I call Ashley James while I am lounging on the sofa. That’s the great thing about working from home: I may not have my ergonomic office chair and the sit-stand desk that I swear has done wonders for my back over the past couple of years, but at least I can conduct interviews while propped on cushions with my feet up.
Or perhaps not. “I wouldn’t ever advise anyone to work on the sofa,” says James, a spokesperson for the Chartered Society of Physiotherapists and national clinical education lead for Connect Health, an independent provider of musculoskeletal medicine . “The sofa lets us get a bit too comfortable, doesn’t really prompt us to move much and that’s when you probably will get a few aches and pains. I would advise people not to work on the sofa.”
We have become a nation of home workers, operating from kitchen tables and back bedrooms across the land. But what is that doing to our backs and shoulders? How do we need to arrange ourselves during months of working from home (WFH) so we don’t emerge from lockdown a shambling nation of hunchbacks?
Eight out of ten us will suffer back pain during our lives and, like millions of full-time computer bashers, I have had occasional episodes of back and shoulder pain. Before the lockdown began I was being treated by the in-house physio for a sore back and shoulder, which I attributed to a day of working from home when I sat round-shouldered on a basic Ikea dining chair over the family computer in the corner of the kitchen.
I started the lockdown back at that same workstation, but after a week I had to stop. To be honest, this had less to do with discomfort than the distractions I found in the kitchen. These included my family and, more seriously, the toaster.
I rearranged the spare bedroom, and alternated between working at the family computer and my new improvised standing desk — an iPad propped up on a stack of old atlases. I love my new work den, but I am a bit nervous about what James will think of the arrangement.
I’m worrying too much. When it comes to how we work at home, James has surprisingly lenient views on most of the ways that we do it. Before we get to that, however, he explains why we all worry too much about back pain.
Between one and two per cent of back-pain cases are worth being seriously concerned about. The rest are not going to lead to long-term problems. “Ninety-eight per cent of back pain is not worrisome. That’s not trying to belittle it and say that it doesn’t matter. Being in pain and being uncomfortable is not a nice experience, but most musculoskeletal conditions shouldn’t be worrisome and will usually go away on their own within six weeks.”
Many people continue to have back pain because they are frightened of moving in case they cause serious damage. “Movement and exercise are really good things to do. If we look at the research and the evidence, it’s the only thing that shows any good effect on back pain. “
I was looking to James to tell me exactly how to arrange my computer and furniture and how to sit. He won’t do that.
“There’s very poor evidence that a specific desk set-up reduces musculoskeletal pain at all.”
Really? “I get that response all the time,” he says, “People are dying for me to tell them that there’s a perfect way to sit but when we look at the evidence, there really isn’t.”
My world is shifting on its casters. I thought you needed to sit with a straight back, in a supportive chair, with your screen at eye level and your keyboard in a position where you can type with your arms straight and parallel with the ground. But according to James it doesn’t really matter if you are hunched over a laptop perched on the corner of a kitchen table rather than at a specially designed desk on a plush executive swivel chair.
“Your best posture is your next posture,” says James. “There’s no perfect, right or wrong way to sit, stand, or move. Our bodies evolved to move in lots of different ways and moving in lots of different ways is good for us. So with home working, or even working in an office, the worst thing to do is have a prolonged position. Yes, slouching for too long will cause some discomfort — a little bit of shoulder pain, a little bit of back pain. But so would sitting in the absolute ‘perfect’ position non-stop. The important thing is not to be stuck in one position for a long time. The key is movement.”
The discomfort you may be feeling after a couple of weeks of WFH is probably down to adopting unfamiliar positions, not necessarily wrong positions. “Your body is very good at adapting and you’ve adapted to working in your usual working environment over a number of months or years. And then when you’re working at home, you’re sitting in a chair you’re not used to sitting in, at a desk that might be a different height. It’s not that it’s necessarily bad, it’s just you’re probably getting yourself into positions that you’re not used to being in for a prolonged period of time. Your body will adapt to it over time. In the interim, the best thing that we can do is get up and move about.”
He advocates breaks for “movement snacks,” such as touching your toes, leaning back and twisting. “Just get some blood flow into different areas of your body. Move your head, move your neck and generally get moving.”
Uzo Ehiogu, a specialist physiotherapist and clinical teaching fellow at the Royal Orthopaedic Hospital in Birmingham, says that in offices we tend to move around a lot during the day. “It’s a nice big open-plan office. You walk to the photocopier and have a chat with someone else at another desk and you can go downstairs for lunch and so on. Now you’re inside for a long time.”
Ehiogu has a series of familiar exercises , which he suggests doing in one or two breaks during the day and recommends one chest-stretching exercise to do once an hour to open up pectoral muscles.
“Flexibility training or stretching exercises are designed to help maintain soft tissue length and joint mobility to promote good postural health,” Ehiogu says. “Postural health will be challenged during prolonged periods of sitting because of the forces of gravity. To counteract the inevitable consequences of gravity it’s important to engage in strength and flexibility training.”
Brendon Stubbs, head of physiotherapy at South London and Maudsley NHS Foundation trust and a lecturer at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, has published a wide range of papers on physical activity and mental health. He warns of the dangers of inactivity.
“Being sedentary and not moving can increase your risk of developing depression and anxiety,” he says. “Therefore, if you are indoors and reducing your activity, it is important to make time to move and stand up and break up your sedentary time to reduce the mental health burden and improve your circulation. This can be small amounts of light walking, going up and down the stairs. My general advice would be for people to not sit or stay in any one position for any excessive length of time. Get up and move every 30 minutes, even if it is to make a cup of tea.”
James says that standing desks are fine, as long as you don’t swap sitting all day for standing all day. “You just shift where you feel discomfort to another part of your body. You might experience less back pain [but] probably more leg and foot pain. Make sure you’re doing a bit of sitting, a bit of standing and that’s great.” Make the change at least every hour, but “use your own judgement on that. Be led by comfort”.
James has a few tips that work for him, but he insists that everyone is different. “I always have my mouse on my right side and my phone on my left, so I’m not always using my right hand. I have papers and pens in easy to reach positions. But you know, there’s no hard and fast rules.”
What about working on my iPad, which sits atop a teetering pile of books? “Absolutely fine.” It’s also good, if you can, to switch between devices.
I have graduated from the hard, buttock-torturing kitchen chair to an office chair I bought online for less than £100 and with which I am less than satisfied. A good chair really matters, doesn’t it? “You always get the people who in work [say], ‘Don’t change my chair, this is set up perfectly for me,’ ” James says. Now I am worrying that a colleague has supplied him with a video of me whining about someone fiddling with my chair.
“Again there’s very little evidence behind that. There’s nothing magic about a specific type of chair. I think a £100 office chair would be just as good as an £800 one if you didn’t tell anyone. It’s like if you get someone to try Sainsbury’s wine and a posh wine. Most people won’t be able to tell the difference.”
For maintaining good posture, there are advantages to home working. These include the millions of hours no longer spent behind the wheels of cars. “If you’re making a phone call you can stand up and walk around the kitchen, maybe around your garden. You can get some sun for a few minutes between calls. There are lots of positives to home working,” James says.
James, like many of his colleagues, is currently offering online consultations, but when this enforced experiment in mass home working eventually ends he expects to be very busy helping people to recover. “I think there will be a queue out the door,” he says.