Standing Desks are good for your health

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Employers are more than ever taking the important steps to minimize and prevent the risk of developing musculo-skeletal disorders (MSD’s) in their workplace.

Varidesk standing desks

Workers whose workstations are inappropriate and poorly matched to their individual needs are at risk of discomfort, long term injury and substantial time off work.

MSD’s can be attributed to sustained postures in the workplace, particularly when people have poor posture. These include; Neck or back pain and stiffness, Shoulder or arm pain, Pins and needles in the arms or legs, Leg, ankle, or foot pain.

Your Physiotherapist at Richmond Physiotherapy Clinic can advise you regarding ways to improve activity levels, postural strength and awareness, and the role of hands on therapy to resolve workplace persistent aches and pains. Call us on 9428 8862 to make an appointment or alternatively book online now.

In a systematic review of standing and treadmill desks in the workplace (2014, MacEwen, B) it was found that;

‘Standing and treadmill desks are intended to reduce the amount of time spent sitting in today’s otherwise sedentary office. Proponents suggest that health benefits may be acquired as standing desk use discourages long periods of sitting, which has been identified as an independent health risk factor for chronic disease (obesity, diabetes and cardiovascular disease) and psychological (worker productivity, well-being) outcomes. Treadmill desks lead to the greatest improvements but are less practical. Neither has much impact on work performance.’

Changing your working position regularly helps to prevent back problems.

Standing work stations can be ideal for people where sitting all day is not an option, ie. “Individuals returning to work after back surgery”

There is no science in deciding which standing work station is the best. Among Richmond Physiotherapy Clinic clients the most popular choice is an Ergotron (~$700), from a company called Tammex or Ergoport in Melbourne, but there’s a list of other resellers on their website. It is easy to alter from sit and stand. The second most popular is the Varidesk (pictured above).

It appears that IKEA has a sit/stand desk that may also be a cost effective option.

Also used by Richmond Physiotherapy Clinic clients are the more expensive Conset and Ergomotion electric height adjustable sit to stand desk.

Benign Positional Vertigo Exercise

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Dizziness; A physiotherapy cure for many patients in a single treatment

Benign positional vertigo

BPPV (Benign Paroxysmal Positional Vertigo) is one of the most common causes of dizziness, affecting up to 50% of patients over the age of 70. The biomechanical condition is caused by the dislodgement of calcium carbonate crystals into a region of the inner ear with sensory organs, triggering vertigo. Physiotherapy can be remarkably effective in treating BPPV, and assessments are available in our physiotherapy practice.

The dizziness resulting from BPPV can be dramatically relieved by physiotherapists that use the forces of gravity to reposition the displaced calcium carbonate crystals to where they no longer disturb the sensory areas of the particular canals of the balance organs. Standard physiotherapy treatment uses a repositioning manoeuvre to move the crystals out of the semi-circular canal. Brandt Daroff exercises are frequently prescribed for patient self-management.

Let our skilled professionals be part of the treatment plan for you.

These exercises are designed to break up the material and unblock the canal. The exercises should be performed 3 times daily if possible. In the initial stages it is permissible to take anti-sickness medication if nausea is a problem. The symptoms of giddiness should be reproduced by the exercises if any benefit is to occur. If the exercises are done regularly, the symptoms should resolve over a period of several days in most cases.

A

Benign positional vertigo exercise a

Sit on the edge of bed, turn head slightly to the left (approximately 45 degrees).

B

Benign positional vertigo exercise b

While maintaining this head position, lie down quickly on the right side, so that the back of the head is resting on the bed. Wait for 20 to 30 seconds for any giddiness to resolve.

C

Benign positional vertigo exercise c

Sit up straight, again waiting for 20 to 30 seconds or for any giddiness to resolve.

D

Benign positional vertigo exercise d

Turn head slightly to right side and repeat sequence in the opposite direction.

Continue as above for 2 to 3 minutes.

Disclaimer: Richmond Physiotherapy Clinic accepts no liability for the result of performing these exercises without actual in–house personal demonstration. Readers may attempt these exercises but do so at their own risk. It is to be understood that these exercises do not in any way substitute professional treatment and Richmond Physiotherapy Clinic advises that you seek treatment and advice for any injury or musculoskeletal disorder as well as one–on–one instruction of these exercises for most effective results.

Knee osteoarthritis

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The greater load on the knee, the increased tendency to develop knee osteoarthritis – resulting in pain, activity restriction & degeneration of the joint.

Knee pain

Knee Osteoarthritis

One quarter of 50 year olds have knee pain and half of the 80 year old population have significant knee pain.

What helps?

  1. Exercise: pain free aerobic and resistance exercise is the scientifically proven intervention for improving knee osteoarthritis pain and activity levels.
  2. Aquatic or water exercise
  3. Hands on physiotherapy
  4. Losing weight
  5. Other interventions have limited evidence of improving knee osteoarthritis. These include: ‘offloading’ knee taping, orthotics, knee braces, altering your walking pattern

Physiotherapy (stretching and joint mobilising) has mild benefit in treating knee osteoarthritis. Manual hands on therapy in addition to prescribed exercises provides the best results, scientifically demonstrated to be better than performing exercises alone (Jansen, J. Physiotherapy, 2011).

Pool exercises do not appear to provide long term benefit. Yet, if you enjoy swimming or water based exercise, there is scientific evidence supporting this form of exercise for knee osteoarthritis.

Each of these interventions can be discussed and appropriately prescribed by our experienced physiotherapists at Richmond Physiotherapy Clinic.

Exercise

The most researched intervention for knee osteoarthritis is exercise – there are benefits for osteoarthritis from most types of exercise. Strengthening exercise includes resistance exercises, aerobic exercise, tai-chi, hydrotherapy or water exercises and home-based exercises. These involve exercises to improve hip strength with particular exercise on the gluteals.

Supervised exercises programs in addition to hands on physiotherapy result in substantially better outcomes. This involves regular progressions or modifications provided by a well experienced, post graduate educated physiotherapists at Richmond Physiotherapy Clinic.

Physiotherapy sessions provide improved long term pain relief, activity levels and strength, rather than doing exercises on your own (Mazières J. Bone Spine, 2008).

Losing weight

Losing weight improves knee osteo arthritis – 2 to 3 times body weight passes through the knee on each stride. The most proven way to lose weight is a combination of diet and exercise.

Changing the way you walk

Gait re-education training (changing the way you walk) appears beneficial to improve pain and function in knee osteoarthritis (Simic, J Biomechanics 2011). Using a walking stick reduces the knee joint load with a corresponding reduction in pain associated with walking. Please consult your Richmond Physiotherapy Clinic physiotherapist to demonstrate how to alter your walking with the view to reducing the load through the knee.

Medication

Whilst analgesics and anti-inflammatory medication appear to help, exercises are at least as beneficial and don’t have side effects. The physiotherapists at Richmond Physiotherapy Clinic attempt to find exercise that is enjoyable, ensuring the program is more likely to be sustained as  an ongoing intervention and management strategy for knee osteoarthritis which, at the current time, does not have a cure.

Glucosamine sulphate

Glucosamine sulphate is a nutraceutical (not strictly a pharmaceutical) with mild beneficial evidence based support.

Misaligned knees

Misaligned knees (knocked knees or bow legs) do not improve as quickly in improving pain and strength than knees that have more normal anatomical alignment.

Braces and taping

Discuss with your physiotherapist whether it is worth trialling the various unloading tape techniques for the knee, with the view to reduce pain associated with physical activity. Many studies have examined braces and taping including neoprene sleeves and patella braces without any substantial proven benefit. The consensus opinion in the physiotherapy and medical world is if bracing or tape reduces your pain and allows you to perform activity with less pain, then it is ok to use them. The larger unloading braces tend to be bulky and uncomfortable and may cause skin irritation. There are also reports of DVT associated with larger braces plus they are difficult to fit with large overweight legs.

Orthotics

Orthotic wedges and various types of footwear do not have strong scientific evidence. However there appears to be some benefits in different footwear to increase pain free activity.

Does different footwear result in your knee giving you less pain with running, walking or playing sport? If so, then see your physiotherapist at Richmond Physiotherapy Clinic for bio-mechanical analysis to ascertain the contributing factors relating to your knee osteoarthritic symptoms.

Marathon long distance training

Does long distance running lead to knee osteoarthritis in the longer term? The evidence suggests in the absence of previous knee injury, there is no increased incidence of knee arthritis compared to the non-long distance running population. If you have had a knee reconstruction or knee surgery, including meniscus surgery, there appears to be an increased propensity to develop knee osteoarthritis with long distance running.

The information contained in this site is not intended as a substitute for advice from a qualified health care professional. Always obtain advice from a qualified health care professional before starting any exercise, stretching or health care program. The author and everyone involved in the production of this site disclaim any liability for any adverse effects resulting from the use of the information presented.

Buying a bed

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Buying a bed is a balance between price and comfort as well as providing potential back support and shoulder relief.

Buying a bed

Bed comfort seems to be all about personal preference. Most people spend many hours choosing a bed;-a percentage of whom are subsequently dissatisfied with sleep comfort outcome. Many others know or suspect they require a new bed but don’t have the health information or experience enough sleep discomfort to initiate the process of looking for a bed.

Medical profession consensus suggests that side lying is the optimal sleep position for most people most of the time. Some neck problems fare better in supine (on your back) with a low pillow.

The seemingly more sophisticated mattress market is dominated by mattresses with multiple pocket springs with 5 and 9 zones. Memory foam, for example, as commercialised by Tempur, is also popular.

A 30 or 60-night comfort exchange guarantee, which allows customers dissatisfied with the comfort or feel to exchange it for another of equal or greater value appears also to be a popular and sensible option. It appears to often take a few weeks for both the bed to settle and the sleeper to adapt. It is also possible that a bed may be eligible for an ATO medical rebate where a doctor or physiotherapy referral is provided, plus the bed may be GST exempt because of potential health product status. There are many dozens of beds available and many retailers.

Also worthy of note is that the Australian Physiotherapy Association recommends a bed, the Sleepmaker Miracoil Advance (5 zone), although no medical reason is provided to support this recommendation. Similarly, many beds come with “endorsements” from, for example, professional associations such as the Chiropractic Association.

Burwood Rd Hawthorn, for example, has 8 substantial bedding retailers/showrooms, allocate a few hours, try different beds and go back a second time to make a decision. Decide what you want to spend for what quality and comfort of bed and what guarantee might apply.

Price Warren is of the opinion that any bed greater than 10 or so years old will be significantly improved upon with a new bed. There is, however, no guarantee of symptom relief or alteration in the progression of any degenerative disease. Price believes there is potential to reduce spinal dysfunction and shoulder disease (for example, side lying on an injured shoulder) when well supported on a comfortable mattress as an alterable factor in the interest of minimising future bother. In other words the progression of arthritic or degenerative disease may well be influenced by the quality of one’s bed (~ 30% of life is lying in bed).

A further factor to consider where night and morning pain exist is that disc and joint pressure is approximately 1/2-1/4 in lying positions compared to standing, and 1/4-1/8 compared to sitting postures (Nachemson, 1964, Journal of Bone and Joint Surgery). It is quite possible that the more upright postures have a more significant impact on lumbar mechanics, loads and pain than those resulting from lying in bed despite lying in bed being the most continuously uninterrupted posture in the life of most people.

For analysis and advice on beds and back pain please consult your Richmond Physiotherapy Clinic physiotherapist. Please also refer to our advice on neck pain and pillows.

The information contained in this site is not intended as a substitute for advice from a qualified health care professional. Always obtain advice from a qualified health care professional before starting any exercise, stretching or health care program. The author and everyone involved in the production of this site disclaim any liability for any adverse effects resulting from the use of the information presented.

Office workstation assessment

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The following guide provides general advice for users of screen-based equipment. The information is designed to assist the majority of users without pre-existing back, neck or shoulder problems.

Establishing an Ergonomic Workstation start can with self-assessment.

  1. Conduct self-assessment of your guidelines.
  2. Adjust workstation to suit guidelines.
  3. Consult with your Physiotherapist, Manager, HR consultant or Ergonomist if further assistance is required.

Workstation assessment

A few changes to your workstation setup should enable you to work in front of your computer with your back, neck and shoulders more relaxed and pain free.

For a more expansive explanation view our ergonomic workstations download.

Neck pain and pillows

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Are you looking for neck pain relief? It could be as easy as changing your pillow.

Neck pain and pillows

Do you wake up in the morning feeling like you’ve got a knot of muscles in your shoulders?

Do you wake up with neck stiffness & headaches that go away after you’ve had a hot shower and breakfast?

If you do, your pillow could be the cause your pain. We ask patients that complain of neck pain about their pillow. How old is your pillow? How many pillows do you sleep on? What size is your pillow? What’s your pillow made out of?

When we ask patients about their pillows, they say…

  • My Pillow? I don’t know, my wife bought it for me. Or.
  • My Pillow? I have to push it in to my neck, because it’s the only way I can get comfortable. Or.
  • My Pillow? I can’t get comfortable with my pillow; I sometimes have to get rid of it through the night.

Many people love their pillow. They take it on holiday or on business trips with them. They can’t risk a bad pillow when they arrive at their destination.

The medical profession generally disapproves of you sleeping on your front or face down. Worse than sleeping face down is sleeping face down with a pillow.

Unless you’re sleeping on a physiotherapists bed with a face hole for you to rest your cheeks on as you lie on your front, you’ll have to turn your head almost fully one way.That means you’ll be twisting your neck with a torsion or twisting force through your neck joints, nerves, muscles, ligaments and tendons. This can give you neck pain and headaches.

So you should sleep on your back or your side. This should be encouraged from childhood. As you age your joints are not as flexible or as resilient, you’ll start to get neck problems and it’ll be harder to change.It’s hard to get out of sleeping on your tummy as adults. Tennis balls sewn in T-shirts, pillows strategically placed by your side are some possible solutions.

Suggestion No.1

Use a contour Pillow which fits into the natural hollow of your neck, whether you’re on your side or back. The most popularly selling pillow at Richmond Physiotherapy Clinic is the Memory Foam Contour pillow. Ask to look at and lie on one next time you are at the clinic.

Suggestion No.2

Make sure your pillow height positions your head level with your spine. This means that broad shouldered men will need a higher pillow than most women.

Pillow height positions

Suggestion No.3

Check your position. When you’re lying in the position of your choice (not on your tummy!) get someone to look at your neck & spine alignment.

Lying on your back with your neck & head level with your spine is a good position for neck pain sufferers.

If you are lying on your side, lie with your back to the person observing you and get them to guide you to have your spine and neck straight.

If you are still in pain please contact the Richmond Physiotherapy Clinic to find out what more can be done and send your neck pain suffering friends this article.

Statements and opinions expressed in articles and other materials are those of the author, and do not necessarily represent the views of the Richmond Physiotherapy Clinic, it’s employees or associates.

The information contained in this site is not intended as a substitute for advice from a qualified health care professional. Always obtain advice from a qualified health care professional before starting any exercise, stretching or health care program. The author and everyone involved in the production of this site disclaim any liability for any adverse effects resulting from the use of the information presented.

Ideal sitting posture

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Where sitting is contributing to back pain or stiffness, a review of sitting posture and positioning is appropriate.

Optimal sitting (ergonomic) chair posture is an inexact science. There is, however, moderate consensus amongst ergonomic and Occupational Health and Safety trained physiotherapists with respect to the correct sitting posture.

Approximately 50% of physiotherapists prefer the chair seat to be tilted slightly forward with the backrest upright and both feet flat on the floor. With the chair height adjusted to achieve these guidelines, the client is instructed to sit on the chair with the lumbar spine relatively flat or curved mildly inwards or away from the seat back and the lower abdominal (transversus abdominus) muscles activated along with the deep neck flexors (chin slightly down and in) and the scapula (shoulder blade) mildly retracted (pulled back). This position is known as an active sitting posture.

Approximately 30% of physiotherapists recommend an alternative sitting posture. In their advice, the seat should be horizontal or tilted slightly back with the back rest similarly tilted back. This means the client sits back in the chair with the chair supporting your back.

Price Warren is of the opinion that most clients should try to sit ~50% of the time in the activated posture with the chair either horizontal or tilted slightly forward and ~30% of the time with the chair tilted slightly back as per the second position (you can choose the remaining 20% providing it is pain free). The optimal posture is where there is least aggravation of the back with no referred pain or back stiffness. He is also of the opinion that it is easier to sit for longer periods in a good quality ergonomic chair that has adjustable seat height, tilt and back support options, than one without these parameters. It is possible to sit on almost any chair well and in any chair poorly.

It is also possible the progression of arthritic or degenerative disease may well be influenced by the quality of one’s chair and your posture and period of time spent in that chair particularly given the disc and joint pressures in sitting postures (Ref; Nachemson, 1964, Journal of Bone and Joint Surgery).

For analysis and advice on chairs, sitting posture and back pain please consult your Richmond Physiotherapy Clinic physiotherapist. Please also refer to our website for advice on Workstation Assessment, Neck Pain, Pillows and Buying a Bed.

Office workstation exercises

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Some simple stretching exercises you can perform at work in front of the computer to keep your back, neck and shoulders relaxed and pain free.

Chin tucks

Start with head in neutral (not poked forward). Slowly draw chin and head backwards. Do not tilt head back – keep eyes level stop at tightness or pain, and return to neutral.

  • 10 Repetitions
  • 1 or 2 Sets
  • Every 2 or 3 hours
  • Daily
Workstation chin tucks
Workstation chin tucks

Neck movements

Tilt head slowly side to side. Rotate head slowly to left and right, do not let chin poke forward. Tilt head down then up. Please note: Do not roll head in circles.

  • 1 movement each side
  • 1 or 2 Sets
  • Every 3 hours
  • Daily
Workstation neck movement
Workstation neck movement

Shoulder rolls and repositioning

Roll shoulders forward and up in a circular motion. Draw them back together slightly and ‘set’ down. Keep shoulders relaxed and maintain shoulder blades in position. Use the back of the chair for support.

  • Set both shoudlers
  • Repeat hourly
Workstation shoulder rolls and repositioning
Workstation shoulder rolls and repositioning

Upper traps stretch

Place one hand relaxed behind back just above belt line. Draw should blade back and hold. Place the other hand on top of head and rotate 1/2 way to that side. Draw head down to collar bone and hold for stretch.

  • Stretch both sides
  • Hold each stretch 60sec
  • 1–2 stretches
  • Twice per day
Workstation upper traps stretch

Arm and mid-back stretch

Place hands together reach over head until you feel a stretch. Keep head and back in this new position and lower arms down. Maintain your shoulder blades slightly back. Use the back of the chair for support.

  • 1 Repetitions
  • 1 or 2 Sets
  • Every hour
  • Daily
Workstation arm and mid-back stretch

Forearm stretch

Straighten elbow out in front. With other hand gently pull wrist down and towards you. Slowly curl fingers in to stretch and hold. Don’t let elbow bend.

  • Stretch both forearms
  • Hold each stretch 60sec
  • 1 or 2 stretches
  • Twice per day
Workstation forearm stretch

Doorway stretch

Place forearms on doorframes (or one at a time). Start with arms and elbows at 90deg. Step forward slowly to feel stretch in chest and hold for stretch. Move forearms up the doorframe to get different stretch.

  • Hold each stretch 60sec
  • 1 or 2 stretches
  • Once a day
Workstation doorway stretch

Lower back extensions

Keep knees straight, use desk to lean against if needed. Arch lower back backwards slowly to tightness / pain only. Return to neutral.

  • 10 Repetitions
  • 1 or 2 Sets
  • Every 3 hours
  • Daily
Workstation lowerback station

Disclaimer: Richmond Physiotherapy Clinic accepts no liability for the result of performing these exercises without actual in–house personal demonstration. Readers may attempt these exercises but do so at their own risk. It is to be understood that these exercises do not in any way substitute professional treatment and Richmond Physiotherapy Clinic advises that you seek treatment and advice for any injury or musculoskeletal disorder as well as one–on–one instruction of these exercises for most effective results.

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How to manage your injury

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How to quickly and effectively manage your acute injuries.

Managing your injury

The best way to prevent more damage is by following the Rest, Ice, Compression, Elevation (RICE) and no Heat, Alcohol, Running, Massage (HARM) regime which should be commenced immediately where possible. After following RICE – it’s important to do no HARM.

For specific injury treatment it is important to obtain an expert physiotherapy diagnosis from an experienced physiotherapist at Richmond Physiotherapy Clinic.

Book an appointment

RICE

Rest

  • Immobilise the injured area.
  • This may involve using a splint, a sling or even crutches.
  • Reduces the amount of small vessel bleeding, tissue damage and allows quicker recovery.
  • You will need to rest the injured body part until your Richmond Physiotherapy Clinic Physio advises you otherwise.

Ice

  • Apply to injured area for 15-20 mins every 2 hours for the first 48-72 hours. You may need to continue this for longer depending in the advice from your Physio.
  • Reduces blood flow, swelling, pain, muscle spasm and prevents any secondary damage to the area.

Compression

  • Apply a firm wide compression bandage including above and below the injured part.
  • Leave on at all times for the first 48-72 hours.
  • Remove for application of ice.
  • Causes blood vessel constriction reducing bleeding and swelling. Your Physio will advise you when you can reduce the compression required.

Elevation

  • Reduces the swelling and small vessel bleeding in the area.
  • Where possible, it is important to elevate the injured limb above the level of the heart at all times.
  • This can be achieved by propping your limb up on pillows when seated or lying, or using a sling for upper limb injuries.

Do not apply ice directly to skin (it may cause a skin burn) and be careful when using it on children as they have a lower tolerance. Careful when using ice on people with circulatory problems and those who are sensitive to the cold.

HARM

Heat

  • Avoid hot baths / showers, hot water bottles and liniment rubs in the first 48-72 hours.
  • Heat increases blood flow to the region – increasing the swelling.

Alcohol

  • Alcohol has a similar effect on the body as heat.
  • Increases swelling by dilating your blood vessels.

Running

  • Any form of exercise too soon is detrimental to the healing tissues.
  • Blood clot / haematoma formation may be compromised – blood flow will increase to the region and healing times will be longer.
  • Your Richmond Physiotherapy Clinic physio will advise you on a suitable return to exercise program for your individual recovery.

Massage

  • Massage performed over the affected area will increase trauma and swelling in the area.
  • Oedema massage performed by a qualified physiotherapist reduces the swelling and small vessel bleeding in the area.