Last month we discussed ways to fast-track your recovery. In this months blog we are going to take a closer look at the main aggravating and maintaining culprits and discuss what you can do to identify these factors, minimise and eliminate where possible.
So what are the main culprits?
-Desk posture and ergonomic workstation set up
-Car seat posture and set up
-Sleeping posture (pillow/mattress/sleep position)
-Gait patterns (how you walk, what shoes you use to walk in)
-Type of physical activity you choose to do if any.
Desk posture and ergonomic workstation
Your workstation set up is probably one of the most common aggravating and maintaining factors, given most people have office jobs. This can become even more problematic in workplaces that have hot desks where workers change their desk on a daily basis, so your desk may not actually be set up right for you, even if you do have your own designated workspace it still may not be set up right for you. Focusing on a few key things can really minimise some of these potential aggravating factors not only for when you are injured but when you are well, bad ergonomics can be a predisposing factor for RSI injuries in the workplace.
In the above picture, you can see the key things to consider when setting up your workstation. The most common mistake people make with their desk workstation is having the screen too low and not directly in front of you, which means you will flex the neck all day long and even be rotating your neck/spine if your screen is not directly in front. This will aggravate any neck, shoulder or wrist injuries. Having your hips below your knees meaning your chair is too low to the floor can really aggravate hip and lower back issues. So make sure that your hips are slightly higher than your knees with your feet still able to rest on the floor (if this is not possible you can get footrests). Making sure the keyboard is not too far away will also help with shoulder, elbow and wrist injuries.
What if you use a laptop?
Most people these days are on laptops, which is where the real problems begin for necks, shoulders, and tension between the shoulder blades. Once again you are likely to have your neck in a position of flexion for long periods. The easy solution is to get another keyboard so that you can raise your laptop screen so that the top 1/3 of the screen is at eye level. As you can see in the picture below it makes a huge difference to your posture.
What if you use two screens?
Two screens become more difficult to deal with and perhaps your health professional can help you further with more specific advice, however being able to identify which screen you use the most and perhaps moving that screen to be directly in front of you will help.
Car seat posture
This culprit usually plays a big role for people with lower back and hip pain, it can also be a trigger for shoulder and neck pain too depending on how far you have your seat from the steering wheel and the habits that you have in placing your arms when you drive and how you place your feet.
There are a few key things to consider if you are suffering from back and or hip pain, making sure your hip is slightly above the knee will help reduce aggravation and most modern cars these days have a function to raise the seat slightly. For more information about car seat posture please see an earlier blog from Dr. Melissa Arnts outlining area’s to adjust. http://www.withoutlimitshealth.com.au/blog/entry/does-your-car-cause-you-back-pain
Sleeping posture can also trigger symptoms depending on the nature of your injury.
Sleeping postures can be very hard to change as they are usually habitual in nature. If you are someone who likes to sleep all twisted with one leg up and the other leg straight (you know who you are) then this position is likely to aggravate hip and lower back issues, the easiest solution is to put a pillow in between your knees to keep your lower back in a more neutral position and can actually make a big difference over an 8 hour sleep period.
If you are a tummy sleeper then neck and shoulder issues will be aggravated every night when you go to bed, so trying to change this habit by sleeping on your side or back will be very beneficial for you but hard to do.
If you have a chronic injury or an acute injury that has been prolonged and is aggravated every night when you go to bed then you may also need to consider checking your mattress and pillow. Having a supported mattress for your hips and shoulders with a pillow that allows your neck to be in neutral is worth spending the money on as it makes a huge difference.
For more detailed information about sleeping postures see Dr. Melissa’s Arnts earlier blog on specific conditions and the best sleeping posture for you. http://www.withoutlimitshealth.com.au/blog/entry/optimal-sleeping-postures
How you walk and what shoes you walk in is always important, but can become particularly important when you have injured an ankle, knee, foot, hip or lower back. If you wear high heels a lot it can even affect your shoulder tension as your center of gravity shifts when wearing heels.
In an initial phase of injury walking may very well be an aggravating factor which should be minimised in the initial stages of injury. After the acute phase has passed it is important to continue moving depending on the nature of your injury as stagnation can also aggravate lower back injuries. Making sure you wear the right shoes when you walk is so important post-injury. Seeking professional advice and assessment really helps in this area as sometimes you have formed habits that you are unaware of in the way you walk and stand. However, you can become aware of certain things you do with your feet when you walk or the way you stand (if you shift your weight constantly to one side) all of these things will give you and your practitioner clues as to what might be maintaining your particular injury. If you are someone that wears heels a lot and you have injured an ankle, knee, hip or lower back, then changing your shoes to allow time to recover should be your priority. Post-injury I always suggest a compromise aiming for the 80/20 rule where you wear good shoes 80% of the time and the nice shoes that are not so good for you 20% of the time. If you have a stand-up desk at work you must only stand in supported shoes. Note that when you transition to flatter shoes it will cause a bit of discomfort in the back as the calves begin to lengthen again, but that discomfort will pass, give it time.
Most people will make a common error that can aggravate or maintain an issue when it comes to physical activity. There are usually two types of people in this category, those that are impatient and in a rush to get back to exercise asap. These types of people simply don’t listen to what the body is trying to tell them and just “push through” and end up doing more damage and consequently taking more time to recover. I always say train smarter not harder and pushing through and forcing your body to do something before it is ready will always be a losing battle.
These people also tend to choose the wrong type of physical activity to return to, sometimes you can return to certain activities but need to be cautious of others, for example, if you had a shoulder injury and wanted to return to the gym, then as a general rule, you would cut out any overhead activities and any arm activities that aggravate your injury until you are fully recovered. Or if you had a lower back issue then deadlifts should be cut out of your gym program until you have fully recovered. Consulting your practitioner on this is very important to avoid re-aggravation. It is very important to understand that you may feel fine doing the exercise put you may pull up sore in the injured area post-exercise a few hours later or even the next morning, this is an indicator that the exercises you did were an aggravating factor.
The other type of people in this category is usually the people who don’t exercise, they are allergic to it, they will find every excuse in the book not to do it, (you know who you are!). These people will not recover as well generally and sometimes is a predisposing factor for the injury to occur in the first place. Our bodies are made to move that is what we are designed for. Movement increases circulation, with nutrient supply abundance and removal of wastes that can build up in joints and muscles causing stiffness. You do not have to be an athlete or slog yourself at the gym every day. In fact, you don’t have to go to the gym at all, just walk for 30 minutes a day and get the recommended 10 000 steps a day can dramatically improve your overall health. Of course, if you have injured yourself and walking is an aggravating factor you will have to wait initially before you can get active, however moving is the key to your recovery after the initial stages.
Hopefully, by understanding these factors in more detail you will be able to manage your recovery time better and also make some changes in your life to prevent some injuries from occurring in the first place. In general, if you make sure that you
-Move every day
-Manage stress levels
you will be off to a great start and decrease the likelihood of injury in the first place, and if you do get injured pay attention to these factors and work with a professional to get you back on track faster.