It’s no secret that uninterrupted sitting and inactivity have been linked to various negative health risks. The way many companies try to address this problem is by incorporating sit-stand workstations in the office. But are these sit-stand units really the answer? Ergonomic Consultant and Physical Therapist Cindy Powell gives us an in-depth method to determine sit-stand desk compatibility. Cindy provides a great deal of insight about all things ergonomics, client service, and how to succeed as an Ergonomic Consultant. 

Cindy has worked many years in healthcare as a Physical Therapist and Athletic Trainer and became a professional educator before finding her home in the world of ergonomics. She has provided years of both virtual and on-site office and industrial ergonomic assessments, injury prevention, return-to-work job coaching services, and has recommended accommodations to keep employees at work. Her industrial work included food manufacturing facilities, warehouses, distribution centers, laboratories, and dentistry. Cindy is enjoying her greatest passion as the owner of Cascade Ergonomics, helping home and office workers create comfortable workspaces. 

In Conversation with
Cindy Powell, MPT, ATC, STS, CEAS III, AOEAS

1. How did you get into ergonomics?

Cindy: I've been surrounded by colleagues that love ergonomics. A couple of them have had their own businesses, and it really piqued my interest. But what really stood out to me as a physical therapist when I was treating patients with work-related injuries, especially for the office, was that they didn't do as well unless I could get on-site and see what their setup looks like or what their work environment looks like. It’s usually very obvious what the root cause was when I got there, and that made therapy so much easier. They would come in and visit me 8-12 times, and the progress was slow. But the minute I’d get on-site and help them, it would speed everything up. For some people, that would wrap up the treatment. So it’s a great adjunct to any kind of therapy. Some people could’ve just done the ergonomic assessment and skipped the therapy. 

The other thing I noticed was it wasn't enough to try to teach people what to do and take that to their workspace. I tried to do that, and it never succeeded. They didn’t know what to order or where to start looking if they needed equipment. But when I was there, we could figure out the problem and figure out solutions. 

I realized I'm onto something here. How could this be integrated into what I do more? So I jumped at an opportunity and took a job as an Injury Prevention Specialist that included lots of ergonomics like hundreds of assessments in industry, maybe thousands for office ergonomics. And these are for some of the largest companies around the world, so I got to see what’s happening all over which was exciting. 

2. You mentioned that you had your start in PT. Did you talk about ergonomics while you were in school or did you take the initiative to jump into ergonomics when you saw patients coming in with the same concerns regarding their office?

I'm not sure if I learned that word when I was in school, but there were a lot of factors. The American Physical Therapy Association started jumping on basic ergonomics early on, which always piqued my interest. But I remember one of my first clients as a young therapist was a school secretary in her 60s, close to retirement. She sat at one of those desks where you sit below everybody, and you look up all the time over the top of the desk to see the kids as they come up. 

Her monitor was in front of her, but she always had to look up. Plus, she wore bifocal reading glasses that added to all the problems. And here's a lady who didn't exercise much in her life and wasn’t athletic. Her neck was full of arthritis. She had headaches, neck pain, and thickened muscles in her sub occipital muscles from looking up repeatedly all those years. She’d come in for a full prescription of months of physical therapy and then leave and come back another year. It wasn't until we honed in on that that I don't recall her coming back after. So it may not be great for revenue, but it's great for the patient overall.

3. There’s a common misconception that in order for a person to get a sit-stand desk, their PT or general practitioner has to recommend it and kind of bypass the whole employer-employee system. Would you be able to share the system that you use to help those employers decide whether a sit-stand desk would be valuable for their employees? 

Cindy: There are always the two kinds of clients. There's the personal client that just wants to know if they should get their own sit-stand desk. They're usually self-employed, or they work from home. The other is the employees who work for companies and want their company to get them a sit-stand desk. They either have pain, or somebody else got one, and they want one too.

So there's a way to go through this to protect employers and decide who is this going to be good for and who is this not going to be a worthy investment for, regardless of whether or not they bring in a doctor's note. This is what you’re going to do:

1. Is there any health issue at stake?

Find out if they have moderate to severe discomfort. If they don't, then the employer doesn’t have to invest in that equipment for them.

2. How long have they had this issue?

Did the issue start two weeks ago and requested to have one because of a sudden onset of back pain or something? Or has it gone on for three to six months fairly consistently?

3. Is there anything documented that a sit-stand desk does help their pain?

Some employees think that a sit-stand desk will help but might find that standing longer increases their pain. So find out if there’s anything that indicates that long periods of standing (15-20 minutes) helped their pain.

4. Do they have a quality chair?

There's no sense in buying an adjustable sit-stand desk if someone doesn't have a properly fitting ergonomic chair to begin with. The truth is they’re going to sit for 50% to 80% of the day regardless of having a sit-stand desk. They’re going to realize that standing over 15 to 30 mins at a time can be very uncomfortable for most people without any major medical problem.

5. Have they ever had an ergonomic assessment?

See if their workstation is set up in a way that promotes good posture and health. This is important because again, why put all the money into a sit-stand desk if you haven’t checked off all the boxes in any one of the items in it? It would only cause a lot of discomfort.

There are also a few areas where we kind of wrestled with employees a little bit:

1. Have them commit to a proper regimen of taking frequent movement and standing breaks.

It usually takes about 4-6 weeks to develop a strong habit. It could be like every 20 to 30 minutes, you stand up and stretch, walk, or go to the drinking fountain. Once they’ve shown that commitment of 4-6 weeks of movement, then they’re more likely to be educated and committed to using a standing desk properly if they get one. 

Any kind of large dynamic movement is always better for comfort and health. If you like to sit for long blocks of time, by the end of the day, you're going to hurt, and no piece of ergonomic equipment is going to stop that. So there's a big education piece there. 

2. Implement other movement strategies.

Do they try to stand if they're on the phone? Can they have stretchy bands or a ball in their office that can break up the static sitting? It’s important to teach that to them because neither static sitting nor static standing for a prolonged period is ideal in itself. It's really the dynamic movements, the change in posture, and the contraction of muscles that help the most with comfort and with health. 

4. After seeing an opportunity for ergonomics, how did you transition into more ergonomics work?

Cindy: I went to work for a company where I did injury prevention and ergonomics. The biggest thing was to start with little projects that can grow into bigger and bigger projects over time. The other thing was developing relationships. It took about six months for people at sites to get used to me being there and understand who I was. We had to start small and then just worked out from there. I started with simple ergonomic assessments where you learn to develop what they call the “ergonomic eye”. So I learned to see risks when I walked by instead of missing them. And then started with risk assessments beginning with different types of recommendations. Let’s say behavioral controls, then management controls, and then moving on to engineering control.

Even starting with small equipment like safety steps, folding tables, and tools. But in the end, I had recommended a $125,000 piece of equipment—a lifter and dumping device. I was walking through the plant one day and the company had one they were trialing. It’s so popular that within a short time, they had two of them. It's so exciting to see that happen. So it's quite a process to develop that trust, to start small and get some small wins. 

5. How has the industry shifted during your career so far?

As I was coming in, these shifts were already happening rapidly. The awareness of the cost of a work injury is rising continually. The fact that musculoskeletal disorders are not going away, and that fatigue is still the number one cause of musculoskeletal disorders out there. OSHA is continuing to become more involved, which gives workers a little more empowerment and safety net than they had before. But there's a lot more recording that has to happen with the companies.

You really need to be on top of the OSHA rules  and regulations. That's why they say that just being a PT, OT, or massage therapist isn’t enough for ergonomics, especially industrial ergonomics. You need to be careful with your documentation because there's things you can do and can't do, and you have to know the difference. You have to know what makes something a recordable injury versus a non-recordable. OSHA's involvement is getting bigger, which I think is a real good thing, especially for us. That steers safety professionals in the companies more towards injury prevention and ergonomics programs for people like us because their jobs are getting bigger and bigger, and they need to rely more on experts in our field to help them do their job. 

And then for office workers, we talked about that big shift and that wavering of am I going to the office? Am I going to stay home? They're kind of stuck in limbo right now.

6. What can you recommend to new graduates and other healthcare professionals looking to dive more into ergonomics?

I’d say all these on a really positive note, but ergonomics is so much more than it would ever seem. And that's a good thing because there's so much great stuff to learn, and it's learnable. You just really have to be very self-motivated, especially if you're not a Board Certified Ergonomist. It's important that you learn and absorb as much as possible. You've got to stay in compliance with OSHA and to understand what the safety professionals have to do and have to meet. 

The other thing is embracing technology is not an option. Most ergonomic assessments in the office are going to be virtual because it cuts out all that travel time. You're going to have all kinds of measurement tools, artificial intelligence, special vision goggles, exoskeletons, wearable sensors. Just recommending a chair for somebody is not as simple as just a chair with certain features. You've got to know brands, price ranges, and make sure these odd size bodies can fit into these chairs that weren’t geared for that. Really love testing everything and learning as much as you possibly can. I think that's one of the areas that healthcare providers really need to work on.

The most time-consuming part for me is learning and helping clients source equipment because many of them don't even know where to begin. They’d rather just pay you the money, and say, “Tell me what to get and where to get it.” And when you're spending other people's money and you can't really afford to make mistakes. So that's the biggest challenge, but it's also the most fun piece. It's about relationship building. You want people to know you have the solution. That they can trust you and come to you.

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And there you have it! If you have additional questions for Cindy, you can connect with her on LinkedIn.

To learn how I'm helping Ergonomics Consultants grow and scale their businesses, sign up to the waitlist. You can get early access to the training series that I'll be doing before the opening of the enrollment at the end of September 2021!