Physiotherapy and working from home
Many workers use display screen equipment(DSE) for more than an hour or so per day and therefore can be classed as “DSE users”. From a physiotherapy point of view it’s very important that people are aware of the best ways to set up their workstations. Here at Roundwood we see on a daily basis that both the set up and how the individual uses their equipment may significantly contribute to musculoskeletal dysfunction and pain.
Lots of guidance regarding DSE use including a self-assessment tool can be found at:
However on visiting workplaces we frequently see that despite staff members having completed DSE training and assessments, that they are still unsure if they are sitting in the best position for them (and we even include physiotherapists in this!!!). The aim of this blog is not to replace the guidance given by the Health and Safety Executive, but to offer some practical hints and tips given our experiences in workplaces over the years.
Setting up your chair
Most office chairs are adjustable in 3 different ways. The height of the seat goes up and down, the backrest goes up and down independently of the height of the seat and the back rest moves in and out (towards your back and away from it).
As a general rule the height of the chair should be the first thing you adjust when you do your quick risk assessment at the start of your shift. You should be able to relax the weight of your forearms on your desk without pushing your shoulders up or down or having to lean forward. Your upper arms should be almost directly by your sides with your elbows bent to a right angle. The height of the seat should be adjusted to allow this to be the case and this should always be your first step in getting yourself in to the correct position.
You should be able to slide your chair right in to your desk so your abdomen is touching the desk gently – this almost “traps” you in a good position and prevents you from slouching as the day goes on.
Once the correct height has been achieved then you can look at adjusting the back rest of the chair. The rounded portion of the chair (that is more prominent than the rest of the back rest) is actually the lumbar support and so should be in the small of your back (the curve that goes in the way in your lower back, roughly below your waist). Chances are that if the back rest is actually resting on the seat portion of the chair, it’s too low and the lumbar support is only supporting your buttock, not your back! Don’t be afraid to move this part of the chair – it’s probably the most common thing we see wrong with a chair, many people just leave the back rest in the position it arrived from the factory in!
Finally in terms of adjusting the chair, the back rest should be upright and fit in to the contours of your back with your bottom at the back of the chair (not perching on the edge!), and so hold you in the upright position between the desk and your chair. Again in practice when we do workstation assessments in the workplace we often see the back rest inclined too far back and the DSE user not even really using it. You should feel that your back is actually touching the backrest when you are in your upright position – this stops us slouching during the course of the day.
There is still significant debate as to whether a chair with arms is better than a chair without. I think this entirely depends on the individual and the workstation however if the arms of the chair are stopping you from getting your abdomen up to the desk then you should probably remove them as they are not necessary. Some chairs come with arms that can be removed or shorted arms that won’t restrict you from getting very close to the desk and these are sometimes a good compromise.
Once you have used the height adjustment on the chair to get your arms in a correct position, you can now look at the position of your feet, knees and hips. The chair should support a significant length of the upper thigh (but bear in mind most chairs are designed for the “average” person and if you are a lot taller, shorter or heavier than “average”, then these are the few exceptions that may require a different chair to a standard office chair).
If you were to take a photograph of you from the side, once in position your hips should be at an approximate right angle, as should your knees and you should also be able to place your feet flat on the floor. If your feet don’t reach the floor in a flat position then you probably need to look at using a footrest.
You should also make sure you have ample room under the desk to move your legs around (I’ve found all sorts under desks when doing workstation assessments, including the Christmas tree!!).
This is the one fact that we all tend to refrain from doing our DSE training – that the monitor should be the distance of your middle finger away when your arm is held in front of you. This doesn’t really require much explanation except to say that it’s important to do this measurement once you have already set your chair up in the correct position and have your bottom to the back of your chair and your abdomen gently touching the desk.
If you use 2 screens at the same time it’s common practice to have one slightly offset against the other depending on which you use the most.
Desk and Zone of Reach
We can all be a bit guilty of having clutter on the desk but it is important for our musculoskeletal health that the keyboard isn’t right at the edge of the desk but is pushed back slightly so that you can rest the weight of your arms on the front portion of the desk. It’s also worth taking some time to think about what you use most on your desk. If you keep your elbows at your waist and wave them around over your desk, this is what is classed as the Primary Zone of Reach and should contain most of the items that you use day to day. The purpose of this zone of reach is to try to prevent you repetitively making larger movements and reaching across the desk as this may leave you at higher risk of shoulder and neck pain. If you find yourself chasing your mouse to the other side of the desk by the end of the day then it is worth putting something in front of it to prevent this or ensuring you always use your mouse mat. Again with the telephone you should be able to pick it up without reaching too far and also never hold it in the crook of your neck whilst typing – this action gives us physiotherapists nightmares!! If answering the phone and typing are a regular part of your job then you should definitely have a headset.
The DSE User
Whilst I’ve tried to focus on practical tips for setting up a workstation, I have only covered the absolute basics here. In addition to your chair, desk, computer and phone there are also lots of other aids on the market that may help you to do your job whilst minimising your risk of pain – these include wrist rests, split keyboards, ergonomic mice, document holders, writing slopes, standing desks and thousands of different models of chairs that are on the market. However it is very important to say that even if you had every single bit of expensive office equipment, that doesn’t necessarily mean that your symptoms will be cured or that you wont develop pain, by far the most important thing you can do is use the equipment correctly and get up and move around or even just stand from your desk as often as you can – at the very least this should be once every hour. Also consider task rotation (for example doing a task that involves being in a different position after a period of sitting) and try to ensure that you spend some time away from your desk at lunchtime and maybe get out for a walk to stretch your legs.
Finally if you hot desk or use different areas to work then you should run through this little routine at the start of every shift as a colleague may well have adjusted it to best suit their needs – this is your responsibility to do every time.
If you are a DSE user and have any ongoing concerns then you should discuss this with your physiotherapist who can give you much more specific advice regarding your condition and workstation set up or could even arrange a workstation assessment with you if your case is of a more complex nature. We also offer corporate packages to employers assisting them with both physiotherapy treatments for staff, workplace visits and generally helping them to keep their workforce well – give us a ring (01226 282560) or email us at firstname.lastname@example.org any time if you require any further information.