What can you do to prevent or recover from analyst's back? After the syndrome was first described in TAP 36/2, readers clamored for more information on chairs and exercises.
The key to back success is to have a high tech, ergonomically engineered chair. These cost a small fortune, so be prepared. If you don't know what this means, or even if you think you do, take a look at the website of a neat design furniture firm called “Design Within Reach”. Log on to their website at dwr.com, and then click on “workspace”, and then on “ergonomic chairs”.
One chair that has the highest ergonomic credentials is the Aeron chair from Herman Miller, which sells for about $800. The Aeron Chair is made from an unusual breathable material, rather than padded upholstery. The Freedom Chair, designed by Niels Diffrient, is another option. It costs $895 or $1195 depending on whether you get a headrest. (Why not splurge? The more support for your beleaguered spine the better.) The point here is to see what an ergonomic chair looks like. Traditionally, the key design concepts have been lumbar support and maximum adjustability. However, the designers of the Aaron chair have now added “sacral-pelvic” support. The chair's inventor, chiropractor Brock Walker, now is convinced that the solution for sitters is to have very low back support, supporting the pelvis so it tips forward, according to a Chicago Tribune interview. Therefore the newest version of the Aeron Chair, just released, emphasizes sacral-pelvic support.
One purpose of all this support and adjustability is keep your body in perfect alignment while sitting. Alignment includes having your feet flat on the floor, your thighs parallel to the ground and your back more or less perpendicular to your thighs. I think we need padded arm and elbow supports in our particular niche profession, but these are very hard to find.
The sad truth is that chairs that cost considerably less than these two are probably not good enough.
The right chair is a necessary but not sufficient condition for back care. A key component is an exercise program that strengthens abdominal muscles (and butt muscles). The idea is to have a strong girdle of musculature surrounding your vulnerable spine.
Here is an extremely simple exercise routine from a physical therapist, designed for this purpose. It only takes about 10 minutes a day, but still makes a marked difference. It consists of four exercises, each of which should be repeated the maximum number of times you can without letting your body go out of proper alignment (I'll explain this below). Thirty repetitions is a good number to start with if you can, but 10 is fine too.
Lie on your back with your arms stretched comfortably at your sides. Tuck your chin in slightly so that your neck is not hyper-extended and strained. Bend your knees and pull your legs up so that your feet are flat on the ground, about a foot from your buttocks.
Take a moment or more to make sure the small of your back is flat on the floor. This necessitates tilting your pelvis up a little. Make sure you grasp this step before proceeding. Failure to keep the small of your back flat means that the wrong muscles will be tightened, and you can actually hurt your back. If you don't know what I'm talking about, get someone to show you before going further. You should not be able to get your hand between your back and the floor.
Keep your back in this position throughout the exercise. (If you start to fatigue, it may pop up; that's an indication you've reached your maximum of repetitions with this exercise. Stop.)
Now, lift up your feet until your lower legs are parallel to the floor. Keeping your back down, slowly extend one leg and then the other, like a slow and controlled bicycle motion. Repeat about 30 times.
Now, roll over onto your left side. Suck in your stomach and keep your body in a straight line. Lift your right leg about 12 to 18 inches in the air, and then bring it back down in a controlled fashion. Your foot must be pointing forward, not up and out, and should be parallel to the floor. Repeat 30 times.
Roll over onto your stomach. Put your head down in a comfortable position. Keep your body flat on the floor from your head to your buttocks. Lift your right leg a small amount, keeping your knee straight, and then let it down slowly, not quite touching the ground. Repeat 30 times, then do the same thing with your left leg. This is a very subtle movement — you're not throwing your leg high in the air. The point is to clench and tighten your buttocks muscles. Be sure to keep your hips square to the ground.
Roll from your stomach onto your right side and repeat the side leg lifts described above.
That's it! You should start to feel the difference in as little as two weeks. It would be a great idea to get a consultation from your own physical therapist (you need an M.D. referral) who can also teach you how to stand and walk properly, and make sure you are doing these or other exercises correctly.
Candidate's Claw is another occupational health hazard, this one prominent in analytic training. It is characterized by a cramped and aching writing hand and is commonly suffered by candidates who write 3 or 4 hours of extensive process notes four days a week. [Ed. Note: It is striking that in the entire debates on certification, the problem of candidate's claw was not mentioned once.]
Unfortunately, graduation is the only real treatment for candidate's claw. A graduate analyst, especially one who has been certified and appointed as a training analyst, can do the vast majority of his or her writing on the computer, thus risking only carpal tunnel syndrome (a topic for another time).
However, certain measures can reduce the ache and cramping. To risk being boring, alignment is again the key here. Make sure your wrist is in a neutral position, i.e. neither flexed
nor extended. The back of your hand should form a straight line continuous with the back of your forearm. Make sure your writing surface is at a comfortable height, one that allows your forearm to be parallel to the ground. A lap desk might help here. Dignified ones are available from stores such as Restoration Hardware and some bookstore chains.
Keep your hand and fingers as relaxed as possible, and check for relaxation frequently.
Chose a pen and paper where the ink flows freely on the page. You don't want to add stress to the system by having to overcome resistance (physical, that is) as you try to move the pen across the page.
Finally, experiment with different pens to see which causes the least stress and strain for your hand. Two widely available pens billed as ergonomically designed are “Dr. Grip” and the “Ph.D” Both cost under ten dollars. It's worth buying both and trying them out, seeing which you prefer. I lean slightly towards the Dr. Grip. Avoid any pen that feels too heavy, even if it's classy and was an expensive gift. Some swear by smaller pens. Susan Levine wrote TAP: “The best pen I have found is a Pilot Precise V Extra Fine Rolling Ball. It requires the least pressure.”
Analyst's Back and Candidate's Claw are not the only orthopedic occupational health hazards faced by analysts. Susan Levine brought the dreaded “Twist” to TAP's attention. This is the problem of tightness and spasms in your neck and shoulder from always twisting slightly to the same side to listen to a patient. (Say your chair is to the left of the patient's head on the couch. You will habitually be maintaining a onesided tilt or twist to the right with your neck). Then of course, everyone is afraid of developing carpal tunnel syndrome, but no one does anything about it or really believes in it. These may or may not be the subject of future TAP articles, but I can promise you that heart disease and G.E.R.D. will not be. Well, on second thought …