338- Ergonomic Factors That Cause Low Back Pain

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langman.

Hello and welcome to the Evidence Based Chiropractor. I am your host, Dr. Jeff Langmaid. We are back with the research on today's episode and this is going to be all about ergonomics. A brand new study came out just a month or two ago titled factors affecting musculoskeletal low back pain due to computer usage. Lot of great factors outlined here. So we know how often people are utilizing mobile tap, mobile phones, tablets, computers and how much of an impact this can make on their musculoskeletal health. This study starts to break down some of those key factors involved in the ergonomics that could lead to back pain today, tomorrow or in the future. Fantastic study, a lot of clinical pearls. We'll break it down in just a moment before we get started. The smart chiropractor powers your patient journey to provide you with more qualified leads, more new patients, better patient retention and consistent reactivations without spending any money on advertising. That is by helping you teach and invite consistently getting out there, having content, having messaging on social, on your Google business listing, on your website, via blogs, email marketing, huge ROR ROI driver within the smart chiropractor. So if you're interested in improving your retention, your reactivations or more new patients, head over to thesmartchiropractor.com again that is the smart chiropractor.com but as I said at the top, today we are talking research factors affecting musculoskeletal low back pain due to computer usage. This came out in the Rawal Medical Journal in January through March. They do a quarterly 2022. So we know that technology has had a huge impact on pretty much almost everybody's life over the last five, 10, 15 years. And almost everybody of every age are facing musculoskeletal issues in which low back pain by far is the most common. Now computer usage, big component of this. It is the most used technology after mobile phones. I always think about it. People just spend so much time sitting each and every day they're sitting on their way to the office, they're sitting while they're at their office, they're sitting on the way home from the office and then they're sitting at night in eating dinner, watching tv, continuing to use their phone or tablet. That's not an indictment, it's Just the facts. And us as chiropractors, we need to be aware of that because we have an uphill battle. If you are taken care of and we're treating people, I don't care if they're in your practice an hour, that still is, 23 other hours that day that they're potentially in suboptimal positioning is a nice way to put it. Or if they're in your practice, 15 minutes, 8 minute visit. Imagine how much time they are spending basically putting trauma on their body through excessive sitting, poor ergonomics, probably not enough movement. There could be, of course, psychological issues, there of course could be nutritional issues. But all of this plays in to what walks through our doors each and every day. And our patients, rightfully so, are expecting us to be able to help them. And we need to have an accurate assessment of, okay, what are they doing all of all day, every day. Because when they come in to see me for 15, 20, 25, 30 minutes, I only have that much time to really not only combat and break even everything else they're doing throughout the day, but do better than that because that's how they're going to find improvement. Now of course we want to guide them towards proactive things that they can do on their own as well. That's the best case scenario. But we all know that that is a hard fought battle and is not a winnable battle each and every time. So people are relying upon us to help them get over the hump, better function, decreasing pain, whatever it might be. A lot of this ties back to their daily activities. And the more that we know about those daily activities and how we can impact them, the better off our care will be and the better results our patients will get, which is a great thing. Now we've talked about a lot of people, pretty much everybody out there, cell phone, tablet, computer, you name it. Some combination of that and this metamorphosis, this change in evolution in industry, ultimately it's less factories and more offices. Just if we look at the last hundred years, it really, really, really has dramatically changed our lifestyle and our set in that really it's enhanced, I guess you'd say, the sedentary nature of our lifestyle, meaning a lot of time sitting, just as we outlined before, driving to work, driving home from work, sitting at work, it is a big, big, big deal. And sitting in is found to be associated with low back pain. There's pretty much no question about that at this point in time. And there are ergonomic recommendations. For instance, the WHO recommends the ideal distance Between a chair and the monitor screen is 20 inches. How many people are measuring that at work? Probably like zero. So good tip to know right there. We'll go through some of these factors as well as we continue to go through this study and weak ergonomics. They also include the distance between the front of the knees and the table, which would be 2 to 3 inches apart, to relax the body and allow proper function. So all of these factors in terms of how we sit at a desk could be meaningful. This study is saying, are they meaningful? And we'll have the answers here in just a moment. So many studies have concluded that low back pain is usually work related, which is interesting. Including the identify a few specific items here. Bending or twisting, squatting or kneeling, prolonged sitting, uninterrupted standing, like heavy physical work and nursing activities such as manually handling patients. A lot of that goes to bending, twisting with weight. So you might say, well, what else is there? That's a real exhaustive list of what you could be doing at work. But we know that it's. I'm not going to tell you anything you don't know here. In terms of dynamics are what's important. Making sure you could of course, you know, twist and bend, you can of course squat and kneel, you can of course sit. But it's when this is taking place over an extended period of time, as days become weeks, become months, become years, that we start to run into potential challenges down the road. So in this study they were looking at office workers and trying to identify some of these factors. The age of everybody in this study was 25 or older and they wanted 50% or more of their working hours at a computer desk. So those were some of the inclusion criteria in this study. Now here were the parameters and this is really the pearls, in my opinion, to take home from this one. And this was the response grading and the parameters. One is they looked at the working hours. Good was less than six, poor was over six. And that was hours seated. Right? Working hours seated. So less than six hours seated a day that was graded as good, they pretty, they had this sort of bifurcated either good or poor. Less than six hours good, greater than six hours poor. So if somebody is sitting more than six hours a day, that should be a yellow flag for you in the practice. Ergonomically, second parameter or factor distance from the screen, good was 50 to 70 centimeters, poor was less than 50 super close to the screen or greater than 70 super far away from the screen. So that magic distance to the screen roughly 50-70cm is good. If they're too close. If they're too far away, not ideal. Next factor or parameter. Height of computer from table. Less than 10 centimeters was good. More than 10 centimeters was poor. That was height of computer from the table. The next one. Distance between keyboard and mouse. Interesting one here. Less than 15 centimeters was good. Greater than 15 centimeters was poor. So when somebody's like reaching way out and there's a huge distance between the computer and, excuse me, the keyboard and the mouse, not ideal. You can picture that in your mind right now. It's pretty clear on why that's not ideal, reaching out like that. But an important factor to keep in mind. These are just like this could be a hit list in your practice. If you are focused on workplace ergonomics, if you are doing ergonomic assessments or if you're getting out there on location at some of these companies, this is the information that you want because this is how you can have a system and a program super cleanly, super easily that can make a meaningful difference. Anyhow. Last factor or parameter was the distance between table and chair. Good was greater than 23 inches. Poor was less than 23 inches. So I'll link this study, of course, in the show notes as we do each and every week, but I'll hit those factors or parameters one more time. One, working hours. Two, distance of screen. Three, height of computer from table. Four, distance between keyboard and mouse. Five, distance between table and chair. Those are those five ergonomic factors that you're definitely wanting to keep an eye on because again, they pretty much have this bifurcated. It is either good or bad, right? It is good or poor. So you could check out the study and see those exact numbers again. But if you are doing, I'll reference this again if you're getting out there into doing on site health or you're doing ergonomic assessments at any companies, big or small, in your community, which I think is a great way to build your brand, to get your name out there to network and connect, to provide a valuable service and yes, to bring new patients into your practice. That list right there, those five factors is probably going to be invaluable to you as you get out and start those conversations. Because I look at that list and I'm like, nobody is measuring this stuff. So if you are the one that begins quantifying and measuring and helping people find improvement, that is a great, great place to be from a positioning sense in your community. Being helpful. One of the tenants at the Smart Chiropractor I always say to our team, our number one job is to be helpful. And I think that extends to many chiropractic practices as well. So what was the conclusion that these researchers had? They had the conclusion that, quote, there was a significant association of low back pain with working posture, distance between table and chair, height of computer, and distance of screen and keyboard among office workers. So there was a significant association. They measured a few, they had data on a few hundred people and they found that there is a direct association. So tying back to what we said a moment ago, utilizing that association for your benefit and for your patient's benefit is a really good idea. Meaning identifying those factors, measuring those items on people in your community, in your practice, when you're going on site at a workplace, and then being able to coach them with around how to mitigate those challenges, number one, and how to find relief. Absolutely critically important. And this is just, I think, also a big deal. When we think about maintenance care in a chiropractic practice. I feel like the pendulum is like all over the place when somebody starts, when we start talking about maintenance care, you know, back in the day it was de facto standard within chiropractic. Then there was a, you know, I say this non ironically as the evidence based chiropractor. There's this evidence based swing that no way that's the worst thing to do and it's taking advantage of people, which I disagree with. And now the pendulum sort of swung back in the middle, which, which I think is a good thing. But here is the gist of it. If you are only, we know pain is the last thing to come and the first thing to go. We know habits are hard to break. We know that when people are feeling better, often they go back to the same things, the same habits, the same exact work environment that added up to drive them into your practice in the first place. So my point of that is, I think it is absolutely wild to not discuss and talk about ongoing and maintenance care. Especially as we've seen in the literature, if somebody's had a previous bout of low back pain and they're going back to sitting six hours a day, they're going back to a sedentary lifestyle, they're going back to all of these things. Once they feel a little bit better in your practice, they're gonna come back in one way or the other. So why let them fall off the cliff, so to speak? Why not at least give them the option of supportive maintenance, wellness, however you want to define it, ongoing care so that you can Do a movement assessment so that you can see what's going on segmentally, regionally, whole body, you can apply that in whatever way you want so that you can at least see how they're doing their at home exercises and see if they're doing them correctly. To me, these are all areas of huge opportunity for us as chiropractors because many people, most people, nearly everybody is not going to change their work environment. I've seen people go through surgery after surgery, after surgery and still go back to a work environment that was suboptimal, let's say in terms of ergonomics and directly causing their issues. So if somebody has a bout or two, even pretty severe pain, but they get over the hump, thankfully, which Most people do, 99.9% of them are going to go back to the same things that push them into your practice in the first place. And I believe us as chiropractors not only have the duty and responsibility to do everything we can to help get them well and get, and empower them to make great choices in their life in terms of health, healthcare choices, but also we need to discuss and have ongoing discussions of if you're going back to doing the same thing, you're probably going to end up back here, right? And that's an, it's a delicate discussion to bring up because everybody of course wants a fix, right? Oh, can you fix me? Did the chiropractor fix me? A surgery will fix me. Biggest myth ever. But there are these thoughts of an ultimate fix and most of the time that's not true. This is about process and management. And management could mean that you are almost zero pain for decades to come. That doesn't mean that you're bound to have pain forever, but it does mean that you need to be realistic with what's going on and that the choices that all of us make each and every day matter to our overall health and wellness. How are we moving? Are we moving enough? What are we doing for hours and hours each and every day? And do we have a positive mindset? Are we getting good nutrition? Those things matter of course as well. So I just want to encourage everybody listening that if you are not, especially with these sedentary office workers, the irony is many times, you know, the crossfitters, the athletes, they get it and want the proactive and maintenance care. Yet many times it's the sedentary workers that may need it the most, right. Are reluctant to do so. But just because some people are reluctant to do it doesn't mean that you should not at least extend that offer and let people know what the benefits there are. This is early detection, it's possible prevention, it's maintenance. And it's really to mitigate future challenges. We want to help people be as healthy as they can be for as long as they can be. And a lot of that comes down to having some accountability and responsibility. And us as chiropractors are great partners in that because we are not by and large a 22nd visit. How you doing? You're not in pain? Good. That's what they're getting everywhere else. So if they're getting care, if they're getting 4 minutes, 8 minutes, 10 minutes, 20 minutes, 25 minutes of care, evaluation, treatment and just conversation about what's going on in their life and your practice, there is supreme, supreme value there. So for all these individuals that you do perform these ergonomic assessments on, when you use these factors and when you see they have challenges, yes, clean up their workstation, guide them to have the best ergonomics possible, but don't shortchange the fact that they're still going to be sitting for a long period of time each and every day on their way to work, at work, on their way home from work, and probably once they get home as well. And that is an area while we can of course inspire people to take action, many won't. And we can be there to support them if they can't right now. So that's my big take home message from today's study. Before we wrap up, I want to say a few words about orthotics. If you have not gotten your free sample pair of Power Step orthotics, head over and do so. I'm dropping the link down below in the episode notes. Pro.powerstep.com sample Pro powerstep.com sample these are the foots I use myself. My father uses them. He's had chronic neuropathy issues, low back issues. They have helped him tremendously. These were built by a podiatrist founded by a podiatrist over 30 years ago. Power Step orthotics are the real deal. If you want to check a free sample pair out for yourself. Pro powerstep.com sample I'll drop that link down in the show notes. And before we wrap, one other thing. If you are looking for a next step in your career, please head over to Chiromatchmakers.com we have over 100 jobs available, paying $85,000 a year and up base salary. So if you're looking for that next step in your career, head over there. Also, if you're looking to build, grow and expand your team with a new chiropractic assistant or a new chiropractic associate in your practice, do not waste a ton of time, effort and energy trying to go through the sourcing vetting interviewing process yourself. Rely on those who do it all day, every day. Team of 14 recruiters over at Cairo matchmakers how helped over 500 docs build and grow their team with ideal team members saving them time, saving them money, using behavioral matching. All of those things that large companies are doing to ensure that they have fantastic people in their practice, you can do as well. Chiromatchmakers.com Other than that Docs Please if you have not left a rating or review on itunes for this podcast, please do so. That helps us reach more and more people. And thank you so much for tuning in week in and week out. If you have any feedback or comments for me, you can always hit me up too@jeffevidencebasedchiropractor.com I hope you have a fantastic week in practice and I will talk to you soon.

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