by Anne Nugent Guignon, RDH, MPH
One year ago, I flew to Denver to visit Crown Seating. I've had the opportunity to visit many factories that make products we use or recommend. It is so rewarding to see how much effort goes into making excellent products. Even more fascinating is to see how much pride people take in making these products. While I was anxious to learn more about seating, I was certainly not prepared for how the trip would change my views about our clinical chairs. The trip turned my thoughts on clinical seating upside down.
For more than a decade, I have encouraged clinicians to consider healthy seating through the use of chairs with arms, a height adjustable seat and lumbar support, a seat pan designed with a pitch that can be changed without effort, and a sloping waterfall front edge to reduce leg impingement.1-4
Spine specialists have always encouraged people to sit with their hips a few inches higher than their knees to maintain a favorable body posture in the lower spine. I taught these concepts and followed these principles in my own clinical practice as well as my home office.
While I knew that a chair with this type of design worked well for many and produced significant relief for those who transitioned from a backless marshmallow-on-a-stick design, less traditional designs were developing some hard-core fans. English saddle and western saddle chairs and ball chairs looked strange, but seemed to provide a healthier workstation for the users,5 especially those who were very petite.
I had a good working knowledge of healthy seating options when I arrived in Denver. However, Steve Knight, president of Crown Seating, made sure I understood every facet of the science of healthy seating – all of the research and the history of seating in the dental office. After spending an entire day absorbing data in a lively repartee, my brain could not absorb another tidbit of information.
Two weeks later, I started using a modified English saddle in my home office. It is made with memory foam and covered with a special antimicrobial fabric. Using a saddle requires one to adopt a sit/stand position.6-8 It felt unnatural for the first couple of weeks, not unlike getting used to wearing magnification loupes. Gradually, the soreness in my sitting bones diminished, and my body started appreciating this new support system.
Saddles require one to sit taller and use core muscles to maintain an erect posture. It is nearly impossible to slump when using a saddle in a sit/stand position. Saddles are much smaller than most traditional clinician stools; therefore, they can be used in small, confined spaces, and the mere design of the seat pan does not allow one to perch on the edge of the chair.5-8
The lack of seat pan bulk and adjustable pitch prevent dangerous leg impingement,4,5 allowing clinicians to come in closer or sit higher9 – all-important factors when treating today's patients that are getting progressively more obese.
These nontraditional stools also perform well for those forced to work in a room furnished with a patient chair the size of a huge lounge chair or one that won't go low enough to the ground. Using a saddle is much more like standing than sitting,10 so these designs lend themselves to working with patients who can't or won't recline.
In addition to strengthening one's core muscles, sit/stand seating allows one to breathe deeper as well as maintain a healthier lumbar posture.2-4 A sit/stand posture keeps one's upper extremities close to the torso to maintain a neutral body posture. When the height of a saddle chair is adjusted correctly, the forearms will be parallel to the floor.
Saddle stools are nimble and move around a traditional patient chair easily. The sit/stand position allows clinicians to reposition the stool by using the strong muscles of the thighs, rather than the weaker ankle/calf portion of the skeletal system. Research has demonstrated that standing burns more calories than more passive traditional sitting, an unexpected side benefit for most of us.11,12
I started this transition a year ago and now use saddle seating in my home office, during clinical appointments, and have even used my saddle in the kitchen when faced with long culinary tasks. My sister, who had major back surgery during the holidays, uses the saddle in her home office. This unique form of seating has benefitted not only my sister but also hundreds of other dental professionals willing to try something a bit different.
It may seem strange to mention one manufacturer specifically, but through the years I've met only a handful of people who really get just how hard dental hygiene practice is and the enormous potential there is to sustain a workplace-related injury that can end our careers. Steve Knight understands it. He spent years as a professional race car driver and knows full well that quality, customized equipment can prevent serious, if not fatal, injuries. Racecar drivers are injured within a split second. Dental professionals develop injuries over decades, much like watching a movie in slow motion.
How nice it is to have an ally on our side willing to invest the time and dollars to make quality equipment for healthy seating options that will protect our careers for a lifetime and help us create our own contemporary comfort zone.
Anne Nugent Guignon, RDH, MPH, provides popular programs, including topics on biofilms, 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.
1. Rempel DM, Wang PC, Janowitz I, Harrison RJ, Yu F, Ritz BR.A randomized controlled trial evaluating the effects of new task chairs on shoulder and neck pain among sewing machine operators: the Los Angeles garment study. Spine (Phila Pa 1976). 2007 Apr 20;32(9):931-8.
2. Makhsous M, Lin F, Hendrix RW, Hepler M, Zhang LQ. Sitting with adjustable ischial and back supports: biomechanical changes. Spine (Phila Pa 1976). 2003 Jun 1;28(11):1113-21; discussion 1121-2.
3. Corlett EN. Ergonomics and sitting at work. Work. 2009;34(2):235-8.
4. Naqvi SA. Study of forward sloping seats for VDT workstations. J Hum Ergol (Tokyo). 1994 Jun;23(1):41-9.
5. Gandavadi A, Ramsay JR, Burke FJ. Assessment of dental student posture in two seating conditions using RULA methodology – a pilot study. Br Dent J. 2007 Nov 24;203(10):601-5.
6. Mandal AC. Balanced sitting posture on forward sloping seat. Accessed at www.acmandal.com on February 8, 2010.
7. Pope MH, Goh KL, Magnusson ML. Spine ergonomics. Annu Rev Biomed Eng. 2002;4:49-68. Epub 2002 Mar 22.
8. Tiedeman J. New concepts in seating. Accessed at www.scif.com/pdf/sftySeatingConcepts.pdf on February 7, 2010.
9. Bendix T, Jessen FB, Winkel J. An evaluation of a tiltable office chair with respect to seat height, backrest position and task. Eur J Appl Physiol Occup Physiol. 1986;55(1):30-6.
10. Husemann B, Von Mach CY, Borsotto D, Zepf KI, Scharnbacher J. Comparisons of musculoskeletal complaints and data entry between a sitting and a sit-stand workstation paradigm. Hum Factors. 2009 Jun;51(3):310-20.
11. Beers EA, Roemmich JN, Epstein LH, Horvath PJ. Increasing passive energy expenditure during clerical work. Eur J Appl Physiol. 2008 Jun;103(3):353-60. Epub 2008 Mar 20.
12. Levine JA, Miller JM. The energy expenditure of using a "walk-and-work" desk for office workers with obesity. Br J Sports Med. 2007 Sep;41(9):558-61. Epub 2007 May 15.
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