There is certainly truth to the phrase, “sitting is the new smoking”. Millions of employees spend the majority of their work day in a seated position, whether it be in a vehicle or at a desk. The problem is that our bodies are built to be upright. The quadriceps, gluteals, hamstrings, low back muscles, and pelvic stabilizers all function to help us move and support our own weight. When these muscle groups aren’t being activated, this can lead to muscular asymmetry and improper posture, causing soreness or discomfort to the low back.
In order to mitigate the risks of prolonged sitting, we first need to identify the physical demands being placed on employees by observing job functions and task-associated behaviors. Once we’ve identified specific areas of risk, we can use these observations to develop hierarchical risk mitigation strategies through the lens of the 3E Process™: Engineering, Ergonomics, and Exercise.
The 3E Process™
Engineering:
Eliminate injury risk by modifying equipment, tools or the work environment, as well as adapting job descriptions or instituting policy changes.
Ergonomics:
Mitigate risk by educating employees on proper body mechanics, avoiding at-risk movements/positions, and using their physiology to further protect themselves.
Exercise:
Counter the physical demands of work by preparing, resetting, and strengthening the body.
Task: Driving a truck or large vehicle
Prolonged periods of sitting leave drivers at risk for soreness and discomfort, particularly in the form of low back pain. The nature of the job requires truck drivers to assume a static posture for long periods of time—meaning they are in a seated position, in a confined space, with their hands on the steering wheel. Their movements do not often vary. Maintaining a static posture for an extended period of time can leave you feeling stiff, tight, and achy.
Preventing and reducing low back pain while sitting and driving a truck is possible through (1) customizing the cab to the best of the driver’s ability, (2) using proper body mechanics and ergonomics while sitting and driving, and (3) implementing a few simple exercises into their daily routine. Proper mitigation can help reduce muscle fatigue, increase driver comfort, and drive down accidents related to operator error.
E1: Engineering
Seat height and popliteal height (back of the knee) are often mismatched when obtaining the right fitting for the driver in their chair. A seat that is too high increases the pressure on the back of the knee, while an overly low seat height increases the pressure and amount of load placed onto the hips. Both types of improper fittings increase nerve pressure and decrease circulation resulting in back pain while sitting.
Recommendation 1: Use seat cushioning to provide lumbar support.
If the seat back can’t be adjusted to recline, additional support may be needed. Seat cushions can help ensure the discs of the lumbar spine will not be compressed and the muscles that run along the spine will not have to work as hard to maintain proper body positioning. The pelvic region has many supportive muscles, nerve innervations, and bony structures—additional padding helps reduce irritation to these areas by absorbing some of the impact of vibrations while driving.
How to fit a lumbar support: The lumbar support device should fit like a puzzle piece to the curve of your lumbar spine, which ends right around your beltline. First, sit with your thighs flat on the chair or seat, positioning your hips and glutes so that they are all the way in the back of the chair, then insert the support device behind the small of your back. A roll of paper towels works as a convenient alternative if you are in a pinch, as does rolling up a towel or sweatshirt (as long as you’re careful they don’t become misshapen). Using mechanisms such as this will help reduce back pain while sitting.
Empty your pockets: It’s easy to forget a wallet or cellphone in our back pockets, but sitting on them puts the body in an unnatural position, which—compounded with the vibrations and movements while driving— can cause soreness and discomfort up and down the kinetic chain.
E2: Ergonomics
In a seated position, the pelvis rotates backwards and causes the curve of the lumbar spine to flatten, placing additional stress on the low back. This stress accumulates when you are sitting for extended periods of time.
Recommendations for how to support back while your sitting:
- Recline the back rest of your seat past 90 degrees to increase lumbar support. Although it may seem counterintuitive, sitting exactly upright means the natural curves of the spine are not supported.
- Your thighs should fit completely onto your seat. The backs of your knees should be 1 inch away from the end of the seat.
- Adjust your seat to ensure thigh clearance is lower than the steering wheel clearance, so you are able to move and lower your legs without interference.
- Maintain a horizontal (90 degree) knee position.
- Keep your elbows close to your sides to avoid reaching when operating the steering wheel.
- Mirrors are an aid—use them whenever possible to avoid twisting or contorting the body.
- Take breaks—at the very least, shifting positions 1-2 times an hour will help to reduce muscle fatigue. Use full breaks to allow for time upright and walking.
- If available, use the air ride feature to reduce the impact on your body while driving and prevent your seat from coming into contact with the floor on tough roads.
E3: Exercise to reduce back pain while sitting
In-cab exercises:
Each of these exercises can be performed inside the cab with the vehicle in park to prevent low back pain while sitting.
Forearm flexion stretch: Lengthens muscles that are responsible for gripping steering wheel for extended periods.
You can either use the steering wheel or your other hand to apply force to the palm of your hand. Put one arm out in front of you with your palm up. Take your other arm and apply pressure to the middle of your fingers (in between the fingertips and the knuckles). Gently extend and straighten your elbow. Apply pressure for 30 seconds, then switch arms.
Scapular retraction: Helps lengthen chest muscles that become shortened/tight and posture begins to slouch forward.
It’s as simple as pinching your shoulders together: just imagine you’re holding a quarter in between your shoulder blades.
Chin tucks: Loosens muscles of the upper shoulders & neck.
Bring your neck back behind the neutral position to obtain end range of cervical extension. If you are creating folds of skin under your chin, then you are doing it correctly. Use your index finger to gently push the neck into end range.
Out-of-cab exercises:
Standing hip extension stretch: Helps lengthen the hip flexors, which become tight during sedentary periods.
Prop your foot on a step or chair that is about knee height. Place one foot on the step, with the opposite leg about 8-18″ away in a split stance. Lean back slowly until you feel a stretch in the back leg—you should feel a gentle pull in the front of your hip. Hold 30 seconds, then change sides.
Repeated standing lumbar extension: Helps reverse the periods of spinal flexion that the body tends to be in during seated positions.
With your legs staggered, slowly lean back while keeping your neck and back straight. Hold for 30 seconds.
Task: Sitting at a desk
Seated work also involves static postures that may lead to muscle strain and fatigue. Some postural issues are dependent on body size and shape: for example, forward-rounded shoulders can cause some to slump forward in their seats; some may favor a particular side of the body, causing them to have to lean; shorter employees may tend to extend their necks more, while taller employees might be used to an overly flexed neck position – all of which can contribute to back pain while sitting for prolonged periods of time.
Another factor that exacerbates the risk of static postures is the type of chairs available to employees, which are typically made in accordance with the average population height and weight. As a result, employees are often left without support where they may need it the most, causing them to use improper posture to adjust their bodies to the seat. This can increase the stress placed on the spine, constrict the joints, impact blood flow, and even cause headache or fatigue. To prevent lower back pain while sitting, discover the 3Es. Engineering, ergonomics, and exercise will help you discover how to properly support your back while sitting .
E1: Engineering
Recommendation 1: Use a footrest to allow the feet to fully rest on the ground.
If your feet are dangling off the floor, the chair isn’t doing enough to support your lower body. A footrest can help provide this support, allow for proper blood circulation, and prevent low back pain.
Recommendation 2: Chairs with multiple adjustment options.
If possible, select an office chair that can be customized and adjusted to best suit your body. Here are the most important features to look for:
- Height
- Backstop lumbar extension (reclining)
- Lumbar tension & resistance
- Lumbar support
- Lumbar firmness
- Pan depth
- 4-way adjustable arms
Recommendation 3: Headrest.
Your shoulders should feel rested, not tense, when leaning back in your chair. If you find yourself having to shrug your shoulders, a headrest might help—they can be installed on most chairs to support the upper back and cervical spine. Headrests may be especially helpful for those of taller stature.
E2: Ergonomics
Recommendations for best-practice positioning:
- Keep your feet flat on the floor with knees bent at 90 degrees.
- Although it may be a force of habit, try not to cross your legs. This can impact blood flow and can cause your muscles to tighten and joints to become stiff. Instead, keep your knees and ankles in line with your ankles being in front of your knees.
- Your hips should be parallel to the tops of your knees when seated, forming a straight and level line.
- Keep your forearms parallel to the floor, with elbows bent 90-100 degrees.
- Your head should be about 18-28 inches away from the screen, with the monitor slightly below eye level.
- Take small breaks throughout the day to get up, stretch, and hydrate. Making this your new routine, you will be able to prevent low back pain while sitting.
E3: Exercise
Utilizing exercise throughout your day is a proactive way to prevent back pain while sitting. Performing dynamic movements causes an increase in tissue temperature, increase in blood circulation, initiates the secretion of synovial fluid to lubricate the joints, and primes the somatic nervous system.
Dynamic warm-up:
Chin tucks: Helps reset the neck muscles to alleviate strain from facing a monitor all day. See previous section.
Shoulder + elbow + wrist extension: Helps reset the upper body and posture to alleviate strain and stiffness. Start with your arms straight in front, and move your elbows as far back as you are comfortably able. Keep your shoulders in that position then, straighten your elbows. Now extend your wrists.
Lumbar extension: Helps alleviate stiffness from forward reaching or prolonged sitting. See previous section.
Heel + toe raises: Increases lower extremity circulation, balance, coordination, and effectively prevents back pain while sitting. Shift weight back onto your heels with the tips of your toes slightly off the ground, then rock forward onto the balls of your feet while raising your heels.
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