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quinta-feira, 29 de maio de 2014

Are You Getting Pain After Sitting At A Desk All Day?

Let’s say you’ve had a busy week. You had a major project that was due by the end of the week and you didn’t have time to worry about taking breaks and getting up to grab lunch. How sore are you? How is your back feeling? How about your neck? Your arms? I’m going to venture to guess that you’re having some aches and pains, maybe even some numbness and tingling in your arms. What does all of this mean? What caused you to be in this pain?
Many people end up in this situation, but not necessarily because they’ve had a busy work week. This kind of problem can occur simply because you have to do the same tasks day in and day out at your computer or desk. But this is your job! You have to do it! So how can you prevent the pain that so often occurs after working at your desk?
The first thing that we need to look at is your POSTURE. Do you tend to slouch with your head forward while you are working? This is a position that commonly causes pain in the back and neck. If you maintain this inappropriate position for a prolonged period of time while also using your arms for typing, you may end up with symptoms into your shoulders and arms as well. Activating your back muscles in order to hold your chest upright is the best way to correct poor posture. Maintaining the head, neck, and shoulders in a neutral position instead of forward, helps to decrease strain along your joints and ligaments. If the pain you are getting is lower, then your problem may be related to the lumbar spine. Sitting upright is also important for this low back region, but other practices including abdominal muscle strengthening and hamstring stretching may also be beneficial. Tightening the abdominal muscles helps to strengthen those muscles that surround and support your spine, thus stabilizing you and decreasing pain. Hamstring tightness can easily occur when you sit for most of your day, so stretching is important after long periods of sitting.
The second thing that we want to look at is your WORKSTATION and ERGONOMICS. If your desk is not set up appropriately, then you may be experiencing more strain on your body than necessary.  This link gives an excellent depiction for the proper set up of a workstation. Consider 4 steps when setting up your computer work station. Step 1 is your chair. Push your hips as far back as possible in your chair, adjust the seat so your feet are flat on the floor with the knees even with the hips, adjust the back of the chair to a 100-110° angle, and adjust the armrests so that your shoulders are relaxed. Step 2 is your keyboard. Pull up close to your keyboard, position the board directly in front of your body, adjust the board height so that your elbows are at 100-110° and your wrists and hands are straight, and place the mouse as close to the keyboard as possible. Step 3 is your monitor, documents, and telephone. Center the monitor directly in front of you, position the top of the monitor approximately 2-3 inches above seated eye level, sit at least an arm’s length away from the screen, reduce glare by positioning the screen at a right angle to windows and adjusting the vertical angle of the screen, position documents from which you are typing directly in front of you between the monitor and the keyboard, place your telephone within easy reach, and use headsets and speaker phone rather than cradling the phone between your head and shoulder. Step 4 is pausing and taking breaks. Take short 1-2 minute stretch breaks every 20-30 minutes, rest and refocus your eyes periodically to avoid eye fatigue, and use correct posture when working. The American Physical Therapy Association (APTA) also released a video that addresses the appropriate ergonomic positioning for desk work. This video can be viewed here.
In general, your body is programmed for movement, so make sure that you get up and move around, even for very short amounts of time. Ultimately, it can make a huge difference on your level of pain. If you have any questions on this topic or any others in which you are interested, feel free to leave any questions, comments, or suggestions. Thank you for reading and stay active.
Resources:

Computer Graphics Workstation Ergonomics How to setup your office computer workspace for functionality and comfort

Basic Office Ergonomics

Even if you are young and healthy, don't underestimate the importance of ergonomics in your workspace. Starting out with good posture and work habits will pay off in the long run. After 25 years of working at a drafting table and computer workstation, I learned this lesson the hard way, with a costly and painful lower back surgery. Proper seating, posture, and a few simple dos and don'ts will save you a lot of misery down the road.

Workstation Desktop Setup

When setting up your desktop arrangement, give a lot of thought to the relationship between all of the hardware pieces (Fig. 4 & 5). You will not want to make frequent changes once you have found the correct positioning. The relationship between your monitor and drawing tablet is especially critical because each time you alter their relative position, you will need to retrain your eye-hand coordination.

Computer Graphics Workstation Ergonomics

If you opt for a dual monitor setup, you will want to look straight at the main monitor. With this configuration, you will not have to keep your head at an angle. You can use your peripheral vision and eye movements to glance at the secondary monitor.
Keep your keyboard, track ball (or mouse), and drawing tablet as close to each other as possible to avoid large arm movements or reaching. Use only a small portion of the drawing tablet as the "active" area as this will allow you to use your fingers instead of your wrist to cover a large area on the monitor. Limiting arm and wrist movement will prevent conditions known as Repetitive Stress Injury (RSI), Carpal Tunnel Syndrome (CTS), or Overuse Syndrome.
Workspace Ergonomics Desk Setup

Workstation Seating and Posture

Posture and the placement relationship of chair, desk, keyboard, mouse, drawing tablet, and monitor(s) play an important roll in how much fatigue you will feel at the end of a long work day.
The first two examples (Fig. 1 & 2) show the classic mistakes people make in their seating position. Fig. 1 known as the "slump" puts tremendous strain on your lower back as your spine must carry all of the weight of your upper torso. This strain on your lower back can be further aggravated by tucking your feet under your chair.
The reclining position (shown in Fig. 2) puts strain on both your neck and lower back, especially if your chair does not have proper lumbar support. Both of these positions also give you a poor viewing angle of the monitor and negatively effect your arm and wrist position in relation to the desk and keyboard.
Our last example (Fig. 3) shows proper alignment between your head, torso, legs, and arms. Your upper body should be in perfect vertical alignment and your forearms should be as horizontal as possible to avoid wrist strain. Additionally, you want to be looking directly at the monitor to reduce side glare from the reflective surface of the screen (although good flat panel monitors give off very little glare.
Computer Workstation Seating Posture Ergonomics
It also helps to have your chair's seat bottom have a slight forward tilt and to use an ergonomic footrest to keep the upper portion of your legs parallel to the ground.
Invest in a top quality chair with arms, headrest and lumbar support. The two chairs that I would highly recommend are the Freedom or Liberty chair from a company called HumanScale and the Aeron Chair from Herman Miller. Both chairs are great looking and come with all of the necessary adjustments to fit your body.

Monitor Positioning & Ergonomics

If you are still working with a CRT "tube" monitor, stop. Unless you spent a small fortune on a Barco Reference Monitor & Color Reference Calibrator, you will be amazed at the difference in sharpness, clarity, color accuracy, and "flicker free" eye-strain relief that comes with a good flat panel monitor as compared to any CRT monitor. Additionally, the curved screen on a CRT monitor gives off a lot of distracting reflections.
In order to reduce eye strain it is important to use the "zoom" feature in your graphics program. Frequently look away from the computer screen and towards a distant field of view, blink your eyes before returning your gaze to the screen. An adjustable monitor arm can help to position the monitor to reduce neck fatigue and glare.
One solution to the problem of eye strain is to have dual monitors of a different resolution Fig. 6. Your main monitor is the one that you will use to draw and paint with, therefor it should be a "High Resolution" "High Definition" or "HD" monitor in the largest size that is practical. This means that it will have a higher DPI (dot per inch, or pixels per inch) rating than a standard monitor. Standard monitor resolution is 72 DPI. Apple's high definition monitor, the Apple Cinema HD series, has 96 DPI at 1920x1200 pixels.
The main reason to use monitors with different resolutions is that you can put all of your drawing software's Palettes, Tool Bars and Dialogue Boxes in the smaller (lower resolution) monitor, so that they appear larger and easier to read. The additional benefit of this configuration is that you can keep all of that screen real-estate clear of clutter so that you can focus on the image you are working on.
You will want to keep your tool and layer pallets along the edge that is closest to the main monitor. This will keep wrist movement to a minimum when changing brushes, colors, layers, etc.
Position your desk and monitor so that the ambient light from the room does not change dramatically throughout the day or into the night. Drastic changes in room lighting from direct sunlight and artificial sources of light will change your color and contrast perception and may necessitate different monitor calibration settings at different times of the day. Always avoid direct sunlight washing across the surface of your monitor.

Ergonomic Seating Recommendations

Herman Miller and Humanscale are the two finest manufacturers of office workstation task seating in the world. Not only do these chairs look fantastic but both of these manufacturer's products represent the state-of-the-art in ergonomic design, comfort, safety, functionality and durability.
Desk Chairs
These chairs, used in conjunction with an adjustable footrest, are an essential part of maintaining correct posture while working long hours at the computer. I have tried many of the chairs from both manufacturers and the Liberty Chair is the one I use everyday. I especially like the mesh back support as it provides a lot of ventilation, keeping your upper torso cool.
Humanscale, Fellowes, Ergo-Wise, Safco Foot Rest
An ergonomically designed, well positioned, and properly adjusted footrest is an important part of maintaining correct seating posture and spinal alignment while seated at a computer workstation. Lack of a footrest forces your lower back to arch forward, putting excess pressure on your lower lumbar discs. Ergonomic footrests place your lower spine in a neutral position, relaxing your lower back muscles, and distributing your torso weight correctly. Foot rest manufacturers include Ergo-Wise, Humanscale, Fellowes and Safco.

Ergo Chairs


Workstation Ergo Footrests


Hand & Wrist Ergo Products

Golf Injury Prevention

If you were not already aware, August is National Golf Month.  If you are not a golfer yourself, it is likely that you have a friend or relative who has already been out to the golf course at least once this summer.  This particular sport is one that has become more popular within the last 10-15 years.  The average golfer is estimated to play approximately 37 rounds of golf per year, spending much more time practicing. It is not surprising then that, with the increase in popularity, there has also been an increase in golf related injuries.
Golf is classified as a low-risk/low-impact sport, but this does not mean that injuries never occur.  Golf injuries can range from concussions and contusions to low back pain and electrocution.  As you can imagine, concussions and electrocution are the less common injuries that occur.  A concussion or a contusion could result from a poor back swing or even an angered golfer throwing a club and hitting a bystander.  Electrocution, on the other hand, could be a result of being out on the golf course during a thunderstorm.  Despite the fact that these forms of injury are less common than other golf related injuries, it is important to be aware of your surroundings in order to limit your risks.
The majority of golf injuries are actually due to overuse.  Common golf related injuries ranked in order of incidence include:
  • Low back pain – the most common injury, typically resulting from repeated trunk rotation and extension (backward motion) while swinging a golf club.  Golfers who carry their own bag are actually twice as likely to have back, shoulder, or ankle injuries compared to those who do not.
  • Elbow injuries– more likely to occur in amateur golfers and are typically a result of poor swing mechanics
  • Medial epicondylitis (golfer’s/thrower’s elbow) – can result from hitting “fat” shots (hitting the ground with the club first)
  • Lateral epicondylitis (tennis elbow) – can result from over-swinging with the dominant arm
  • Wrist injuries– more common in professional golfers and typically occur in the lead wrist (opposite of dominant hand)
  • Wrist flexor/extensor tendonitis – due to overuse
  • Hook of hamate fracture (small bone of the wrist) – can result from a hard hit off of the ground while gripping the club
  • Shoulder injuries – subscapularis (one of the rotator cuff muscles), pectoralis (“Pecs”) and latissimus dorsi (“Lats”) muscles are the most commonly used muscles during a golf swing
  • Impingement syndrome (a bursitis and tendonitis in the shoulder) – can result from repetitive motions and poor postural positioning
  • Rotator cuff problems – can result from overuse, especially when the muscles are weak
  • Arthritis  – can result from general wear and tear on the joints, especially with repetitive motions and any prior injury
So what can you do to decrease your risk of injury?  For the back, a 2004 study found that increasing back extension range of motion and rotation range of motion of the lead hip (the hip opposite to the dominant hand), may decrease your chances of getting low back pain.  Exercises like rows, pull downs, and yoga/pilates can help strengthen the back to avoid injury. For the elbowgolfers elbow can be reduced by slowing down your golf swing so that there is less shock on the arms as the ball is hit.  Exercises to strengthen this area include tennis ball squeezes, wrist curls, and reverse wrist curls.  These exercises can also be helpful for preventing wrist injuries.  For theshoulders, a good warm up with exercises focused on the shoulder muscles, especially the muscles most used during the golf swing, will help to reduce injury.  It is important to stretch the arms as well as the back and legs prior to golfing.  Don’t underestimate a good warm up by practicing your swing with a bucket of balls prior to starting play.  One additional component that is a key for any golfer is a proper swing.  The best way to ensure that you do not have poor mechanics during your swing is to have a professional like a golf-pro or a physical therapist assess you.  The physical therapist can help you determine the appropriate exercises to do to improve your mechanics.  We offer a video swing analysis as part of our golf fitness assessment, here at Advanced Physical Therapy and Fitness.
If you have any questions on this topic or any others in which you are interested, feel free to leave any questions, comments, or suggestions. Thank you for reading and stay active.
Resources:

Understanding Amputation

Understanding Amputation                                                                                                       
In a recent blog, we discussed how injuries in people with diabetes can lead to complications such as amputation, so we thought it would be a good idea to provide some information on amputations.  According to the Amputee Coalition of America, there are more than 2 million people in the United States living with limb loss, and another 500 people lose a limb each day.
The most common cause of amputation is poor circulation or peripheral arterial disease (PAD), usually due to diabetes or atherosclerosis (plaque buildup in the arteries).  PAD frequently occurs in individuals between 50 and 75 years old.   More than half of all amputations occurring in the USA are in people diagnosed with diabetes.  Various studies have shown that 28-51% of amputees with diabetes will undergo a second amputation within 5 years. In a 2011 study published in Diabetes Care, researchers found that males with diabetes, who were heavy smokers, with high blood pressure and diabetic eye disease, and had less blood glucose control, were more likely to have lower limb amputations.  If you are diabetic, controlling your blood glucose and blood pressure and not smoking can reduce your risks of amputation.
Other causes of amputation are trauma and cancer.  Trauma is the major cause of amputation in younger people.  Large numbers of amputations have occurred as a result of the wars in Iraq and Afghanistan.  Between 2000 and 2011, there were over 6000 traumatic amputations in US service members.  Many of the combat related amputations involve more than one limb.  Amputations due to cancer make up less than 2% of all amputations.
Amputations can occur in the arms or legs and are described by the level at which the limb is removed.  For example, loss of a leg somewhere between the ankle and the knee would be described as a below knee or transtibial amputation. Amputations occurring through a joint are called disarticulations. 
Rehabilitation for amputations begins very soon after surgery.  Tight fitting garments or sometimes casts are used to assist with control of swelling and residual limb shaping.  For lower limb amputations, upper body strengthening is important, especially if the individual will need to use a walker or crutches before being fitted for prosthesis (artificial limb).  The amputee’s prosthetist, physical and occupational therapists, and physician should work closely together to achieve the best function possible for the individual.  Often psychological counseling or support groups such as the Amputee Support Team of Central Pennsylvania (www.astamputees.com) can be very beneficial to those individuals about to undergo an amputation or who have just had an amputation.  There are many other support groups throughout the United States which can be found at www.amputee-coalition.org.
There are a great variety of prosthetic arms and legs available and there is not one “best prosthesis” for a given type of amputation.  Prosthetic prescription and fitting are very individualized and most likely will be changed during the course of an individual’s life due to technological advancements, changes in the individual’s size or functional ability.  Prostheses have come a long way from the “wooden leg” of the Civil War era to the advanced myoelectric, “bionic” and osseointegrated (attached to the residual limb by the bone rather than suspended from it by one of several methods) prostheses of today.  There are also specialized prostheses for different activities such as running. 
Physical therapy for individuals with lower limb amputations consists of overall conditioning, strengthening and flexibility of both lower limbs, as well as gait (walking) and balance training.  For upper limb amputations, strengthening and flexibility of both arms is important as well as mobility and strength of the muscles around the shoulder blades.  Use of myoelectric prostheses requires special training in use of residual muscles to make the hand of the prosthesis function optimally.
If you have any questions about this topic or any other physical therapy topics, please feel free to leave any questions, comments or suggestions.  Thank you for reading and stay active.

Resources:
Sahakyan K et al. The 25-year cumulative incidence of lower extremity amputations in people with type 1 diabetes. Diabetes Care. 34:649-51, 2011.
Rieber GE et al. Lower Extremity Foot Ulcers and Amputations in Diabetes found athttp://www.diabetes.niddk.nih.gov/dm/pubs/america/pdf/chapter18.pdf