[toggle_content title=”CASE STUDY 1 – Arm pain and numbness in fingers”]
Problem
A 35-year old marketing consultant presented with a 6-8 month onset of constant and variable right arm pain at a level of 4-7 out of 10; worse at the outside of the elbow and forearm, with sharp pain and numbness into the small and ring fingers that worsened with use of the mouse and keyboard. She also complained of intermittent and variable stiffness, tightness in the neck and back of the shoulder; intermittent headaches at the back of the head and over and behind the eyes, 2-3 times weekly. Her work required mixed, multiple tasks on the work surface with short keyboard entries to the computer.
Solution
The woman was petite, and the chair seemed too large and too high to allow good foot support, even with the footrest, and consequently difficult to support upright spinal posture. Her use of the keyboard tray and arm required frequent visual neck bend see to the keyboard, along with looking back up to see the monitor. Arm support was only at the palmar wrist on the keyboard tray for mouse use, keyboard use, and resting between keyboard use.
The ergonomics recommendations included finding a smaller chair to fully support the thigh and back, and one with the feature to adjust the seat pan angle to accommodate the forward tasks. The seat height was lowered to 17 inches for stable leg support, and the recommended work surface height was demonstrated with a level keyboard tray. The work surfaces were soon lowered to 26 inches height; the keyboard tray and arm was removed, and the keyboard was moved onto the work surface.
The physical therapy recommendations provided at the assessment included general office posture exercises, instruction on use of the workstation and office products (copyholder, headset, monitor position and adjustment, left handed mouse) chair adjustments, and an independent neck care program, with very specific instructions for the care of the radial nerve. A survey was returned at 60 days to report a clear outcome with no symptoms.
Problem
Four years later, the same woman called to say all the symptoms had returned with use of the computer, but at a level of 3-5 out of ten. She reported that the symptoms had previously resolved, but came back in the last few months. A brief history showed exactly the same symptoms as earlier, but no change in the desk or type of work, and no change in the chair or footwear. A recheck of the seat height showed this woman was sitting two-inches taller than previously. When I asked if there was any other change that might have happened besides work, she said, “Well, I’ve had a couple of kids…”
Solution
The ergonomics solutions were fairly simple: raise the work surface two inches. The remaining recommendations for the chair and products were still intact, and working well.
Apart from the obvious stress of two kids, less sleep and a full-time job, the physical, mechanical needs of childcare were considered for body mechanics. The Office Exercise, Neck Care and Nerve Care programs were also reviewed.
She reported a 50-60 percent improvement at follow-up two weeks after the surfaces were lowered, and continued progress thereafter.
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[toggle_content title=”CASE STUDY 2 – Neck and arm pain and hand numbness”]
Problem
A 42-year old medical researcher who did writing and grant project administration for a large HMO reported intermittent and variable neck pain, with pain into both arms (3-7 on a scale of 10), worse in the upper arms to the elbows, with intermittent, alternating glove-like numbness in either hand. I saw her work as simple a mix of forward and reclined tasks: mixed use of the computer and phone, administrative projects with paper, calculator and writing on the work surface (forward); intermittent use of the phone for interviews (reclined).
Solution
The solution included a chair and adjustments to accommodate the forward tasks and the use of an appropriate work surface height as described earlier. Typical ergonomic and physical therapy recommendations were made, and a follow-up visit was provided to conclude the consult about 2-3 weeks later when the work surfaces and chair were installed.
Problem
The client called about two weeks later to state the initial pain had resolved to 0-2 out of 10, but she had a new symptom: intermittent and variable tightness and pain at the top of both forearms to the wrist at a scale of 3-4 when she transcribed notes from interviews. That task was the only problem, and her other symptoms continued to improve. She wrote transcripts from audio recordings of interviews once or twice weekly, for 75-100 minutes, total. Her keyboard skills were capable of 80-90 words per minutes, but not used for the regular work demands. The sustained transcription task 1-2 x/weekly was a remaining problem.
Solution
A keyboard tray and arm were installed, but used only for the few days that sustained keyboard work was needed. The keyboard was put on the surface for the majority of work tasks. Her symptoms resolved.
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[toggle_content title=”CASE STUDY 3 – Wrist and forearm pain”]
Problem
A 37-year old writer and editor for web communications reported intermittent and variable severe hand wrist and forearm pain in both arms (7-8 out of 10) with use of the keyboard and mouse that developed over the course of about 18 months. He had three different ergonomic assessments, ultimately with the installation of voice-recognition software, an electric table to allow sitting and standing postures, a full feature ergonomic chair, ergonomic keyboard and mouse. Symptoms continued to worsen to the present level, and disability leave was considered.
The recommended posture in each previous assessment was to lean back in the chair, and position the table 1-2 inches below the height of the elbow to allow the forearms to float freely above the keyboard and work surface. The practical result of this choice was to minimize support for the forearm and shoulder. The client was not a touch-typist, and needed to see the keyboard frequently, causing repeated and sustained neck bending, combined with more sustained effort to maintain the “floating” posture over the keyboard.
Solution
Our solution was to lift the table about three inches and allow full forearm rest postures with the keyboard deeper on the work surface supporting a natural shoulder position. The chair pan was tilted forward at a height with the feet firmly on the floor to permit forward tasks with minimal spine bend. The Physical Therapy solution was to provide a Neck Care program to minimize sustained forward bending at the neck, and an independent Nerve Care program to reduce inflammation in the nerves from the neck and shoulder. Symptoms resolved completely in 6-8 weeks.
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[toggle_content title=”CASE STUDY 4 – Fused knee and back and leg pain”]
Problem
A 62-year old attorney with a fused left knee reported back and leg pain with sustained sitting and computer use. Left leg and back pain were constant and variable at a level of 6-8 out of 10 for more than 35 years, as the result of the knee fusion. Stiffness and tightness at the neck and shoulders were reported as constant, but incidental to the low back and leg pain. The seated posture was on a typical ergonomic office chair in reclined posture, and a step stool was used to support the straight left leg in sitting. The client was not a touch-typist, and used a keyboard tray and arm under the work surface. The computer was used for research, editing and composition, and others transcribed briefs and reports for editing.
Solution
Our solution was to lower the chair to a height that would allow good leg strength and support from both legs on the floor, and the work surface height was moved to permit arm support on the work surface. A custom chair pain was made with a 6-inch wide by 4-inch deep relief cut from the left front of the chair pan on a fully adjustable chair to allow the heel of the left leg on the floor, and allow the pelvis to rotate forward for a more neutral spine posture in forward tasks. The client reported the pain subsided to a level of 1-3 out of 10 in the four years following the installation.[/toggle_content]