Watch Your Back in the Reading Room

Unlike other specialists, radiologists spend long hours performing reading room-based work, leaving them susceptible to a sedentary lifestyle. Compared to internal medicine and pediatrics residents, who take an average of 4,785 steps/day, radiology residents average 2,257 steps/day. Sitting for a minimum of six hours during the workday was a major contributor to radiology residents' overall inactivity.¹ Living a sedentary lifestyle is a risk factor for cardiac and metabolic health dysfunction, as well as a predictor for nonspecific low-back pain. Sitting for extended periods of time results in a prolonged low-level load imposed on the lumbar spine, decreasing lumbar lordosis, along with causing contracture of the hip flexors, such as the iliopsoas muscle. This sustained contracture increases muscle pressure and decreases blood flow, ultimately altering the alignment of the pelvis and resulting in back pain.² As radiologists, both present and future, we must take the proper steps to avoid long periods of inactivity and maintain spine health. Here are a few things you can do to increase activity and keep your spines happy and healthy.

Measure your workplace activity levels
Activity monitoring devices, such as Apple watches and Fitbits, can measure your daily steps and calorie expenditure. They can also be programmed to notify you during prolonged times of inactivity. Setting a goal of 10,000 steps a day is a reasonable target for a healthy adult.³ A study in JAMA Neurology found that walking 10,000 steps a day was linked to a significant reduction in heart disease, stroke, heart failure, various types of cancers and dementia.⁴ Breaking up prolonged sitting with moderate-intensity walking can also help improve attention and executive function throughout the workday.⁵

Create an ergonomic workstation
Integration of sit-stand desks is a great way to avoid periods of prolonged sitting. Standing throughout the workday can be an effective way of improving overall health, vitality and work-related engagement.⁶ When you decide to sit, make sure to choose a chair that supports your spinal curves and promotes good posture. Here are a few ergonomic recommendations that can be easily implemented in the reading room to improve productivity and comfort.⁷

• Choose a chair that provides proper lumbar support and has adjustable height and armrests.
• Desks should provide support for keyboards that allow height and angle adjustment.
• Ergonomically designed mouses and alternate user input devices should be considered.
• Mountable monitor arms that allow for angle adjustments are preferred over bases.
• The distance from screen to eyes should be at least 25 inches and eye level should be slightly above the center of the monitor screen.
• Suggest the 20/20/20 rule (every 20 minutes focus on something 20 feet away for 20 seconds) to prevent the deleterious effects from prolonged periods of image viewing.

Incorporate lumbar extension training in your workouts
Poor posture and sitting in a slouched position can put strain on the lumbar discs and cause loss of disc hydration.⁸ Coupled with weak and deconditioned extensor muscles of the lumbar spine, slouching can put you at risk for low-back pain. Strengthening your back extensors will ultimately allow for better posture and reduce the likelihood of low-back pain from prolonged sitting. One study showed that one lumbar extension training session per week was enough to gain strength and reduce pain in patients with chronic low-back pain.⁹ Try these back extension variations in your next workout to keep your back strong and pain free.

Despite your work being sedentary, you don’t need to be. Taking a proactive role to combat a sedentary lifestyle is an effective way to prevent health dysfunctions down the road. Get your steps in, avoid prolonged sitting, and watch your back in the reading room to increase your productivity and keep your mind and body in tip-top shape.

ACR Resources

• Wellness Walks
• Well-Being Curriculum and Fitness Challenge for Residents

References

1. Lamar, D.L., Chou, S.H., Medverd, J.R., Swanson, J.O. Sedentary Behavior in the Workplace: A Potential Occupational Hazard for Radiologists. Curr Probl Diagn Radiol. 2016 Jul-Aug;45(4):253–7. doi: 10.1067/j.cpradiol.2015.10.007. Epub 2015 Nov 10. PMID: 26675263.
2. Kett, A.R., Sichting, F., Milani, T.L. The Effect of Sitting Posture and Postural Activity on Low Back Muscle Stiffness. Biomechanics. 2021; 1(2):214–224. https://doi.org/10.3390/biomechanics1020018
3. Tudor-Locke, C., Craig, C.L., Brown, W.J., Clemes, S.A., De Cocker, K., Giles-Corti ,B., Hatano, Y., Inoue, S., Matsudo, S.M., Mutrie, N., Oppert, J.M., Rowe, D.A., Schmidt, M.D., Schofield, G.M., Spence, J.C., Teixeira, P.J., Tully, M.A., Blair, S.N. How many steps/day are enough? For adults. Int J Behav Nutr Phys Act. 2011 Jul 28;8:79. doi: 10.1186/1479–5868-8–79. PMID: 21798015; PMCID: PMC3197470.
4. del Pozo Cruz, B., Ahmadi, M., Naismith, S.L., Stamatakis, E. Association of Daily Step Count and Intensity With Incident Dementia in 78 430 Adults Living in the UK. JAMA Neurol. 2022;79(10):1059–1063. doi:10.1001/jamaneurol.2022.2672
5. Chrismas, B.C.R., Taylo,r L., Cherif, A,. Sayegh, S., Bailey, D.P. Breaking up prolonged sitting with moderate-intensity walking improves attention and executive function in Qatari females. PLoS One. 2019 Jul 12;14(7):e0219565. doi: 10.1371/journal.pone.0219565. PMID: 31299061; PMCID: PMC6625720.
6. Ma, J., Ma, D., Li, Z., Kim, H. Effects of a Workplace Sit–Stand Desk Intervention on Health and Productivity. Int. J. Environ. Res. PublicHealth2021,18,11604. https:// doi.org/10.3390/ijerph18211160
7. Siddiqui, K.M., Chia, S., Knight, N., Siegel, E.L. Design and ergonomic considerations for the filmless environment. J Am Coll Radiol. 2006 Jun;3(6):456–67. doi: 10.1016/j.jacr.2006.02.024. PMID: 17412101
8. Citko, A., Górski, S., Marcinowicz, L., Górska, A. Sedentary Lifestyle and Nonspecific Low Back Pain in Medical Personnel in North-East Poland. Biomed Res Int. 2018 Sep 9;2018:1965807. doi: 10.1155/2018/1965807. PMID: 30271778; PMCID: PMC6151221.
9. Bruce-Low, S., Smith, D., Burnet, S., Fisher, J., Bissell, G., Webster, L. One lumbar extension training session per week is sufficient for strength gains and reductions in pain in patients with chronic low back pain ergonomics. Ergonomics. 2012;55(4):500–7. doi: 10.1080/00140139.2011.644329. Epub 2012 Mar 8. PMID: 22397454.