll under your lower back or on your side with
  your knees slightly bent). Do not sleep on your
  side with your knees drawn up to your chest. You
  may want to avoid sleeping on your stomach,
  especially on a saggy mattress, since this can
  cause back strain and can be uncomfortable for
  your neck.

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Back Pain Prevention

• What is the best position for sleeping and lying
  down? (Contd)
• Select a firm mattress and box spring set that
  does not sag. If necessary, place a board under
  your mattress. You can also place the mattress on
  the floor temporarily if necessary. If you've
  always slept on a soft surface, it may be more
  painful to change to a hard surface. Try to do
  what's most comfortable for you.
• Try using a back support (lumbar support) at
  night to make you more comfortable. A rolled
  sheet or towel tied around your waist may be
  helpful.
• When standing up from the lying position, turn on
  your side, draw up both knees and swing your legs
  on the side of the bed. Sit up by pushing
  yourself up with your hands. Avoid bending
  forward at your waist.

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Office Chair Selection 9 Ergonomic Tips

• 1. Height Adjustment
• Easily raises or lowers the seat to bring your
  hips and torso to the correct 90 degree sitting
  position appropriate for the level of your work
  area.
• With both feet flat on the floor and knees bent
  at a comfortable angle, your lower legs are
  supported without putting pressure on your
  thighs.

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Office Chair Selection 9 Ergonomic Tips

• 2. Angle Adjustment
• Can be at the back, seat or both, and allows you
  to change the angle between your torso and
  thighs.
• Puts you in the correct neutral position to
  support and maintain the natural curve of your
  spine.

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Office Chair Selection 9 Ergonomic Tips

• 3. Seat Pan
• The seat pan should be at least once inch wider
  than your hips and thighs on either side, and
  should not be too long for your legs.
• Chairs with seat slider adjustments can
  accommodate users of almost any side.
• A contour seat is highly recommended for proper
  distribution of weight over the seat's surface to
  reduce fatigue and leg pain and allow you to sit
  for extended periods.

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Office Chair Selection 9 Ergonomic Tips

• 4. Adjustable Tilt and Tension Control
• Allows you to regulate the angle support, from
  locked in place to free floating.
• Especially useful for multi-tasking, and to help
  maintain support as you lean into/away from your
  desk throughout the day.

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Office Chair Selection 9 Ergonomic Tips

• 5. Backrest
• Proper support can be achieved by height
  adjustment to the backrest of your chair, or the
  backrest can be adjusted to support the contour
  of your back as well as your neck and shoulders

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Office Chair Selection 9 Ergonomic Tips

• 6. Memory Foam
• Energy absorbent memory foam (including
  LIFE-Foam and WonderFoam) conforms to your
  body's contours providing gentle, virtually
  pressure-free support, thereby improving posture
  and reducing stress.

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Office Chair Selection 9 Ergonomic Tips

• 7. Adjustable Armrests
• To achieve the proper neutral position for wrists
  and arms, consider these 3 factors
• Height Adjustment helps relieve fatigue in neck
  and shoulders
• Width Adjustment increases support in
  coordination with your shoulder span and the task
  at hand
• Pivoting/Articulating armrests rotate or swivel,
  allowing you to maintain a relaxed position
  despite your movements.

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Office Chair Selection 9 Ergonomic Tips

• 8. Lumbar Support
• Provides support to the lower back (lumbar
  region) which encourages correct sitting posture
  to reduce strain on the vertebral disks. Improves
  relaxation and prevents back pain.

55
Office Chair Selection 9 Ergonomic Tips

• 9. Cervical Support
• Offers support and relieves pressure on your neck
  and shoulder (cervical region) especially when
  leaning back. Support is provided by either an
  attached headrest or high back chair.
• The key is to maintain good posture while
  sitting. But it's more than just sitting up
  straight. Check out your posture right now, are
  your
• Feet flat on the floor (not crossed or tucked
  under you)?
• Back and shoulders against the backrest of the
  chair?
• Elbows and lower arms resting lightly on the
  armrests?
• Shoulders relaxed and slightly dropped (not
  hunched forward)

56
Office Chair Selection 9 Ergonomic Tips

• 9. Cervical Support
• Offers support and relieves pressure on your neck
  and shoulder (cervical region) especially when
  leaning back. Support is provided by either an
  attached headrest or high back chair.
• The key is to maintain good posture while
  sitting. But it's more than just sitting up
  straight. Check out your posture right now, are
  your
• Feet flat on the floor (not crossed or tucked
  under you)?
• Back and shoulders against the backrest of the
  chair?
• Elbows and lower arms resting lightly on the
  armrests?
• Shoulders relaxed and slightly dropped (not
  hunched forward)

57
Office Chair Selection 9 Ergonomic Tips

• 9. Cervical Support (Contd)
• Hips slightly higher than your knees?
• Knees bent comfortably (there should be 2-4
  inches between the back of your knees and the
  edge of the chair)?
• Eyes facing the computer screen?
• It is important that all three normal back curves
  be present while you are sitting, especially for
  people who sit for long periods of time.
• A small, rolled-up towel or a lumbar support
  pillow is a great way to help you maintain good
  sitting posture and avoid spinal stress.

58
THANK YOU FOR YOUR TIME!!!

• Any Questions?