1.2 Back, neck and shoulder pain

"The typical seated office worker has more musculoskeletal injuries than any other industry sector worker, including construction, metal industry, and transportation workers."

Eric Jensen, quoted in Deskbound: Standing Up to a Sitting World

Back pain. Everyone has it at some point.

I (Euan) have had recurrent problems with lower backache for years and years. Most of the time it doesn’t give me any significant problems, but occasionally my lower back goes into spasm and I’ve suddenly found that my feet are unreachable. I can only gaze at them from a distance and touching them is an unimaginable reality. They may as well be on the Moon.

I’ve needed the help of my 10-year-old daughter to put on my socks, getting in and out of a chair is a major exercise, and driving has suddenly become a desperate challenge. I get a few days of my muscles squeezing in all the wrong places and then it relents. The muscles relax and it all goes back to normal.

I know I am in a permanent battle against my poor posture. I sit at work and I can feel myself curling over the desk. As I type this I’m forcing my shoulders back, trying to engage my tummy muscles. In another five minutes I’ll be slumped over again, wondering why my lower back feels so stiff.

When it all gets too much and I feel like I’m 120 years old, groaning every time I stand up from my chair, I’ll do a few exercises and stretches. I know there are ways to get my back feeling better, to unravel the knots, and regain mobility. It is hard to make it a habit but it is possible.

"Sitting in one position for hours, I guess it's inevitable, and even though I try to move around to prevent stiffness, it's easier said than done. That's the nature of writing, you get lost for hours and forget to move."

Becky, The Healthy Writer survey

Sitting, sedentary occupations and back pain

The evolutionary development of becoming a biped comes with some serious disadvantages in terms of our lower back. Unfortunately, in modern times, we’ve compounded the problem by becoming less active and then spending a huge amount of our time sitting down.

One of the reasons a sedentary lifestyle results in problems like lower back pain is due to physical deconditioning. Which is a polite way of pointing out that you are turning into a weak-limbed blob. The evidence is reasonably convincing that this happens in people with low back pain, though we do, as is often the case, have the old chicken and egg dilemma of causality. Did the deconditioning cause the back pain or did the deconditioning happen because of enforced inactivity due to back problems?

Whichever way this falls it doesn’t matter too much in terms of management, because it's clear that exercise helps low back pain.

One thing is strongly shown in the evidence: if you have had low back pain in the past, you are nearly ten times more likely to get a recurrence in the following year. Other studies have shown similarly high recurrence rates.

So, if you are the kind of person who is getting pain, then prioritizing your back now is a worthwhile investment.

Mechanical low back pain

If you are getting low back pain or aches then chances are you have something known as mechanical low back pain. It’s a catch-all term rather than one specific problem.

The back is a complex beast.

The bones are balanced on each other with multiple ligaments and muscles holding it all in the right place. When it starts getting a bit out of whack, then some muscles contract and you can quickly end up with pressure and spasm causing you pain.

Doctors talk about red flag signs and these highlight people who have something a lot more nasty than mechanical low back pain. Joanna mentions this in her description of the severe back pain she has suffered in the next chapter. Red flags include symptoms such as night-time pain, severe nerve pain, and any loss of control of the bladder or bowel.

The red flags are to try and pick up the tiny percentage of people with something more sinister than mechanical low back pain. It might be a slipped disc when the squishy cartilage between the vertebral bones protrudes and presses on the nerves as they leave the spinal cord. It might be another more serious problem where the bones themselves are diseased, perhaps through cancer or TB. If you have a red flag symptom, you definitely need to consult a healthcare professional.

Neck pain

Balancing our heavy heads with their giant homo sapiens brains on the top of our spines is a challenge. If you’ve ever suffered any kind of neck pain, the need for constant micro-adjustments to keep your head steady becomes painfully apparent. Rates of neck pain in office workers range from 42% to 69% in any given year.

That makes it incredibly common.

The evidence shows that people who are overweight are more likely to have problems with neck pain. Other studies have suggested that neck pain can be associated with slightly different factors, even such things as workplace bullying and sleep problems.

This might seem unrelated, but to a doctor this is a common way for some neck pain to present. It is a manifestation of stress. I certainly notice on my most stressful days that I hold myself with a ferocious tension and my shoulders slowly come up toward my ears. It is important to be aware of the cause as the management of that type of neck pain needs to be addressed differently.

"I recommend that people who spend long periods of time at their computer adopt a regular practice such as chi kung, tai chi, yoga, or whatever best suits them. Always check that your shoulders are relaxed and that you're neither slumping forward or back. Do shoulder/neck rolls to relax those areas."

CM Barrett, The Healthy Writer survey

Prevention of low back pain

One of the first things to do, if you can, is to avoid getting back pain in the first place.

We all know the truism that an ounce of prevention is worth a pound of treatment. Given the numbers of people suffering from low back pain, then you will be doing extraordinarily well if you avoid it, but it is absolutely a condition that comes and goes; it waxes and wanes in the vast majority of people.

The trick is that when you're enjoying a period when your back isn't bothering you, do something about it.

So, what can you do?

There has been a systematic review and meta-analysis into the prevention of low back pain. This is a scientific method to combine all the available research and it looked at a range of different options including strategies such as exercise, education, combining exercise and education, back belts, and shoe insoles.

They found that the best combination is exercise in combination with education to reduce the risk of low back pain.

Exercise on its own will reduce the risk as well. The evidence suggested that on their own, education, back belts, shoe insoles, and other ergonomic efforts probably don't do a huge amount to reduce episodes of low back pain.

The main challenges with any of these studies is the overall lack of high-quality evidence. That's a recurrent theme in almost all the studies that look into low back pain. The actual numbers suggest that exercise on its own could reduce the risk of a low back pain episode by about 35%. With exercise and education together that rises to a 45% reduction in risk of a low back pain episode. This was effective for up to a year but the effects reduce when past the one-year point.

You have to keep exercising to keep the risk of low back pain down.

That doesn't seem like a surprising finding, as it is not a one and done type of problem. You need to make long-term changes to your exercise habits to reduce the risk of back pain in the years to come.

Dynamic sitting, or wobbling around on a Swiss ball

There has been lots of research into how different seating options can help people with low back pain. There is a little bit of evidence that the use of a backrest can help in some circumstances, as can adjustable seat height and chairs which increase lordosis (those that make your lower spine arch backward more), so getting a good chair is a worthwhile investment.

There has been a lot of interest in the role of dynamic sitting or active sitting, using chairs, stools, or stability balls, where there has to be a constant amount of micro-adjustment in order for people to sit comfortably. If you’ve clocked someone wobbling away on a giant Swiss ball in front of their desk then you’ve seen them in action.

Gimmick or good evidence-based option?

A systematic review into these dynamic sitting methods found seven studies. The results were variable and the single randomized controlled trial that had a decent length of follow-up didn't find any significant reduction in low back pain. So, not much to go on there. I’d say they are worth a try if you are game. Joanna talks about how she uses a Swiss ball in the next chapter, and in Part 2 we'll cover ergonomics and improving your workspace as well as more help for your back.

"Being seated for so many hours a day has led to on and off shoulder, arm, and leg pain, which I've solved to a great extent with a desk that can go from standing to seated to standing again several times during the day."

Shelley Sperry, The Healthy Writer survey

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