What Can We Do To Prevent Injury?

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By Amy Temes, DPT and Valerie Hilton, DPT

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Poor posture may result in imbalances in muscle strength and excessive strain on the neck, shoulders, and upper back. These imbalances can lead to pain and, over time, can result in soft tissue injury or degeneration of joints. Common tasks that people often have difficulty maintaining correct posture for include: desk and computer work, sleeping, driving, reading, cooking, and/or crafts. In standing upright with correct posture, the spine should be allowed to form an “S” curve while the hips, shoulders, and ears are maintained in alignment. Posture is more difficult to maintain while sitting because the spine position changes. Maintaining the ideal “S” curve is more difficult. When lying down to sleep, the curves of the neck should ideally be supported by the pillow and mattress. However, depending on the stiffness of the spine and the surface one is lying on, this can be difficult to achieve.

Proper work station setup and seated positioning is important for preventing stress-related injuries.

Work Station Recommendations

Posture

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For postural support, sit all the way back in the chair; knees should be slightly lower than hips with the seat tilted forward if possible; avoid twisting the neck and back; do not cross legs or shift weight to one side.

Back

Lumbar support should fit into the curve of your low back, providing even pressure and support; back angle of the chair should be adjustable for occasional variations and should support the upper body in a vertical position.

Seat

Adjustable height and angle; firm cushion; “waterfall” front helps circulation to legs and feet; avoid sitting in a reclined position; try tilting the seat pan forward to achieve better seated posture.

Desk

Work surface height should allow room to move legs and make postural adjustments; adjustable surface height preferable; if keyboard and mouse are on the desk, the work surface should be large enough to permit different positions of the monitor, keyboard, and mouse.

Feet

Entire sole should rest comfortably on the floor; use a foot rest only if desk height cannot be adjusted.

Keyboard

Position horizontally or slightly declined, sloping away from the user; when hands are on the keyboard, forearms should be horizontal or sloping slightly downward; hands should be in line with the forearms so wrists are straight and fingers relaxed.

Telephone

Cradling telephone receiver between head and shoulder can cause muscle strain; using a headset allows head/neck to remain straight while keeping hands free.

Monitor

Eyes should be level with the top third of the screen; monitor should swivel horizontally and tilt vertically; place monitor in vertical position to decrease glare on the screen.

Document Holder

In line with the monitor and between the monitor and keyboard without obstructing the monitor screen; correct placement allows the eyes to easily and naturally view the document without turning the head/neck.

Appropriate Body Positioning and Support

Since most people spend six to eight hours per day sleeping, appropriate positioning and support during this time is essential. It is typically less stressful on the neck and shoulders when sleeping on the back and sides.

Sleeping on the stomach can result in neck pain as a result of stress to the joints and muscles. Some people benefit from placing a rolled-up towel inside the pillowcase to help support the neck because most pillows just support the head. This creates an adjustable contour pillow.

In any sleeping position, it is best to avoid sleeping with your arms overhead because it puts extra stress on the shoulder joint.

The above principles can be applied to hobbies and other daily activities, such as driving, reading, crafts, and cooking. When performing these activities it is important to bring work up to the body to prevent the head from hinging forward. This can be accomplished by setting pillows on the lap when working from a seated position. In either sitting or standing position, the shoulders should be kept back and down with the chin tucked slightly toward the Adam’s apple.

Building Strength and Balance

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To work at preventing neck and shoulder injuries, it is also important to build strength in key muscles of the neck, shoulders, and mid-back. Increased strength in the muscles in the front of the neck and the middle back will help to provide balance, good support, and stability for the neck and shoulders.

Additionally, it is important to maintain a balance between strength and flexibility of the muscles on the front part of the chest wall and the joints of the upper back. It is also common to develop stiffness in the upper back, (especially after the age of 30) which can perpetuate poor posture. Lengthening muscles that are short, strengthening those that are weak, and decreasing stiffness in the mid-back will make it easier to achieve optimal posture.

See pictures A, B, and C for example exercises to strengthen and improve mobility in these areas.

Physical therapists are trained to evaluate and assess each individual patient and to develop a personalized plan of care for each. They can help recommend fitness programs, make recommendations for work station setup and proper lifting, and help restore balance and strength after injury