Your Computer and You

A Healthy Workstation That Works

Setting-up your computer workstation to be a healthy environment is a key element in avoiding repetitive stress injuries.Monitor position, seat height, and elbow-wrist placement are the main elements of a ergonomically healthy design. Your chair seat height and the keyboard should be aligned so that when your hands are on the keyboard, your elbows are parallel to the floor. In other words, in an ergonomically efficient typing position, your elbows are neither above nor below the keyboard. Your wrists should be in a neutral position when typing, neither flexed nor extended. Chronic wrist flexion or extension will result in fatigue and overuse. Position your monitor or laptop display so your neck flexes slightly and your angle of gaze is directed downward about ten degrees. If you’re using a mouse, it should be close to the keyboard, so that good elbow alignment is maintained. You should not have to reach for the mouse. It should be right there.

Windows and Mac users actually do have one thing in common - computer ergonomics issues, namely, pain.^1,2 Beyond the usual hardware and software gotchas we deal with on a daily basis, the real bottom-line question is, “how to play nice with my computer”.

Doing computer work is a funny kind of work, a type of activity we’re still getting used to. It’s not physical work in the sense that there’s no heavy lifting going on, no truck-driving, no emergency services heart-pounding decision-making.

But computer work is still an intensely physical activity, although the work is pretty subtle. In computer work it’s the small muscles that are getting the workout, not the big muscles we’re used to thinking about.

Wrist muscles, tendons, and ligaments. Finger muscles, tendons, and ligaments. Shoulder muscles, Neck muscles. All of these are involved in ongoing repetitive tasks when you sit at a computer and one hour turns into two, two hours turns into three, and suddenly half the day is gone and you notice you’ve got a killer stiff neck.

Or, one day the tendons on the back of your hand begin to hurt, feeling irritated and inflamed. Or your shoulders and upper back are tight and painful.

Your hands or shoulders feel better by the time you go to sleep. But the next day, as soon as you start to type they act up again.

This is all very uncomfortable, because you’ve got to do your work.

What’s going on?

These various pain patterns in your hands, wrists, shoulders, and neck can be grouped together as a repetitive stress syndrome. Repetitive activities, done over a long period of time, can irritate and inflame the muscles, tendons, and ligaments that are involved in doing the work.

But computer work involves repetitive tasks. How can you avoid these painful problems?

The best approach is to prevent them in the first place.³ If such a syndrome does develop, relative rest is indicated. Reduced computer activity, in smaller intervals, is a good solution. A very useful work-around for right- or left-arm pain is to teach your non-dominant hand to use the mouse or touchpad. This training may take a few weeks - the valuable result is the ability to switch hands whenever you like, distributing the workload between the two sides. Much better.

The most important aspect of prevention is to take a quick, refreshing break once an hour. This is a critical habit to develop. Get out of your chair, walk around, get some fresh air if possible. Change your environment for a few minutes - talk to a co-worker for a moment, get a drink from the water-cooler down the hall, seek out a picture, wall-covering, or landscape you’ve never seen before.

These activities refresh your body AND your brain, and you’re ready to do another hour of productive, creative, healthy work. You’ll feel much better, you’ll be avoiding repetitive injuries, and your workday will be more enjoyable.

¹Keyserling WM, Chaffin DB: Occupational ergonomics - methods to evaluate physical stress on the job. Annu Rev Public Health 7:77-104, 1986.
²Computer Workstation Ergonomics. Centers for Disease Control and Prevention, 2000. http://www.cdc.gov/od/ohs/Ergonomics/compergo.htm
³Robertson MM, et al: Effects of a participatory ergonomics intervention computer workshop for university students. Work 18(3):305-314, 2002.

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Pregnancy, Parenting, and Lower Back Pain

How to Pick Up Your Kids

We’re not talking minivan here. Moms and Dads spend a lot of time bending and lifting. We want to do this right, as much as possible, and not have a lot of down time while our injured back is healing. First, get as close to your child as possible. You want to have your arms right next to your body, not extended in front of you. Next, always bend your knees. Never bend over with straight legs. Next, suck in your stomach muscles. When you activate your abdominal muscles, you’re taking a lot of potential strain off the lower back muscles. Your abdominal muscles are designed to carry the weight. Finally, straighten your legs, continuing to activate your stomach muscles, holding your child close to you. With a little practice, safe lifting will become a habit.

You’re pregnant! Congratulations! Your body’s changing—wondrously, marvelously. One unexpected and unwelcome change may be lower back pain. Recent studies suggest that two-thirds of pregnant women experience lower back pain.¹

These statistics seem reasonable. The weight of the growing baby, plus the weight of the placenta and amniotic fluid, create an unbalanced load in front of the lower back. The result is irritation of spinal ligaments, muscles, and tendons, causing pain, muscle spasm, and loss of mobility.

Of course, some cases of pregnancy-related back pain have specific medical causes. Uncommon conditions such as pregnancy-associated osteoporosis, septic arthritis, and inflammatory arthritis may need to be considered.²

That said, the vast majority of cases of back pain in pregnancy are mechanical in origin.

Your doctor of chiropractic will perform a complete examination and determine the correct course of treatment, if appropriate. Once you’re feeling better, you can begin

stretching and doing safe, gentle exercises that will help prevent recurrences of lower back pain. The goal is to strengthen your lower back and minimize the mechanical effects of pregnancy.

The best method of preventing back pain in the first place is being fit. This includes healthy nutrition, gaining a moderate amount of weight, and regular exercise. Your obstetrician will likely recommend vitamin and iron supplements and will monitor your weight. The average healthy woman gains between 25 and 35 pounds during the course of her pregnancy.³

Let’s fast forward a few years. Your newborn is now a toddler. Parents know that if you have kids, stuff happens. You bend over to place a bulky car seat in your car. Then you place your child in it. And then, you bend over to remove the car seat from your car. If you’ve gone to the mall, kids want Daddy or Mommy to carry them. Pick them up, cart them around, put them down again.

What’s a parent to do? It’s not like you can avoid any of these activities. Your kids are kids - it’s up to you to do stuff for them. The answer lies in regular exercise. “But how will I find time to exercise, when there already isn’t enough time to do the things I need to do?”

That’s a tough question, but if you recognize the benefits, you’ll make the effort to make the time. Forty-five minutes or an hour per workout, three or four times a week, will be plenty. And, once you’re in the habit of exercising, you’ll notice it’s easier to lift your kids, easier to bend over, easier to carry them. It’s easier because you’re

fitter and stronger. And healthier. And, surprisingly, you’re having more fun.

¹Pennick VE, Young G: Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev 18(2):CD001139, 2007.
²Sax TW, Rosenbaum RB: Neuromuscular disorders in pregnancy. Muscle Nerve 34(5):559-571, 2006.
³Jain NJ, et al: Maternal obesity: can pregnancy weight gain modify risk of selected adverse pregnancy outcomes? Am J Perinatol 24(5):291-298, 2007.

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When Is Back Pain More Than Back Pain?

Your First Chiropractic Office Visit

Your chiropractor’s purpose on your first office visit is to make sure you’re in the right place. He or she wants to make certain your back pain really is back pain - and treatable - rather than being a symptom of an underlying medical condition. Your chiropractor will take a complete history, learning the facts about your problem. How long you’ve had the pain, the nature and quality of the pain itself, whether the pain is localized or radiating, and whether the pain wakes you up at night are key elements in solving the puzzle. Following the history, your chiropractor will perform a complete orthopedic and neurologic exam, gathering all the information necessary to arrive at what’s called a “working diagnosis”. If your chiropractor concludes that treatment is appropriate, she will outline the anticipated stages of improvement and recovery, noting that further evaluation will be done if you’re not getting better in a timely manner.

Out of the blue, your back starts to hurt. At first, it’s just an annoyance. You can live with it. You’ve had lower back pain before and it went away on its own.

Now it’s a few weeks later. You’ve got a low-grade pain that’s not getting any better. You’re actually worse, in fact, because your back hurts most of the time.

What to do?

You don’t want to run to a doctor. After all, it’s just back pain. Everybody has back pain. So you begin to solicit advice from your friends. And, of course, your friends have plenty of advice. “Do these exercises my doctor gave me.” “Do these stretches - they worked for me.” “Go to yoga class.” “I know a great Pilates instructor. She’ll get you in shape and your back will stop hurting.” “Take vitamins and drink more water.” “Meditate.”

Your friends mean well and it’s all very good advice. But none of it seems to work. Another month goes by and now the pain is increasing. It’s even affecting your sleep.

It’s time to see a doctor. But which one? For the most part, medical physicians are not experts on back pain. Typical recommendations include rest, moist heat, and anti-inflammatory medication.^1,2 But, really, you’ve done all that. You need more specific advice.

Choices might include doctors of chiropractic, orthopedic surgeons, and physical therapists.

Many orthopedic surgeons are spinal specialists, but what they do is surgery. This would be a last resort, typically, after other treatment options have failed.

Physical therapists are highly skilled practitioners who focus on exercise, rehabilitation, and re-training. They are not primary care providers, and typically patients are referred to physical therapists by family physicians, chiropractors, and orthopedic surgeons.

Doctors of chiropractic are spinal specialists, too, and what chiropractors have to offer is expert conservative therapy.³ Chiropractors treat back-related problems all day, every day, and are the right doctor to see first.

As spinal specialists, chiropractors receive extensive training in evaluating patients with back pain. Chiropractors consider all aspects of the problem, and develop sound treatment plans based on the facts. If a person does not respond as anticipated, their chiropractor has a “Plan B” in place for further evaluation and possible referral.

When choosing a doctor, you’re allowed to ask questions and participate in the process. The strategy for follow-up is critically important.

First, if you’re improving and doing well, how will can you help keep the problem from recurring? Will your chiropractor prescribe stretches, exercises, and other self-care action steps to help you keep yourself well?

And, what steps will be taken if your problem and pain are not improving? Where might you be referred for further tests and evaluation? Chiropractic treatment is a powerful tool in most cases of back pain. Symptoms should begin to improve quickly. Have your chiropractor outline the “Plan B” if you are, in fact, not getting better.

Your doctor of chiropractic will be able to answer these questions.

¹Zuhosky JP, et al: Industrial medicine and acute musculoskeletal rehabilitation. Arch Phys Med Rehabil 88(3 Suppl 1):S34-39, 2007.
²Cayea D, et al: Chronic low back pain in older adults. What physicians know, what they think they know, and what they should be taught. J Am Geriatr Soc 54(11):1772-1777, 2006.
³DeVocht JW: History and overview of theories and methods of chiropractic. Clin Orthop Relat Res 444:243-249, 2006.

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Childhood Sports Injuries

Kids and Fitness

It’s never too early to get your kids into a fitness routine. This is a habit that will last a lifetime.Without regularly scheduled exercise and sports activities, children will automatically default to watching television, playing on the computer, and playing video games. These pastimes are great for stimulating creativity and developing hand-eye coordination, but contribute nothing to a child’s level of fitness. One out of three American children are overweight, obese, or at risk for being overweight. This appalling public health information indicates a much greater risk of diabetes and heart disease as the child becomes a young adult. Regular exercise and good nutrition will help a child maintain an appropriate weight and will promote longlasting health benefits.

Kids get hurt all the time. They’re running, they’re jumping, they’re crashing into things. Kids want to have fun, and when they play, they play full-out.

So, when kids play real sports, stuff happens.1,2 Whether your kid plays soccer, baseball, football, or studies karate, a broken bone, sprained ankle, or twisted knee is just the natural fallout of learning new skills and having a good time.

The treatment for most childhood sports injuries is straightforward and standard.3 For strains and sprains that involve only mild to moderate swelling and pain, the time-honored RICE protocol is followed - rest, ice, compression, and elevation.

Pediatric orthopedists get involved when the injury is more severe or when an arm or leg bone is broken.

But there are other issues, and every parent needs to be aware of these possibilities. In one of the unusual chains of circumstances that make the practice of medicine and the practice of chiropractic so interesting, a physical trauma (like a sports injury) can reveal an underlying serious problem.

In other words, various disorders of bone may not show themselves in terms of symptoms until a physical trauma makes them apparent. Such problems include metabolic disorders, growth and development problems, and even benign and malignant tumors.

What would make a parent suspect such an issue? First, if the child’s pain seems out-of-proportion to the degree of injury. A mild knee sprain - for example, caused by tripping over second base while trying to stretch a double into a triple - should not be causing significant pain.

Also, mild-to-moderate injuries should not be warm to the touch. A parent can evaluate this. And, a child should not be running a fever after an activity-related injury.

It would also be suspicious if the pain did not improve daily. For the majority of injuries, pain that lingers beyond several days suggests an underlying problem. Children are resilient. Healthy kids heal quickly. They want to shrug off an injury, forget it happened, and get back to playing.

If your child isn’t getting better in a few days, seems lethargic, or feels ill following an injury, warning bells should go off.

Your family chiropractor is familiar with all such conditions and scenarios. He or she is always alert to unusual situations and will recommend the appropriate steps to take, including a complete physical and x-ray examination. If necessary, your chiropractor will be able to recommend appropriate specialists for follow-up, including hematologists, endocrinologists, and pediatric orthopedists.

These more serious problems are uncommon. And, of course, well-informed parents help their kids grow up healthy and strong.

¹Caine D, et al: Incidence and distribution of pediatric sports-related injuries. Clin J Sport Med 16(6):500-513, 2006

²Emery CA: Risk factors for injury in child and adolescent sport: a systematic review of the literature. Clin J Sport Med 13(4):256-268, 2003

³Demorest RA, Landry GL: Prevention of pediatric sports injuries. Curr Sports Med Rep 2(6):337-343, 2003

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