Posture and Comfortby Hugh Babington Smith
Management tools for reducing risk to posture
There are many tools available to help reduce risks to posture. These range from equipment to a wide range of advisors and sources of information. This section aims to tell you a bit about each to help you decide how to proceed.
You can find any amount of information – a quick internet search on a phrase such ‘computer posture’ will throw up the usual thousands of results. Much of the advice is sound, but very little is complete. Publications and websites often have diagrams or photographs of ‘perfect posture’ and many of these are either not helpful or, occasionally, simply wrong – joints at wrong angles, equipment in unsatisfactory positions or the subject shown with a clear slouch.
Adjust the seat of the office chair so that the work surface is ‘elbow high’.
Quite apart from having to decide what ‘elbow high’ means, a small person following this advice could end up with his or her legs dangling...
Use diagrams to help you understand some point that is being made, not as blue-prints for behaviour.
Posture is unique to each of us; there is no one solution for everybody.
So, to answer the question, ‘How do I use the information I can find?’, either get training yourself or, if you realise that the training need is specialist, find someone who has the appropriate skills to put across the information correctly. Published information can then be used as a reminder. See the page on using Display Screen Equipment.
Areas for training
Below are some of the ways in which you might seek to reduce the risks to musculoskeletal health by having your team trained, either individually or in groups.
- Understanding posture is the most essential area for training, because if each individual understands the principles (in other words, the contents of the first half of this topic) and how these apply to them, they then have the capability and responsibility of reducing their own risk. They are more likely to be posture conscious all the time, and are best placed to monitor their own posture.
- Using equipment and furniture: it may sound crazy, but especially with chairs that have movement, it is important to understand how they work in order to use them correctly and avoid damage that might arise from misuse.
- Understanding health generally: posture is part of health, and an understanding of exercise and diet will complement any training on posture.
The word ‘ergonomic’ is frequently misused, as much so-called ergonomic equipment has never been near an ergonomist. So, how do you assess whether you are getting value for money?
From the musculoskeletal point of view, the best position is the next position. Periodic movement will go a long way to avoiding musculoskeletal problems. However, repeated movement, especially if incorrect, will create problems (such as repetitive strain injury/RSI). So a reasonable expectation of ergonomic equipment is that it will either help people move correctly or reduce the likelihood of incorrect movement. It has to be remembered, though, that that incorrect use of ergonomic equipment can still cause damage.
Some chairs are designed to move with the slightest user movement, so that when the sitter reaches out, for instance, the chair under him will move too. For certain movements, this encourages the body’s muscles, especially the postural ones, to work or be given a chance to rest. (This kind of chair can offer an example of potential for damage, however, because if someone other than the user should sit on it without knowing the way it moves and without understanding how to control their body, they are very likely to be extremely surprised to the extent of falling off.)
Sit/stand desks, which can be raised electrically to allow working at a standing position, are an excellent investment. This is recognised in Scandinavia, where offices have to supply adjustable desks if needed. Prices are now coming down and where they are equivalent to a normal desk, the decision should be a ‘no brainer’. (Often, a lower back sufferer is unable to sit for long but could be at work if able to work while standing up between periods of sitting.)
Preventing incorrect movement
Some equipment is good because it ensures the user avoids incorrect movements. An example is a telephone headset, so that the handset is not held between head and shoulder, a position that is a postural sin.
More difficult are things such as pointing devices – mouses (also known as rodents, mice, manual input devices), trackballs, drawing pads and pen devices. There are literally hundreds on the market, many of which are claimed to be ergonomically designed. There is a danger here: they may be bought to avoid one repetitive action, but you may find that damage results if the new equipment leads to the user making different repeated too-frequent movements. There is no point in investing in something only to leap from the frying pan to the fire.
So, when spending money on equipment, you should also consider paying for advice on what to get and training in how to use it.
If the chair and/or desk manufacturer is offering training for their ‘ergonomic’ equipment, this is reasonable (though not conclusive) evidence that they know what they are talking about.
Tip: ask what the ergonomist’s input has been.
Sometimes the ergonomic need should be obvious, such as a chair and table for a very large or very small person. Office furniture is made to ‘norms’, which cover a reasonably large (usually 95 per cent) proportion of the population. So if someone is outside the norm, it is very likely that they will need special provision. This extends not just to the major items, but to keyboards and pointing devices.
How effective is ergonomic equipment?
Generally speaking, if the purchase and training requirements have been thought through, it is very likely that the user will be pleased with a new piece of ergonomic equipment and will use it, for it will remove the cause of pain.
Without the appropriate knowledge and training, however, a piece of equipment tends to be a toy, played with and later discarded. Hopefully, of course, if postural habits change for the better, the equipment may in any case be less necessary and consequently discarded. On the other hand, discarded equipment may be a sign that the user has simply gone back to bad habits, this requiring less effort than change. Depending on the size of the company or department, it may be worth having a pool of smaller items which can be made available to others.
Producing ergonomic software is becoming a separate branch of ergonomics. It generally entails producing software that people find easy to use. If this leads to a reduction of stress, it is of course a positive move.
Many large companies also use software to interrogate computer users in order to find out who might be suffering from what. Many methods are used, from occasional questionnaires through to software that will monitor the amount of typing a person is doing and prevent them from exceeding a certain level.
You should particularly be aware of speech recognition software, which is becoming better with every generation. In principle, this works by the computer learning to recognise the individual’s speech so that they can give it instructions (‘open file X’, ‘print’) or dictate. As with all gizmos, some people find this type of software easier to use than others. It can be said, though, that if you can master it, the benefits will be great. It may not, unfortunately, be suitable for open-plan offices.
There are also many programs and combinations of software and hardware which can transform the lives of people with specific disabilities. Examples include input devices that operate by the movement of a finger, head or even an eyelid. You should be aware of the potential advantages of this type of device if you have a team member who has a disability.
It is a characteristic of the whole field of health at work that prevention tends to be paid lip service, and the expertise is often reactive. First, employees may not be upfront about their problems; second, it is easier to react to the measured – such as days’ absence, for example. So, should you seek specialist advice on a postural matter? This slightly depends on the problem, and there are in any case several categories of specialist.
There are several qualifications where the training and practice may cover workplace ergonomics and posture in particular. Many professionals seem to collect certificates and degrees, so that you may find a person has moved from being a nurse through health and safety qualifications to ergonomics.
True ergonomic advice should be sought when it can be effective: at the design or planning stage. In large businesses, an ergonomist will be able to advise effectively on organising to meet the requirements of the business. For instance, even before briefing an architect to build, say, a new airport terminal, medical centre, hospital or cinema complex, it is worth taking advice, as understanding human flow for design purposes is one of the subjects on which ergonomists are expert.
At a different level, an ergonomist could usefully give advice on equipment and furniture. Ergonomic advice should also be sought if a specialist machine is being designed.
Health and safety professionals
Their expertise tends to be in the administration of health and safety, with an emphasis on following procedures. Knowing the legislation backwards is not necessarily a reason to trust their postural advice. Having said that, some do gain enormous practical experience in understanding posture.
Physiotherapy is a health-care profession concerned with human function and movement. In layman’s terms, physiotherapists know about bones, muscles, nerve systems and what they do. There is a special interest group, the Association of Chartered Physiotherapists in Occupational Health and Ergonomics, and if you are seeking advice about posture, physiotherapists within this group are a very good starting point.
Occupational physicians and therapists
Occupational medicine is the prevention, diagnosis and treatment of diseases and injuries at work. Occupational therapy is the assessment and treatment of physical and psychiatric conditions, using specific, purposeful activity to prevent disability and promote independent function in all aspects of daily life. Very large companies will have an occupational health department, though members of this department may or may not have postural expertise.
Sometimes these are professionals with an appropriate qualification, but whether this is so or not, they are always ready to give advice! This will range from very sound advice, from firms using designers with relevant professional qualifications, to the frankly cowboy manufacturers. Buyer beware!
There are several agencies that can provide information, services and advice on equipment for people with disabilities (see Websites).
There are many other disciplines and systems of training which may or may not be helpful to the individual. Examples include sports therapists and shiatsu and Pilates practitioners. They are unlikely to be of much help to the manager in the workplace unless allowed to run classes on site.
Some companies allow masseurs to practice at the workplace, or in a separate room, using portable specialist chairs and concentrating on neck massage. These may be popular, but are reactive. If you find they are very popular, there is probably some symptom that is escaping your notice. This may well be generally poor posture caused by or exacerbating some other stress factor.
Company X prides itself on its initiatives to look after its employees. Approached by an Indian neck masseuse, they allowed her to come in once a week, offering fifteen-minute sessions, part-funded by the company.
After a month, only four people had had a massage.
Employees were not stressed!
To meet the requirements of the legislation, DSE assessments have to be carried out by health and safety staff or other in-house staff ‘if they have (or are trained for) the abilities required’. The regulations are quite clear that assessors ‘recognise their limitations as to assessment so that further expertise can be called on if necessary’– in other words, the average assessor will not be able to do eye tests or give postural advice. It is all very well sending the telephonist on a half-day course, but do not expect them to be able to solve postural problems.
A good internal assessor will know his or her own limits. Their claim to competence should be matched by their experience. They are often grateful for some outside help.
Some very large companies use the services of specialist consultants who provide online assessments. The employee watches videos or DVDs to see how to do things, and answers online questions, the answers being compiled and examined centrally and any obviously urgent problems tackled. The attractions of such routes are obvious, but if you are considering purchasing this type of advice you should demand good evidence of the consultant’s effectiveness.
Other companies use external assessors, whose qualifications may range from fairly basic DSE assessment training to specialist qualifications mentioned above; again, assure yourself of their effectiveness.
A word about call-out
Many companies use external advice only in cases where they feel they cannot make progress themselves and it becomes apparent that a case is so serious that the person is a liability – either medical or legal, or perhaps both. While this may save money in the short term, it is a policy that has several disadvantages.
The first is that if a person is working up to having a condition that is going to require professional intervention, they are already working below par. It is simply not in the interest of the employer to let this situation continue.
Secondly, at this stage, trust between employer and employee is simultaneously breaking down. Many of these conditions arise because a person is working under pressure, and that pressure is becoming stressful. If the employer is apparently not listening, the employee will cease to trust. This is equally the case if the employer just believes that the employee is ‘trying it on’ or ‘whingeing’.
Properly professional intervention will be neutral. The employer, even if paying the bill, should have broad shoulders and be ready to accept the facts as reported to them. Ignoring or rejecting advice, comment and opinion because it is uncomfortable will simply delay progress and, at worst, could count against the employer if the case reaches tribunal or court.
Try to avoid getting to that stage of call-out; it can be said that every call-out is the consequence of a management failure.