Office Syndrome And its Intervention

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Office syndrome refers to a group of various symptoms including the inflammation, pain or soreness of neck, shoulder and back muscles. It is mostly experienced in employees whose job requirement or demands includes doing computer and laptop work or clerical work by sitting in same posture for longer hours. It is not a disease but refers to a group of symptoms related to unhealthy sitting posture.

Employees doing 'work from home' are also experiencing pain related to office syndrome.  The only difference is the change in workplace but the job duties and completion are the same with longer sitting hours in front of laptops. Office syndrome have been most often reported by 60-70% of office workers most often within the age range of 16-35 years or more. In the beginning, the symptoms may recover quickly without much worry but as the same working behavior patterns and sitting posture continues for many week then the symptoms will become chronic and sustained. Therefore, primary and secondary prevention is essential to stop the symptoms to occur (primary) and/or to prevent them from getting worse later (secondary).

Office work can be considered as a sedentary work level category. Sedentary job or work requires employee to sit for upto 6 hours a day. It involves occassionally lifting no more than 10 pounds at a time and lifting or carrying small items, such as paperwork. A job is considered sedentary if walking or standing only takes up about 2 hours in a 8 hour work duty. 

Fig : Office Syndrome 

Signs and symptoms of Office Syndrome :

• Back pain, neck pain, knee pain, wrist pain, thumb pain and shoulder pain
• Numbness or heaviness and tingling sensations of finger, arms and feet
• Chronic muscle ache
• Tendonitis such as De Quervain's tenosynovitis 
• Stress headache or tension headache
• Fatigue, insomnia, depression
• Eye muscle strain, dryness felt in eyes
• Giddiness or dizziness due to prolonged sitting

Fig : Symptoms of Office Syndrome

Fig : Wrong and bad sitting posture while doing computer or laptop work. Signs of bad posture includes excessive leaning forward, forward headed neck, excess stooping from thoracic spine, chair distance far from the table, no wrist or forearm or elbow support

Affects on body due to prolonged sitting for longer duration : (Note: all these impairments in body structure and function occurs after prolonged inactive and unhealthy lifestyle, wrong working habit which includes prolonged sitting)

• Imbalance between trunk/abdominal flexors and back extensor muscles. Abdominal muscle tightness, kyphotic or rounded posture (stooping) of spine, scapula protracted. Shoulder girdle shrugged or elevated, due to trapezius muscle action, while doing computer or laptop work like reading or typing.
• Hip and knee flexor muscles become short and tight with limited range of motion and stride length.
• Sitting requires your gluteus muscle (buttocks muscles) to do absolutely nothing and they get used to it. Inactive lifestyle and less use of this muscle due to longer hours of sitting leads to gluteal weakness. Evidence shows that the discomfort was increased in hip/thigh/buttock after 90 minutes of prolonged sitting. Discomfort in the buttock was rated considerably higher than the thigh.
• If most of your job timings involves laptop work, then continuous forward headed neck posture can strain the cervical vertebral muscles and further cause agonist-antagonist muscle imbalance , weakness and pain initiates.
• Sitting for long period of time slows blood circulation, which causes fluid to pool in the legs. Problems range from swollen ankles or appearance of varicose veins to dangerous blood clots called as Deep vein thrombosis (DVT).
• Less amount of weight bearing activities lead to risk of developing osteoporosis or demineralization in bones due to lack of physical activities, exercises, walking etc. These activities also improves joint function and reduce joint pain because physical activity boosts the circulation of synovial fluid, which is used to lubricate joints.

• Risk of Obesity increases with prolonged sitting habit and inactive lifestyle for many months. Ability to process fats is decreased. Excess weight in the belly area can cause your pelvis to pull forward (anterior pelvic tilt). This is a condition known as lordosis. As the curve in your back gradually becomes more pronounced due to lordosis, your back muscles tighten under the pressure contributing to chronic strain and pain. 
• The highest discal pressure are seen in loaded slumped sitting, that is sitting with the lumbar lordosis reversed (flexed) while holding a weighted object. Person is at a risk of developing herniated disc (prolapsed intervertebral disc) due to prolonged flexed position of spine while sitting for prolonged time. This can lead to spinal nerve compression and patients experience symptoms of lower-limb tingling, numbness (heaviness of legs), radiating pain (sciatica) starting from lowerback and weakness.
• Evidence shows that sitting for long period of time increases the risk of developing heart disease and diabetes. Prolonged sitting leads to insulin resistance and decreased utilization of glucose, by body tissue, from bloodstream. There is also increased risk of high blood pressure and high level of LDL cholesterol (bad cholesterol) which can further lead to atherosclerosis, coronary  artery disease and heart attack.
• Blood flow to the brain also slows when the person is mostly involved in sedentary work involving prolonged sitting for 2 hours or more. This will reduce the amount of oxygen received by the brain tissue for efficient cognitive functioning. Cognitive function includes attention, concentration, executive function (decision making, problem solving, motor planning), working memory.  
• Evidence shows that mental status was perceived to decline from 90 minutes. There was increase in mental fatigue over 4 hours of prolonged sitting, alongwith decrease in the heart rate and altered neuroendocrine biomarkers, potentially reflecting an influence on the autonomic nervous system. It was suggested that relatively low energy expenditure and metabolic rate of prolonged sitting has negatively impact brain health and thus potentially affects cognitive functions.
• Research shows that after prolonged sitting without any break for 4 hours or more, there as a decrease in brain blood flow. However, when the sitting duration was combined with short walking break after every 30 minutes, the reduction in brain blood flow was prevented and instead a slight increase in blood flow was observed. These results suggests that sitting continuously is bad for brain blood flow, but taking regular short exercise or stretch breaks for approximately 5 to 8 minutes after  sitting can help maintain blood flow.   

Interventions for Office Syndrome :

It can be divided into 2 intervention strategies namely primary prevention and secondary prevention. (Note : Whole rehabilitation protocol should be performed by the patient under guidance and advice of therapists)

1) Primary prevention : It aims to avoid the development of disease in healthy individuals. Intervention approach is based on health promotion and awareness. It includes :

• Behavioural strategies like lifestyle modification, stress management, smoking cessation, regular physical activity, nutrition optimization, weight management, etc. Make a habit to do aerobic exercises for 4 to 5 days every week for 45 minutes to 1 hour in order to save your body from ill affects of sitting and improve your body's fitness, strength and endurance.
• Injury or strain prevention includes ergonomic redesign of workplace and home (if doing 'work from home'), healthy exercise program, low back care and educational programs related to joint protection and work simplification techniques. Using ergonomic chair for prolonged sitting. Back school workshop or seminars should be organized to educate these employees related to office syndrome causes, symptoms and prevention.
• Tips to reduce eye strain : 
• Use blue -light blocking glasses (Blue block glasses)
• Reduce screen glare by adjusting or changing the monitor direction with respect to light source. Install anti-glare screen protector. 
• Don't forget to blink in order to prevent eye dryness. Blinking of eyes helps to sweeping and lubricating tears across the cornea and helps is removing foreign debris from eyes. Reduce your screen time.
• Take occasional break and rest your eyes by by looking away from digital screen. After every 20 to 30 minutes, look at something 20 feet away for atleast 20 second and then again refocus your eye at your work. 
• Pay attention to surrounding lighting : eliminate excess of incoming light source through windows, bulbs etc. Computer or laptop screen should not be facing  directly opposite to the window as this will increase the screen glare (reflecting light). Shades or curtains can help to reduce light level. The best window position is to the side of your computer or laptop  (not facing the window) at about 2 to 3 feet distance away.
• Change the font size, use large monitor size, prefer using contrast background while typing or reading, use of document holder, etc.
• Simple exercises and stretching during work hours mainly includes neck, shoulder, scapular, trunk, back, hip, knee and ankle movements in sitting or standing position (as shown in images). Exercises helps to maintain the brain blood flow and trigger the production of brain derived neurotrophic factor (BDNF), which grows neurons in the brain. It also helps fight the effect of cortisol (stress hormone). 
• These exercises and stretching should be performed after every 1 hours of continuous sitting. If you are not able to take a break due to important meeting, then perform simple ankle up-down and rotation movements, knee extension- flexion and hip flexion-extension and abduction-adduction movements in sitting position within available space.

Fig : Simple hip, knee, ankle movements in sitting position which can be performed anytime even during working hours.

• Learning and implementing use of joint protection techniques.
• Respect For Pain : Stop activities before you reach the point of discomfort or pain. For example, wrist pain due to typing with wrist in wrong alignment. Neck pain due to excessive neck flexion or forward headed neck posture while reading from laptop or mobile.
• Balance Activity And Rest: Rest before becoming tired. Plan rest periods after 1 to 2 hours of working. By resting for 5 to 10 minutes during an activity, you will have more energy to continue. 
• Avoid Staying In One Position For Extended Periods Of Time : Plan rest periods. Change your position. Stretch and relax your joints. 
• Maintain Or Use Your Joints In Good Alignment : Maintain proper posture. For typing, rest your forearm and wrist on the table-top. This will keep the shoulder  muscles and elbow flexors relaxed and energy is conserved. Neck should be maintained in neutral with minimal flexion or extension range occasionally.
• Maintain Proper Weight distribution : Additional weight can stress weight-bearing joints (hip, knees, feet, back). Before lifting any object initially anticipate or check for the weight.      
• Stress Management : work-related stress occurs in employees if there is increase in the work demands, work load, personal factors, less coping skills, etc. Longterm stress leads to decrease in immunity, affected cognitive and psychosocial functioning and affected quantity and quality of work. Employees should be taught about stress management strategies namely deep breathing exercises, time management skills, mood diversion through laughter or talking with loved ones, cognitive behavioral therapy etc.

Fig : Correct sitting ergonomics for laptop and/or computer employees and if doing reading or writing activity.

Fig : Healthy Behavioural acceptance which includes rest break for stretching.

Fig : Above exercises and stretching to be performed during rest break

2) Secondary prevention :  It aims to reduce the impact of disease that has already occurred by early identification and treatment. Intervention approach is based on remediation, adaptation, environmental modification and disability prevention approach.  It includes :

• In acute pain and soreness complaints of joint and muscles, initially visit Physician for evaluation, diagnosis and medical management. Further, patients will be referred to Physiotherapist or Occupational therapist for exercises and rehabilitation, lifestyle modification and ergonomic changes and advise.
• In acute pain conditions like trapezius spasm or soreness, neck pain, low back pain the patient should apply hot water fomentation for upto 8 to 12 minutes or cold water/cold pack fomentation for upto 4 to 6 minutes. Initially if there is swelling or inflammation and redness, apply cold water or cold pack fomentation then as the swelling subsides the patient can start with hot water fomentation.
• In acute stage, avoid muscle stretching, avoid muscle strengthening, avoid working with muscle pain or soreness condition. This will add on to increase inflammation of the affected part. Give rest to the pain area or joint and perform minimal range on movements for initial 4 to 7 days as per Physiotherapist or Occupational therapist advice. Pain management can be done using Physical agent modalities as directed by Physiotherapist.

• Ergonomic modification and redesign of whole setup which includes ergonomic chair with wheels and back rest, keeping frequently used objects at easy reach on table, adjustable chair height, adjust monitor tilt, minimize screen glare, use blue-light blocking glasses, angled or sloped laptop stand etc.
• In later stage as the pain intensity decrease or when the pain subsides, performing daily therapeutic exercises like flexibility training, strengthening exercises of upper-limbs, lower-limbs, scapular muscle, core-muscle, neck muscles should be performed (as explained in primary prevention part). This will help is maintaining stability of spine, decrease load on passive structures of spine (ligaments, capsule) and improve muscle endurance and blood supply to the brain and heart tissues.
• Continue following the instructions as mentioned in primary prevention strategies.

Fig : Ergonomic sitting arrangements for office work involving laptop or computer use

Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it.” – Plato

You can also refer to our previous blog related to Low back pain care and intervention. (Click on the below link)

Lockdown and Low Back Pain

Thankyou for reading!!!

Dr. Ashwini Sangar, Dr.Pallavi Khadse-Kolhe, Dr.Sheetal Tatar-Dhande.