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Sitting? Where, what and how

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Sitting, everyone does it, everyone has an opinion about it and virtually everyone uses something to sit on. And there are plenty of seating options to choose from, from office chairs, stools and balls to combined sit/stand solutions.

Some are a visual promise of ultimate sitting comfort, while others are more Spartan models with no clear front or back. Virtually every manufacturer has their own unique perspective on sitting, a perspective born from their own ideas about the causes of problems that can arise from sitting in an office environment. It's for good reason that seating products are often called 'seating solutions' in the market. It subconsciously suggests that the activity of sitting itself is intrinsically problematic. That idea has gained traction over the last few years with the risks of prolonged sitting compared to the risks of smoking.

The idea that sitting comes with not a few risks is underscored by the strict standards and guidelines to which office chairs must conform, ostensibly to ensure that employees can work in a safe and healthy way. There must be some reason behind all these rules and guidelines, right? But just what problems are we talking about, exactly, and more importantly, what's causing them? What are opinions and what are facts? It's time for an update on the benefits and drawbacks of sitting in office environments.

Common complaints

Lower-back pain, complaints of arm, neck and shoulders (also known as CANS, previously called RSI) and eye complaints have long dominated the top three spots on the list of physical strains in office environments.

When those complaints lead to impairments, it can cause real problems for both employee and employer in the form of lurking threats like loss of productivity, absenteeism and, at worst, disability.

Because the employer is responsible for providing a safe and healthy working environment, sooner or later they're going to take steps to prevent or reduce such complaints. As a general rule, solutions often consist of measures like purchasing another chair or seating solution, an ergonomic mouse and/or keyboard and (in the case of eye complaints) possibly another monitor, perhaps paired with screen glasses.

And the employee? They’ve often already tried to make changes in their behaviour or working methods. Experience, however, tells us that old habits die hard, so it's nice when there's an 'ergonomic' product that can provide a solution. But mind you, the intention is obviously not to use these kinds of solutions to continue indulging bad habits. Even a perfectly equipped workspace can't compensate for improper use.

Misconceptions about lower-back problems

Opinion: 'sitting increases the risk of lower-back problems'. It seems like this is the prevailing opinion among many employers, employees and, to my great surprise, a good many (para)medical professionals, as well. It's easy to see why this viewpoint is so hard to get rid of. Between 60% and 90% of the Western population will have lower-back problems at least once in their lives. An increasing number of people are sitting for work and we're sitting more and longer – according to the lifestyle monitor, an average of 8.7 hours in 2015. The link between sitting and lower-back problems makes sense, so it's easy to make. But just because it sounds logical doesn't make it true.

Fact: There is actually no evidence of a causal relationship between sitting alone and the risk of lower-back problems. Sitting in an office environment won't give you back problems, anyway. That was the conclusion reached by both the Health Council and the Netherlands Centre for Occupational Disease following an extensive international literature review.

But it's also not the case that there is no connection at all between the risk of lower-back problems and working in an office environment. That link, however, isn't about the ergonomics of the work environment, but rather your level of satisfaction with your work.

So does it even matter how I sit and what I sit on? It definitely matters, but not because it's the cause of lower-back problems. If you already have problems, it's important to know how you should sit so that you experience as few issues as possible. How you sit also partly determines whether or not you run an increased risk of neck, shoulder and arm complaints, but we'll dive deeper into that later. The type of chair you sit on partly determines the best way for you to sit.

And to rid the world of another misconception, it's fine to sit actively without a backrest. People can spend hours horseback riding, playing piano, sitting on a barstool or enjoying all kinds of other fun hobbies without back support and experience no problems at all. However, when it comes to office chairs, it seems like a back support is a vital and indispensable part of the chair, as though, without a backrest, we're taking a health risk. The interesting thing is that people, after experiencing serious lower-back problems, are actually more likely to prefer a seat without back support. This at least seems to suggest that people with a 'sensitive' back can benefit from active sitting. More on this to come.

And yes, of course, long periods of active, unsupported sitting require attention and practice, in the same way that a standing desk would. Everyone knows that when you want to run a half marathon, you need to slowly, methodically extend your training times. Active sitting and standing to work are no different. With good sitting and good standing, as with all skills, practice makes perfect.

Neck, shoulder and arm complaints
As we've already mentioned, how you sit partly determines whether you run an increased risk of neck, shoulder and arm complaints. Proper seated posture is a prerequisite for holding the head straight above the shoulders, which keeps the strain on the neck as neutral as possible. The right chair can support such good posture.

The weight of the head, which averages around 5 kilograms, pushes downwards perpendicularly, following the natural curvature of the spine. The muscles around the cervical spine alternate between contracted and relaxed in order to balance the head on the spine. You can see how difficult that actually is when someone is threatening to fall asleep and they begin to 'nod off'.

When we recline in our chairs, the entire back becomes more rounded and the head begins to slide forward. It's clear, then, that the balance is gone. What's left is continuous, unilateral tension in the neck muscles, which keeps the head from toppling over and keeps the eyes on the screen. To prevent even further reclining, people will often place their elbows on their armrests or desktops for extra support. But it's difficult to work with two elbows fixed in place, particularly when it comes to fine motor skills like typing and operating a mouse.

The most popular solution, particularly for those who can't touch type, is to get support from the left side and allow the right hand to do most of the work. We know that operating a mouse for a prolonged period and not touch-typing can increase the risk of neck, shoulder and arm complaints. It's not surprising that shoulder and arm complaints occur primarily on the right side, as 85% to 90% of the population is right-handed.

Issues with sitting

The fact that sitting isn't a risk factor for lower-back problems doesn't mean that it doesn't matter what you sit on. There's also the question of comfort. Everyone wants to sit 'comfortably', after all. For the skilled 'active sitter', a stool with no back support can be just as comfortable as a perfectly adjusted office chair is for the more average office worker. But just how do you perfectly adjust your office chair? Research tells us that 80% of office workers only use the chair's height adjustment function. You won't be surprised to hear that that's not enough. Paying attention to the points below will help you get more comfort out of your chair.

Active (unsupported) sitting
If you want to sit actively and unsupported, you can achieve this by, for instance, sitting on the edge of your chair or sitting halfway back on the seat. Some chairs have an 'active' setting which tilts the entire chair forward. When using this setting, it's important to keep your back straight and you'll often find that you want the seat in a higher position. Your knees are lower than your hips, making the angle between your torso and thighs greater than 90 degrees. This facilitates sitting up straight, is less strenuous on the back and is therefore more comfortable for people with lower-back problems. In theory, the higher you sit, the smaller the seat you need. One of the advantages of active sitting is that it requires your leg muscles to be more active, helping you burn some extra calories.

Supported sitting

If you want to sit supported, it's important to sit all the way back on the seat.

Otherwise, the backrest can't support your lower back, causing you to recline. Although this doesn't make a difference in the risk of lower-back problems (because there is none), it does determine the position of your head on your shoulders. Set the height of your backrest or lumbar support so that it fills the lower back and your torso relaxes into the backrest. Adjust the angle of the backrest slightly backwards so that you can effortlessly sit up straight.

For those with back problems: by tilting the backrest slightly backwards, you decrease the pressure on the lower back, which can be nice. When it comes to seat height, optimal positioning will ensure an even pressure across the buttocks and thighs. The guiding principle is that if the feet are placed directly under the knees, the knees will form an angle of 90 degrees or greater.

A seat that is too low can increase the pressure on the buttocks, which will make you want to straighten your legs and cause you to recline. A seat that is too high can give you an uncomfortable feeling in the backs of your thighs, causing you to shift forward in the chair and, again, recline. In both cases, the head is no longer straight above the shoulders. You should also always make sure that there's enough space between the back of the knee and the front of the seat. Your chair probably has a knob to adjust that distance.

Change your posture

But don't worry, the intention is not to spend eight hours a day sitting like this. It's actually good to regularly change your posture, to stand up and take a walk around. But proper sitting posture should be part of every office worker's standard skill set, just like touch typing or using keyboard shortcuts instead of doing everything with the mouse.



If you’ve perfectly adjusted your chair and you're sitting comfortably, it's also important to make sure that you have the right desk height and that your keyboard and mouse are easily accessible. The desk height can be lower if you touch type and keep the keyboard closer to your body. If you can't touch type or prefer to have the keyboard and mouse further away, the desk height needs to be higher. Check to see if you can easily rest your arms on the armrests or your desktop and if you can easily read from your screen. Don't lean forward off of your backrest, but maintain continuous contact between your back and the backrest. Otherwise all of your effort will have been for nothing. And yes, old habits die hard. But it's not about how many times you fall, it's about how many times you get back up.

Erik Saathof
Registered corporate physiotherapist
Stradon, leading in employment and health
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