Because so many chronic pain diagnoses can be traced back to our places of work, NEUROMUSCULAR REHABILITATION P.T. is always available to perform in-person job site evaluations on behalf of patients. Renée St. Jean has conducted ergonomic evaluations, set up and training for proper computer use on dozens upon dozens of occasions, at locations across southern and central Maine.
Because the physical profile of each patient is so radically different, and each workstation is subtly different, it’s difficult to identify the root of a workplace/ergonomic issue without being on site — to observe exactly how the patient moves, rests and reacts from moment to moment. This is very detailed work. See here a sample job site evaluation, issued by RSJ to a female patient (referred to here as Jane Doe) in 2016:
Jane Doe was evaluated with surface EMG assistance today at her office. She feels she has had improvement in her cervical symptoms since trying to incorporate the new positional and inhibitory techniques learned in therapy recently. She has had only 2 sessions of treatment as I felt she really needed to be seen on site based on her description of her desk set up.
She has bifocals and frequently used cervical hyperextension to view through the bottom of her glasses. She recently purchased computer glasses for this reason. This should solve the problem if she uses them consistently.
Observations:
Jane sits away from the back rest of her chair while keying / mousing. On inspection of her chair, the back is not adjustable, the lumbar supports was too low for her size and the chair height could not be elevated high enough to accommodate appropriate elbow height for keying at this desk level. (Elbows were quite lower than keyboard height).
The mouse is placed on a pullout writing surface to the right of her desk . This positioning causes her to reach back with her right arm to mouse near her hip region. (We moved things on her desk to allow for her mouse to be just right of her wave keyboard for a more neutral posture). Jane’s phone was also moved to front right rather than far reach to the right.
Equipment:
Ergonomic Wave keyboard, traditional mous, headset for phone (currently not using secondary to discomfort of the unit on her ear; she may do better with an over the head version with microphone), pull-out writing surface on right and left of desk, metal non-adjustable height desk with center drawer removed to allow for use as a computer desk (drawers located to right and left under desk), 4 in riser for VDT, older office chair with non adjustable back, unable to rise to proper height for computer work at the present desk height.
Current Set-Up:
Seat height: 20 ¼ in
Elbow height: 26 ½ in
Desktop height: 28 ¾ in
Mouse tray 27 in
VDT distance 27 in
4 in riser for VDT (appropriate)
Modifications to Set-Up:
We trialed 2 newer chairs which were in the office. One worked fairly well, but is not available (used by a co-worker). The other was not appropriate for seat pan depth and arm rests. Utilizing a newer seat at it’s highest setting, we were more closely able to achieve the appropriate elbow height for computing at this desk but a foot rest will be needed.
Jane was able to key with normal resting values at the modified set up (chair at it’s highest setting, makeshift foot rest, mouse position moved onto desk, etc.).
Suggested Modifications to Job Site:
If current desk is to be used, it may be hard to find a chair which rises high enough to accommodate proper elevation — to be used as a computer station. An adjustable-height desk would be preferable but not necessary. If using current desk set-up, the chair would need to rise to a seat height of 22 inches, with no arm rests, and should have the appropriate seat pan depth to allow 2-3 fingers between her knee crease and the chair seat. If she is to use this desk and this height for a chair, a foot rest will be needed as well.
If an adjustable desk is chosen, Jane would still benefit from the use of an adjustable chair with appropriate lumbar support and no arm rests. She could then be set up at floor level without using a footrest. She should have her mouse just to right of keyboard and phone in front of that. If she develops more significant symptoms in the right forearm, I asked her to consider transferring her mouse to the left side.
Jane was writing on the pullout tray to her left and reaching across her desk to write with the right hand. We practiced writing on the right pullout tray instead, since the mouse was moved to the desktop surface. SEMG levels were considerably improved with this set up.
Some significant SMEG improvements were also made by moving her phone more to the center front than far right corner. Once she would reach for the phone in this position and then key while talking or write while talking, her cervical recruitment levels had a hard time coming down to resting afterward. With the modified positioning and writing on the right pull out tray, she was able to significantly reduce her cervical recruitment and return to resting within a normal time frame.