The Office Athlete: Improving Posture (and Preventing Pain) in an Office Setting

The Office Athlete: Improving Posture (and Preventing Pain) in an Office Setting

Capstone Project By: Kate Nagel, SPT

Background

Prior to Physical Therapy school, I worked for the Social Security Administration as a Management Analyst.  The job detailed eight to 10 hours at a desk each day, often completing various requests for statistical data or contract information.  While the work was interesting, it was extremely sedentary and resulted in the development of postural dysfunction, including forward head and rounded shoulders.  I often suffered from headaches, neck pain, and low back pain, despite the fact that I would take standing walk breaks, and workout at lunch time.  When it came time to think of a capstone topic, I knew that I wanted to learn more about postural dysfunction in office workers, or “office athletes” (as one of my clinical instructors called this patient population).  I was able to make this the focus of many research projects during my third year, and decided to present my research findings in the form of an educational presentation to the faculty and staff of the Allied Health Sciences (AHS) department.

Overview and Project Purpose

One in four adults spent around 70% of their time sitting, while six out of 10 adults utilize computers on a daily basis.¹  This sitting, sedentary behavior of looking at a computer screen causes 3.6 times more force on the neck compared with correct standing posture, applying additional pressure to the joints and muscles of the cervical spine, eventually creating a forward head posture.² The body further compensates by creating rounded shoulders due to an “upper crossed syndrome”².²  The lumbar spine is also often flexed or bent forward when sitting at a desk, creating added pressure on structures like discs and ligaments due to the deconditioning of low back postural muscles.³ This resulting postural dysfunction creates pathologies related to neck, jaw, shoulder, and low back pain.^2–6 Luckily, physical therapy can help this patient population, as evidence has shown that stretching and strengthening exercises, along with ergonomics education, has been proven to improve pain related to postural dysfunction in office workers.^7–11

To verify that there was a need for my educational presentation on postural dysfunction, I sent out an electronic survey to the AHS department.  The results of the survey supported a need for an educational presentation on postural dysfunction in office workers since over 90% of the respondents complained of neck, back, jaw, shoulder or other pain from poor posture or sitting at a desk, while 100% of respondents complained of pain related to prolonged computer work at a desk.  The educational presentation and materials I provided to the AHS hopefully enhanced their knowledge of various poor posture pathologies, taught them therapeutic exercises they could easily complete at their desk, and find ways to improve their work station set up to prevent or improve their posture.

Capstone Products

An educational Power Point presentation with additional educational materials were created and presented to the AHS faculty/staff on March 24, 2017.

Additional Works

Other assignments from the Fall 2016 semester that helped build a research knowledge base as I prepared to complete my capstone project included:

• Advanced Orthopedics (PHYT 875): Research Paper Topic: Postural Dysfunction
• Evidenced Based Practice II (PHYT 752) Clinically Appraised Topic (CAT): Cervical pain and postural dysfunction in 30 year old female office workers.

Health Literacy Evaluation

While creating my capstone products, I tried my best to utilize “plain language”¹² within the presentation and educational materials despite the majority of my audience potentially having basic medical or physical therapy knowledge.  While the language of my presentation and educational materials should be understood by the various audience members, I also took the “death by Power Point”¹³ YouTube video seriously and tried to avoid heavy text, excessive bullets and clashing backgrounds.¹³ According to Phil Waknell, presentations can “suck”¹⁴ in three ways: “death by Power Point”¹⁴, reading, and boredom.¹⁴ Since many of the slides lacked excessive text, I was not tempted to read directly from them during the presentation.  Additionally, I made the presentation interactive by having the audience perform the therapeutic exercises in their educational materials.  This also utilized the “teach-back technique”¹², as I first demonstrated the exercises and had the audience demonstrate after me, proving they understood the correct form and technique of each exercise.¹²   The educational material distributed during the presentation contained both illustrations of an ergonomic desk set up and exercises, along with written text explaining the pictures. “Plain language”¹² is utilized throughout the materials, and the materials are written at about a sixth grade reading level according to the SMOG Value Calculation.¹² While that is slightly higher than the recommended fourth to fifth grade reading level for patient educational materials, my audience is in (or associated with) a healthcare profession and (hopefully) will be able to understand the materials.¹²  Overall, I felt that the presentation and materials were well received by the audience, and received very few clarification questions throughout the presentation.

Evaluation, Feedback, and Self-Reflection

Following my presentation, the audience completed a feedback form.  The results are as follows:

Capstone Presentation Feedback Form	Strongly Agree	Agree
The objectives of the presentation were clearly defined.	67%	33%
The presenter was well prepared for the presentation.	50%	50%
The presentation was well organized.	100%	0%
The presentation enhanced my knowledge about various pathologies related to poor posture.	50%	50%
The presentation enhanced my knowledge about ways I can alter my workstation set-up to minimize or avoid pathologies related to poor posture.	100%	0%
The presentation clearly demonstrated exercises that I can easily complete at my desk.	100%	0%

 

This feedback informed me that I effectively organized my presentation and explained work-station set up and exercises well, but can still improve in defining presentation objectives, explaining poor posture pathologies, and my overall preparation for the presentation.  I also received additional constructive comments regarding presentation style (speaking tone, use of visual aids, ability/inability to answer questions, and lack of laser pointer use).  I really appreciated all of the feedback provided from my audience since public speaking is not my strong suit and I am aware that I can struggle to answer questions when I am under pressure. I look forward to working on these suggestions as I may consider presenting at various physical therapy conferences.  Being able to answer questions is especially important, as it demonstrates my competency in the material.

Another evaluation tool I utilized was a short quiz, distributed and collected at the end of the presentation.  The quiz helped demonstrate that the audience understood the main points of my presentation related to anatomy, poor posture pathologies, risk factors, exercises, and work station set-up.  While everyone answered the questions about anatomy, poor posture pathologies, exercises, and work station set up correctly, the majority of the audience got the question about risk factors incorrect.  That indicated that I should have explained the risk factors material in more detail, and/or maybe should have written the question differently.

Overall, I felt the presentation went well, and I received great verbal feedback and constructive criticism from my committee members.  One thing that I hope to improve for future presentations is adding more visual aids.  During my capstone presentation, I explained proper work station set-up with text, then provided a picture at the end of the explanation.  My advisor had a great suggestion of placing the picture on every slide, explaining the picture along with the text.  This will provide multiple mediums of information for the audience, hopefully making it easier for them to understand.  Another idea I hope to put into practice is more demonstration within the presentation.  I stated what poor posture looked like, but demonstrating it would also provide the audience with another medium of understanding.  This could also be utilized in a picture format within the presentation as well.  Having the audience demonstrate what they believe is poor posture could also make the presentation more interactive.  Finally, I attempted to utilize Lecture Capture to record the presentation, but ran into difficulties with background noise/conversations that prevented me from posting it to the capstone website.  For future presentations, I will have a more accurate time length of the presentation, and make sure that all microphones are muted following the conclusion of the presentation.  All in all, this presentation was successful in providing the audience with information about improving posture in an office setting, and I look forward to teaching my future patients the knowledge I have gained from organizing this capstone project.

Compilation of Capstone Materials

Advanced Orthopedics Research Paper

Evidence Based Practice II CAT

Pre-Presentation Survey to AHS faculty/staff

Power Point Presentation

Power Point Presentation References

Educational Materials

Feedback Form

Quiz

Acknowledgements

I would like to extend my appreciation to my capstone advisor, Mike Gross, PT, PhD, FAPTA, for his support and assistance during the creation of my presentation and educational materials.  Your availability to answer my many questions throughout the capstone process was much appreciated!

My capstone committee members, Phil Witt, PT, PhD and Georgia Njagu, also greatly contributed and supported me during the organization and creation of my capstone presentation and educational materials.  From booking rooms and meeting times to providing additional ergonomics materials and information, your feedback and contributions were extremely helpful.  I really appreciate both of you for being willing to be on my capstone committee.

Finally, I would like to thank my husband, family, and UNC DPT 2017 classmates for supporting me throughout these last three years and throughout this capstone process!

References

1. Owen N, Sparling PB, Healy GN, Dunstan DW, Matthews CE. Sedentary behavior: emerging evidence for a new health risk. Mayo Clin Proc. 2010;85(12):1138-1141. doi:10.4065/mcp.2010.0444.
2. Kim E-K, Kim JS. Correlation between rounded shoulder posture, neck disability indices, and degree of forward head posture. J Phys Ther Sci. 2016;28(10):2929-2932. doi:10.1589/jpts.28.2929.
3. Mörl F, Bradl I. Lumbar posture and muscular activity while sitting during office work. J Electromyogr Kinesiol. 2013;23(2):362-368. doi:10.1016/j.jelekin.2012.10.002.
4. Physical Therapist’s Guide to Temoromandibular Joint Disorder. Move Forward website. http://www.moveforwardpt.com/symptomsconditionsdetail.aspx?cid=0cb55ce4-d260-4887-ad29-d8cb18e0b91e. Published 2016. Accessed April 6, 2017.
5. Bullock MP, Foster NE, Wright CC. Shoulder impingement: the effect of sitting posture on shoulder pain and range of motion. Man Ther. 2005;10(1):28-37. doi:10.1016/j.math.2004.07.002.
6. Linaker CH, Walker-Bone K. Shoulder disorders and occupation. Best Pract Res Clin Rheumatol. 2015;29(3):405-423. doi:10.1016/j.berh.2015.04.001.
7. Sihawong R, Janwantanakul P, Sitthipornvorakul E, Pensri P. Exercise Therapy for Office Workers With Nonspecific Neck Pain: A Systematic Review. J Manipulative Physiol Ther. 2011;34(1):62-71. doi:10.1016/j.jmpt.2010.11.005.
8. Im B, Kim Y, Chung Y, Hwang S. Effects of scapular stabilization exercise on neck posture and muscle activation in individuals with neck pain and forward head posture. J Phys Ther Sci. 2016;28(3):951-955. doi:10.1589/jpts.28.951.
9. Tunwattanapong P, Kongkasuwan R, Kuptniratsaikul V. The effectiveness of a neck and shoulder stretching exercise program among office workers with neck pain: a randomized controlled trial. Clin Rehabil. 2016;30(1):64-72. doi:10.1177/0269215515575747.
10. Macedo AC, Trindade CS, Brito AP, Socorro Dantas M. On the Effects of a Workplace Fitness Program upon Pain Perception: a Case Study Encompassing Office Workers in a Portuguese Context. J Occup Rehabil. 2011;21(2):228-233. doi:10.1007/s10926-010-9264-2.
11. Mahmud N, Kenny DT, Md Zein R, Hassan SN. The Effects of Office Ergonomic Training on Musculoskeletal Complaints, Sickness Absence, and Psychological Well-Being. Asia Pacific J Public Heal. 2015;27(2):NP1652-NP1668. doi:10.1177/1010539511419199.
12. Jensen GM, Mostrom E. Patient Education and Health Literacy. In: Handbook of Teaching and Learning for Physical Therapists. 3rd ed. St. Louis, MO: Elsevier, Butterworth, Heinemann ; 2013:198-216.
13. McMillan D. Life After Death by PowerPoint 2012 [YouTube]. September 12, 2012. https://www.youtube.com/watch?v=MjcO2ExtHso. Accessed February 23, 2017.
14. Waknell, P. What are the secrets of a great WikiTalk? [YouTube]. April 17, 2013. https://www.youtube.com/watch?feature=player_embedded&v=jT-H6UrinG0#at=45. Accessed February 23, 2017