Anne Guignon 1207rdh


July 1, 2012
A lot of work and study has gone into the science behind using a sit/stand position for tasks that require an upright posture or forward movement.


A lot of work and study has gone into the science behind using a sit/stand position for tasks that require an upright posture or forward movement. Clinical dentistry can benefit from using safer seating postures.

Word is getting out that saddle seating is a healthy option for the workplace. Actually not just saddle, but any seating option that allows the user to maintain an S-curve in the lumbar region. Sitting in a traditional seat with the thighs parallel to the floor flattens the lumbar spine, creating undue stress on the entire musculoskeletal system.

In addition to contributing to back strain, traditional seats have deeper, bulkier seat pans. This size of the seat pan can distance the clinician from the actual workspace -- the patient's mouth. Unless one has really long legs, many people rarely use a chair's lumbar support and instead perch on the edge of the chair.

The two most popular sit/stand seating options are an exercise ball or a saddle stool. Each one creates an active working posture with the user sitting in a balanced, tripod configuration with the feet flat on the floor. Properly adjusted, sit/stand positioning benefits include sitting up higher, erect posture, deeper breathing, more stable reach, improved leg circulation, and a balanced pelvic position. The user's core and thighs get a workout as they move from one location to another.

More people are now using a ball as an office chair. Some balls come with a square plastic support cradle, outfitted with four casters and plastic risers to increase the ball height for those with long legs. The size or firmness of the ball can be adjusted by adding or letting out compressed air. Basically the height of the ball chair remains static, which is fine for working at a desk, but less than ideal if clinicians with different physical proportions use the same ball during the busy clinical day. In addition, the size of the patient, as well as the ability to adjust the relative height of the patient chair, can mean changing the height for a sit/stand position. While testing the ball at a recent dental meeting, I was unable to achieve enough height to gain a comfortable sit/stand position. This problem is eliminated when using a saddle with an adjustable lift that is correctly sized for the user.

The seats on both Western and modified English saddle designs are very small compared to traditional chairs and typically don't have armrests. Also, most saddles do not have lumbar supports because the natural curve of the lower back is not compromised. Less bulk means clinicians can move in closer to the patient, a big plus when treating large patients or working with a patient chair built like a doublewide recliner. The smaller size also fits better in cramped treatment rooms. Petite clinicians love being able to reach higher, especially when the patient chair will only go so low.

The seat configuration of a modified English saddle is quite different than a Western design. Most people prefer a modified English configuration, which looks somewhat like a warped Frisbee on a downhill trajectory. The seat is a wide oval, with a mild rise in the middle, a design that allows the user to maintain a wide stance. Western saddles are narrower and have a prominent hump in the middle, a design that works well for those that have a narrow pelvis and are uncomfortable adopting a wide leg stance.

To get the most out of using a saddle, it is important to understand that sit/stand positioning is not the same as traditional seating. Just like getting on a horse, it is a good idea to hold on to the front of the saddle and mount it from behind or slightly from the side, a method that keeps the clinician in control of the seating process. It is important to position your backside far enough back on the seat so the front edge of the saddle is visible. Those with generous assets in the posterior need not worry about overhang from the back of the seat. Backing onto a saddle seat, such as with a traditional chair, increases the risk of landing on the floor rather than sitting safely on the saddle.

Once on the saddle, the seat height can be adjusted so you are standing with legs apart, feet on the floor, and buttocks resting on the saddle. Saddle seating opens up the angle of the thigh to the trunk. Aim for a 60- to 70-degree angle, as compared to the 90-degree angle of traditional seating. Sitting on a saddle is like standing with a slight squat with the hips higher than the knees, thighs in a downward slope, legs spread apart, and feet pointed at a slight outward angle consistent with the position of one's legs. If the saddle seems too high, lower the height. As your spine becomes accustomed to a sit/stand position, it is not uncommon to raise the overall height of the saddle.

Seat pitch is the final adjustment. Sit/stand positioning rotates the pelvis forward. There is a quick test to see if the seat angle is correct. Properly adjusted, one should be able to pick up both feet off the floor at the same time and feel balanced. If not, sit on the stool with feet flat on the floor, and loosen the knob or raise the lever that controls the seat pitch and adjust the angle slightly. Users typically find the saddle's sweet spot by making a minor adjustment that creates the perfect seating posture.

Users may initially notice some soreness. Sit/stand positioning requires the body to use different muscles and bones than traditional seating. Just like learning to use loupes, it's important to gradually introduce your body to these postural changes. Get up and move around. Swap out seating systems. Stretch. Learning to use a saddle is not hard, but it is different.

Clinicians who have adopted a sit/stand seating posture report less fatigue, better posture, and a significant reduction in back and shoulder pain. Healthy postures translate into happier, more fulfilling careers. It makes sense to adopt healthy seating as a cornerstone of your personal comfort zone. RDH

ANNE NUGENT GUIGNON, RDH, MPH, provides popular programs, including topics on biof lms, power driven scaling, ergonomics, hypersensitivity, and remineralization. Recipient of the 2004 Mentor of the Year Award and the 2009 ADHA Irene Newman Award, Anne has practiced clinical dental hygiene in Houston since 1971.ANNE NUGENT GUIGNON
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