Office chair

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An office chair that can swivel and be adjusted to various heights and angles

An office chair, or desk chair, is a type of chair that is designed for use at a desk in an office. It is generally comfortable and adjustable and can swivel 360 degrees.

Contents [hide] 1 History 2 Ergonomics 3 Task chair 4 See also 5 References 6 External links

History

One the earliest known innovators to have created the modern office chair was naturalist Charles Darwin, who put wheels on the chair in his study so he could get to his specimens more quickly.^[1]
With the advent of rail transport in the mid-19th century, businesses began to expand beyond the traditional model of a family business with little emphasis on administration. Additional administrative staff was required to keep up with orders, bookkeeping, and correspondence as businesses expanded their service areas. While office work was expanding, an awareness of office environments, technology, and equipment became part of the cultural focus on increasing productivity. This awareness gave rise to chairs designed specifically for these new administrative employees: office chairs. This caught the attention of Otto von Bismarck, who is credited with popularizing the office chair by distributing them throughout parliament during his time in office.
The office chair was strategically designed to increase the productivity of clerical employees by making it possible for them to remain sitting at their desks for long periods of time. A swiveling chair with casters allowed employees to remain sitting and yet reach a number of locations within their work area, eliminating the time and energy expended in standing. The wooden saddle seat was designed to fit and support the body of a sitting employee, and the slatted back and armrests provided additional support to increase the employee’s comfort. Like modern chairs, many of these models were somewhat adjustable to provide the maximum comfort and thus the maximum working time.

 Ergonomics

In the 1970s, ergonomics became an important design consideration. Today, office chairs often have adjustable seats, armrests, backs, back supports, and heights to prevent repetitive stress injury and back pain associated with sitting for long periods. Ergonomic chairs fit an individual's needs and provide support where the individual needs it. New concepts of office chairs include a seat oscillating forwards and sideways and an oscillating seat back to allow the body to move as much as possible during sitting. ^[2]

Task chair

A task chair is a type of office chair that is commonly used in conjunction with an office desk. These chairs have multiple adjustments to be able to be used by many different users.^[

Low back pain

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Low back pain

The five vertebrae in the lumbar region of the back are the largest and strongest in the spinal column.
ICD-10	M54.4-M54.5
ICD-9	724.2
MedlinePlus	003108
eMedicine	pmr/73
MeSH	D017116

Low back pain (or lumbago) is a common musculoskeletal disorder affecting 80% of people at some point in their lives. It accounts for more sick leave and disability than any other medical condition.^[1] It can be either acute, subacute or chronic in duration. Most often, the symptoms of low back pain show significant improvement within a few weeks from onset with conservative measures.

Contents [hide] 1 Classification 2 Cause 3 Pathophysiology 4 Diagnostic approach 4.1 Imaging 4.2 Red flags 5 Prevention 6 Management 6.1 Conservative 6.2 Acute back pain 6.3 Chronic back pain 6.4 Surgery 6.5 Some or no benefit 7 Prognosis 8 Epidemiology 9 In pregnancy 10 See also 11 References 12 External links

[edit] Classification

One method of classifying lower back pain is by the duration of symptoms: acute (less than 4 weeks), sub acute (4–12 weeks), chronic (more than 12 weeks).

[edit] Cause

Most cases of lower back pain are due to benign musculoskeletal problems and are referred to as non specific low back pain. They are generally believed to be due to a sprain or strain in the muscles of the back and the soft tissues,^[2] especially if the pain arose suddenly during physical load to the back, and the pain is lateral to the spine. The rate of serious causes is less than 1%.^[3] The full differential diagnosis includes many other less common conditions.

• Mechanical:
  • Apophyseal osteoarthritis
  • Diffuse idiopathic skeletal hyperostosis
  • Degenerative discs
  • Scheuermann's kyphosis
  • Spinal disc herniation ("slipped disc")
  • Spinal stenosis
  • Spondylolisthesis and other congenital abnormalities
  • Fractures
  • Leg length difference
  • Restricted hip motion
  • Misaligned pelvis - pelvic obliquity, anteversion or retroversion
  • Abnormal Foot Pronation

• Inflammatory:
  • Seronegative spondylarthritides (e.g. ankylosing spondylitis)
  • Rheumatoid arthritis
  • Infection - epidural abscess or osteomyelitis

• Neoplastic:
  • Bone tumors (primary or metastatic)
  • Intradural spinal tumors

• Metabolic:
  • Osteoporotic fractures
  • Osteomalacia
  • Ochronosis
  • Chondrocalcinosis

• Psychosomatic
  • Tension myositis syndrome

• Paget's disease

• Referred pain:
  • Pelvic/abdominal disease
  • Prostate Cancer
  • Posture

• Depression^{[citation needed]}
• Oxygen deprivation

[edit] Pathophysiology

The lumbar region in regards to the rest of the spine.

The lumbar region (or lower back region) is made up of five vertebrae (L1-L5). In between these vertebrae lie fibrocartilage discs (intervertebral discs), which act as cushions, preventing the vertebrae from rubbing together while at the same time protecting the spinal cord. Nerves stem from the spinal cord through foramina within the vertebrae, providing muscles with sensations and motor associated messages. Stability of the spine is provided through ligaments and muscles of the back, lower back and abdomen. Small joints which prevent, as well as direct, motion of the spine are called facet joints (zygapophysial joints).^[4]
Causes of lower back pain are varied. Most cases are believed to be due to a sprain or strain in the muscles and soft tissues of the back.^[2] Overactivity of the muscles of the back can lead to an injured or torn ligament in the back which in turn leads to pain. An injury can also occur to one of the intervertebral discs (disc tear, disc herniation). As the body ages, the spine does as well. Due to aging, discs begin to diminish and shrink in size, resulting in vertebrae and facet joints rubbing against one another. Ligament and joint functionality also diminishes as one ages, leading to spondylolisthesis, which causes the vertebrae to move much more than they should. Pain is also generated through spinal stenosis, sciatica and scoliosis. At the lowest end of the spine, some patients may have tailbone pain (also called coccyx pain or coccydynia). Others may have pain from their sacroiliac joint, where the spinal column attaches to the pelvis, called sacroiliac joint dysfunction. Physical causes may include osteoarthritis, rheumatoid arthritis, degeneration of the discs between the vertebrae or a spinal disc herniation, a vertebral fracture (such as from osteoporosis), or rarely, an infection or tumor.
In the vast majority of cases no noteworthy or serious cause is ever identified. Usually the pain resolves on its own after a few weeks. Intensive testing for a physical cause without waiting for the pain to recede is not prudent because any problems identified may be irrelevant and misleading.^[5]

[edit] Diagnostic approach

Acute back pain is defined as pain less than 6 weeks while chronic back pain is defined as pain that has been present for over three months. The intermediate time period is known as sub acute back pain.^[6] Determination of the underlying cause is usually made through a combination of a medical history, physical examination, and, when necessary, diagnostic testing, such as an x-ray, CT scan, or MRI.

[edit] Imaging

From 1994 to 2006, MRI scans of the lumbar region increased by 307%.^[7] Imaging rates and surgery rates are directly related. Where imaging rates are highest in the country, surgery rates are the highest.^[8] The American College of Physicians as well as the American Pain Society both highly advise against consistent imaging in patients who deal with nonspecific low back pain.^[9] However, the use of MRI and CT scans is recommended when a patient deals with consistent leg and back pain.^[9] There is no relation between MRI/CT scans and positive patient outcomes.^[10]
X-ray
X-rays are useful in determining deformities in one's bones. They can provide one with the most obvious causes of low back pain due to bone fractures or changes in bone due to aging.
Bone density test
Osteoporosis does not cause low back pain; however, bone fractures may occur due to osteoporosis, resulting in low back pain.
X-rays and CT scans are not required in lower back pain except in the cases where "red flags" (listed below) are present.^[11] If the pain is of a long duration X-rays may increase patient satisfaction.^[12]

[edit] Red flags

• Recent significant trauma

• Milder trauma if age is greater than 50 years

• Unexplained weight loss

• Unexplained fever

• Immunosuppression

• Previous or current cancer

• Intravenous drug use

• Osteoporosis

• Chronic corticosteroid use

• Age greater than 70 years

• Focal neurological deficit

• Duration greater than 6 weeks^[13]

[edit] Prevention

Low back pain is common and there are several methods of prevention. Although exercise show conflicting results in treatment of acute episodes, it is effective in preventing recurrences.^[14] Proper lifting technique may also be important.^[15]
A number of studies were conducted about the relationship between the spine and nicotine. Cigarette smoking is a factor that inversely affects the success and proper healing of spinal fusion surgery. In patients who underwent cervical fusion, a smokers rate of nonunion was much greater than a nonsmoker.^[16] Smoke and nicotine cause the spine to age faster than normal. Smoking also reduces blood flow to the lower spine and causes the spinal discs to degenerate.^[17]

[edit] Management

[edit] Conservative

For the vast majority of people, low back pain can be treated conservatively. A number of recommendations which may help alleviate symptoms include:^[18] applying heat or cold,^[19][20] physical therapy,^[21] and continued activity within the limits of the pain with bed rest being discouraged.^[22] Firm mattresses are less likely to lead to improvement when compared with a medium-firm mattress.^[23]

[edit] Acute back pain

Medications

Short term use of pain and antiinflammatory medications, such as NSAIDs or acetaminophen can help with the symptoms of lower back pain.^[24][25] However, these medications are not without risk and for persistent pain a health care practitioner should be consulted. Muscle relaxants for acute^[24] and chronic^[25] pain have some benefit, however, there are concerns with side effects, and their routine use is discouraged.^[26] Muscle relaxants are more effective in relieving pain and spasms when they are used in combination with NSAIDs.^[27]

Activity

Staying as physically active as possible is recommended by most guidelines. Bed rest is discouraged as not being helpful.^[24][28] Even when the pain is severe, some activity is still preferable to prolonged sitting or lying down, as long as it does not involve movements such as heavy lifting that would further strain the back.^[5] Structured exercise in acute low back pain, however, leads to neither improvement nor harm.^[29]

Spinal manipulation

Most reviews and guidelines have found that spinal manipulation (SM) therapy for low back pain of unknown cause is of no benefit beyond standard conservative management.^[30][31] A 2007 U.S. guideline weakly recommended SM as one alternative therapy for spinal low back pain in nonpregnant adults when ordinary treatments fail,^[32]. The Swedish guideline for low back pain in 2002 does not recommend considering SM therapy for acute low back pain in patients needing additional help, possibly because the guideline's recommendations were based on a higher evidence level.^[30] A 2008 review found that SM is similar to other forms of conventional care.^[33] A 2007 literature synthesis, however, found good evidence supporting SM and mobilization for low back pain and exercise for chronic low back pain.^[34] Of four systematic reviews published between 2000 and May 2005, only one recommended SM, and a 2004 Cochrane review^[35] stated that SM or mobilization is no more or less effective than other standard interventions for back pain.^[36] A 2008 systematic review found insufficient evidence to make any recommendations concerning medicine-assisted manipulation for chronic low back pain.^[37]. However, the American College of Physicians and the American pain Society still recommend spinal manipulation when other conservative forms of treatment for lower back pain have failed.^[38]

[edit] Chronic back pain

Low back pain is more likely to be persistent among people who previously required time off from work because of low back pain, those who expect passive treatments to help, those who believe that back pain is harmful or disabling or fear that any movement whatever will increase their pain, and people who have depression or anxiety.^[5] A systematic review (2010) published as part of the Rational Clinical Examination Series in the Journal of the American Medical Association reviews the factors that predict disability from back pain.^[39] The data quantified that patients with back pain who have poor coping behaviors or who fear activity are about 2.5 times as likely to have poor outcomes at 1 year.
The following measures have been found to be effective for chronic non-specific back pain :

• Exercise appears to be slightly effective for chronic low back pain.^[40] The Schroth method, a specialized physical exercise therapy for scoliosis, kyphosis, spondylolisthesis, and related spinal disorders, has been shown to reduce severity and frequency of back pain in adults with scoliosis.^[41]

• Tricyclic antidepressants are recommended in a 2007 guideline by the American College of Physicians and the American Pain Society.^[42]
• Acupuncture may help chronic pain^[25]; however, a more recent randomized controlled trial suggested insignificant difference between real and sham acupuncture.^[43]
• Intensive multidisciplinary treatment programs may help subacute^[24] or chronic^[25] low back pain.^[5]
• Behavioral therapy^[25]
• The Alexander Technique was shown in a UK clinical trial to have long term benefits for patients with chronic back pain.^[44]
• Back schools have shown some effect in managing chronic back pain.^[45]
• Spinal manipulation was shown to have a clinical effect similar to that of other commonly used therapies and was considered safe.^[46]
• Clinical research shows that treatment according to McKenzie method is as effective as other commonly used methods^{[47][48][49][50][51][52][53][54][55]}

Prolotherapy, facet joint injections, and intradiscal steroid injections have not been found to be effective.^[56] Epidural corticosteroid injections are said to supply the patient with temporary relief of sciatica. However studies show that they do not decrease the rate of ensuing operations.^[57] Therapeutic massage is proven to be effective for chronic back pain.^[58] Traditional Chinese Medical acupuncture was proven to be relatively ineffective for chronic back pain.^[58]

[edit] Surgery

Surgery may be indicated when conservative treatment is not effective in reducing pain or when the patient develops progressive and functionally limiting neurologic symptoms such as leg weakness, bladder or bowel incontinence, which can be seen with severe central lumbar disc herniation causing cauda equina syndrome or spinal abscess.^{[citation needed]} Spinal fusion has been shown not to improve outcomes in those with simple chronic low back pain.^[59]
The most common types of low back surgery include microdiscectomy, discectomy, laminectomy, foraminotomy, or spinal fusion. Another less invasive surgical technique consists of an implantation of a spinal cord stimulator and typically is used for symptoms of chronic radiculopathy (sciatica). Lumbar artificial disc replacement is a newer surgical technique for treatment of degenerative disc disease, as are a variety of surgical procedures aimed at preserving motion in the spine. According to studies, benefits of spinal surgery are limited when dealing with degenerative discs.^[60]
A medical review in March 2009 found the following: Four randomised clinic trials showed that the benefits of spinal surgery are limited when treating degenerative discs with spinal pain (no sciatica). Between 1990 and 2001 there was a 220% increase in spinal surgery, despite the fact that during that period there were no changes, clarifications, or improvements in the indications for surgery or new evidence of improved effectiveness of spinal surgery. The review also found that higher spinal surgery rates are sometimes associated with worse outcomes and that the best surgical outcomes occurred where surgery rates were lower. It also found that use of surgical implants increased the risk of nerve injury, blood loss, overall complications, operating times and repeat surgery while it only slightly improved solid bone fusion rates. There was no added improvement in pain levels or function.^[61]
Spinal fusion
The logic behind spinal fusion is that by fusing two vertebrae together, they will act and function as a solid bone. Since lumbar pain may be caused by excessive motion of the vertebra the goal of spinal fusion surgery is to eliminate that extra motion in between the vertebrae, alleviating pain. If scoliosis or degenerative discs is the problem, the spinal fusion process may be recommended. There are several different ways of performing the spinal fusion procedure; however, none are proven to reduce pain better than the others.^[21]

[edit] Some or no benefit

Additional treatments have been more recently reviewed by the Cochrane Collaboration:

• Massage therapy may benefit some patients.^[62]

• Heat application may have a modest benefit. The evidence for cold therapy is limited.^[63]

• Yoga has been found beneficial.^[64][65]

• Correcting leg length difference may help by inserting a heel lift or building up the shoe.^[66]

• The role of narcotics for chronic low back pain is uncertain.^[67]

• A 2008 review found antidepressants ineffective in the treatment of chronic back pain^[68] even though some previous studies did find them helpful.^[25]

• Transcutaneous electrical nerve stimulation (TENS) has not been found to be effective in chronic lower back pain.^[69]

[edit] Prognosis

Most patients with acute lower back pain recover completely over a few weeks regardless of treatments.^[70][71] With the usual lumbar muscle strain or sprain as the cause, over 90% of patients are completely recovered within one month.^[72] Although an episode of lower back pain may settle quickly, recurrence rates are about 50% in the following 12 months. About 2% of the population with low back pain are temporarily or chronically disabled by their form of low back pain. 41% of adults aged between 26 and 44 years reported having back pain in the previous 6 months. Most had occasional episodes of pain that lasted a few days, was mild or moderate in intensity, and did not limit activities. Although a high percentage of individuals have persistent lower back pain, 75% of them self-manage their problem and a few become significantly disabled by low back pain. In the United States, the costs of low back pain range between $38 and $50 billion a year and there are 300,000 operations annually. Along with neck operations, back operations are the 3rd most common form of surgery in the United States.^[73]

[edit] Epidemiology

Over a life time 80% of people have lower back pain,^[71] with 26% of American adults reporting pain of at least one day in duration every three months.^[74]

[edit] In pregnancy

50-70% of all pregnant women experience back pain.^[75]
As one gets farther along in the pregnancy, due to the additional weight of the baby, one’s center of gravity will shift forward causing one’s posture to change. This change in posture leads to increasing lower back pain.^[76][77]
The increase in hormones during pregnancy is in preparation for birth. This increase of hormones softens the ligaments in the pelvic area and loosens joints. This change in ligaments and joints may alter the support in which one’s back is normally used to.^[78][79]

[edit] See also

• Back pain
• Bertolotti's syndrome
• Coccydynia
• Degenerative disc disease
• Facet syndrome
• Sciatica
• Tension myositis syndrome
• Upper back pain
• Spinal stenosis
• Failed back syndrome

[edit] References

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2. ^ ^{a b} irishhealth.com > Lumbago Retrieved on Dec 25, 2009
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Coccydynia

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Coccydynia or Coccygodynia
Classification and external resources
ICD-10	M53.3
ICD-9	724.79
eMedicine	pmr/242

Coccydynia is a medical term meaning pain in the coccyx or tailbone area, usually brought on by sitting too abruptly.

Contents [hide] 1 Synonyms 2 Diagnosis 3 Natural history 4 Clinical features 5 Non-surgical treatment 6 Surgical treatment 7 See also 8 External links 9 References

[edit] Synonyms

Coccydynia is also known as coccygodynia, coccygeal pain, coccyx pain, or coccaglia.

[edit] Diagnosis

A number of different conditions can cause pain in the general area of the coccyx, but not all involve the coccyx and the muscles attached to it. The first task of diagnosis is to determine whether the pain is related to the coccyx. Physical examination, high resolution x-rays and MRI scans can rule out various causes unrelated to the coccyx, such as Tarlov cysts and pain referred from higher up the spine. Note that, contrary to most anatomical textbooks, most coccyxes consist of several segments: 'fractured coccyx' is often diagnosed when the coccyx is in fact normal or just dislocated at an intercoccygeal joint ^[1][2].
A simple test to determine whether the coccyx is involved is injection of local anesthetic into the area. If the pain relates to the coccyx, this should produce immediate relief ^[3].
If the anesthetic test proves positive, then a dynamic (sit/stand) x-ray or MRI scan may show whether the coccyx dislocates when the patient sits ^[4].
Use of dynamic x-rays on 208 patients who gave positive results with the anesthetic test showed:

• 22% Posterior luxation (partial dislocation of the coccyx backwards when sitting)
• 5% Anterior luxation (partial dislocation of the coccyx forwards when sitting)
• 27% Hypermobility (excessive flexing of the coccyx forwards and upwards when sitting)
• 14% Spicule (bony spur) on the coccyx
• 31% Not possible to identify the cause of pain

This study found that the pattern of lesions was different depending on the obesity of the patients: obese patients were most likely to have posterior luxation of the coccyx, while thin patients were most likely to have coccygeal spicules.

[edit] Natural history

One way of classifying coccydynia is whether the onset was traumatic versus non-traumatic. In many cases the exact cause is not known (called idiopathic coccydynia).
Coccydynia is often reported following a fall or after childbirth. In some cases, persistent pressure from activities like bicycling may cause the onset of coccyx pain.^[5] Coccydynia due to these causes usually is not permanent, but it may become very persistent and chronic if not controlled.
Rarely, coccydynia is due to the undiagnosed presence of a sacrococcygeal teratoma or other tumor in the vicinity of the coccyx. In these cases, appropriate treatment usually involves surgery and/or chemotherapy.

[edit] Clinical features

Activities that put pressure on the affected area are bicycling, horseback riding, and other activities such as increased sitting that put direct stress on the coccyx. The medical condition is often characterized by pain that worsens with constipation and may be relieved with bowel movement. Rarely, even sexual intercourse can aggravate symptoms.

[edit] Non-surgical treatment

Since sitting on the affected area may aggravate the condition, a cushion with a cutout at the back under the coccyx is recommended (the donut cushion traditionally recommended by doctors is generally useless for this condition). If there is tailbone pain with bowel movements, then stool softeners and increased fiber in the diet may help. For prolonged cases, anti-inflammatory or pain-relieving drugs may be prescribed. The use of anti-depressants such as Elavil (amiltriptyline) may help alleviate constant pain. Local nerve blocks are often beneficial. Tailbone pain doctors specializing in Physical Medicine and Rehabilitation at New Jersey Medical School have published that sometimes even just a single local nerve block injection at the ganglion impar can give 100% relief of coccydynia when performed under fluoroscopic guidance.^[5]

[edit] Surgical treatment

In rare cases, surgery to remove the coccyx (coccygectomy) may be required. Typically, surgery is reserved for patients with cancer (malignancy) or those whose tailbone pain has failed to respond to nonsurgical treatment (such as medications by mouth, use of seat cushions, and medications given by local injections done under fluoroscopic guidance, as noted above). .^[6]

[edit] See also

• Ganglion impar
• Coccyx (tailbone)

[edit] External links

• www.coccyx.org, website about coccydynia causes, treatments and coping with the condition
• Coccyx pain, tailbone pain, coccydynia at eMedicine
• Xray, MRI and other images about tailbone pain

[edit] References

1. ^ Postacchini F, Massobrio M (October 1983). "Idiopathic coccygodynia. Analysis of fifty-one operative cases and a radiographic study of the normal coccyx". J Bone Joint Surg Am 65 (8): 1116–24. PMID 6226668. 
2. ^ Kim NH, Suk KS (June 1999). Clinical and radiological differences between traumatic and idiopathic coccygodynia.. 40. Yonsei Medical Journal. pp. 215–20. http://www.coccyx.org/medabs/kimsuk.htm. 
3. ^ Marx, Fred A. (1996). "Coccydynia/Levator Syndrome, A Therapeutic Test". Techniques in Coloproctology 4 (1). http://www.coccyx.org/medabs/marx.htm. 
4. ^ Maigne JY, Doursounian L, Chatellier G (December 2000). "Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma". Spine 25 (23): 3072–9. doi:10.1097/00007632-200012010-00015. PMID 11145819. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0362-2436&volume=25&issue=23&spage=3072. 
5. ^ ^{a b} Foye P, Buttaci C, Stitik T, Yonclas P (2006). "Successful injection for coccyx pain". Am J Phys Med Rehabil 85 (9): 783–4. doi:10.1097/01.phm.0000233174.86070.63. PMID 16924191. 
6. ^ Foye PM (2007). "Reasons to delay or avoid coccygectomy for coccyx pain". Injury 38 (11): 1328. doi:10.1016/j.injury.2007.06.022. PMID 17884057.