Your Guide to a Fully Ergonomic Workstation

July 23, 2013/in Back Pain Prevention, Ergonmoics/by admin

If you spend a lot of time sitting at your work desk, it can actually cause some serious health issues if the workstation is not set up properly. Here are some easy adjustments you can make to ensure that you will maintain a healthy posture at an ergonomic workstation.

This is your guide to a fully ergonomic workstation:

Chair

Sit on your chair with your hips completely pushed to the back of the seat.
Adjust your chair height so that your feet are flat on the ground.
Your knees should be level to your hips or slightly lower than your hips.
Recline the back of the chair so that it is at a 100°-110° angle.
Support your lower back with a by using an inflatable cushion or a small pillow for extra support. You can also add on a lumbar support to your chair.
Set the arm rests at a height where your shoulders are able to relax comfortably on them. Another option is to remove the arm rests altogether.

Keyboard

Position the keyboard so that it is directly in front of you and centered with your body.
Sit closely to your keyboard to avoid overreaching.
While your shoulders are relaxed, position the keyboard so that your arms are at a 100° angle. Ensure that your wrists and hands are straight.
If you need to tilt your keyboard up, make sure that your chair reclines so that you are still at a 100° angle.
If you’d like to use a palm support, make sure that you don’t let your palms rest on it while typing, as this is not recommended. Additionally, try to keep your wrists slightly elevated when typing.
Keep your mouse as close as you can to the keyboard. It should also be at the same level as the keyboard.
If you need to adjust your seat height to accommodate the keyboard, keep a footrest under your desk for your feet to rest on. This way your feet will not be left dangling.

Computer Monitor

Adjust the monitor to keep your head in a neutral position when working.
The top of the monitor should be around 2 to 3 inches higher than eye-level when seated.
Your screen should be at least an arms length away.
Reduce glare and reflections on your computer screen by adjusting the monitor’s positioning.
If you are using a laptop, place it on an adjustable stand, and use an external keyboard and mouse.

Phone

Keep your phone as close to you as possible.
Wear a headset when possible to avoid holding the handset with your shoulder.

In addition to these guidelines, try to avoid slouching and leaning as much as possible, and don’t forget to take 1-2 minute breaks to stretch every 20-30 minutes. No matter how ergonomically correct your workstation is, sitting for prolonged period of time in a static position can significantly decrease blood circulation which can lead to other health risks. Take the time to set up your workstation the right way. By following this quick guide to a fully ergonomic workstation, you will be able to work safely and comfortably.

Ergonomic Chair Setup

January 29, 2013/in Ergonmoics/by Dr. Kevin Rose

Comfortable desk work begins with proper chair setup. Follow these helpful tips to ensure a proper ergonomic chair setup.

Chair Setup

Push your hips as far back as they can go in the chair.
Adjust the seat height so your feet are flat on the floor and your knees are equal to, or slightly lower than, your hips.
Sometimes the desk height forces you to have the chair higher than you what will allow you to touch the ground. If your feet don’t reach the ground put a small box under your desk to rest your feet on.
The back of the chair should be at a 100°-110° reclined angle which should create an angle between your body and your thighs of 90° -100°.
From UCLA Ergonomics
Make sure your upper and lower back are supported. Use extra cushions at the small of your back if your chair does not have adequate support.
Adjust the armrests so that your shoulders are down and relaxed.
If your armrests prevent your shoulders from being in a relaxed position, remove them.

Keep your body straight with the head and neck upright and looking forward, not to the side. Do not hunch over or slouch.

OTHER TIPS

Don’t cross your legs while sitting. This can cut off circulation and/or lead to hip problems.
Make sure your chair seat has a soft, downward curved edge so that it does not dig into the back of your thighs. This can also cut off circulation.
When purchasing a chair the best feature is its ability to adjust each component separately.
If sitting is too painful, consider a standing workstation.

Next post “Ergonomic Keyboard and Mouse Setup”

Best Chiropractor in Mission Valley

December 3, 2012/in Uncategorized/by Dr. Kevin Rose

Congratulations to Dr. Rose, DC on being voted 2012 Best Chiropractor in Mission Valley by Mission Valley News.

Click Here for the entire release.

Mission Valley News offers community news and information on Mission Valley, Old Town, Linda Vista and surrounding areas.

Piriformis Syndrome Part III- Treatment

November 16, 2012/in Conditions/by Dr. Kevin Rose

Piriformis Syndrome Treatment

The two main goals of treatment are 1) to relief irritation to the sciatic nerve and 2) address any functional problems that may be contributing.

If the sciatic nerve is inflamed the first step is to decrease aggravation from compression. Things to avoid are leg crossing, sitting on your wallet, and sitting on hard surfaces. Things you should begin doing are applying ice to the piriformis, stretching of the piriformi, and taking oral anti-inflammatories (as directed). Stretching every 2-3 hours (while awake) is a key to the success of non-operative treatment. Prolonged stretching of the piriformis muscle is accomplished in while lying on your back with the hip flexed and passively adducted/internally rotated (see picture). Another exercise that can be helpful to decrease irritation between the piriformis and sciatic nerve is a nerve gliding exercise. This exercise tensions the sciatic nerve and allows it to move relative to the piriformis. It is sometimes called nerve flossing to better describe how the nerve moves through other structures. Two types of nerve gliding exercises are pictured below. (Pictures from http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=53203)

Manual therapy can be extremely helpful in releasing tension on the sciatic nerve and addressing functional deficits. Soft tissue therapies, including myofascial release and Graston®, aimed at releasing tension and muscular adhesions within the piriformis can be beneficial. Chiropractic spinal adjustments can help address functional contributions from the spine such as sacroiliac joint hypomobility and low back dysfunction. Hyperpronation of the foot can be addressed through orthotics in the short term and foot strengthening in the long term. Pronation is a normal foot motion however overpronation may lead to increased external rotation of the hip with walking putting tension on the piriformis and sciatic nerve.

Treatment may take several months of consistent work and it is important not to get discouraged. As long as there is no progression of neurological symptoms conservative treatment is the best option. Your symptoms should be monitored by a healthcare practitioner to ensure there is no progression.

-Dr. Kevin Rose, DC

Piriformis Syndrome Part II- Evaluation

October 22, 2012/in Conditions/by Dr. Kevin Rose

Clinical Diagnosis

Piriformis syndrome occurs most frequently between ages 40-60 and is more common in women than men. Some reports suggest a 6:1 female-to-male ratio for piriformis syndrome; , possibly because of biomechanics associated with the wider quadriceps femoris muscle angle (ie, “Q angle”) in the pelvis of women. Reported incidence rates for piriformis syndrome among patients with low back pain vary widely, from 5% to 36%.

The most common symptom of patients with piriformis syndrome is increasing pain after sitting for longer than 15 to 20 minutes. Many patients complain of pain over the piriformis muscle (ie, in the buttocks), especially over the muscle’s attachments at the sacrum and medial greater trochanter. Symptoms, which may be of sudden or gradual onset, are usually associated with spasm of the piriformis muscle or compression of the sciatic nerve; these symptoms include radiating/shooting pain or tingling or numbness in the back of the thigh, leg, or foot. These symptoms must be evaluated by a healthcare provider to differentiate the possible causes. Patients may also complain of difficulty walking and of pain with internal rotation of the involved leg, such as occurs during cross-legged sitting or walking. X-rays or an MRI offer little help in directly diagnosing piriformis syndrome but may be used to rule out other causes of sciatica such as a herniated disc in the lumbar spine.

Functional Evaluation

There are many functional abnormalities that may have either caused or resulted from this condition. Once the diagnosis has been made, these underlying, perpetuating biomechanical factors must be addressed.

Functional biomechanical deficits associated with piriformis syndrome may include the following:

Tight hip external rotators including pirifromis
Tight adductors (groin)
Hip abductor weakness
Lower lumbar spine dysfunction
Sacroiliac joint hypomobility
Hyperpronation of the foot and prolonged toe-off

Functional adaptations to these deficits include the following:

Ambulation with the thigh in external rotation
Functional limb length shortening
Shortened stride length

Next post will discuss treatment options for piriformis syndrome

Piriformis Syndrome: Overview and Causes

October 19, 2012/in Conditions/by Dr. Kevin Rose

Piriformis syndrome is a unique cause if sciatic nerve irritation (neuritis) or sciatica. The condition, which can mimic lumbar disc herniation, usually is caused by irritation of the sciatic nerve due to spasm and/or contracture of the piriformis muscle. Piriformis syndrome is also referred to as “pseudosciatica”, “wallet sciatica”, and “hip socket neuropathy”.
It frequently goes unrecognized or is misdiagnosed in clinical settings. Piriformis syndrome can “masquerade” as other common somatic dysfunctions, such as intervertebral discitis, lumbar radiculopathy, primary sacral dysfunction, sacroiliitis, sciatica, and trochanteric bursitis.

(Image from http://www.concordortho.com/patient-education/topic-detail-popup.aspx?topicID=4214fc65d020761633286131e407d037)

Anatomical Considerations

The proper understanding of piriformis syndrome requires knowledge of the anatomy and anatomical variations in the relationships between the sciatic nerve and the piriformis muscle.

The piriformis muscle is flat, pyramid-shaped, and oblique. This muscle originates on the front of the sacrum and inserts at the greater trochanter of the femur. With the hip extended, the piriformis muscle is an external rotator of the hip; however, with the hip flexed, the muscle becomes a hip abductor.

In most of the population, the sciatic nerve exits the pelvis deep along the lower surface of the piriformis muscle. However, many developmental variations of the relationship between the sciatic nerve in the pelvis and piriformis muscle have been observed. In as much as 22% of the population, the sciatic nerve pierces the piriformis muscle, splits the piriformis muscle, or both, predisposing these individuals to irritation of the sciatic nerve.

From http://www.anatomyatlases.org/AnatomicVariants/NervousSystem/Images/70.shtml

Causes of Piriformis Syndrome

Piriformis syndrome can be caused by a variety of issues. The underlying mechanism is from irritation to the sciatic nerve. Below are some causes of irritation to the sciatic nerve as it passes the piriformis muscle:

1. Muscular problems

Spasms and adhesions in the piriformis muscle cause compression and irritation of the sciatic nerve. Muscular damage or tightness can develop from a single injury or repetitive use injury. Vigorous physical activity can lead to such an injury- (commonly seen in athletes such as runners, cyclists, and dancers).

2. Postural

Hyperlordosis (increased curvature of the low back) and increased foot pronation are both risk factors for piriformis syndrome

3. Traumatic

Direct compression of the piriformis and/or sciatic nerve from an external soure such as a wallet.

4. Partial or total nerve anatomical abnormalities

An anomaly in the nerve itself as it passes through the piriformis muscle can lead to dysfunction

5. Other causes can include the following:

Pseudoaneurysms of the inferior gluteal artery adjacent to the piriformis syndrome
Bilateral piriformis syndrome due to prolonged sitting during an extended neurosurgical procedure
Cerebral Palsy
Total hip arthroplasty
Myositis ossificans

Stay tuned…… the next post will talk about how this problem is diagnosed and treated.

POSTURAL STABILITY IN DANCERS AFTER INJURY

September 5, 2012/in Sports Injury/by Dr. Kevin Rose

Ballet dancers are widely known for their superior body control in various challenging body positions. In fact it has been found in recent studies that ballet dancers have better postural control when compared to other elite athletes. However, what has not been examined is the effect of injury on postural balance in dancers. A recent study in The American Journal of Sports Medicine by Lin, et al, addresses this vary issue.

Postural balance requires a combination of several different sensory inputs: visual, vestibular (inner ear), and somatosensory (from the skin, joints, muscles, etc). Somatosensory input gives the brain information about where the body is in space; this is called proprioception. These sensors can be damaged with ligamentous and muscular injuries such as ankle sprains and in turn lead to a deficit in proprioception. Proprioceptive deficits can put a dancer at more risk for re-injury or new injury.

The recent study by Lin was the first study that evaluated stability in dancers in ballet specific postures following an injury. Three different groups were studied: healthy dancers, injured dancers (with sprained ankles), and health non-dancers. Postural stability was evaluated on a balance sensor that monitors subtle deviations in stability. This was done with the eyes open and then again with the eyes closed to further stress the proprioceptive component of balance. As expected the injured dancers had decreased control not only in ballet specific positions but also in a simple single leg standing position when compared to healthy dancers. Surprisingly the injured dancers had worse stability control than the non-dancers. Many dancers, and other athletes, that I have treated often assume that a skill such as balancing will come back without training, however this is not the case, and as the study indicated it regresses to the point that is worse than untrained people.

The postural deficits were most notable in side to side control with single leg standing and front to back control with first and fifth position. Compensation was noted at the knee and hip joints in an attempt to make up for the injured ankle. The en pointe position crated the most stability issues; injured dancers were inferior in all directions of stability. With lateral ankle sprains the most commonly damaged ligament is the anterior talofibular ligament. This ligament is stressed maximally when the ankle is plantar flexed, such as during en pointe positions. It is not surprising that when this ligament is damaged the proprioception during pointe is significantly disturbed.

This study brings to light the importance of a thorough rehabilitation program that includes proprioceptive training in ballet specific positions. Typically a sprained ankle takes 6-8 weeks to recover. During this time it is critical to begin proprioceptive training to ensure that the balance deficits do not lead to further injury. Additionally if a dancer has a past injury of ankle sprain without proper rehabilitation it is likely that postural stability still remains and there is an increased risk to further injury. If this is the case, dancers should begin a 3-4 week proprioceptive training plan that includes ballet specific posture.

Dance injuries and rehabilitation are unique and should be managed by a healthcare practitioner that is experienced with the subtleties of dance medicine. Proprioception training for ballet typically includes balance exercises on an unstable surface such as a Bosu ball or stability disc. These exercises should be done in normal stance position as well as ballet specific positions. Whole body vibration may additionally add value as a proprioceptive trainer especially early during rehab when range of motion is limited. KinesioTape or RockTape are also good taping methods that help protect the joint and provide increased proprioception when applied properly. Keep in mind that a training plan should be designed specifically for each injury and you should not attempt to manage the injury without the supervision of an experienced healthcare practitioner.

BACKPACK SAFETY

August 23, 2012/in Back Pain Prevention/by Dr. Kevin Rose

Backpacks are a practical way for students to carry schoolbooks and supplies. They are designed to distribute the weight of its contents among some of the body’s strongest muscles; however, in recent years, the weight of student backpacks has increased dramatically and has become a public health concern. Studies show that heavy backpacks can lead to both back pain and poor posture, notes the American Chiropractic Association (ACA). In fact, in 2001 backpacks were the cause of 7,000 emergency room visits and countless complaints of muscle spasms, neck and shoulder pain.

Here are some tips on purchasing a backpack, packing a backpack, and wearing a backpack to reduce the risk of injury.

Purchasing a backpack, what does a good backpack need

Wide( > 2), Padded Straps
The bag should have wide padded shoulder straps. Wide straps and padding distribute the load over more area of
the shoulder and alleviate pressure points.
Padded Back
The back of the backpack should padded as well to encourage the pack to sit flat against the back.
Lightweight
Reducing the overall weight carried begins with a light backpack. The stress on the back is caused by the weight of the bag, don’t forget that the weight of the bag contributes to the overall weight. Anything you can do to reduce that weight will reduce the stress.
Waist Strap
A waist strap dramatically helps direct the load away from the shoulders and onto the much stronger waist and hip muscle group.
Proper Size
Use the chart below for general recommendations by age or for more accuracy you can take measurements of your child’s back. The width should be from the outside ridge of the one shoulder blade to the other. The height should be from the shoulders to the waist line (belly button) plus two inches. See the diagram below to help with measuring.

Loading a Backpack

Load heavy items close to the back (the back of the pack)
Heavy flat items should be placed against the back. This increases the body’s ability to support the weight with stronger muscle groups such as the hips and core.
Don’t overload (see weight chart below)
As a general rule the weight of the backpack should not be more than 15-20% of the students body weight. It should not exceed 25 pounds in any case. Below is a table with the recommended weight to be carried based on the student’s weight.

How to wear a backpack properly

Wear BOTH straps
This helps distribute the load more evenly and helps hold the load more securely to the back. Wearing one strap can lead to shoulder and back pain.
Adjust shoulder straps so the backpack ﬁts snugly against the back
The back pack should rest no lower than 4 inches below the waist line. Remember that the waistline is in line with the belly button not the top of pelvis.
Fasten waist belt and adjust strap length to secure and distribute the weight evenly
The benefits of the waist strap can only be seen if the strap is worn. Don’t forget to have your student fasten it when wearing.
The lower bulk of the backpack should rest in the curve of the lower back and not more than four inches below the waist
This also contributes to allowing the stronger muscles of the hips and shoulders to support the load.

Other considerations

Monitor what your child is carrying to school each day to help him or her avoid carrying unnecessary items which add weight to the backpack.
Periodically check to see if your child is wearing his or her backpack correctly.
Assist your child with cleaning out and organizing the backpack weekly.
If the backpack weighs more than 15% of your child’s body weight have child carry a heavy book or two under his or her arm.
Ask your child if he/she has any discomfort during or after wearing the backpack.
Help your child ﬁle work at home so he/she only needs to bring required work to school each day.
Talk to your child and teachers about ways to reduce backpack weight.
Some books can be found online at low cost. Consider purchasing a second copy to keep at home so your child doesn’t have to carry it back and forth.
Share any concerns about backpack weight with your child’s teacher or administrator.

Taking the time to make careful consideration regarding your child’s backpack use is important to prevent injury. If your child does develop back pain have him or her seen by a qualified health professional for proper diagnosis and treatment.

-Dr. Rose, DC

Dr. Rose is a San Diego Chiropractor located in Mission Valley. More information regarding the services he provides can be found at www.RoseChiropracticSD.com.

References

American Chiropractic Association. Backpack Misuse Leads to Chronic Back Pain, Doctors of Chiropractic Say. Accessed at acatoday.org

Admas, Chris. A Fitting Guide for a Child’s Backpack. 2006.

Howard County Public School System. Backpack Safety Guidelines

Preventing Throwing Injuries in Youth Baseball

July 6, 2012/in Sports Injury/by Dr. Kevin Rose

More and more young baseball players, especially pitchers, are coming down with “Little League elbow,” or “Little League shoulder.” Don’t let the names fool you; these are real medical diagnoses with real consequences. Among pitchers under 12-years-old, as many as 45 percent complain of chronic elbow pain, according to several published studies. At the high school level, nearly six in every 10 pitchers suffer chronic elbow pain. Most will heal with a combination of rehabilitation and prolonged rest while some will require surgery.

How to prevent throwing injuries

Limit the number of pitches

A broad recommendation is that pitchers base their number of pitches each week by multiplying their age by 10, so an 8-year-old would limit his pitches to 80 per week. A 12-year-old would throw no more than 120.

The American Academy of Orthopaedic Surgeons (AAOS) recommends limiting the number of pitches per game to 60 to 100, with no more than 30 to 40 in a single practice session, adding that innings pitched should be limited to about four per week, with a minimum of three days rest between starts.

Warm Up

Research studies have shown that cold muscles are more prone to injury. The AAOS suggests an active full body warm up followed by slow, gentle stretching, holding each stretch for 30 seconds. A knowledgeable coach or trainer should be able to guide your athlete in this area.

Throw Correctly and Master the Basics

Poor throwing motions put undue stress on the elbow and shoulder. It is especially important that between the ages of 8 and 14 players receive skilled instruction in proper throwing mechanics. Pitching lessons should focus on gaining control, increasing velocity and developing a command of the strike zone.

Recognize the warning signs

One of the most important factors to preventing the development of serious injuries is early identification and treatment. Young players often ignore pain or are encouraged to play through it. This way of thinking can be extremely harmful and lead to more serious complications that may not heal without aggressive treatment and possible surgery. However, if caught early, most youth throwing injuries can be relieved with a combination of therapy, rest, and rehabilitative exercises.

Early signs of injury include decrease in ability to throw the ball as fast or as accurately, loss of enjoyment in playing baseball, elbow or shoulder pain with or after throwing. If any of these signs are present, the player should be evaluated by a healthcare professional. More significant signs include prolonged persistent pain after throwing, swelling at the elbow, and difficulty straightening the elbow.

Any persistent pain, loss of motion or joint should keep a player on the sidelines until the symptoms disappear or a doctor clears the players. Be sure to consult a health care professional familiar with the intricacies of baseball injuries if any of these signs are present.

-Dr. Kevin Rose, DC, CCSP®

Dr. Rose is a Certified Chiropractic Sports Practitioner® located in San Diego. As a former professional baseball player, having played three seasons in the minor leagues, Dr. Rose understands the unique characteristics of baseball injuries first hand.

Preventing Dance Injuries

June 15, 2012/in Sports Injury/by Dr. Kevin Rose

The physical demands placed on the bodies of dancers have been shown to make them just as susceptible to injury as football players. For this reason, more emphasis should be placed on creating awareness of risk and preventing injuries in dancers. Most dancers begin dancing at a young age, the repetitive practice of movements that require extreme flexibility, strength, and endurance make them prime candidates for overuse injuries. In fact, there is little doubt that the vast majority of injuries are the result of overuse rather than trauma. These injuries tend to occur at the foot, ankle, lower leg, low back, and hip. These injuries show up with greater frequency in dancers as they age, so it is extremely important to emphasize what the young dancer can do to prevent future injuries.

WHAT CAUSES DANCE INJURIES?

Dancers are exposed to a wide range of risk factors for injury. The most common issues that cause dance injuries include:

Type of dance and frequency of classes, rehearsals, and performances
Duration of training
Environmental conditions such as hard floors and cold studio
Equipment used, especially shoes
Individual dancer’s body alignment
Prior history of injury
Nutritional deficiencies

How to Prevent Dance Injuries

Getting and keeping dancers free of injury in a fun environment is key to helping them enjoy a lifetime of physical activity and dance. With a few simple steps, and some teamwork among parents, teachers and health professionals, dancers can keep on their toes and in the studio with a healthy body.

Key Points

Dancers should remember a few key things to prevent injury:

Wear properly fitting clothing and shoes
Drink plenty of fluids
Resist the temptation to dance through pain
Pay close attention to correct technique
Be mindful of the limits of your body and do not push too fast too soon
Perform proper warm-up and cool-down

Parental Oversight

Parents play a large role in injury prevention. First, they must be careful not to encourage their children to advance to higher levels of training at an unsafe rate. Specific to ballet, parents should ensure that the decision to begin pointe training is not made before the child’s feet and ankles develop enough strength. Age 12 is the generally accepted lower limit, but strength and maturity are more important than age.

Proper Instruction

The first line-of-defense to prevent injuries may be dance instructors. From the onset of instruction teachers should establish a class environment where students are not afraid to share that they are injured and need a break. Students should also be consistently instructed on the importance of warm-ups and cool-downs, proper equipment, and at what point, whether by age or maturity, it is appropriate to move on to the next level of dance.

Health Care and Screening

Health professionals play a significant role not only in treating and rehabilitating the injuries dancers incur, but also in preventing them. Dancers respond well to providers who respect both the aesthetics and intensity of dance. Experienced providers can initiate and facilitate screening sessions for dancers to help identify potential problems and prevent future injuries. They should be considered a natural part of a dancer’s career and sources of insight into staying healthy. A dancer should return after an injury only when clearance is granted by a health care professional.

REFERENCES

Clippinger, K. Dance Anatomy and Kinesiology. Champaign, IL: Human Kinetics, 2007.

Howse, J. Dance Technique and Injury Prevention. 3rd ed. London: A & C Black, 2000.

Solomon, R, J. Solomon, and SC Minton. Preventing Dance Injuries. 2nd ed. Champaign, IL: Human Kinetics, 2005.

www.stopsportinjuries.org

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