Grant Garrigues, MD, Shoulder Specialist at Midwest Orthopaedics at Rush, talks about how factors related to work from home can affect our ergonomics.
Tell me when you started to notice this was becoming an issue, that patients were coming in with this problem?
Dr. Garrigues: So as a shoulder and elbow specialist for over 10 years, I’ve seen this sort of issue my whole career, issues related to, basically, shoulder pain due to chronic poor posture and poor ergonomics in the workspace. During the COVID-19 pandemic, really in late March when people started working from home exclusively, we saw a dramatic uptick in the amount of patients that were coming to see us for those sorts of issues.
So, what were some of the common things that patients were saying to you when they would come in and they would complain about this pain? What were some of the key words or indicators that they would complain about? Where was that theme?
Dr. Garrigues: So, there are a couple common sites of pain within the shoulder. A lot of patients would have pain in the anterior superior shoulder, worse with activity, reaching out away from their body or reaching over head. And they would often, upon further discussion, realize that they were working at their kitchen island or sitting on their couch with their laptop and they had changed kind of the way they work. They might have also changed their workout habits. Commonly, they might be working in a very sedentary, poor posture way, but then try to go do a bunch of pushups. If the pushes aren’t balanced with pulls this will further the imbalance and hunched shoulder posture. And so the work and the workout, if not done correctly, work in a negative feedback fashion to really cause the poor shoulder posture that causes painful pinching in the front of the shoulder.
So, is this something that you immediately attributed to COVID or is this just a common thing that we see with people based upon us having poor posture as human beings?
Dr. Garrigues: It took me a little while to put it together. We’ve been seeing these patients for a long time with these issues, but then with COVID a much higher prevalence of these problems. I find that you learn a lot from talking to your patients, and really it was the patients that suggested the mechanism—”I’m working in a different workspace … I’m not sitting on this chair that I’m used to … my screen is a different height.” So, it was really in talking to the patients that we realized there may be a connection. And then, as I’ve been talking to patients going forward through this pandemic, you’ve realized that that’s an almost ubiquitous cause of this problem.
So how is a home office setting, different than maybe your typical office setting? You know, some of us have spaces that mimic that in the office. Some of us probably have poor office spaces in general. But what the differences usually are and how these differences can trigger pain?
Dr. Garrigues: Some people have a home office where they have a nice supportive chair, a nice desk at the right height, good lighting, everything very similar to in an office. But the main difference really is the laptop versus the desktop. With a laptop, unless you have some sort of dock, the keyboard and the screen are literally coupled. And so, you end up, by definition, with your hands are down low on the keyboard and then the screen just above the height of your hands. That’s going to lead to neck flexion, a forward and downwardly rotated posture of your shoulders. So in a setting where you have a desktop, you can have the keyboard at a proper posture for your hands and arms and then have your screen – your monitor up high where you can see and look directly and not have to have that hunched down posture. So, the main difference is really the prevalence of the laptop. A laptop is designed for portability, but when you’re using it day in, day out for all of your, you know, work, it can lead to some problems.
So what does hunching over do to the anatomy that can lead to that pain?
Dr. Garrigues: So what happens is basically, you can see the collarbone here, shoulder blade or scapula, and the humerus. This is a left shoulder. And what can happen is there is a bony roof for the shoulder called the acromion, and underneath that is the rotator cuff. So, if the shoulder is in a forwardly-tilted and downwardly-rotated posture, it’s going to pinch off the area available for the rotator cuff so that, when the patient then raises their arm, there’s abnormal contact. If things are open like this, it really opens up that space and allows the rotator cuff to breathe, so to speak. This is worse with poor shoulder posture. It also can be worse with muscle imbalances. So, people that try to go to the gym and just do the “beach muscles,” so to speak. So, your pecs and your lats and your muscles that you see when you look at the mirror. Those are all going to point things forward. You need to really work on the small muscles around the shoulder blade to counteract that and lead to a balanced shoulder posture.
So, if we unfortunately find ourselves hunching because of the workspace that we have, how can something like physical therapy or strength training help counteract that?
Dr. Garrigues: Absolutely. So, the first important thing is stretching out the muscles in the front. So that may be as simple as, you know, a few minutes out of every hour, just standing up and literally just opening things up – letting those pectoralis major, pectorals minor, some of those anterior muscles stretch out. The second thing is going to be strengthening the muscles in the back. So, these are small muscles like the serratus, the rhomboids, the levators, the lower trap – these are small muscles that don’t get enough credit in the gym! The way to work them out is with rowing type exercises. Not an upright row but a row where you’re really thinking about pulling those shoulder blades back and down, pinching them together, sticking your chest out–that’s going to get those muscles at the inferior-medial aspect of the shoulder blade to help hold things in alignment.
What are some tips that you would have? And I – you mentioned a few of them about the – you know, the laptop. We talked about the differences between an office space and the home – office workspace and home workspace. But what are some, like, maybe at home tips? You talk about putting your laptop up on some books or elevating it. So just hit a couple of those tips.
Dr. Garrigues: So the worst thing you can do is use your laptop as an actual laptop. If you’re just sitting on a couch with the laptop sitting on your thighs, your arms may be comfortable, but your head, neck, and shoulders are all going to have this downwardly-rotated posture. That’s absolutely the worst thing you could do. I mean, it’s fine here and there, but if you’re doing that for eight hours a day or more working, that’s going to lead to some chronic problems. If you have a desktop monitor, that’s ideal. If you could put that monitor up a little bit higher to where your head and neck are aligned, your shoulder blade posture can be up while your hands are in the proper posture–that’s ideal. So, raising that monitor up – just putting it on a stack of books can be helpful. So again, using a laptop with a doc or using a desktop is really key and probably one of the first steps to really get good posture in a home workspace.
And then what are some of the long-term effects of the repetition of this? And again, it’s a little bit repetitive, but we do this a little every day. Obviously, after the first day you can feel discomfort. But the long-term effects of actually being to the point where when you’re in a normal position, unable to get back to what we would call, standard anatomy.
Dr. Garrigues: So, the big problem is you get this chronic muscle imbalance where everything gets rolled forward. And then, when you decide to do something overhead, is when the real problems begin. For example, a couple of my patients recently have been working at home with poor posture and then decided, hey, I want to go, for example, paint part of my house. And when they painted their ceiling one weekend, suddenly doing overhead activity where the shoulder blade needs to roll back fully, but it can’t anymore because it’s lost that flexibility in the front and the strength in the back. That type of thing leads to big problems.
Another patient example is a patient who was working from home a lot of hours at the laptop and wanted to get out and throw the football with his son. So now he’s doing overhead activity. So, it’s OK when you’re just working down here, which is 90% of your activity. But then when you do decide to paint the ceiling, throw the ball, go for a swim, or reach overhead, anything that’s going to be above shoulder height, that’s when the real problems begin. And the problems can be inflammation, we call that “bursitis.” It can also lead to rotator cuff tendonitis or even rotator cuff tearing. So, these are real problems that can really affect patients in a major way.
So if you are experiencing pain and you think that it may be attributed to your workspace or your working from home routine, what you can do to improve it?
Dr. Garrigues: So, the first thing, again, is to examine, do you have good posture? “Mindfulness!” right? We hear about mindfulness these days. Be mindful of your posture while you’re in that work setting and make sure you’re not making things worse. And then, if that doesn’t alleviate the situation in short order, absolutely, you want to reach out to a shoulder specialist. You can come see me here if you’re in the Chicagoland area at Midwest Orthopedics at Rush. If you are not in our area, you’re somewhere else in the country or an international patient, I do remove visits, telehealth, and virtual second opinions. You can also see a specialist in your area. Have them look at your shoulder. Again, they’ll talk about some of these exercises. It may be so bad that you might need an injection to kind of kickstart the anti-inflammation process. And then, typically, it’s going to be referral to a physical therapist to teach you some of these exercises, some of these postural stretching and strengthening maneuvers, that you can do. And then that’s when you’re going to be headed on the road to recovery.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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