Posture and Ergonomic Workstation Setup Guide

Proper Posture and Work
Station Set-Up
Chad Elms, PT, OCS,

FAAOMPT
2 The Back University©

7 Secrets to Eliminating Low Back Pain…Forever Chad Elms, PT, OCS, FAAOMPT
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About the Author
Chad Elms, PT, OCS, FAAOMPT
• Physical Therapist
• Orthopedic Certified Specialist
• Fellow in the American Academy of
Orthopedic Manual Physical
Therapists
After graduating physical therapy school in 2000 from The University of

Texas Health Science Center at San Antonio, with a Master’s Degree
in Physical Therapy, Chad went on to pursue an advanced certification
in a three year residency program with a focus on Manual Therapy
(using hands-on techniques to change the way the body functions) and
Orthopedics. After successfully completing his Manual Therapy
Residency program, Chad became a Fellow in the American Academy
of Orthopedic Manual Physical Therapists, an honor shared only by
about 400 other therapists in the nation. At that time he also sat for,
and successfully passed, his Orthopedic Clinical Specialist
examination, to give him the distinguished honor of being an
Orthopedic Clinical Specialist, a certification shared by only about 3%
of the physical therapists in the nation.
In 2002, Chad decided to pursue his dream of opening his own

outpatient physical therapy practice in Helotes, Texas. The practice
quickly flourished developing a good reputation for providing “Hands
on Care for Faster Results.” His experience and knowledge have
allowed him to work with a variety of patients throughout the San
Antonio community, to include players from the NBA’s San Antonio
Spurs, the Chicago White Sox, and Olympic athletes. He has also
worked with PGA golfers, professional soccer players, been on the
therapy team for the San Antonio Ballet, and has worked with
numerous collegiate and high school athletes, as well as a multitude of
other patients of all ages and activity levels in the community.
Today, Chad is the co-owner of three outpatient physical therapy

clinics around San Antonio, Texas and the manager of a fourth clinic
owned by another group of investors. As a result of the tremendous
expansion of his businesses, Chad now spends the majority of his time

working with his physical therapy team to ensure that the quality of
care that helped the business thrive in the beginning is still maintained
at their four locations.
When he is not working in and on his business, or with patients, Chad

enjoys spending time with his wife and one year old son, working out
regularly and participating in ministry work through his church.

Introduction
STOP…FREEZE…Don't Move Your Position At All! Consciously,

take an inventory of how you are positioned and sitting right now as
you read these very words.
• Are you slumped over with your head forward?

• Are you leaning to one side or the other?
• Check your shoulders…are they rounded forward, rather than
pulled back and upright?
• Now, check the position of your legs. Are both of your feet flat on
the floor or are your legs crossed?
• How about your computer monitor? Is the top of the computer
monitor eyelevel when you are sitting up straight?
If you found yourself in any one of these positions, your posture may
be directly contributing to your pain. Did you know that poor posture is
not only one of the major culprits of back pain, but that is also affects
many joints and muscles, as well as your heart and lung capacity? It
can also be the precursor to reduced physical performance and a
decreased quality of life. An even greater concern is that many of the
well-intended people that will treat you throughout the medical
community do not necessarily appreciate this relationship.
Though poor posture is so prevalent, I find that it gets overlooked by

many practitioners throughout the medical community. In my physical
therapy practice, I work with individuals on a daily basis that suffer
from neck, shoulder, mid back, or low back pain due to having had
poor posture over a long period of time. The reason that this is the
case is that poor posture changes the way your body moves. Not only
does it cause limited motion in certain areas, but it actually forces other
areas of the body to have excessive motion in order to compensate for
the areas that are not moving.

In my opinion, posture is one of the most important keys to eliminating

low back pain forever. Since I have worked with so many patients with
medical problems directly related to their posture, I have long felt that
there should be more written on the issue of improving posture. It
seems that no matter what a patient’s physical problem is, I always
end up addressing the
“….poor posture changes the importance of posture
way your body moves.” throughout daily activities. And,
it seems that every time I work
with someone on tips for improving their posture, I always hear how
helpful it was and that there should be something out there that
teaches people on ways to help improve their posture.
As a result, I have put together this BONUS Postural Report in order

help as many people as I can work on improving their posture.

Poor Posture May be Your Missing Link
Having proper posture is definitely one of the most important secrets to

eliminating neck, shoulder, mid back, and low back pain. In fact, good
posture is not only crucial to decreasing low back pain, but it is also a
key to increasing your general health and your body’s overall
performance. Though my mom always told me to sit up straight as a
kid, I never really realized the true benefits of having good posture.
Did you realize that poor posture not only increases stress on the
ligaments and discs in your neck, mid and low back, but it also leads to
poor shoulder mechanics, decreased lung capacity (your ability to take
a deep breath without being
“…good posture is not only limited), as well as a decrease in
crucial to decreasing low the body’s overall performance
back pain, but it is also a key and efficiency in daily activities?
to increasing your general
health and your body’s overall Many people I work with in
performance.” physical therapy think that since
they are adults and have had
poor posture for years, that they
will be unlikely to change their
posture. “I’ve tried to work on sitting up straighter, and I just can’t
seem to get it,” I often hear. Though I will admit that proper posture
can be a difficult thing to master, like anything else, good posture is a
habit that can be developed with repetition over time.
In this section, we are going to review what proper posture is and

discuss how to work on posture so that it becomes second nature. We
will discuss some proven, time tested tricks you can use to teach your
body to have good posture so that eventually, you will have good
posture without even having to think about it any more!
Though we already covered finding your neutral spine in an earlier

chapter, this is going to be crucial for finding your ideal posture as well.
So, if you are still a little unsure as to how to find your neutral spine at
this point, I would recommend that you go back and review that section
until you are able to find your neutral spine both lying on your back and
in standing.

Proper Standing Posture
Let’s start by working to find a proper posture in standing. I am going

to teach you to find a good standing posture the same way I teach my
patients in the physical therapy clinic. To begin, you must find your
“neutral spine.” Though I discuss this in depth in my book, 7 Secrets to
Eliminating Low Back Pain…Forever, we will discuss it here briefly as it
is a vital component for obtaining an optimal posture. One of the ways
I like to find a “neutral spine” is in the standing position.
First, you will need to find a mirror that you can see your hips and waist
in. Usually, a full length dress mirror is best, though most bathroom
mirrors will work too. It is usually easiest to work on this as you are
about to shower or dress because it is easiest to see what position
your back and hips in while you are in your undergarments. To find
your neutral spine in standing, start by facing sideways in the mirror.
Next, you are going to have to find some bony “landmarks” again. If
you need, refer back to the anatomy chapter again just to make sure
you know which bones you are finding.
The first bone you are going to find is your pubic bone, which is the
palpable bone in your lower abdomen right above your pubic area.
Place your 1st and 2nd fingers of your right hand about two inches
above this bone, as this is going to be one of the bones we use to help
you find your neutral spine. The next bone you are going to find is
your posterior superior iliac spine. Again, this is another mouthful, but
do not let the name confuse you. It is not necessary to know the name
or understand why it is named as it is; you just have to know how to
find the bones. I think the easiest way to find these bones is to put
your hands on your waist, as the picture below demonstrates. With
your thumbs wrapping around toward the back part of your pelvis, you
should feel two boney prominences (one on each side) with your
thumbs, as is demonstrated in the picture below. Sometimes, you may
also see a “dimple” in the mirror where these bones are located.

Once you have found these bones in the back part or your hips “mark”
their position by placing your 1st and 2nd fingers of your left hand on the
side closest to the mirror. Now, you should have both bones marked
and be in the position demonstrated in the picture below.
As you can see from the picture above, your fingers in the front are
usually lower than the bone in the back part of the hips. So you can
see this relationship easier, I am exaggerating this fact by arching my
back more than normal, though this is what I commonly see in my
patients because of their tight hip muscles.

In order to find your neutral spine in the standing position, you want to
rock your hips and pelvis backwards. It is almost as if you are trying to
tuck your bottom in. If it helps you to picture it, you can also think of it
as the same motion that you used while lying on your back to flatten
your back. Using the mirror for visual feedback, you should notice that
as you tuck your bottom in and roll your hips and pelvis backwards, the
bone in the front (your pubic bone) gets higher and the bones in the
back get lower. In other words, they are leveling out. When your hand
in the front is level with your hand in the back, you have found your
neutral spine in standing. See the picture below.
Once you have found your neutral spine, you are going to use your
lower abdominal muscles to help you hold your neutral spine. To do
this, you simply try to pull your abdominal muscles in toward your spine
and up toward your throat. In doing this, you should feel the muscles
in your lower abdomen contract.
To make sure they are contracting, simply find the pubic bone again,
put your fingers about two inches above that bone, and make sure
these muscles are firm. Sometimes, it is helpful to practice relaxing
and contracting the muscles (by pulling your belly button in toward your
spine and up toward your throat) to make sure you are getting these
muscles to contract.

From there, I’m going to have you raise your arms with your elbows
bent (like you are in the “stick up” position). Put your arms in the
position shown in the picture below, though you will be in the standing
position.
Next, bring your elbows back so that you are “pinching” your shoulder
blades together. I like to use the example that if I put a pencil between
your shoulder blades, you are trying to focus on squeezing that pencil
so that if I let it go, you would be able to keep the pencil in place
without it falling. Once your arms are back as far as they will go,
slowly lower your elbows to your sides.
After you lower your arms so that they are back down by your sides,
you will probably notice that your shoulders are back and it feels like
you are holding your shoulder blades together. One thing I want you to
pay special attention to here is that you are not shrugging your
shoulders up toward your ears. Instead of having the shoulders
shrugged, you want to make sure your shoulder blades are pinched
together and down. You want to imagine that you are not only

squeezing them together, but that you are also trying to pull them down
toward your back pockets.
At this point, you may also feel that your chest is out a little, which is a
good thing. Now that we have your back and shoulders in a good
position, we want to focus on getting your head and neck in a proper
position. To do this, try to “pull” your ears straight back over your
shoulders by pulling your chin straight back. If it helps, you can
actually take your index finger, put it on your chin, and then push your
chin straight back so that your ears are now over your shoulders.
Now that your ears are back over your shoulders, make sure you are
looking straight ahead. From there, slightly tuck your chin so that your
eyes are looking just slightly below the horizontal plane. Ideally, you
want to tuck your chin so that if you are looking straight, your eyes are
about 15 degrees below the horizontal plane.
When I teach this posture to patients in the clinic for the first time, they
often laugh and say they feel like they are really stiff, or robot like, and
that they aren’t sure they can actually do anything from this position.
The reason that is the case is because for many of us, our bodies are
so used to being in a slouched position that it is somewhat difficult to
actually get in a proper posture. Even though it does often feel
awkward at first, your body will adjust to being in a good posture, and it
will feel more natural over time.
The key is that you have to start working on it regularly, which we will
discuss later in this section. For now, I just want you to understand
what a proper standing posture is and to make a commitment to start
working on it.
Proper Sitting Posture
Finding a proper sitting posture is very similar to finding your proper

standing posture. Obviously, the main difference is that with sitting
posture, you also have to make sure you position your body correctly
on your chair. Let’s cover the ideal sitting posture. You will probably
find it beneficial to follow these steps in your chair as you read this
section.
Ideally, you want to sit on your chair so that about half of your thigh is
on the chair and about half of your thigh is off the chair. Most of the
time, it is necessary to “scoot” forward a little in your chair to achieve
this position. Additionally, you want to make sure that both feet are
positioned firmly and flat on the floor. The reason that you want part of

your leg on the chair and part of your leg off the chair is that it puts you
in a position to distribute some of your body’s weight through your feet,
so that all your weight is not going through your spine. Now, the
problem with this that you may have noticed already is that when you
scoot forward on your chair, it moves you away from the back rest on
the chair, so that you do not have a back support. Obviously, having
no back support in your chair is also somewhat problematic, so we
need to address this.
Depending on your chair, there are a number of things you can do to

solve this problem. Some chairs have a back rest that adjusts forward
or backward to give you support no matter how far to the front or back
you are positioned on the chair. If you have this feature on your chair,
you are set. Simply adjust the back forward to where it gives you
support when you are sitting properly in your chair.
If you have a chair with a fixed back, or a back that does not move far
enough forward, your best bet is to do one of three things. One, you
can roll up a towel so that it forms a roll approximately 6 inches in
diameter. Then, you simply place this in the space between your low
back and your chair, at about the same level as your belly button.
The second thing you can do is take a pillow off your bed and fold it in
half. Then, just as you would do with the towel roll, you place the
pillow between your back and the chair at about the level of the belly
button.
The last thing you can do is purchase a lumbar support roll, though
honestly most of these do not provide much more support, or give you
any different support than either of the other two methods we
discussed. The advantage of purchasing a lumbar support roll is that
many of them have straps so they can be attached to the chair you use
most often. Consequently, it stays on the chair all the time and you do
not have to remember to get your lumbar roll before you start to work.
This can be advantageous because you have to be a little more
disciplined if you are going to use a self-made towel or pillow roll, as
you usually have to remind yourself to get it before you sit down.
Since we are covering proper positioning on the chair, there is one

more thing that is important to make sure you do to properly position
yourself on your chair. That is, you want to make sure that you adjust
the height of your chair so that your knees are either level with, or
slightly below your hips. This is very important because if your chair is
so low that your knees are higher than your hips, it promotes a
slumped posture and makes it very difficult for you to maintain proper
posture in sitting. When your low back is in a slightly flexed or

slumped position, it increases stress on the ligaments, discs, and

muscles of your low back. On the other hand, if your knees are level
with, or even slightly below your hips (which I prefer), it promotes a
better posture in your low back.
“When your low back is in Having a better posture in your low
a slightly flexed or back also makes it easier to have
slumped position, it better posture in your upper back
increases stress on the and neck.
ligaments, discs, and
muscles of your low back.” Once you have your legs in a good
position on the chair, finding a
proper sitting posture is very similar to the procedure you used in
standing. You must first find your neutral spine in sitting. This is done
by rolling your hips and pelvis backward to round out your low back,
then rolling them all the way forward, arching your low back. In this
position, your low back is most likely very arched and you are sitting up
really straight. From this position, slightly roll your hips and pelvis back
a little bit, so that you are still sitting straight, but instead of your back
being in an arched position, it is simply in a nice, upright posture.
Basically, you are in a position between your back being all the way
slumped and all the way arched, as it was when you had your hips
rolled forward.
You can also use the same technique for finding your neutral spine in
sitting as you used in standing. Remember how we discussed finding
your neutral spine in standing as you were standing sideways in the
mirror? You can also do this in sitting. Simply find your pubic bone,
just as you did before, and place two fingers about two inches above
this bone. Next, find your posterior superior iliac spine (just as you did
in standing) and use your 1st and 2nd fingers on the opposite hand to
mark this landmark. When you find both of your “landmarks,” roll your
pelvis forward and backward until you are able to line your hands up.
When your fingers on both hands are lined up, you have found your
neutral pelvis in sitting.
Once you have found your neutral spine in sitting, position your
shoulders, and then your head and neck the same way you did in
standing. Again, this may feel awkward for you, and that is
understandable. Rest assured, if you really make a commitment to
working on your posture, it will feel more natural as the body becomes
more accustomed to your new posture.

What is the Best Way to “Work” on My Posture?
As I mentioned in a story earlier, many of my patients often say they

feel stiff or robot-like when they get in a correct posture. That is
because the body has become used to holding a slumped posture for
so long, that it now feels natural, perhaps even comfortable, to sit in a
slumped posture. Even though it may feel natural, it is a well known
fact that sitting in a slumped position puts extra stress in several places
throughout the neck, mid back, and low back. Over time, this
sustained stress puts your ligaments, discs, and muscles at increased
risk of injury.
Though sitting or standing in a proper posture can be uncomfortable

and a little strenuous at first, remember that as you work on your
posture, your body will eventually become used to holding your ideal
posture. Even better, once you train your body to the point where your
muscles are conditioned to hold a proper posture, you will not even
have to think about it, as your body will eventually hold correct
postures on its own.
I know what you’re thinking. That sounds great, but how do I get my
body to hold a proper posture without me even thinking about it?
That’s a very valid question, but here is how you get there. If after
reading this, you were going to make a commitment to improve your
posture…and you started today by trying to hold a perfect posture
throughout the rest of the day…you
would probably be really sore and “Though sitting or standing in
discouraged for the next few days. a proper posture can be…a
That is because your muscles are little strenuous at first, your
not used to, or conditioned for, body will eventually become
holding your body in a perfect used to holding your ideal
posture. posture.”
For that reason, I teach all my

patients that improving posture is something that has to be done
continuously throughout the day. In fact, you need to work on your
posture hundreds of times throughout the day. I know, I know, that
sounds pretty far fetched. How do you work on your posture hundreds
of times a day, right? Who has time for that? Before you throw your
hands up, let me explain what I mean.
You have to start becoming consciously aware of what position your

body is in as you do your regular activities throughout the day. Each
time you catch yourself in a slumped position, whether you are sitting
or standing, move your body back into your ideal posture. Then, hold
that posture for 30 seconds to a minute. After that, let your body rest a

little bit. Then, literally one to two minutes later, put your body back
into the ideal posture, and hold it for another 30 seconds to a minute.
If you work on this continuously throughout the day, you will start to
notice that your body will become conditioned to hold your perfect
posture longer and longer the more you work on it.
In the beginning, you may get tired and only be able to hold a good
posture for 30 seconds, whereas a month “down the road,” you may be
able to hold a proper posture for 15 minutes before you get fatigued
and need to switch positions.
That is why I say that posture, like anything else, is a learned habit. If
you work on it continuously throughout the day, holding a proper
posture will eventually become second nature. Once your body gets
conditioned for it, you will get to the point where you work for 30
minutes on the computer and find that you have held a proper sitting
posture the whole time, while you were mentally focused on something
else!
Proper Work Station Set Up
Since working at a desk, or on a computer, is so prevalent in our

society, I would like to spend some time at this point covering how to
make sure your chair, desk, and computer station are set up properly.
For those of you that have very active jobs, we will go into a lot more
depth on keeping proper body
“…posture, like anything mechanics during other daily
else, is a learned habit. If activities in our next secret.
you work on it continuously
throughout the day, holding Since many of us spend a lot of
proper posture will time at a desk, one of the most
eventually become second important things to cover in the
nature.” beginning is making sure you
have a proper office chair. Now,
contrary to what you may think, you do not have to spend a lot of
money to find a good chair, with all the options you may need.
I have done a lot of research on chairs for my patients and have found
very good chairs from around $100.00 ranging in price upward to what
you might pay for a used car. Though this may seem like an
exaggeration, there are chairs out there for almost as much money as
you are willing to spend. That being said, just because a chair is more
expensive does not mean that it is necessarily going to have any more
functional features than the chair for $100.00. You just have to know
what you are looking for and have a little time to test them out.

Since you are likely going to be spending a lot of time in your office
chair, it is certainly ok to spend some time sitting in the chairs at your
local office supply company before you make your purchase. Though
you may feel a little silly, you will be more likely to make a better
purchase if you test the chairs out before hand. Doing so will also
ensure that you not only find a chair with all the features you are
looking for, but that you also find one that is comfortable for you. If it
makes you feel any better, I have spent a lot of time in Office Max
“sitting around” testing their chairs. Though I have gotten a few
strange looks from other shoppers, I always feel better knowing I made
an educated purchase.
What to Look for in an Office Chair
Basically, there are five options that you want to look for in finding the
optimal office chair for you.
The Height Adjustment – though this is somewhat self

explanatory, it is best to look for a chair that allows you to adjust the
height of the seat. In other words, you can lower it if you have
shorter legs and you can raise it if you are taller. As we touched on
earlier, this is very important because you want to make absolute
sure that you have a chair you can adjust for your height, so that it
allows you to work with your feet flat on the floor. You also want
this feature because it allows you to maintain the relationship of
having your knees level with or slightly below your hips.
The Adjusting Seat Back
This option is usually a lever you pull to adjust the seat back
forward or to push it further back. As we also discussed earlier, this
is important because when you scoot forward in your seat, most of
the time it leaves you without a back rest. If you have a chair that
has an adjusting seat back, you can bring the back of the chair
forward to give you support as you work. This allows you to sit
forward enough in your chair that you can distribute some of the
weight through your feet, vs. all of the weight going through your
back. This will also eliminate the need for rolling up a towel or
pillow to fill the space between your seat and your low back, as
your seat back will come to you giving you the support you need.

Adjustable Arms
Though many office chairs have arms on them, not all of them are
adjustable. Since no two individuals are identical, it always amazes
me to see a chair with fixed arms that do not adjust because they
do not fit many people. Adjustable arms are very important
because they give your upper body some support as you are sitting
at your desk, taking pressure off your neck, upper back and
shoulders. Without arm rests, your shoulders and upper back
muscles are basically responsible for holding your arms in position
for as long as you are sitting to work. If you have adjustable arm
rests, however, you can raise (or lower) the arm rests to the proper
height necessary to support your arms, decreasing the stress on
your upper back and shoulders.
What is the proper height for your arm rests? When you are sitting
up straight in your ideal posture, with your elbows bent at a 90
degree angle (your arms are in the shape of the letter “L”) you want
to raise (or lower) the arm rests so that they give you minimal
support under your elbows and
forearms. You do not want your arm “You do not want your
rests so high that your shoulders are arms rests so high that
shrugged, nor do you want them so your shoulders are
low that your forearms are not even shrugged…You just want
touching them when you are sitting them giving your
up straight. (When you do not forearms light support.”
position your arm rests high enough,
you usually end up slouching to rest your arms on them, so you end
up in a slumped posture). You just want them giving your forearms
light support, in order to take some of the stress off your upper back
and shoulders.
The Tilting Seat Pan
The seat pan is the part of the seat that you sit on. Some chairs
have an adjustment that allows you to tilt the seat pan downward
(so that the front part of the seat is lower than the back edge of the
seat) and backward so that the front edge of the seat is higher than
the back edge of the seat. This feature is designed to allow you to
change the position of your seat throughout the day, so that you are
able to relieve the pressure on your back from time to time by
changing positions throughout the day.

This is also a nice feature in that if you tilt your seat pan downward,
so the front edge of the seat is slightly lower than the back edge, it
reinforces the relationship of having your knees slightly below your
hips, which I like. Again, this is preferable because when your
knees are slightly below your hips, it helps rotate your pelvis
forward so that you sit up straighter.
The Swivel Chair Adjustment
This feature is one that allows your chair to turn to the left and right,
or swivel back and forth, while you remain in the sitting position.
The reason I recommend this feature is because it helps in
promoting proper body mechanics through routine activities you
perform at your desk. It really comes in handy when you need to
reach into a desk drawer, if
“The swivel adjustment… you drop something on the
allows you to turn you chair floor as you are working, or if
to the right or left, so that you you need to reach for an
are able to keep your low object that is not easily within
back in a neutral position as your reach. If you do not
you are reaching.” have the swivel chair
adjustment, the tendency is
to stay seated in your chair
and twist your body (mainly your low back) to be able to reach for
what you need. The swivel adjustment not only allows you to stay
seated, but it also allows you to turn your chair to the right or left, so
that you are able to keep your low back in a neutral position as you
are reaching. The swivel adjustment also ensures that you are able
to turn your chair so that your spine stays in line with your hips
throughout most of the activities performed at your desk.
Other Nice to Have Features
Though the features above are the ones I usually require in a chair,
I realize there are many other features that are “nice to have,”
though not absolute necessities. Other features I prefer to have in
an office chair are one with wheels, again because it helps in
promoting proper body mechanics while you are working. Just like
the swivel adjustment, if you have a chair without wheels and are
trying to reach something just outside your grasp, people usually
have the tendency of twisting or bending at the low back. Wheels
on your office chair give you the option to move your chair over
short distances to help you eliminate poor body mechanics (twisting

or bending the low back) when you are trying to get something
outside your immediate reach.
Another feature I think is a “nice to have” is a chair with a built in

lumbar support. Again, though this is a nice feature, this is really
the one I care the least about, as I can easily make my own lumbar
support using a towel or folded pillow, or I can buy one for not too
expensive. So, if you find a chair in your price range with all the
other features we have discussed, but it is missing the lumbar
support…I recommend buying the chair and making (or purchasing)
your own lumbar roll.
Sometimes to find a chair in your right price range, you may have to
pick the most comfortable chair that has as many of these options
as you can find. At times, you may have to pick a chair that has
most of the options but is missing one; that is ok. However, do not
feel like you have to sacrifice what you want just because you may
not have a large budget. I recently found an office chair in a major
office supply company for around $100.00, which included every
one of the features we discussed. Granted, though this is
somewhat expensive for a chair, there are many chairs out there for
much more expensive than this with no features at all—they just
look fancy. Though finding a chair that looks fancy is great, finding
a fancy chair without the features we discussed above is not going
to help you prevent or eliminate back pain.
I also view this as one of those things that is very important for your
overall health. If you are someone that has a hard time with
spending extra money on an office chair, you have to truly ask
yourself how much your health and feeling good is worth to you.
Though they can be somewhat expensive, an office chair is
something that will not only last for years, but it is a crucial piece of
equipment for ensuring you are able to maintain good posture while
you are at work. Feeling good physically at work will also ensure
you are as productive and efficient as possible and not limited in
your productivity due to back pain.
Setting up Your Desk and Computer Monitor
Though there are a number of options we could discuss here (different

types of desks that allow you to stand or sit), those are outside the
scope of this book. Though I am a proponent of anything that allows
you to change positions frequently throughout the day, the things we
will discuss in this section are simple and cost effective ways you can
prevent unnecessary stress on your back as you work.

One of the biggest mistakes I see people make in setting up their work
station for optimal productivity and proper work ergonomics is not
having a proper chair. I think it all starts there because if you do not
have your chair set up properly, you can have the most expensive
chair and desk set up out there and you will still be placing
unnecessary stress on your low back. Since we have already covered
sitting posture in your chair, along with how to position yourself
properly in your chair, you are already one step ahead of the vast
majority of people out there. Once you have your chair positioning
down, here are some other important tips to follow in making sure your
work station is set up properly.
First, make sure your computer screen/monitor is positioned directly in

front of you. I see a lot of work stations set up so that the person
working there has to slightly turn their head or whole body to look at
the computer screen. Though this may seem somewhat harmless,
think about the imbalance this creates after hours of sitting with your
head or body slightly turned to one side. Though you may not feel pain
at the time, imagine what happens to your body hour after hour, day
after day, and year after year, from sitting in an improper position.
Eventually, muscles on one side of your spine tend to shorten, while
the muscles on the other side of the spine get longer, and often
weaker, causing imbalance in the muscles that support and stabilize
your spine. This, in turn, affects your everyday activities because your
muscles no longer properly stabilize your back as you bend, squat, lift,
carry, and move throughout the day.
The second thing you want to ensure is that the top edge of your
monitor is eye level when you are sitting up straight in your ideal
posture. This is important for the following reason. The body has a
tendency to try and take the easy route with almost everything we do
and working on the computer is no different. If the top edge of your
computer monitor is much lower than your eyes, your screen is way
too low.
In this scenario, the body wants to get eye level with what you are
working on, so even though you may start out in a good posture, you
will quickly catch yourself slouching down so that your eyes are level
with the monitor. If your monitor is too low and does not have an
adjustment that allows you to move it up or down, try putting an old
phone book underneath the base of the monitor, in order to adjust it to
the proper height.
If your computer monitor is too high, you will find that you have to look
up, which increases stress on the neck. I often relate this example to

going to see a movie and sitting on the front row, way too close to the
screen. Has this ever happened to you? If so, do you recall how not
long after the movie started…you probably started to feel discomfort in
your neck from looking up at the movie screen? What happened then?
Most likely, you did not keep a good posture in your low back, but you
probably slid down in your chair a little bit so you could rest your head
on the backrest and take some of the pressure off your neck.
I see this same scenario play out in people that have their computer
monitors too high. Since it is uncomfortable to maintain your head
looking up at the monitor for a long period of time, you usually have a
tendency to slouch down and lean back in your chair a little bit, which
causes you to be further away from your computer screen. This also
usually causes you to have to reach for your keyboard, promoting a
poor (forward and rounded) posture in your shoulders.
Another common mistake I see in work station set up is improper

positioning of the keyboard. Many times, I see the keyboard on the
desk, right in front of the computer screen. Though this may work if
you are a fairly tall person, most desks are too high to put your
keyboard on, which does not allow you to maintain proper positioning
in your elbows as you work. When you are typing, you want to make
sure that your elbows are kept in a 90 degree bend (the shape of an
“L”).
Another thing you want to ensure is that you can still reach the
keyboard when your arms are straight down by your side and your
elbows are bent at a 90 degree angle. In other words, you do not want
to have to reach your arms forward to get to your keyboard. Ideally,
you want to have the option of your keyboard sliding to you, which is
why those trays that mount under your desk, holding your mouse and
keyboard, work so well.
Though many desks have this feature, many do not. If your desk does
not have the tray that pulls toward you, that is ok. You can actually
buy trays that self-install fairly quickly and easily at any major office
supply store for a very reasonable price. Recently, one of the
receptionists in our newest office was complaining of some tightness in
her upper back and neck. We quickly realized that because we had
the desks built into our receptionists’ office area that we did not have
pullout keyboards. The next day, I went to our local office supply store
and purchased a pullout keyboard tray for about $20.00. The tray
installed easily and was the final piece of the puzzle needed to help
ensure my co-worker was able to maintain proper body mechanics
while typing on her computer.

The reason that keyboard positioning is so crucial is because if you

have to reach forward for your keyboard, your body will do whatever it
takes to get closer to your work. Consequently, even though you may
start out in a good posture, you will quickly find yourself slumped
forward, leaning in toward the keyboard. This not only promotes a
poor posture in the neck and shoulders, but it also causes you to
slump your mid and low back, increasing stress on your whole spine.
Another important tip to keep in mind while you are typing is this.
Make sure you get a stand to hold papers that you are typing
information from. Many times, I see individuals go to type a report or
enter information into a spreadsheet and they put the papers down on
their desk beside their computer monitor. The problem with this is that
after a short period of time, you end up looking down and to the side
for long periods. This places unnecessary stress on the muscles of the
neck and upper back and makes it difficult for you to hold a proper
posture for any length of time as your neck is stooped forward. To
prevent this from occurring, I always recommend purchasing a stand
that you can put next your computer monitor that will hold your work in
an upright position. This allows you to keep your neck in a proper
position and helps you to maintain good posture while you work.
Since my goal with this book is to over deliver on the information I

provide you, I want to throw in a bonus tip here of something I often
teach in the clinic to those coming in for neck and upper back pain.
The tip is this: it is imperative that you get a head set for your phone.
Time and time again, I see individuals that talk on the phone holding it
between their ear and shoulder by shrugging one shoulder up, while
typing with both hands. This is absolutely terrible for your neck and
upper back, but it also usually causes you to lose a proper posture in
your low back as well, because your low back tries to compensate for
the awkward positioning of your neck and upper back. So, though this
seems like a tip that applies mainly to someone having neck pain, it is
also very applicable to those with low back problems, as it directly
affects the positioning of your low back.

Closing Thoughts
My purpose in writing this report was to give you some tips on proper
postures for your daily activities, just like I give my patients undergoing
physical therapy. Having worked with so many patients that have told
me, “I wish I had known all of this, years ago,” I wanted to make these
principles available to as many people as I could.
My goal is to be able to touch the lives of as many people as I can

through my materials using the knowledge and experience I have
acquired. If you know friends or family members that may be suffering
due to low back pain, do not let them put up with pain any longer.
Recommend they go to http://www.TheBackUniversity.com and
download their free copy of this report.
If after reading and implementing the recommendations contained in

this report, you feel you would benefit from more knowledge and tips
such as these, go to http://www.TheBackUniversity.com/7Secrets now.
Here you will find out how YOU can eliminate back pain and regain the
quality of life you deserve!

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Proper Posture and Work

Chad Elms, PT, OCS,

2 The Back University©

All information and content in this E-book is protected by copyright. All

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About the Author

Chad Elms, PT, OCS, FAAOMPT

After graduating physical therapy school in 2000 from The University of

In 2002, Chad decided to pursue his dream of opening his own

Today, Chad is the co-owner of three outpatient physical therapy

4 The Back University©

When he is not working in and on his business, or with patients, Chad

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STOP…FREEZE…Don't Move Your Position At All! Consciously,

• Are you slumped over with your head forward?

Though poor posture is so prevalent, I find that it gets overlooked by

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In my opinion, posture is one of the most important keys to eliminating

As a result, I have put together this BONUS Postural Report in order

7 The Back University©

Poor Posture May be Your Missing Link

Having proper posture is definitely one of the most important secrets to

In this section, we are going to review what proper posture is and

Though we already covered finding your neutral spine in an earlier

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Proper Standing Posture

Let’s start by working to find a proper posture in standing. I am going

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Proper Sitting Posture

Finding a proper sitting posture is very similar to finding your proper

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Depending on your chair, there are a number of things you can do to

Since we are covering proper positioning on the chair, there is one

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slumped position, it increases stress on the ligaments, discs, and

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What is the Best Way to “Work” on My Posture?

As I mentioned in a story earlier, many of my patients often say they

Though sitting or standing in a proper posture can be uncomfortable

For that reason, I teach all my

You have to start becoming consciously aware of what position your

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Proper Work Station Set Up

Since working at a desk, or on a computer, is so prevalent in our

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What to Look for in an Office Chair

The Height Adjustment – though this is somewhat self

The Adjusting Seat Back

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The Tilting Seat Pan

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The Swivel Chair Adjustment

Other Nice to Have Features

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Another feature I think is a “nice to have” is a chair with a built in

Setting up Your Desk and Computer Monitor

Though there are a number of options we could discuss here (different

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First, make sure your computer screen/monitor is positioned directly in

22 The Back University©

Another common mistake I see in work station set up is improper