Office Ergonomic Evaluations

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Office Ergonomic Evaluations

• Petti Redding, OTR
• P.R.I.D.E. Wellness Systems, Inc.

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The DisconnectEngineering VS. Medicine

• Primary goal
• to keep individuals from experiencing pain
• All bodies are NOT created equally
• So how can we exclude functional human anatomy
  from any discussion about ergonomics?

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Job Demands Physical Capacity If they dont
equal, you get PAIN!
Physical Capacity
Job Demands
Increase this
Decrease this
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Job Demands

• 24/7/365 days a year as we only have 1 body to
  do our at work, on the weekend, in the evening,
  on vacation, etctasks.
• So the state of our bodies relates to how we feel
  not only at work, but all other times as well.

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Physical Capacity

• Core strength of the spine
• Muscular endurance
• Joint range of motion
• Postural balance

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Structural Integrity of the Human Body Key
Components

• Bony Alignment is dictated by health and balance
  of the core muscles
• The body adapts to the positions it is put in
  over extended periods of time

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I was born like that

• Slow regression of postural balance over time
• Sitting is a major factor
• Constant postural fight against gravity
• Inactivity is a large factor
• But the primary culprit is
• MUSCLES

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Muscle anatomy and function
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A different view of a sarcomere
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At the cellular levelthe sliding mechanism
theory
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Muscle sarcomere in action
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Dysfunctional musclesthe trigger point

• Muscles contracting in over-stretched,
  over-shortened or over-worked positions
• Muscles holding a static, isometric contraction
  for extended periods of time
• lead to a in blood flow and
  resulting energy crisis

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Trigger Point Formation

• 1st Actin and myosin proteins fail to disconnect
  in multiple sarcomeres
• 2nd Leading to increased tension throughout the
  entire muscle

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Sample trigger point and referred pain area
(Scalenes)
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The bowling ball principle
Balanced ball on platform and rigid structure
Unbalanced ball falling off Platform and rigid
structure
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The body adapts to the position we put it in
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Neutral alignment of the headThe case for the
double wedgie

• The head should be aligned with the hip and the
  shoulder.
• Whats holding up the head here?
• (hint those neck and shoulder muscles)

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Chairsbut it says its ergonomic

• Chairs must have these adjustments
• seat height
• armrest height
• Chairs should have these adjustments
• upper back angle
• lumbar height and amount
• seat depth

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But what if it doesnt?The Double Wedgie(no,
not that wedgie)
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Why use Wedgies?

• Inadequate lumbar support (the most crucial
  component to keep head aligned)
• Back leans too far back
• Back curves around shoulders (pushes shoulders
  forward and rounds back)

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What chairs need them?

• In our experience, majority of chairs need them.
  ( Actually, the EMPLOYEE sitting in the chair
  needs them)
• Chair brands that we use them in
• Steelcase
• Herman Miller
• Humantech
• And about 90 of other chair companies

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What pad to use for the wedgie

• Multiple foam layers to customize fit
• Made by Master Manufacturing
• Model 92011 Black or 92041 Gray
• Available in just about every Office Supply
  catalog out there

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How to apply

• Lumbar 1st
• Position at belt level or a little below
• Remove 1 or 2 layers of foam if employee voices
  initial discomfort with pad

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How to apply

• Upper wedgie next
• Apply like an
• inverted T
• Remove 1 or 2 layers if employee voices initial
  discomfort

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Wedgie tricks

• Explain why
• Place in chair then continue with eval
• Remove pad afterward just to see what feels
  better
• Remind employee to tweak pads if they feel
  discomfort later. ( you must ease them into
  change slowly)

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Other issues

• Seat depth 2-4 fingers width from seat edge to
  behind knee
• Armrest height no higher than shoulders relaxed
  and elbows bent with hands lower than elbows
• Seat height no higher than top of legs level
  with floor. ( Use footrest if you have to)

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Keyboard Placementthe secret trick

• Relax your shoulders, hands in your lap
• Keep elbows at your side (no reaching)
• Raise your hands to just above your lap, lower
  than your elbows
• What do you feel in your shoulders?

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What we DONT want
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Wrist rests are not for the wrists!

• Placement at the heel of the hand (remember the
  mountains and the valley)
• Problems dont come from the wrist, they come
  from the neck, anyway.
• The more tense the shoulders are, the more tissue
  damage and chance of nerve compression at the
  neck and shoulders.
• (unless the floating technique is working for
  them)

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How to fix keyboard position

• Adjustable keyboard tray or shelf
• Adjustable table or desk
• If cant lower desk, then raise chair, and then
  raise floor (footrest)
• Add GEL wrist rest (think Pillsbury doughboy)

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Ulnar deviation
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Wrist extension

• Back of hand should be bunny slope, not black
  diamond
• Test for employees to feel static contraction
• Hold muscle, bend wrist back and forth
• Now hold wrist up, then type
• While typing flatten wrist
• Feel the difference

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Negative Tilt of the keyboard

• Go through wrist extension demo
• Set tilt slightly, then explain slow progression
  to more
• Let them try it

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Where does the mouse go?

• Mouse adjacent to keyboard at same level
• Adjust mouse speed and snap to default
• Control panel or settings
• Select mouse, then pointer options
• Increase mouse pointer speed to max
• Select snap mouse to default

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Alternative Keyboards

• Split keyboards such as Microsoft and many knock
  offs.
• Forearm neutral keyboards such as Goldtouch

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Alternative Mouse/trackballs

• Make a change only to make hand position MORE
  neutral
• Consider what employee does w/ mouse
• IF employee complains of wrist pain, problem is
  probably from shoulder reaching

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Monitor position

• Key is where the head is, not where the monitor
  is
• Conflicting theories height and distance
• Focus on neutral positions
• Watch the employees head as you do your
  evaluation
• Always ask about glasses and/or bifocals

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Monitor height trick (works every time)

• Get employee positioned in chair correctly
• Turn off monitor
• Ask employee to close eyes and roll head around
  to loosen muscles
• Keep eyes closed, and put your head in the most
  comfortable, balanced position you can find
• Open eyes and look straight ahead- what was the
  very 1st spot you saw?
• If no glasses or bifocals, eyes should focus 2-3
  inches below top of monitor.

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Bifocals

• Do the head roll technique to find neutral
  position of the head
• Have employee raise and lower chin to see which
  is better to see monitor
• Raise or lower monitor accordingly (You will
  probably LOWER it)
• Focus on the head, not the monitor.

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What if they still hurt?Tools to have

• Trigger Point Therapy Workbook
• Noodles
• Racketballs
• Backnobbers
• Golf balls
• Exercise balls
• Pilates on the Ball

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What if they still hurt?Primary areas

• Hands, wrists, elbows and shoulders
• Upper back and top of shoulders
• Low back and hip

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Remember Structural Integrity

• Focus on total body alignment, not just a single
  muscle or joint
• Pain is probably coming from a referred area, not
  the area of the painthe trigger point
• Focus on correcting behaviors that lead to
  postures that create imbalances

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Additional Techniques

• For best results, use when employee 1st voices
  discomfort
• Equipment fixes only generally dont take care of
  the problems
• Employee should assume responsibility for
  behavior changes and other techniques

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Step 1 Trigger Point Deactivation

• Use of self help manual Trigger Point Therapy
  Workbook
• Provide employee use of backnobber, racketball,
  golf ball, etc.

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Noodle StretchUse for all upper extremity
problems

• Booty to back of head on noodle.
• Elbows in the dont shoot me position, just
  touching ground
• Allow hands to slowly fall toward the floor,
  keeping 90 degree
• angle at elbow
• 4. Hold for 10 minutes, 2 times a day

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Hamstrings up WallUse for low back pain

• Place small rolled towel in small of back
• Position booty close to wall, with legs up wall
• There should be just a SLIGHT stretch in the leg
  and hip
• Hold for 10 minutes

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SupermanUse for everyone

• Start prone, keeping chin tucked in, body aligned
• Raise up upper body, and squeeze shoulders
  together
• 3x5 sets, build to 10x10 sets

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Structural Integrity

• The body is more than the sum of the parts
• Preventive maintenance is the key
• Solutions generally arent found in new stuff
• ADDRESS PROBLEMS WHILE THEY ARE SMALL, TO PREVENT
  REAL INJURIES

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Questions?

• Thank you
• Petti Redding, OTR