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Ergonomics/Computer Job, TMJ and Neck Pain

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Question
I wondered if you had any tips for someone who works long hours at a computer and has developed TMJ and back-of-neck/occiput pain from head-forward posture.  I am 50 years old, male, sole wage earner in family of five.  I have found some things in the last year to improve the TMJ and neck pain like soaking the neck/jaw in the hot tub, swimming.  And if I sit with chest up (imaging someone has hooked my sternum and lifting up) this seems to align things better.  The problem is that keeping that posture in the morning is relatively easy.  But by the late afternoon it is difficult to maintain this posture.  Any tips on how to battle head forward posture into late into the day?

Answer
Yes, Michael, there are a few things that you can do to help yourself. They all require a bit of self-inspection which can be difficult. However, some people find it easier if they have someone else take a picture of them while they are using the computer. You can then look at the picture of yourself to be an accurate judge.

There are some of things that could help you maintain that chest up posture throughout the day. Before we get into them; however, I want to explain why that chest up posture feels so good.  When you stick your chest out your head moves back over your shoulders.  Stand in front of a mirror and turn sideways so you can see yourself in slight profile.  In a perfect world you would see almost a straight vertical line running from your ear to your shoulder.  In other words, your head is centered on top of your body.  Most people walk around (and use the computer) with their heads jutted forward.  When looking in a mirror you can see your head sitting in front of your shoulders, almost like your nose is trying to arrive in the room first.  This head forward posture is one of the things that plays a big role in TMJ/neck pain.  

Now, this is where the picture of you working on the computer comes in.  Where is your head relative to your body?  If I had to guess I would say that it was probably jutted forward when you are fatigued.  

Into the details:
1. do you have enough lumbar support in your chair-back to keep you sitting upright?  You should be able to relax back against the backrest while still being in that butt out, chest up position.  
2. The back of the chair won't do it all.  The keyboard and mouse should be down by your lap so that you can type with your elbows down by your ribs.  If you are reaching forward, your body will slump forward.  Also, if you are reaching forward the weight of your arms is being carried by your neck muscles -- something they were not designed to do.
3. This step has two parts:
A. When was the last time you had your vision checked?  If it has been more than a year, you may want to consider having it checked.  
B. Can you reach out and touch your monitor while sitting back in the chair in that comfortable yet supported chest up position? Your eyes if you don't need glasses, and most mid-range lenses if you need glasses are set for best viewing of the computer somewhere around 22-24 inches from the eye.  For the average adult this means being able to reach out and grab the monitor.  (By the way, if the monitor is off to one side or the other, move it center.  There is no reason you should be looking sideways all day.)  
Basically, straining to see the monitor is one of the biggest contributors to TMJ/Neck pain.  It may be that by the end of the day your eyes are fatigued and you have to lean forward to see the screen. If that is the case, bring the monitor even closer.  At the start of the day it will serve to remind you to sit back.  By the end of the day it will be a comfort for your eyes that they can see without straining.

Let's start there and you can tell me how things work out.  That is a lot to digest at one time.
Good luck,
Naomi

Ergonomics

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Dr. Naomi Abrams, OTR/L, CEAS

Expertise

I can answer questions regarding office, healthcare, and industrial ergonomics as well as general health and safety issues. I specialize in macro-ergonomics which deals with both individual issues (such as injuries and prevention) as well as corporate/organizational prevention plans. This includes working with companies that are interested in creating company-wide safety programs, health programs, and intervention strategies. My background is in occupational therapy and I am able to answer questions regarding specific medical injuries and workers compensation. This also makes me uniquely qualified to speak on the aging workforce and modifications specific to that population. I cannot answer questions regarding OSHA regulations and legal issues. While I know some things about manufacturing, I am not an engineer and tend to refer some of those questions to others.

Experience

My company, Worksite Health & Safety Consultants, an ergonomic and occupational health consultation firm has just turned eight years old. We are located in the Washington metro area. As owner I travel around the world speaking on ergonomics, aging in the workplace, and occupational health. I have consulted in the field of occupational health and ergonomics for the last twelve years. Additionally, I am an Occupational Therapist and have specialized in the treatment of work injuries/work-related musculoskeletal disorders and modifications for return to work post-injury for the last fourteen years.

Organizations
American Occupational Therapy Association Rehab Practice Owners Network Women Business Owners of Montgomery County Leadership Montgomery

Publications
Why is My Office a Pain in My...? by Dr. Abrams Ergonomics for Therapists, 3rd Edition, edited by K. Jacobs Work Special Interest Section Quarterly ergoweb.com Montgomery County Gazette Quoted in multiple blogs and online magazines

Education/Credentials
Occupational Therapy Doctorate with a specialization in ergonomics Masters of Occupational Therapy Certified Ergonomic Assessment Specialist

Past/Present Clients
confidential

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