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Managing Low Back Pain A Challenge for the Next Millennium

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Title: Managing Low Back Pain A Challenge for the Next Millennium


1
Managing Low Back Pain A Challenge for the Next
Millennium
2
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

3
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.

4
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.

5
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

6
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.

7
Anatomy of Low Back Pain
8
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.

9
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.

10
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

11
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

12
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.

13
Causes of Low Back Pain
  • Common Causes of Low Back Pain Include
  • Sprain/Strain
  • Obesity
  • Aging/Degeneration
  • Herniation

14
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.

15
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.

16
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.

17
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.

18
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.

19
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

20
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.

21
Causes of Low Back Pain
22
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

23
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

24
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.

25
Signs and Symptoms of Low Back Pain
26
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

27
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.

28
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.

29
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.

30
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.

31
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.

32
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

33
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!!

34
Back Pain Prevention 4 Harmful Habits
  • 2 - Bad Posture How 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!
35
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!!
36
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
37
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.

38
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.

39
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.

40
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.

41
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

42
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.

43
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.

44
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.

45
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.

46
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.

47
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.

48
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.

49
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.

50
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.

51
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

52
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.

53
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.

54
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
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