Desk Jobs: Preventing Aches and Pains
After this crazy past year and a half, we have had more people than ever working from home and spending more and more time sitting for work. This can also include people that drive all day for work! People who sit for 8 or more hours per day are at increased risk for diabetes, anxiety/depression, decreased bone density, musculoskeletal pain, and reduced circulation, putting them at greater risk for stroke or heart attack. In addition, studies have shown that people who sit for 8 or more hours per day have an increased risk of mortality similar to obesity and regular smoking!
Musculoskeletal Impairments from Sitting All Day
As you can see in the photo above, the sitting position, particularly with a forward flexed posture, can shorten several different muscle groups. This prolonged shortening of the muscle can lead to decreased flexibility of the muscles attached to your spine, increasing tension where it doesn't belong. The muscle groups that predominantly get tight as a result of the seated posture include the suboccipital muscles (at the base of your skull), the upper trapezius muscles (top of your shoulder up into your neck), scalenes (from collar bone up into your neck), the pectoralis muscles (across your chest) and the hip flexors (front of the hip).
On the other side, the muscles that are on a stretch while in the seated position tend to get weak over time and limit your spine's stability. The muscle groups that tend to get weak in the seated position include the cervical stabilizers (muscles deep in your neck that support your spine), upper back muscles, core muscles, and glutes (in the back of your hip).
The Good News
It was also found that regular exercise at moderate intensity at least 2 times per week could combat these general health risks described above! This could be going for a run, a resistance workout, or an exercise class at the gym! There are also many ways to improve circulation, bone density, and musculoskeletal pain throughout the day using movement. Some suggestions include:
Getting up from your seat every 30 minutes. Really, set yourself a timer and get up to stretch or walk for just a few minutes, go make copies, move the laundry to the dryer or let the dog out. These breaks in sitting can act as a good reset for your body!
Standing desk or position table above a treadmill. This is a great one if you have the means to get a standing desk or if it is something that your office provides. If you have a portable tray table, you can also position it above a treadmill or stationary recumbent bike in your home. You could also get a small pedal bike to position under your desk.
Walking during conference calls or meetings. If you don't need your computer during the meeting, get outside and go for a walk.
Walk during your lunch break. If you have an hour for lunch, try to take at least 15 minutes to get outside and go for a walk. It is an excellent way to get some fresh air and improve your afternoon energy levels.
Next, we will be breaking the body down into 3 major areas: the neck and shoulders, the chest/upper back, and the low back/hips. Then, we will discuss general recommendations to improve posture or reduce pain in these areas or adjustments you can make to your desk area. We will then discuss specific stretches/exercises you can do right at your desk or that you could start to incorporate into your exercise routine.
The Neck & Shoulders
One of the most common things I see as a physical therapist related to people who have jobs where they work at a computer all day is neck pain or tension headaches. When sitting and looking at a computer monitor, it is common for your head to start to come forward with rounded shoulders, putting increased strain on the muscles in the back and sides of your neck. We will discuss specific things to stretch these muscles and strengthen the muscles that provide stability below. However, some things that you can also do to reduce this strain and tendency for pain include:
As we described above, taking breaks about every 30 minutes provides that postural reset for your body.
Take a look at your desk setup. You want your elbows bent at your sides about 90 degrees to reach the keyboard and mouse. If your keyboard and mouse are too high (increased elbow flexion), it may cause you to shrug your shoulders, leading to neck strain and tension headaches that begin at the base of your skull. If your keyboard and mouse are too low (elbows more extended), it may cause you to slump over more so that you have to look up at your monitor, which can have the same effect on the neck muscles.
Take a look at your monitor setup. You want the monitor tilted, so you are looking straight ahead or just slightly below eye level. You want the monitor about 20-25 inches from your face.
Make sure you have a good chair with good support for your low back to promote better posture. It is best if the chair that has adjustable arm support as well.
Exercises you can perform during the workday - in your office
You can perform these exercises easily sitting at your desk and reduce the strain placed on the back of your neck while also strengthening the deep neck flexor muscles to provide better stability for your neck.
Scalene Stretch
Sit up tall in a chair. Place the arm on the side you would like to stretch behind your lower back or straight down to the side. Tilt your head toward the opposite shoulder and back slightly. You should feel a stretch down the front of the side of your neck. Hold 3 times for 30 seconds each.
Upper Trap Stretch
Sit up tall in a chair. Place the arm on the side you would like to stretch behind your lower back or straight down to the side. Tilt your head to the opposite side until you feel a stretch down the side of your neck. Hold 3 times for 30 seconds each.
Levator Scap Stretch
Sit up tall in a chair. Place the arm on the side you would like to stretch behind your lower back or straight down to the side. Turn your head toward the opposite shoulder and then look down toward your hip. You should feel a stretch down the back of your neck to the shoulder blade. Hold 3 times for 30 seconds each.
Seated Chin Tuck
Start in a seated position with your shoulders relaxed, looking straight ahead. Tuck your chin in to resemble a double chin. Hold this position for 5-10 seconds and perform 10 repetitions. Do not extend your neck back or flex your head forward.
Exercises to add to your current routine
These would be great exercises to use as a home exercise program or to integrate into your current exercise program a few days a week for progressive strengthening of the deep muscles stabilizing your spine.
Supine Chin Tuck
Lying flat on your back, tuck your chin in, as to resemble a double chin, or like you are trying to flatten your neck onto the floor. Hold this position for 10 seconds and perform 10 repetitions. When this exercise becomes too easy, progress to the next one below.
Chin tuck with Head Lift
Perform chin tuck as above. While maintaining the chin tuck position, lift your head 1-3 inches off the floor and hold up to 10 seconds (as long as you can maintain the chin tuck), then return your head to the floor and then relax the chin tuck. Perform 10 repetitions.
The Upper Back, Chest and Shoulders
Another prevalent thing that we see in physical therapy is the limited mobility of the upper back. Some people have pain, typically around the shoulder blade, between it and the spine. However, it is more common that the lack of upper back (thoracic) mobility leads to issues in the neck or low back. The spine is meant to move together, with mobility present in all segments. When the thoracic spine gets stiff, we overuse/all the mobility has to come from the neck or low back...leading to pain. As a result, you may experience symptoms in your neck or back or radicular symptoms, symptoms that shoot from your spine down into your arm or leg.
Many of the general recommendations for posture and desk set-up that we discussed in the neck and shoulder section also apply to the upper back. You want to select a chair with a good arm and lumbar support to avoid that forward-slumped rounded shoulder position. If your current chair does not have a good arm or lumbar support, you can add one or get creative with pillows. You can get a small pillow to put behind the small of your back or roll up a towel for more firm support. You can also position a pillow across your lap to support your elbows as needed as well, to avoid leaning forward and slumping your shoulders.
Exercises you can perform during the workday - in your office
Thoracic Extension
Stand facing your desk or a counter that’s about waist to chest high. Place your hands on it and walk your feet back so that your feet are under your hips. Push your buttocks/hips back to move your chest down towards the floor. Keep your elbows locked out and tighten your quads. Hold 10 seconds and repeat 5 times.
Pectoralis Stretch
Stand with both forearms on a door frame so that your shoulders and elbows are at about 90 degrees. Keeping your forearms on the wall, take one step forward until you feel a stretch across your chest. Hold 30 seconds and repeat 3 times.
Seated Scapular Retraction
Sit upright with good posture. Squeeze your shoulder blades together and down holding for 5 seconds. Keep your chest up while doing this exercise. Repeat 10 times.
Exercises to add to your current routine or home exercise program for progressive strengthening.
Foam Roll Pectoralis Stretch
Place a foam roll on the floor and lie back on it with the foam roll running under your spine. Start with your arms together straight in front of you. Lower your arms out to the side until you feel a stretch across your chest. Hold 30 seconds and repeat 3 times.
You can also do the pectoralis stretch with your elbows bent at 90 degrees and relax the forearms back towards the floor behind you. Hold 30 seconds and repeat 3 times.
Thoracic Extension over Foam Roll
Place a foam roll on the floor perpendicular to your spine. Lie back with the foam roll running across the level of your spine that you would like to stretch. Cross your arms across your chest or wrap your hands around the back of your head to support the weight. Ensure you do not pull your head forward, keep it in line with the rest of your spine. Inhale, then as you exhale, allow your body to relax over the foam roller. Move slowly and repeat. You can perform at various levels of your upper back.
Rows with Scapular Retraction
Stand with a resistance band anchored on a door handle or cable column at the wall, just above waist height. Stand up tall, squeeze your shoulder blades together and pull your elbows back. Make sure you keep your shoulders down during the movement. Repeat 10 times, perform 2 sets. *To add some core strengthening/stabilization, stand on 1 foot while doing this exercise!
Serratus Press
Start lying on your stomach with your elbows directly under your shoulders.
Relax and inhale; on the exhale, push your shoulder blades apart while keeping your core muscles tight. Hold 10 seconds, repeat 10 times.
Side-Lying Thoracic Rotation
Lie on your side with your head supported on a pillow, and your knees bent at 90 degrees with your spine in a neutral position. Reach your arms out in front of you, with your hands together.
Inhale, then rotate the upper arm to the other side, following your hand with your head on the exhale. Be sure to rotate from your upper back and keep your knees/lower back steady. Perform 10 repetitions, moving slowly.
The Lower Back, CORE and hips
Another common thing that we see in physical therapy is limited mobility in the hips and weakness through the core and glute muscles. Lower back pain is one of the most common causes of disablement, and its already high prevalence is rising. When you are seated for a period of time, it is common for the pelvis to rotate posteriorly, rounding out your lower back. This position also causes your hip flexors (iliopsoas) to shorten and become tight. The shortening of the hip flexor muscles makes it more common for your pelvis to excessively tilt forward when standing or walking, which causes your back to arch too much.
Prolonged sitting causes problems in your spine itself as well. When you are sitting and your low back flattens, the interior portion of the discs between your vertebrae pushes backward. This causes more pressure in the back of the disc, which can cause that aching pain in your lower back. It can also push out or bulge to put pressure on the nerves as they exit your spine, causing pain, numbness, or tingling down your leg.
Again, your desk and chair setup are essential, just as we have discussed for the neck and upper back. It is important that when seated in a comfortable position, you have lumbar support behind you (either from your chair or a lumbar pillow/towel) and that your feet are flat on the floor. If the chair is too short, you end up flexing your hips even more. If it is too tall, it can pull you more into that position of the posteriorly rotated pelvis. To keep your core muscles and hips engaged when sitting, you could use a stability ball for sitting at your desk.
Just be careful with your setup, the ball that I have here in the clinic fits my legs well, but it has me sitting too low at my desk. So when I use this at work, I use a small height-adjustable tray table so that I'm not looking up or shrugging my shoulders!
Exercises you can perform during the workday - in your office.
Standing Lumbar Extension
Start standing with your hips supported on your desk or at a counter. Hold the counter for support and gently lean back just until you start to feel a stretch in your back and then come back forward. You want your back muscles to stay pretty relaxed. Use your core and arms to support your weight, so your spine is moving more passively. Perform 10 repetitions.
Sit to stand or Squats to Chair
You can start seated in your chair (stationary one, not rolling). Scoot to the edge of your chair, lean your shoulders forward over your toes, and come up to standing. Be sure to extend your hips all the way and squeeze your glutes at the top. You can also do this as more of a squat. Start standing in front of your chair, squat down to touch the chair, and come back up. Make sure your knees are not going over your toes and that you are keeping your back straight. Perform 10 repetitions.
Exercises to add to your current routine or home exercise program for progressive strengthening.
Hip Flexor Stretch
Lie on your back on a bed, with one leg bent up and the other leg straight (you should be on this side of the bed). Dangle this leg down off the edge of the bed. You will feel a stretch in the front of your hip and thigh. Hold 30 seconds, repeat 3 times.
To get a deeper stretch, you can pull the opposite leg toward your chest.
Or you can use a strap, belt, or dog leash to gently pull your leg back. (you can pull back as I do in the picture, or take the strap up over your shoulder and pull down in front of you.
Prone Press Up
Start lying on your stomach on the floor. Bring your hands under your shoulders and push your upper body up into an extended position until you start to feel a stretch in your low back. Keep your hips and thighs on the floor at all times. Try to keep your back muscles as relaxed as possible, use your arms and keep your glutes engaged.
Bridges with Band
Tie a resistance band around both thighs, just above your knees. Lie on your back with your knees bent and legs hips-width apart so there is some tension on the band. Raise your hips up into a bridge, keeping the knees hips-width apart. Be sure to keep your core engaged. You do not need to arch your back. Control the movement back down to the start position, maintaining constant tension on the band.
Prone Hip Extension with Knee Flexed
Start lying on your stomach with your knee bent to 90 degrees. Squeeze through your glutes and lift your knee up off the floor. Your foot should move straight up toward the ceiling. Repeat 10 times. It is important to make sure your back muscles stay relaxed, don't lift your hips or twist your back. If you have back pain, you can put a pillow under your stomach for support.
Squats with Hip Extension
Stand with your feet shoulder-width apart with the option to add a resistance band around your thighs or ankles (harder). Engage your core and squat down, bending from the hips. Keep your back straight as you push your hips back and counterbalance by leaning your torso forwards. Your weight should be evenly on your heels and the balls of your feet, not your toes. Squeeze your glutes at the bottom of the squat and keep them tense as you straighten back up to the start position.
At the top, squeeze your glutes and extend 1 leg straight back, then the other. Do not bend forward or arch your back.
Deadlift Hip Hinge
Stand with your knees slightly bent, holding a pair of dumbbells or a kettlebell.
Hinge forward at the waist, keeping your back straight, and lower the dumbbells towards your lower leg. Squeeze your glutes and hamstrings and return to a standing position. Repeat for 10 repetitions.
We have discussed all these ideas for people who spend the majority of their day sitting at a desk; however, other professions spend the majority of their day sitting, for example, people who drive all day for work. You can incorporate many of the same strategies for checking the postural setup of your seat and steering well to make sure things are optimally configured for you. You can also use a lumbar support or towels/pillows to support your arms as needed. During your stops to eat or use the restroom, you can incorporate brief sessions of stretching and exercise using your vehicle or a bench. Make sure you take time to get up and walk around for a little while to get the blood flowing in your legs and try to choose healthy snacks and stop at rest areas as opposed to fast-food restaurants as you are able!
No matter how you spend the day working, there will always be some prolonged positions or postures that we have to work through. Whether you are lifting for work, sitting, standing, driving, or constantly on the move, there are ways to help prevent injury. Getting at least 2 days of moderate-intensity exercise is so vital for our health. I listed some articles for reference below, and as always, feel free to reach out with any questions at: Cari@movementmatters-pt.com
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Disclaimer
This blog is provided for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition.
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