I have a client at the moment you is experiencing ongoing cramping in her thoracic spine. When she is away from work for a number of days this improves and it gets worse when she returns to work. She is currently seeing a physiotherapist but there has been no improvement.
I have assessed her workstation and there are no overt risk factors present. She completes computer work for the entire day (developing posters and other educational and promotional material) using both the keyboard (without a number pad) and a mouse. Her original chair did not seem to support her properly as she is very petitie so we have provided her with a trial smaller statured chair. This chair appears to support her better but she is still having the same symptoms. I have stressed the importance of frequent stretch breaks throughout the day and do feel that she is completing these.
Does anyone out there have any suggestions for what I can try to improve her comfort level? I have spoken to her about relaxing her muscles and leaning back on teh backrest as I think that she may now be over-correcting her posture while seated at work and this may be contibuting to the tension in her back.
Any ideas are welcome!
I have personally had problems with my thoracic spine area for many years. With muscle relaxers, physical therapy, changes to my work station and lots of stretch breaks, I can keep it under control most of the time.
Have you asked her about her outside hobbies and interests? Something she is doing outside of work may be contributing to the problem. Another thing I often check is the weight of any bags that are carried, particularly if they are carried on one shoulder. If one has a shoulder bag with a laptop, shoes, wallet, iPod, telephone, etc., the bags can be very heavy and are most often carried on one shoulder. I started carrying the minimal amount I could on any given day and switched to a lightweight backpack that I always put over both shoulders. If I have something really heavy that I need to transport, I use a roller bag. These are things I always check with the people I evaluate.
Sr. Loss Prevention Specialist
Wells Fargo Bank
You might explore the possibility that your client is sitting in a slight foward posture due to visual issues. She may be moving forward to see better and thereby experiencing increased tension in the back. (The "vacuum effect" of the monitor may be sucking her forward to see better). If this is the case her visual consideratations will prevent her from relaxing or leaning back against the seat back cushion.
I often advise clients to work at 1/3 of their maximum viewing distance. If this appears to be an issue: Consider increased image size (lower resolution on display settings tab, or larger font if mostly working with text), larger monitor, move the monitor closer, ,move the client in closer, or corrective lenses.
I hope this helps.
Gene Kay, MS CEA
First thing that comes to mind given my strong medical background as part of my Physiotherapy training in a large hospital setting is to ensure that the T Spine pain is not arising from a medical related issue. When I hear female and I hear T spine pain which is not seeming to improve with ergonomic and Physiotherapy intervention is to refer the employee to her MD ASAP – to rule out the Red Flags; making sure there is no metastatic SOL at the T spine which is the most common spot secondary to breast cancer; infection; fracture (not necessarily from trauma as it can be due to osteoporosis, ankylosing spondylosis etc). This is the very first thing I would order even if I am asked ot perform an ergonomic assessment.
Once that is completed and ruled out – the next assumption being made is that of spinal instability?? In all my years of work as an Ergonomist and Physiotherapist I have yet to see anything like this – go back to your anatomy – the T spine is so very very well buttressed with the facet joint angle; rib attachment; ligaments etc etc that this is pretty much an impossible thing to occur. So, refer the employee back to the PT for a correct diagnosis (and don’t be afraid to demand this of the professional).
Then and only then have a look as to whether her arms are being well supported on adjustable width armrests (you said she is a <5th percentile female yes?). Holding the arms in typing and mousing postures for >34-66% of each day will increase the static load at the shoulder/neck specifically Lat Dorsi and Trapezius MMs. Over time the loading at the T Spine discs will increase which may be contributing to ongoing symptoms
If the chair is new and fits well simply ask the dealer to retrofit the chair with 4 D adjustable armrests. Show the employee how to use them and why these are important for her.
Let me know how this goes and if I can assist further
JE Sleeth Hon B.P.&H.E.(Kin), B.Sc.PT.
I would agree with JE to rule out serious pathology through an MD first to make sure this is just mechanical back pain this client is dealing with. If all serious pathology is ruled out and the patient has no contraindications to manual therapy , I would check to see if the PT has tried "thrust manipulation" to the thoracic spine and rib joints. I know this is the opposite approach to JE’s instability hypothesis, but there is good recent evidence supporting the use of thrust manipulation for thoracic and cervical related pain. Additionally, assessing the patient for psychological issues would be important and this would also be a contraindication to manipulation or other PT treatment because the likelihood of success would be low. Just my two cents worth.
Bret Derrick, PT, OCS, CEES
Bret Derrick, PT, CEES
HI Bret – thank you for your reply. In order to ensure I remain on top of things re T spine and use of thrust type manual therapy please send along any research & evidence you have – just summaries are fine & don’t go out of your way ok – I want to be on top of these changes and your advisement is a good start. Thanks much for your help JE Sleeth http://www.optimalperformance.ca
What area of the T spine is giving the troubles?
C/T junction? Middle? low?
What are her sx?
Possible Thoracic outlet syndrome?
any hand/ulnar or neck/shoulder sx?
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