One of the most common questions I get is whether kidney belts are useful to reduce back pain particularly in forklift or truck drivers and people handling goods.
It’s a good question. I often think of the image of the weight lifter with his kidney belt. They must know something?
To simplify the science, a lot of lower back pain can be contributed to spinal tissue failure from prolonged or recurrent high compression or shear forces through the spine that occur when:
Lifting heavy weights
Lifting lighter weights using poor posture e.g. with arms stretched out in front (functionally increasing spinal compression and shear forces) or with high repetition.
Sustaining postures that reduce the lumbar curve (such as bending or slouch sitting)
Being exposed to whole body vibration through sitting in a vehicle for more than 3 hours per day.
Is there anyway that we can reduce this spinal loading without changing our handling techniques?
Yes: if you hold your breathe for a few seconds, this raises the pressures in your abdominal cavity which reduces spinal loading by relaxing the spinal muscles (the back muscles increase spinal loading when they work) (5-7). However, you can’t hold your breathe forever and this advantage is lost. So not really a workable solution.
What about kidney belts? Research found that kidney belts can slightly lower spinal muscle contractions (8-11%) and limit the amount of forward bending during lifting and encourage squat lifting, therefore reducing spinal loading in this scenario (6), however, kidney belts tended to increase spinal muscle contractions in forklift drivers and make them more likely to experience back pain than forklift drivers who didn’t wear them (6,8).
I most often hear people blame their chair when they’re uncomfortable at their computer workstation, but in reality, a common cause for their actual discomfort, is the incorrect placement of their monitor, particularly when the monitor is placed too far.
A monitor position that is too far from the user causes people to lean forwards away from the backrest to lean in towards the monitor.
This causes prolonged slouching and poking chin postures, creating pressure on joints in the upper neck causing headaches, and over activation of the upper trapezius muscles leading to neck pain as well as high compression on the lumbar spinal discs leading to back pain.
So, how do we fix this? Buy a new chair? Of course not. If you’re sitting badly, always check that when leaning backwards against your chair, if you place your arms in front of you like Frankenstein, your fingers touch the screen. If they don’t, bring your screen closer.
At the same time, ensure that your forearms are supported either on your desk, or on your armrests. This will differ depending on other factors in your setup.
Please join the conversation, ask questions, make comments or share with friends and colleagues if you found this helpful.
Lower back pain is a very complex problem and may have many causes. One cause is when spinal tissue failure occurs as a result of high compression forces applied through the spine leading to spinal injuries. High spinal compression forces may lead to micro fractures in the vertebral endplates, compression fractures of the vertebral bodies and damage to the spinal discs (1-3).
Activities which cause high spinal compression forces include:
Lifting heavy weights.
Lifting lighter weights in weak postures which increase the functional weight of the object and thus the load on spinal tissues (e.g. lifting from the floor or above shoulder height).
Sustained spinal bending postures (with or without a load in the hand).
High repetition spinal bending postures (with or without a load in the hand).
Exposure to whole body vibration in vehicles that experience vibrational acceleration including shocks between 2-6g (11).
Certain body postures also create higher compression forces through the spine than others. For example, bending the spine while lifting, increases the pressures on the spinal discs by more than 100%. Spinal bending combined with twisting increases spinal disc pressures by more than 400%. On the other hand, when people recline backwards in a chair, even while adopting a slouching posture, spinal disc pressures reduce by 50-80% – a posture most of us adopt when we’re getting tired during extended bouts of sitting. Sitting up straight in a chair actually creates twice the spinal compression compared with reclining backwards in a chair – something to tell your granny or your teacher when they criticize your reclined slouching posture!
In 1979, it was noted that when heavy lifting was performed while holding one’s breath (for a few seconds), the intra-abdominal pressure was raised, the spinal extensor muscles activity reduced and both led to reduced compression loading on the lumbar spine, reducing the risk for spinal injury. However, if the heavy lifts extended for longer than a few moments, the breathe was released and the intra-abdominal pressure fell to much lower levels, reducing this spinal support mechanism substantially (5). This reduction in spinal compression due to raised intra-abdominal pressure was supported by research published in 2003, 2006 and 2010 and showed that the greatest benefit occurred when the body was in flexed (bent) postures (6-8).
The question arises as to how raised intra-abdominal pressure reduces spinal compression and helps to protect the spine from spinal compression failure leading to spinal injury and lower back pain.
Both abdominal and spinal extensor muscle contraction cause an increase in the spinal compression forces. However, the abdominal muscle contractions (0- 40% MVC) also assist in raising the intra-abdominal pressure, and when doing so, the net forces on the spine result in reduced spinal compression. In these circumstances it was also found that there was a reduction in the activity of the erector spinae muscles, with a greater reduction in these muscles’ activity corresponding to a greater increase in intra-abdominal pressure (8).
Furthermore, a 2013 published study revealed that chronic lower back pain sufferers who were experiencing a remission from their pain still exhibited lower levels of agonistic abdominal muscle activity and higher levels of antagonistic paraspinal muscle activity when compared to healthy individuals when performing spinal flexion (stooping/bending) with or without handling a load. This alteration in their abdominal and spinal muscle recruitment activity/ patterns could result in increased spinal loads (not measured in their study) and possibly contribute to the recurrence of lower back pain in individuals where these altered recruitment patterns have become the norm (9). On the other hand, research published in 2011 showed that activation of the core muscles showed no improvement in spinal stability, casting doubt on the mechanism in which core muscle rehabilitation is used to assist in the treatment of chronic lower back pain (10).
Chaffin D.B.; Park K.S (1973). A longitudinal study of low-back pain as associated with occupational weight lifting factors. Am Ind Hyg Assoc J. 34(12):513-25.
Freivalds A.; Chaffin D.B.; Garg A.; Lee K.S. (1984). A dynamic biomechanical evaluation of lifting maximum acceptable loads. J Biomech. 17(4):251-62.
Adams M.A.; McNally S.D.; Chinn H.; Dolan P. (1994). Posture and the compressive strength of the lumbar spine. J Biomech. 27(6):791-791.
Hutton, W. C.; Cyron, B. M.; Stott, J. R.R. (1979). The compressive strength of lumbar vertebrae. J Anatomy. 129(4): 753-758.
Daggfeldt, K.; Thorstensson, A. (2003). The mechanics of back-extensor torque production about the lumbar spine. J Biomech. 36(6): 815-823.
Arjmand, N.; Shirazi-Adl, A. (2006). Role of intra-abdominal pressure in the unloading and stabilization of the human spine during static lifting tasks. European Spine Journal. 15:1265–1275.
Stokes I.A.; Gardner-Morse M.G.; Henry S.M. (2010). Intra-abdominal pressure and abdominal wall muscular function: Spinal unloading mechanism. Clinical Biomechanics. Nov;25(9):859-66.
D’hooge, R.; Hodges, P.; Tsao H.; Hall L.; MacDonald D.; Danneels L. (2013). Altered trunk muscle coordination during rapid trunk flexion in people in remission of recurrent low back pain. J of Electromyograhy and Kinesiology. Feb;23(1):173-81.
Stokes I.A.; Gardner-Morse M.G.; Henry S.M. (2011). Abdominal muscle activation increases lumbar spinal stability: analysis of contributions of different muscle groups. Clinical Biomechanics. Oct;26(8):797-803.
Bazrgari, B.; Shirazi-Adl, A.; Kasra, M. (2008). Seated whole body vibrations with high-magnitude accelerations—relative roles of inertia and muscle forces. Journal of Biomechanics. 41:2639-2646.
If you’ve been following my posts, you’re starting to realise that I keep harping on about how common neck pain is among office workers. During my pre-corporate practice days, lower back pain and knee injuries were the most common ailments I treated. Once I moved into the corporate environment though, I was totally amazed at the high incidence of neck pain I encountered.
Who of you find yourself constantly referring to papers, writing on documents, capturing data from sheets and then working with the information on your computer as part of your job? I find this quite common among book keepers, data capturers, etc.
How does working between papers and a computer increase your risk of developing neck pain? There are a number of factors to consider in these scenarios.
When people work with papers/documents, I find few people actually have a proper document holder to hold the paper/document at eye level. Instead, I find that people are placing the papers/documents on their desk instead, causes people to bend their neck for long periods of time during the day, increasing the risk of developing neck pain. The solution is to use a document holder which will allow you to keep the papers/documents that you are working with at eye level if there is no need to write on them. If there is no money in the office for a document holder, rest the paper/document against the computer screen and use a stapler to keep it there. It works just as well and is free.
If there is a need to write on documents, I find that people often tend to place them flat on their desks, forcing a bent neck posture which increases the risk of developing neck pain. If you do need to write on paper/documents while working on your computer at the same time, grab an arch-lever folder that will slant upwards like the old school desks when we were in primary school. This will allow you to keep a more upright posture while you lean on the folder and make notes on your paper/document. You can then flip it back onto your chest when you need to type, and then flip it back down over the keyboard when you need to write again. It’s a slightly irritating thing, especially when you’re not used to it, but, before throwing out the idea, weigh up the pros and cons of getting used to working like that versus experiencing frequent bouts of neck pain.
I also find that when people are working with documents on their desk, they may push their computer screens back and out of the way or move their computer away to one side to allow them space to work on their desks. Pushing your computer far away from you and placing documents on the table between yourself and your computer and keyboard will create a poking chin posture, which is a high risk posture for developing neck pain (read my post on spinal posture and pain). Placing your computer screen to one side is another high risk posture for developing neck pain. Both postures create compressive forces on neck joints resulting in an increased risk of developing neck pain. The solution here is the same for the scenario above: use an archer-lever folder as well as bringing the computer screen back to a position straight in front of yourself and to the correct distance from yourself when you work (read my post on how to to correct the distance of your computer screen to reduce neck pain).
You need to maintain your lumbar curve in your car seat.
Your lumbar curve is there to help reduce the loading on your spine. When you slouch, you increase the pressure on your spinal discs and increase your risk of developing a spinal disc problem that may result in lower back pain. The backrest of your chair is specially shaped to help maintain your curve. To gain the benefit of your backrest, ensure that your buttocks are positioned right back against the backrest and that you are leaning backwards into it.
2. In order to sit properly while you drive and maintain your lumbar curve, you need to position your legs at the correct distance from the pedals to prevent tight hamstrings on stretch from flattening your lumbar curve (read my post on tight hamstrings and lower back pain).
Your hamstrings attach to the bottom of your pelvis and go on stretch when you straighten your knee. If you have tight hamstrings, when you straighten your knees to reach/press down on your car pedals, the stretch in your hamstrings will result in your pelvis being rotated backwards and your lumbar curve flattening, increasing the pressure on your spinal discs and increasing your risk of developing lower back pain.
In order to determine the correct distance of your car seat to the pedals, place one hand in your lower back and feel the curve of your lower spine, then move your seat forwards and back until you can comfortably reach the pedals while still maintaining your lower/lumbar spinal curve.
3. Incline your car seat’s backrest to -8 degrees to reduce the loading on your lumbar spine and reduce spinal fatigue.
There is more loading on your spine when your backrest is upright than when it is reclined backwards. You instinctively know this, and when you are tired from sitting upright for too long, you will intuitively move your buttocks forwards on the chair seat and lean backwards to take the strain off your spine. Thus, positioning your car seat too upright will cause fatigue of your back and increase your risk of developing lower back pain if you are driving for long periods of time.
4. Elevate/lower your chair so that your hips are 90 degrees or less. If your hip angle is too sharp, this will also increase your risk of slouching in your chair, which in turn will lead to increase pressure on your spinal discs and increase your risk of developing lower back pain. If your seat does not allow you to sit high enough, help yourself by sitting on a small cushion.
5. Move the steering wheel up/down/forwards and back until you find a comfortable distance from yourself to the steering wheel. Your elbows should be slightly bent. This will prevent your shoulders from fatiguing, which when it occurs, will also increase your spinal loading and spinal fatigue when driving and increase your risk of developing lower back pain or aggravating your current pain.
Neck and lower back pain are such common complaints that we all know someone (if it’s not ourselves) who has experienced at least one of these complaints. There are many causes for neck or lower back pain. These can include different types of injuries, disease processes, genetic predispositions, and most importantly and commonly of all, our posture. Our posture at work and our posture at home and at play.
Our work posture is getting more and more attention, especially since the advances in technology have relegated most of us to work behind a computer for long hours each day. There are a host of things to consider in our work environment that can negatively affect our posture and cause our neck or lower back pain.
Part of my job is going around performing office ergonomics for people. One of the most common things I hear is people blaming their chair for their neck or lower back pain. Most often, however, this is not correct and the real culprit is the monitor and where it has been positioned on the desk. Luckily, this is a much cheaper and easier solution to the problem.
Your poor monitor position (read my post on 4 poor monitor positions that cause neck pain) is definitely one of the first places to look if you suffer from neck or lower back pain and you think your work posture is to blame. There are a number of factors to consider in relation to your monitor position, but one very important and neglected element is the correct monitor distance that your monitor is positioned away from you while you work.
If your monitor is positioned too far away from you, you will find yourself leaning forwards in order to see your screen better, creating all sorts of problems in your spine (especially in your neck and lower back) and over activating your shoulder muscles, all leading you down the path of aches and pains.
So what is the correct distance that you should place your monitor?
Generally, your monitor should be positioned a lot closer to yourself than you think it should. And if you don’t believe me, ask yourself why you keep leaning forwards when you work.
How do you determine the correct distance that you should position your monitor at? I call it the “Frankenstein” test.
Firstly, position your chair as close to your desk as possible while your arms and wrists are still able to comfortably work on your keyboard and be supported with an elbow angle of 90-120 degrees. (In order to get close enough to your desk, you might need to adjust your armrests. Generally I find that most armrests get in the way of the desk when you want to come closer, so one solution is to raise your armrest so that it just slides onto the surface of your desk, allowing you to bring your chair closer. If you are unlucky enough not to have adjustable armrests and your armrests are really stopping you from bringing your chair sufficiently forwards, I recommend getting your building maintenance to remove them. Use your desk for your arm support instead).
Then, lean backwards against your backrest and replicate Frankenstein’s outstretched arms – where your fingertips end, that is where your screen should be.
Closer than you think? Give it a try and remember to keep leaning back against your chair’s backrest. Your backrest is there to help keep you in good posture while you work. A combination of those two factors (leaning back in your chair and having your monitor at the correct distance away from you) will go a long way to reduce your neck or lower back pain associated with poor working posture.
Who of you find that at the end of a day at work, your neck or shoulders are sore or aching? Neck pain is so common, that between 30-50% of the population will suffer from it at some point, and office workers are even more at risk of developing neck pain.
There are a number of reasons why neck pain is so common, particularly amongst office workers. Let’s look at a few of the reasons why:
The way that you sit at your desk and use your technology has a large impact on your physical posture and can either relieve or create neck or lower back pain. The posture that you sustain for extended periods of time will have a knock on effect on your muscles, joints, circulation of the blood, circulation of your nervous system and importantly, the ability of your lungs to expand and thus oxygenate your brain. Are you enabling all these systems to work well or are you compromising them through your posture and creating neck or lower back pain?
When we work too long and too hard without breaking our work up into bite size chunks, we deplete our energy and our concentration levels and reduce our effectiveness, but, we also tire our bodies out more than we otherwise would that could lead us to developing neck or lower back pain. In fact, research has shown that a lack of micro breaks throughout the day results in a higher risk of developing aches and pains. Hmmm, who would’ve thought? and it’s the one thing I’ve noticed about South Africans – we don’t pace ourselves. This is really not good for our health.
Ah, who feels like moving when they’re tired? I must confess that I’ve had more than my fair share of couch potato moments. Not only that, most of us hate breaking our work rhythm when we’re on a roll. However, exercising regularly (on a daily basis or even once a day) is great for us in soooooo many ways. Moving helps relieve tension that has built up in our tissues. It also improves our circulation and helps protect us from aches and pains. It is good for stress relief and for our general health/cardiovascular system. Overall, if you are suffering from neck or lower back pain, exercise can help you reduce it.
An interesting thing I’ve noticed in my work is that even if someone has a really bad computer setup causing them to sit in an awful posture, if that person moves every hour, they invariably don’t get the aches and pains their colleagues who don’t move and sit in the same position do get.
Furthermore, moving throughout your day keeps your mind fresh and helps you perform better at your job. Taking active micro breaks is definitely worth considering in your work day!
4. And Stress!
Stress, stress, stress. The silent killer. The thing in our life that can take everything that’s good and run it down.
Researchers have discovered that working under time pressures and deadlines have a significant association with the development of neck pain. They’ve also shown that if you are being managed by someone who has a poor leadership style, you’re also more likely to suffer from muscular aches and pains. Eina!
And lastly, if you are experiencing psychosocial stress, you are also more likely than your peers to be experiencing neck and shoulder pain.
Dealing with stress is not easy. It’s a process that requires learning new skills and looking at our life and situations in new and different ways. If you are suffering from stress, you owe it to yourself to find ways to reduce its detrimental affect on your life.
Ariens G.A.M., Bongers P.M., Hoogendoorn W.E., Houtman I.L.D., van der Wal G., van Mechelen W. 2001. “High quantitative job demands and low coworker support as risk factors for neck pain.” Spine 26 (17): 1896-1903
Bongers P.M., Ijmker S., van den Heuvel S., Blatter B.M. 2006. “Epidemiology of work related neck and upper limb problems: Psychosocial and personal risk factors (Part I) and effective interventions from a bio behavioural perspetive (Part II).” Journal of Occupational Rehabilitation 16: 279-302.
Gawke J.C., Gorgievski M.J., van der Linden D. 2012. “Ofﬁce Work and Complaints of the Arms, Neck and Shoulders: The Role of Job Characteristics, Muscular Tension and Need for Recovery.” Journal of Occupational Health 54: 323–330.
Ferreira Jr M., Saldiva P.H.N. 2002. “computer-telephone interactive tasks: predictors of musculoskeletal disorders according to work analysis and workers’ perception.” Applied Ergonomics 33 (2): 147-153.
Fjell Y., Osterberg M., Alexanderson K., Karlqvist L., Bildt C. 2007. “Appraised leadership styles, psychosocial work factors, and musculoskeletal pain among public employees.” International Archive of Occupational and Environmental Health 81 (1): 19-30.
As I mentioned previously, 30-50 % of people will suffer from neck pain and office workers are at a greater risk than others for developing neck pain. One of the reasons that neck pain is so common in the office environment is that people bend their neck too much in an office job. Research has shown that individuals who bend their neck for 70% or more during the day dramatically increase their risk of developing neck pain compared to their colleagues who don’t.
What are some of the reasons that cause people to bend their neck for too in an office environment?
The computer/laptop/tablet monitor that you’re using is positioned too low on your desk while you work, forcing you to bend your neck.
You are working with documents a lot and don’t have a document holder to hold them up at eye level, thus causing you to bend your neck while you work.
You don’t know how to touch type and you are forced to keep looking at your hands when you use the keyboard, forcing you to bend your neck throughout the day while you work.
When I go around to companies and perform office ergonomics, helping people to sit correctly at their computer workstations, sometimes correcting someone’s computer ergonomics is not enough to resolve the problem. If an employee constantly still develops neck pain despite having their computer workstation setup correctly (click here to view software to help you correct your computer ergonomics) , and neck injuries such as whiplash, or arthritis, or any systemic diseases which may cause neck pain are not clouding the picture, the reason why they may still be developing neck pain is possibly due to the fact that they are 2 finger typers, constantly looking down at their keyboard.
What is the solution when an inability to touch type is the problem? Simple, but it does require some effort. Learn how to type properly. There are a number of FREE online typing courses:
I’m sure there are more, just google it if you don’t like any of the one’s I’ve mentioned above. If you do use any of the above, I would appreciate feedback to help with the recommendation to others. Please post comments to this article.
Learning how to touch type will help you to keep working in a healthy body posture, reducing your need to bend your neck so often through the day and therefore reduce your risk of developing neck pain. Another bonus to learning to touch type is that the increased fluidity and speed of your new found typing skills will also help you to work faster which may also help reduce some of the deadline stress associated with your job. Stress in and of itself can also be a factor in your neck pain (read my post about stress and neck pain). A double bonus. Good luck and please let me know how it goes.
Ariens G.A.M., B. P. (2001). Are neck flexionk, neck rotation, and sitting at work a risk for neck pain? Results of a prospective cohort study. Occupational and Environmental Medicine, 200-207.
Cagnie B., D. L. (2007, May). Individual and work related risk factors for neck pain among office workers: a cross sectional study. European Spine, 16(5), 679-686.
Guzman J., H. E.-J. (2008). A new conceptual model of neck pain linking onset, course and care: The bone and joint decade 2000-2010 task force on neck pain and its associated disorders. Spine, 33(4S), S14-S23.
Guzman J., H. S.-J. (2009, February). Clinical practice implications of the bone and joint decade 2000-2010 task force on neck pain and its associated disorders. Journal of Manipulative and Physiological Therapeutics, 32(2S), S227-S243.
So, you’ve discovered that your monitor (laptop, tablet or desktop computer screen) is positioned too low on your desk (read my post about 4 monitor positions that cause neck pain) causing you to bend your neck for too long, straining your neck. How can you go about correcting this and ease up the strain on your neck causing your neck pain?
Well, firstly, the changes to your monitor are entirely dependent on the type of technical device that you use. There are, however, certain principles that apply to all types of devices with a monitor that you might use that you need to be aware of in order to adjust your monitor correctly and reduce your neck pain.
Using the same device’s keyboard, mouse (or touch pad) and monitor and sit in the correct position for your body can be a bit tricky. Often this scenario will place you in a really poor posture when using your device, and if this posture is prolonged, it will likely result in you developing neck pain. The way out of this it to lower your chair until your head is looking straight ahead at your screen and place the keyboard of your laptop far enough away so that your elbows are >90 degrees (open elbow angle) but not so far that when you lean back in your chair, your monitor is further than arms’ length away (which will result in forward leaning posture creating high risk of back and neck pain). Phew!!
Again, whether you are using a laptop or desktop (or tablet), your monitor needs to be at eye level, allowing the curve in your neck to remain neutral (chin level, not tucked in or poking out). Your cervical lordosis (neck curve inwards as in the xray below) is pivotal for good posture behind your device.
3. You will need some assistive device to help raise your monitor to the correct height. Some desktop monitors have a built-in system that allows you to move the monitor up or down as desired, but most do not.
Let’s consider each scenario separately:
If You Use a Desktop Monitor
If you are using a normal, old fashioned desktop monitor, this will be one of the easier scenarios to raise your screen to the correct height. Just use books (it’s cheaper), a monitor raise or an adjustable monitor arm (check our our monitor raise and adjustable monitor arm in our shop).
If You Use a Laptop
People who use laptops sit in terrible postures unless they use a laptop raise (check out our laptop raise) or books to elevate the laptop monitor to eye level and use a second keyboard and mouse. Please ensure that you purchase a proper laptop raise that elevates the monitor sufficiently and doesn’t do a half job and leave you bending forwards over your machine. Alternatively, lower your chair until your monitor is at eye level as described above.
“Alu MacBook Desk shot” by David under Licence CC BY 2.0If You Use a Tablet
Tablets are an even greater ergonomic risk than laptops. Their screens are small and their keyboards laughable. If you’re crazy enough to use it like a working computer, you will have to get a tablet stand (and more than likely need to raise even that up on books to get it to the right height) as well as a second keyboard and mouse (check out our tablet stand).
This tablet raise/stand allows you to use your tablet like a computer, however, it will still need to be raised further on books etc to get the screen to eye level. In addition, you will also need a keyboard and mouse to allow for proper ergonomics and to avoid unnecessary back and neck pain.
Member of the Ergonomics Society and Health Professions Council of South Africa