Your Office Chair Is Hurting You
But also, forget standing desks. Try ‘active sitting,’ according to a trauma surgeon who wants to cure sitting disease.
Dr. Turner Osler was perfectly content working as a trauma surgeon at the University of Vermont — then he received a grant for researching biostatistics from the National Institutes of Health, which required him to regularly sit down at a desk for the first time in his career. That’s when his back pain started. “All the chairs I tried made my back worse, so I took a deep dive over the course of the year to figure out a better and affordable solution,” he says.
Now, Osler, who’s currently a research epidemiologist at the University of Vermont, channels his health research into a new mission: preventing what he calls “sitting disease.” On top of creating and selling chairs that promote “active sitting” — which requires sitters to move while in the chair — Osler donates chairs to schools around the country, which he views as a practical way to improve public health.
I spoke with him about the impact of sitting disease, the problem with modern ergonomics (including standing desks), and how he plans to use his research and designs to improve public health.
Elemental: How does your work as an epidemiologist encourage you to educate people on the health implications of constantly sitting?
Turner Osler: What I’m most interested in is sitting disease, which is a constellation of obesity, hypertension, diabetes, and heart disease that seems to come as a package. We’re in an epidemic of all these things. It’s likely the case that sitting still all day is mostly the source of these problems.
But that’s a hard case, because most people don’t care about a heart attack they might have 20 years from now. But what people do care about is the back pain they have right now.
Active sitting, which requires people to move when they’re sitting, solves both of these problems, reducing back pain and increasing metabolic rate. We’re kind of hijacking sitters’ neuromuscular systems and compelling them to be active, even when they sit.
What is it about sitting that’s so risky for our health?
People aren’t supposed to be sitting all day. This is a catastrophic misuse of our anatomy. We’re designed to be hunter-gatherers. Uniquely among our primate brethren, we have a requirement for exercise. We need to get in a lot of walking to make our biochemistry work properly. So when you force people to sit, a lot of things go wrong.
For one thing, it’s hard to move when you’re trapped in a standard 90–90–90 ergonomic posture, where your hips, knees, and ankles are at a 90-degree angle. In addition to immobility, there’s the back-pain issue. Eighty percent of Americans have back pain that sends them looking for medical help at some point in their lives. This is a shocking figure to someone like myself, who has taken the spine apart in the operating room and the anatomy lab. The human spine is fine on its own. The fact that it goes wrong in 80% of us really makes no sense, unless you pull the camera back and see how we’re using our backs.
“Ergonomics doesn’t exist to make people more comfortable or improve posture. Ergonomists came into the world to make people more efficient on an assembly line. It’s an industrial concept.”
In cultures where people don’t sit on crappy office chairs, back pain is much less common. For example, in places like Korea and Japan, where people squat or kneel or sit with other postures, there’s a much lower incidence of back pain. Viewed from this angle, it seems like our whole back-pain epidemic is really a created problem.
What’s the biggest problem with most standard office chairs?
People who make so-called ergonomic chairs have realized that when you sit in a 90–90–90 configuration, you lose the back’s natural curve. So they’ve tried to reconstitute it with lumbar support — by pushing on the small of the back to regain that curve. But pushing on the back doesn’t fix it. What you need to do is lower your knees below your hips by adjusting the seat of the chair to be higher.
Your spine doesn’t need to be forced to succumb to a posture an ergonomist thought would be good. Your spine knows how to support itself if it isn’t given false input from a backrest and lumbar support. All these things distract your spine from sitting in a balanced posture. By putting people back in charge of their posture and allowing their muscles to support them, their muscles get better, and their core strength gets better.
Speaking of ergonomics, it seems like sitting disease is more of a mindset problem than a chair problem. Do you think traditional ergonomics perpetuate “sitting disease”?
Ergonomics doesn’t exist to make people more comfortable or improve posture. Ergonomists came into the world to make people more efficient on an assembly line. It’s an industrial concept. Now employers want to design people’s experience on an assembly line so they don’t get a repetitive stress injury and sue them. So ergonomics has come to have much more thoughtful implementation. But at root, it was how to get more widgets off the assembly line, which isn’t a very elevated purpose if you’re trying to think about your employees.
I was shocked when I started going to ergonomic conferences and discovered that the state-of-the-art research was really pretty bad. When you look at the textbooks, people are sitting in postures that just don’t make any sense anatomically. The whole ergonomic industry is ready for a reboot. Basically all ergonomic office chairs are the same. They spin, they have various amounts of chrome, and they have lumbar support. But if lumbar support was the answer, why does everyone still have back pain?
What about trendy alternative options to crappy office chairs, like yoga balls?
Yoga balls were actually invented in the neonatal intensive care unit in Denmark in the 1950s. They had preemies who had trouble with secretions, so they would rock them around on the balls to drain their lungs. Over time, the balls got bigger, and the yoga crowd got the idea to use them for exercise. And then a perfectly reasonable person could say, “If it does some good at the gym, why wouldn’t you sit on one and get some exercise all day long?”
But to sit well, you have to dial in the height of your chair. No one knows how tall a yoga ball is. You might be able to read the diameter on the package, but when you sit on it, that’s not how high it is! It depends on the leak rate, the pressure, and the temperature.
The University of Michigan recently banned employees from sitting on yoga balls due to “catastrophic failures.” Since yoga balls are made out of cheap plastic, it’s not a question of if the ball will pop, but when. People go straight to the ground.
And standing desks? Could those help?
Standing desks are also a complete failure. There was a paper out in 2018 that followed 7,300 people for 10 years, half of them in sitting occupations, half standing. Those standing had twice the rate of heart attacks. When you’re upright and walking, your leg muscles are moving rhythmically, squeezing the veins and pumping blood back to your heart. When you stand still, the vessels just dilate in your legs and the blood just sits there. You’re setting up the conditions for a heart attack. You can die like that.
As a general surgeon, I’ve stripped miles of varicose veins out of people who stood in assembly lines in their careers. It’s an ugly operation, and it’s mostly gone. But with this fad for standing desks, I think we may be stripping varicose veins out of people again.
Do you have a big-picture plan for preventing sitting disease?
Schools are a uniquely important environment for what I call “spinal prophylaxis,” or preventing back pain. There are 25 million kids in schools sitting on crappy chairs, but there isn’t really money to replace them all in a reasonable time frame.
So we designed our way out of the problem and came up with the Button chair, a simple design we give away to schools as a digital file. They just take a sheet of plywood and put it on a CNC router, which is a robotic chisel that cuts shapes you tell it to cut. About 200 schools have downloaded our file, which cuts out chair pieces that snap together with a self-locking joint we invented. The tipping mechanism is a used tennis ball.
Schools can have as many active chairs for kids as they might want to make, which is significant because schools will be the last to have the resources they need for active sitting.
This is really important to me. As a surgeon, I could help one person at a time in the operating room, maybe 5,000 or 10,000 over the course of my career. But as an epidemiologist designing a chair I can stuff through the internet, I can touch millions of lives.