Among the working people between the ages of 18-64, the disorders of the muscular and skeletal systems rank the first among the factors that cause
functional limitations and restrictions. Moreover, the incidences of cumulative traumatic disorders on the soft tissue of muscular and skeletal systems
have appeared to increase steadily in modern socities.
The muscular-skeletal system is exposed to severe risks of disorder with such occupations of the office sector. The joints and the structures other
than the joints are frequently injured. The occupations of the office sector are as follows:
1. Computer users
2. Telephone operators
4. Authors - draftsmen - artists
5. Civil Servants - secretaries
6. Self-employment occupations (doctor, pharmacist, architect, lawyer etc.)
7. Others (tailor, designer, stylist etc.)
As a result of the cumulative trauma with such office jobs, primarily the soft tissue gets irritated and secondarily the bones and muscles are
affected. The neck, waist, upper and lower extremities are highly vulnerable. As next to the occupational factors, various environmental, personal and
phsysical risk factors multiply the complaints of the patients.
The following clinical pictures are frequently observed with the occupations given above:
1. Neck Disorders
2. Back Disorders
3. Disorders of soft tissue (muscle knots, muscle tension and contractions, circulatory disorders, overuse disorders) (Picture 1, Picture 2)
Picture 1: Hand disorders with people who use computers
Picture 2: Hand, elbow and shoulder disorders with people who writes
Back is especially a vulnerable part of the body; it endures the mechanical stress and the functional tension of the body movement system, and also
professional and sportive traumas etc. In time, the diseases that cause back pain may lead to chronic pain syndromes and disorders which may handicap
people by seriously restrict ing the daily activities. If you consider the medical expenditures, the total number of missed workdays and the cost of the
loss of functions for long periods of time, you can understand that the financial impact of the back pain on the economy is huge.
Neck pains are also very common illnesses that cause functional disorders and that degrade the quality of life of office workers.
Common causes of neck and back pain can be summarized as follows:
1. Diseases of skeleton and joints
Congenital (genetic) disorders (spina bifida, blocked vertebrae)
Traumatic factors (falling, overexertion)
Degenerative diseases (calcinosis)
Infalamatory factors (tuberculosis)
Metabolic disorders (osteoporosis)
2. Soft tissue diseases
Sprains ve strains
Aches due to the postural deformities(Picture 3)
Fibromyalgia syndrome (aching all over the body)
Myofacial pain syndrome (local pain)
3. Pains triggered by the internal organs
Picture 3: Disorders that are caused by the improper posture of an office worker who works at a desk job in front of a computer.
The principles of treatment against neck and back problems are as follows:
1. Protective measures
2. Treatment Methods (Resting, medication, physical theraphy, surgery)
3. Rehabilitation applications (Determining the risks that cause neck and back pain, dissmissing the factors that cause mechanical pain)
Exercising, as being one of the ways of treatment, have recuperative affects and improvements on the body. The advantages of exercising are as follows:
1. Strenghtens the bones, tendons, ligaments, tendons and muscles.
2. Improves the nutrition of cartilages of the joints and the discs.
3. Provides oxygenation of skeletal muscles.
4. Develops of neuromotor control and coordination.
5. Enhances the cardiovascular and respiratory functions.
Prevention of back pain:
Back pain, which disrupts our daily routines and decreases the quality of our lives, is a very comon nuisance to humans. For instance, it is one of the
most common causes of missed workdays due to illness. Moreover, the tratment of back pain is expensive. Therefore, we should take care of our back when
working at our desks and avoid the habits which are bad to the back:
If you are complaining about back and neck pains, you should sit at an adjustable chair having a high and hard backrest; you should
certainly avoid sitting at soft and low level chairs. Your sitting position on the chair should be straight, you should lean aginst the backrest
comfortably and you should not perch on the edge of the seat. You can also support your back with a pillow. You can sit cross-legged at the seat.
The back of the chair should support the back and waist well. The knees should be slightly higher than the knees.
You should use a footstool so that our feet rest flat on the floor. The chair should support our back and we should sit close to the
desk. A sloping desk will prevent you from huncing your shoulders; thereby it reduces the pain and provides a healthier working environment.
At your desk, you should not turn only your waist to move, instead you should turn all the body. The most useful items and properties
should be within your reach at the desk.
To carry the objects that are placed in high places, you should first use a seat to reach the object easily. Then you should handle the
object smoothly and carry it close to your body.
Too much sitting in one position is bad for our muscles and joints. We should take lots of short breaks or perform stretching exercises at
our desk. If you are sitting too much, you should stand often, for example you should stand 10 minutes every two hours. If you are standing too much you
should sit or lie down 10 minutes every two hours.
In addition to the protective measures mentioned above, specific standards should be set and the workplace should be rearranged within the framework
as orderd by these occupational standards Ergonomic job analysis should be conducted at the workplace to determine the factors that protect the workers
against occupational cumulative trauma disorders. Ergonomics is an applied science that coordinates the design of devices, systems, and physical working
conditions with the capacities and requirements the worker. This increases the safety and efficiency of man in his working environment.
Prevention of neck pain
Following back pains, the second most common disorder that the patients complain about are the neck pains. Every one person out of three in the
general population is suffering from neck pain once in the course of lifetime. Neck is a very flexible part of the body with great movement capabilities;
however, this renders the neck also one of the most vulnerable part of the body against blows and injuries.
People develop neck diorders because of injuries due to the accidents, recurrent minor traumas, bad posture, overuse or over exertion, wear out and
diseases. One or more of these factors may cause neck disorders and restricted movements. You should be careful about the following hints to protect
yourself from neck pains:
You should sit sraight at a seat that has arm supports. Your feet should rest flat at the floor. Your shoulders should not bend downwards
or droop from lack of support. You should hold your shoulders backwards slightly and comfortably. Your back should be supported by a backrest and your
feet should rest on the ground. You can support your neck with a pillow. You should slightly bend forward on your seat to stand up.
You should avoid sitting for prolonged periods of time studying, using a computer, reading or watching TV. You should not bend over the
desk, instead you should use sloping desks.
Performing tasks with your hands stretching above your shoulder level is detrimental to your shoulders since the muscles in this area may
be constricted and this may consequently lead to severe shoulder pains and restrictions with the shoulder functions. Be careful not to use your arms above
the shoulder level. If you are to perform tasks with your hands stretching above your shoulder level, you should raise yourself with a ladder or a seat
to the reasonable height that would not cause burden on your shoulders.
Sudden and rigid movements may lead to spasmic pains on arms and neck. You should avoid abrupt, rigid and harsh neck movements.
It is very important to wear comfortable clothes at job. Tight and close-fitting bras constrict the veins, nerves and muscles of our arms
and consequently hinder their nutirition.
Guidelines for people who work in sedentary position:
Sitting for prolonged periods of time can be major cause of neck and back pain; therefore, protective measures and rehabilitation implementations gain
more significance everyday to be able to reduce the problems of neck and back pains. Especially workplace is ergonomically arranged according to the
physical capabilities and restrictions of the employees. The posture of the person should be corrected so that the increased und unnecessary stress to the
back muscles and spinal discs are reduced. (Picture 4). The poor posture should be corrected this way. The people should take frequent breaks to stretch
and relax at the workplace. The tools and the workplace should be rearranged ergonomically. If possible, the workplace should be organised in such a way
that you do not need to bend, slouch or twist your posture very frequently. For best performance, the distance between the computer and your eyes should
be 25-30 cm. and the elbows should rest 85-100 degrees. (Picture 5, Picture 6, Picture 7).
Picture 4: The normal posture of a standing person
Picture 5: The ideal sitting posture of a person using a computer
An appropriate seat at your workplace should have the following standards:
There should be no need for additional supportive tools.
A good support for the curve of the back.
Arm supports and arm height adjustment.
Pneumatic seat height adjustment
5 legs to create stability
A steady an non-slippery sitting base
Curved front (Picture 8)
Picture 6: Improper keyboard use
Picture 7: Proper keyboard use
Picture 8: The standards of a healthyseat
An appropriate desk at your workplace should have the following standards:
The legs should have space to move freely.
The size of the desk should be sufficient to accomodate he electronic objects and other workplace staff.
The height of the desk should be adjustable to use the desk with multiple tasks (e.g. writing, drawing, using computer) (Picture 9)
Picture 9: The standards of a healthy desk
The most serios disadvantage that paves the way for the development of persistent neck and back problems is the poor physical condition of the body.
The office workers should be trained about the ways to avoid such health problems. However, ergonomical and proper workplace design, frequent exercising,
and rotation in the job will surely produce favorable results.
A healthy back implies that there should be an equilibrium of four physiological small degree curvatures on the spine. (lordotic curvature in the neck,
kyphotic curvature in the back, lordotic curvature in the back, kyphotic curvature at the end of spinal columd). A good posture requires us to maintain
these curvatures in their natural equilibrium. And to maintain the equilibrium well implies that as you are sitting, standing, stretcing & extending,
carrying objects or walking, you must have a strong and flexible musculoskeletal body structure.
Consequently, to find a solution to the back and neck problems of office workers, the internal and external risk factors should be determined well in
advance and the required measures should be taken to eliminate these risk factors. Physical activities are especially important for physical health and at
the same time they increase the performance of employees at work. Therefore, regular exercise and similar activities should be recommended and opportunity
to leave the sedentary environment of the workplace should be given to the employees.
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Prof. Dr. Halil KOYUNCU *
Specialist Dr. Erdal YÜCEL **
Dr. Halime TOROS *
* Univ. of Istanbul Cerrahpaşa Medical School - Physical Medicine and Rehabilitiation Department
** Self-Employed Doctor