Musculoskeletal Disorders in Shorter People - I

Sedentary lifestyle is a major source of mechanical load and this will come as a surprise to many. If one analyzes the type of patients commonly observed in the orthopaedic clinics, then one will find majority of them to be those who are into sedentary habits; students, desk workers', housewives, retired personnel, those who are resting more. Sitting is a major source of static and dynamic loading. Sitting continuously is a static activity and sitting twisted is a combination of dynamic and static activity. Similarly regarding the other body parts.

Mechanical loads depend upon the dynamics between the user and the environment in which he or she are undertaking the tasks and the body part (s) that is involved while doing so. The working environment (kitchen, office, transport and similar other areas) are all designed keeping an average height and body structure into consideration. The farther the user is from the average the more the need to compromise while using these working environments and the problems are maximum near the extremes of the range.

We will consider the challenges faced by shorter than average individuals in two common scenarios; desk work and house wives. In today's age, many females are performing both these roles. In addition to the working environment one has to seriously take into account the impact of gadget use in the overall contribution to the mechanical overloading and thus musculoskeletal disorder. Using the various body parts in poor posture (beyond their normal zone of functioning) is a major source of mechanical loading to those body parts.

Desk Worker:
How will a short user compensate while working on a workstation and what are the potential areas of mechanical overload he or she is likely to expose?
  1. They will tend to sit more at the edge of the chair to compensate for their height and body discrepancy and thus perpetually be in a slouched position. (Back, tail bone)
  2. If they have a bulky body and sit completely in the chair, their back of the knees will be pushed against the edge of the chair (knee pain, swelling at the ankle)
  3. Will mostly raise the chair height to be able to work at the desk properly and look into the monitor without putting strain on the back. In doing so will be sitting at the edge of the chair and keep the legs dangling or crossed (Swelling at ankles, calf pain, knee pain, ankle)
  4. In such a scenario, may wear heels to keep feet grounded (calf, ankle, toes)
  5. If there is no facility to raise the chair then they will continuously work in a strained position by keeping the shoulders raised, hyper extending the neck to be able to watch into the monitor, sitting at the edge of the chair which encourages slouching (neck, shoulder, back)
  6. If the user is thin built and is using a executive type of chair, he or she will be lost in the chair. This size discrepancy can also lead to poor posture as the body has ample space in the surroundings to perpetuate poor habits (one sided back, neck, upper back, buttock)
  7. If they are simultaneously working on 2-3 computers then the repetitive twists and turns will also contribute to the possibility of spinal column pain.
  8. If the arm rests in the chair are not adjustable then they may have to raise the shoulders to be able to keep the wrists, elbow and forearm in the working zone and creating pressure points and overload (tennis elbow, carpal tunnel syndrome, cramps, shoulder stiffness)
Image result for desk work and "short user"
There is a quite a lot of awareness to maintain a good posture at the spine and thus all shorter than average users will attempt to rectify that mismatch. This is done by raising the height of the chair such that their eye is at the level of the monitor. Once that is achieved the other body parts are not provided adequate attention and there can be multiple adjustments taking place.

If the chair is raised then the following postural faults should be looked into:
  1. Is the user sitting completely in the chair or sitting at the edge and slouching?
  2. Are the feet planted?
  3. If the desk is high and if one has taken the chair higher, where and how are the feet supported
    1. with legs tucked below the chair and feet planted on the base of the chair?
    2. sit in the chair with only the toes touching the floor?
    3. sit cross legged (tucked below opposite buttock, crossed at knee or crossed at ankle) in the chair?
  4. Does one require to raise one's shoulders to reach to the desk and operate the mouse?
  5. Does one use a keyboard tray or have to reach up to the keyboard on the desk?
Housewives:
  1. Is she comfortable working in the kitchen?
  2. Does she require to stretch out or raise her shoulders while working at the kitchen or cooking?
  3. Does she require to stretch out while cleaning the utensils in the sink, as the sinks are deeper compared to the level of platform.
  4. Does she stretch herself to pick up objects from a higher level?
  5. Can she completely sit in the sofa or a chair and able to rest her feet on the floor?
  6. Does the back of her knee press against the edge of the sitting surface?
  7. Does she slouch or collapse within yourself while sitting?
  8. Does she sit on both of her buttocks or prefer to sit on one buttock or tilted?
  9. Does she have difficulty in dining while sitting on the dining chair?
  10. Working on the floor will not be much of an issue as the bending distance is relatively less. But the short arm lengths may lead to more stress on the shoulders and back for undertaking household works.
In the next post we will understand the likely areas of mechanical overload for this individuals and the solutions that can be helpful.

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