Hey, I'm hyper mobile and if you're listening to this, I'm
guessing that you might be too. Hi, my name is Alex and I'm your
hyper mobile host. And today we are talking all
about hyper mobility and the workplace.
Now in my work as a UK registered osteopath, this is
something which comes up a lot in my management of patients.
A lot of my patients have to be able to work or they are able to
work and they're continuing to do that right now.
And because work takes up so much of someone's time, it's
something that I consider to be high yield.
So this means when I look at my patient, I'm thinking okay like
what are they doing when they're not in their appointment with
me, What do I need to help their body be able to do perhaps or
how might they be injuring themselves knowingly or
unknowingly when they're not in the clinic room?
So work is a very important thing in my management of
patients, and something which comes up very often is the idea
of ergonomics. So I'm sure you have all heard
of the term ergonomics. It comes from ergo, ergo meaning
work and nomics meaning science of and it's the science of how
humans relate to their workplace.
And there are different types of ergonomics.
There's physical ergonomics, how your body relates to your
workplace. There's organizational
ergonomics. I believe there's psychological
ergonomics as well. There are all of these different
types of ways that a human can relate to their workplace, but
for the purposes of today's episode, we're just going to be
focusing on physical ergonomics. Now, ergonomics has had kind of
a renaissance in the the last 150 or so years.
It wasn't really a thing until the late 1800s, but it first
appeared actually in the 5th century BCE when someone named
Hippocrates. He's pretty famous.
You might have heard of him. He described A surgeon's office
setup. So they had surgeons back in
ancient Greece because they had a lot of things back then.
And he said, you know, the surgeon needs to have these
tools and in this position and organized this way so they can
do their work most effectively. And that's kind of a good
summary of ergonomics. It's like we need to have this
stuff set up like this to help with the work outcome.
However, there's a deep conflict at the heart of ergonomics.
And this conflict started to appear when ergonomics, after
centuries have been not really a thing, came back into the public
consciousness. So it was actually.
So it was actually someone named Frederick Taylor in the 19th
century who who made famous the idea of the scientific
management method. And the idea of the scientific
management method came from Taylor's studies of people who
shoveled coal. So he was looking at these these
workers and saying, how can we get them to be more efficient at
their work? His main concern was the work
output, the end result. So he said if we get a longer
shovel handle does that help? If we make the size of the
shovel smaller, does that help if we I don't make the shovel
like sharper or something? He was looking at how he could
try to optimize that workers tool to improve their work
outcome without any regard for the the worker by the way, other
than how fast they were able to do that task.
He was then followed by two Russian researchers, 2
Vladimir's of Vladimir Bektorev and Vladimir Mia Sisychev.
I think I got that kind of right and their aim.
Unlike Taylor who only cared very clearly about the
efficiency of the work being done, their aim was to have
efficiency coupled with a minimum of health hazards,
absence of fatigue and a guarantee of the sound health
and all round personal development of the working
people. So these two researchers, they
basically rejected Taylor's proposal to turn man into a
machine. And unfortunately, based on what
I hear from my patients and some of my own experience in
different workplaces, I think that probably most businesses
today, they have kind of sided more with Taylor.
I think there's a lot of prioritizing of the work
outcomes instead of, you know, really truly caring about the
health of the employee. However, obviously every company
is different. There's a lot of variability in
this field. Some people have companies they
absolutely praise and other people have companies that they
do the opposite of in that regard.
So when it comes to ergonomics itself, the way that it most
often comes up in in my work is patients will tell me, you know,
oh, I've I've had an ergonomics checkup, I've had the, I have
the special chair and I have this like special mouse that I'm
supposed to use. And all these things, they're
not really helping. And the reason I think that's
the case is because a lot of the science which ergonomics is
based off, if not all of the science, is based on people with
normal connective tissue or it's not taking into account people
with hypermobile connective tissue.
So we have information on interventions, which we have
evidence helps, helps people in general, helps people with
normal connective tissue because that is the average person.
But if we have a hypermobile person, they may not and are
often not helped by those interventions.
So that lumbar support cushion doesn't help.
That I don't know that standing desk doesn't help at all, makes
things worse sitting upright with that perfect posture after
being taught how to do it, that injures them.
So hyper mobile people are in a bit of a bind because even when
they reach out to their workplace and they say like, hey
I, you know, I'm feeling really uncomfortable work, I'm
struggling with neck pain or back pain or whatever, can you
help me? Their work, the, the offers that
are being proposed by the workplace are often not suitable
for these individuals. Today I'm going to share how I
support patients in managing life as an employee, you know,
and trying to get through that just work essentially.
But before I get into that, there's kind of a choice that
everyone has to make. And that choice is, do you feel
confident talking to your workplace about accommodations?
Or are you someone who wishes perhaps to just try and improve
things as much as possible and in a way that's discreet and
that keeps your, you know, all your health issues private to
you? And again, that choice is really
personal. I encourage everyone to think
about their workplace and some of the expectations and some of
the stigma perhaps, and how that might affect them.
In a perfect world we would all be able to talk to all of our
workplaces about our needs and support interventions, but
that's not the reality. So as always, as I like to say
on here you do you think about what you want to do before you
do it. And ideally, of course, do it
with a qualified healthcare provider.
Because as always, this episode is not in any way shape or form
medical advice. It is for informational purposes
only. OK, So when it comes to hyper
mobility in the workplace, the single biggest source of harm in
my opinion is the the setting situation.
So a lot of people are told or are pressured to do this.
They're they're pressured to sit in a normal upright seated
position. So feet on the floor, you know,
knees at 90 degrees, hips at 90 degrees, back, straight elbows
supported that type of typing position.
And we're talking here of course about workers in sedentary desk
based jobs. I'll talk about work that
requires long periods of standing in a little bit.
OK. But that position injures hyper
mobile people, their connective tissue and again, that's the
stuff. Think of it like the glue in
your body that holds everything together.
It's not as sturdy and the amount of energy and effort
required to maintain that upright position often doesn't
work for them. So what I recommend people do is
try and change positions as much as they possibly can.
So every 20 minutes or every half hour, literally just
cycling through positions and saying, OK, I'm going to sit in
that upright posture and then I'm going to cross one leg,
cross the other, Maybe I'm going to stand at my desk for a bit,
maybe I'm going to sit in a different chair.
Cycling through I find is the best way to help people avoid
injury. And the analogy that I use for
this is imagine if you had a pancake in a hot pan and you
were trying to avoid burning it. If you couldn't take it out of
the pan, what you would do is just keep flipping it.
So that's what we're doing here. We're trying to avoid having
that person have essentially what would be classified almost
as like a repetitive strain injury.
They're spending too much time, whatever too much might be in
that one position and being hurt.
So what I encourage patients to do is just be changing
constantly. Now this becomes a bit of a
problem, of course, in open plan offices.
So I've have had patients who work in high profile kind of
professional careers and they tell me, look, I can't be
sitting weirdly at my desk because I'll get judged for
that. And in that case, of course we
have to take a different strategy.
But if you can change position, if you have a chair that allows
you to do so, I used to, I used to do that to my chair.
For example, I take the armrest off.
Back when I was working in a more desk base job, I would
change the height of the chair up and down all the time just to
try and like vary the position I was in.
If you can change the position you're sitting in, that will
help and I will also try to remember to link in the show
notes some research about why sitting upright isn't as good
for you as you might think it is.
I think it's this like yet another way we kind of punish
ourselves by not being good enough is saying, oh if only I
was more perfect, if only I could just sit in that perfectly
upright position, then I wouldn't have pain.
And it's it's a really seductive and compelling idea even from
from a business perspective. If if we think of Healthcare is
a business, because a lot of it is in many ways.
If we think of the idea of like telling the patient, oh you're
not good enough. If if you're if you work harder,
if you sit upright better, then you won't be in pain.
It's a way that we shift blame to the patient and say it's your
fault. So I have a lot of thoughts on
posture. But in summary, just just change
positions. If you can do it somehow some
way. Change position, different
chair, different positions, standing, sitting, do as much as
you can there. Now of course you can also
certainly find ways to affect the way that your feet relate to
the ground. Some people find stools helpful,
Some people like to have their legs dangling a bit.
I have patients who hate when I have the treatment table so low
that their feet are touching the floor.
So be aware that again, what you are told is perfect, might not,
and in fact probably isn't going to be perfect for you.
Additionally, some patients find it helpful to find time to have
positions of what I call true rest.
So again, hypermobile people, their tissues are loaded
differently in different postures than a person with
normal connective tissue has their tissues loaded.
And a big issue I see at workplaces is neck pain, chronic
neck pain. And my patients will describe it
as like it feels almost like their arms are like just ripping
the tissue between their neck and their shoulder.
It's a really intense pain. It often goes into a headache
and I like to use this like, hand gesture.
I'll do this in clinic. I say like, is your headache
like this? And it kind of, it's like a claw
coming out of the inside of your head.
So it's affecting your eyes, your teeth, your neck.
And that happens because of the nerves and their relationship to
the neck and the shoulder. But anyways, finding a way to
have what's called true rest is very beneficial and it just
means unloading those structures.
So instead of having the arms hanging down too far,
unsupported, and even if they're supported for a normal person,
remember they might not be supported for a hyper mobile
body. What I recommend patients do is
that they get cushions and try and elevate their armrest so
they're up almost like this, like I'm showing it.
If you're watching the video version, hi, you can see me
here. But having those arms really
elevated takes tension off the neural tissue that runs between
the shoulder and the neck. Additionally, it depends on your
workplace, but some patients find it helpful to roll a towel,
wrap that around their neck, and use it just to lift through the
side of their neck. And again, that's just, that's
giving that person's body a way just to be truly at rest.
Because if you're a hyper mobile person listening to this, you're
going to know that getting injured from sitting or lying
down or all these things that are supposed to be restful is
normal for hyper mobile people. So we have to be very strategic
there. Additionally, a lot of people
find it helpful to think differently in terms of mice.
So obviously a lot of work like setups require people to have a
mouse. And the common recommendation
when the mouse results or contributes potentially to
something like a carpal tunnel syndrome or wrist pain is to
give the person this. Like I call it a Penguin mouse.
I don't know what it's called, it's like an upright joystick
mouse thingy. Anyways, what I find works
better and what I use with my patients is actually an
animation tablet. So you can get tablets, I don't
mean like iPad style tablet, I mean an animation tablet.
It's a very different thing. But you can get these tablets
from a company like Wacom, for example, and they don't have to
be expensive, Like don't get the expensive one unless if you're
an animator, okay. But you literally have like a
little pen, a little stylus, and you just tap on it depending on
where you want the cursor to go. And they are incredibly
lightweight. And because they don't require
the same pressure as writing, it's not painful in the way that
writing is for some people. And it's an intervention which I
think can make a big difference and certainly it's an option
worth having. So I've had patients with very
complex wrist injuries who ended up ultimately using a
combination of that like joystick Penguin, mouse thing
and the animation tablet and they found that really
effective. So again, if you see a theme
here, it's thinking outside the box as well-being aware that you
might be more sensitive to temperature changes because a
lot of hyper mobile people have issues with with something
called thermal regulation. So making sure that you have a
blanket at your desk or that you have layers that you can take
off perhaps. But being aware that you are
going to want a very narrow temperature range and that it's
unlikely that your office is going to be able to get that
perfect for you potentially and just having a strategy in place
to deal with that can make a big difference.
Now of course you have to think of the human themselves and then
I don't know if this counts as ergonomics because ergonomics is
the person relating to the environment.
But when it comes just to getting through the work day,
it's very important to think of things like hydration.
So a lot of people find having a little bit of salt with their
water beneficial. Again, there will be some
patients that this is not safe for, so speak with your medical
doctor before making any changes please.
But if you're someone like me who grew up during the low salt,
low fat era, hi, it can be helpful to try adding in a
little bit of salt with your water.
So maybe having some cucumber slices with salt sprinkled on
them, or a few salt and vinegar crisps or just something to get
your salt intake up a little bit.
Put salt on your food if you want, or have an electrolyte
tablet or such such it or whatever.
The reason that this works is because, as my grade 11 biology
teacher like to always say, water follows salt.
So when you drink water, in order for it to be absorbed
through your kidneys, you need to have enough salt in your body
to make that chemical process happen.
So water follows salt. And if you're someone and you
feel like you're just drinking like liters of water and then
you're going to the bathroom and it's clear.
And that that was me growing up, by the way.
Think of upping your salt intake because it might make a big
difference. And when it comes to upping salt
intake and we'll do a whole episode on this one day because
I have a lot of thoughts on it, but I like to think of dynamic
dosing. So for me, I have like a base
level of salt that I'm making sure I get every day as a
supplement, but if it's hot I'll take a bit extra and if I've
worked out that day, I'll take a bit extra.
So I have, I'm able to adjust my dose depending on what I've
asked my body to do that day, which makes a lot of sense as
well thinking in terms of nutritional intake.
So I was literally just talking about this with a patient last
night and they were saying that they felt like they're a little
bit differently, that they're a little bit sensitive when it
comes to caloric intake. And if they go too long without
eating, they feel like they start to crash and they think
that they have maybe like a a blood sugar issue.
But everything's come back normal.
And one thing that I find seems to help a lot of hypermobile
individuals is just trying to really regulate what you're
taking in and when. So making sure that you're
eating at regular intervals and maybe even having smaller meals
more often. That is something that research
does seem to suggest improves quality of life for hyper mobile
people, partly due to potential digestion issues and so on.
But making sure that you're eating off, that you're getting
enough calories in is key. And in all honesty, the single
biggest issue I see in my patients are people who are not
getting enough calories in or they're waking up, they're
feeling a bit poorly and then they're not eating until late at
night where they're having a big meal and they're having that
kind of irregularity in caloric intake.
So trying to find a snack that you can just like have
throughout the day that's healthy and that's kind to your
body might be yet another way that you can make a difference.
And of course, again, this isn't going to be a groundbreaking
tip, but blue light blocking glasses, hyper mob people often
have eye issues. They're sometimes a little bit
sensitive. So having blue light blocking
glasses can make a big difference.
If you've never tried them, I recommend you try them.
They're not that expensive. You can get a pair online and I
swear by them and a lot of my patients were by them, so
definitely give those a try. Now I hope that I've given you
at least a a few ideas in terms of things you can do at the the
workplace if you're a sedentary worker that are pretty discreet.
I'm now going to talk briefly about workers who have to stand
because I once waitressed for about 3 weeks and it was very,
very hard. So standing up for long periods
of time is really challenging for hyper mobile people.
And long doesn't mean like 8 hours.
Like long for me means like half an hour or an hour.
And this is for a variety of reasons.
So a lot of hyper mobile people have issues with blood pressure
regulation. And what I mean by this is that
when they go from sitting or lying down to standing, their
body struggles to accommodate that change in posture to
regulate their blood pressure. And some people will have a form
of orthostatic intolerance that's classified as POTS,
postural orthostatic tachycardia syndrome.
It's a very specific thing with a specific set of diagnostic
criteria. But other people will have
orthostatic hypotension, which seems to be a lot more common.
Based on my clinical work and this type of sensitivity to
blood pressure dysregulation is common in the hypermobile world,
I would say that the majority of my patients seem to have a
slightly abnormal blood pressure.
And I think a big problem again that hypermobile people run into
is that we privilege low blood pressures.
Growing up, I was someone who always had 90 / 60 blood
pressure. I felt cold all the time.
I felt I had it. I didn't feel great, but every
time I saw my family doctor, they were like, wow, your blood
pressure is so low. You must be in such good health.
No, low blood pressure does not make you feel good and 90 / 60
is really the cutoff they use. So again, a lot of people are at
that kind of cutoff line when you stand for long periods of
time. If you're someone who's hyper
mobile and if it affects your cardiovascular system, which
again it doesn't affect everyone in the same way.
So please speak with your qualified and trusted healthcare
provider. But we run into issues with
things, for example, like blood pooling.
So feeling like your legs are really, really heavy, Feeling
like they're swollen even if they aren't visibly swollen or
feeling like they're in pain is common for a lot of hyper mobile
people. And the way to relieve this is
to lie down or to be able to sit at least.
But if you're doing a job like serving at a restaurant, that's
not an option for you. So in that situation, my advice
is if it's possible. Honestly, I found working in
retail so much easier. If you can find a nice boss who
will let you sit down if you work in the restaurant industry,
like speaking with your boss and seeing if you can perch on a bar
stool if there's time in between that type of work.
I was out for dinner the other night and the server took a seat
to take our orders and I I don't mind that I'm the type of
customer. Like I told her, I said I'm so
happy you're taking a seat because I know how uncomfortable
my feet were when I was working as a server.
So sit as long as you like. I know she had work to do, but I
was happy to have her sitting down to take our order.
So my hope is that the industry itself will change over time.
However, I'm very aware that working in restaurants is hugely
high pressure and that there are certain demands and that people
have to stand. So you have to stand.
Here's how you do it. Tip #1 compression socks can
make a big difference. I held off on wearing them for a
long time. They're not the cutest, they're
not the most comfortable, but they really make a difference.
So if you're someone who's standing for long periods of
time, I strongly recommend that you get a pair.
There are all different types. I think the best entry point is
looking at like a sports pair. So I bought a pair from a
company that make them for cyclists and I found those who
work really well for me. I wear them at clinic if you
might see me in them if you see me at clinic.
Additionally thinking of the type of surface you're standing
on. So a lot of hyper mobile people
end up being prescribed hard orthotics and although like the
concept in theory is correct, the execution is deeply
problematic. I cannot tell you how many
people I've had to tell to throw out £500 orthotics and it makes
me very sad to have to do that because I know they've spent
money on them from some other healthcare provider.
But they end up injuring patients and they injure hyper
mobile people because the hard orthotic literally presses into
and compresses the bottom of the foot and what it seems like
hyper mobile people really benefit from in in addition to
some mild support. Not not a big correction, but
like a mild correction, they benefit from a soft standing on
a soft surface, like a soft kind of springy surface.
So I think that we need to perhaps think more carefully
when it comes to orthotics in the materials that were being
that we're using to make them or the maybe putting an insole on
top, maybe something that's like a memory foam or something.
But it's, I compare it to someone punching the bottom of
your foot. It's why a lot of hypermobile
people can't wear Birkenstocks, because the hard bottom of the
shoe injures the bottom of their foot.
So thinking of what you're wearing when you stand, if
you're someone who's in a job where you have to stand, can
help as well, trying to walk as much as possible.
So the thing I hear over and over again when I make content
about standing on my social media accounts is I can walk for
hours, but I can't stand for more than 20 minutes.
And I'm like, yes, I understand you and I think that's because
when you're walking your calf pump mechanism, so that's
basically a structure in the back of the calf which helps
with the return of blood and lymphatic fluid from your leg
and your feet up all the way back to your your heart and your
head. But that mechanism works through
dorsiflexion and that's a term that describes the movement if
you're walking of your knee going over your toes.
So it's like if you're sitting down, it's if you point your
toes up toward your head, and if you're walking, you're making
sure that that fluid is getting kind of pushed back up.
But when you're standing, it's just pulling.
So if you can find ways to kind of put a walk in or be that
person to say like, hey, I'll I'll do that walk or whatever,
that might help as well. Now finally, I do want to say
there is a place for mobility aids and braces and there are
people who need them and there are a lot of people who need
them, who are unable to access them or who feel embarrassed or
stigmatized. And firstly, I want to tell
you're not alone. I have so many patients who feel
very selfconscious, especially because often in hyper mobile
people they will need them one day and not need them the next
because it can be in some instances A dynamic disability
and an invisible disability. So firstly, if you feel
selfconscious, you're not alone. And I, there are a lot of great
disability advocates and other creators out there who can speak
better on this than I can. But we my hope is that in the
future we'll have a world where people are supported and just
doing what they need to do for their bodies, because there's
nothing wrong with that. But in terms of mobility aids,
of course, talking to Rickley's being like I might need this and
having a healthcare provider even maybe support you in that.
So I wrote a letter for a patient recently and I was
worried. I was a bit strong in town, but
I said this patient needs this and This is why.
And they need this, this and this.
And some days they need this and other days they won't need this.
And this is how it is. And I sent it to the patient and
because I I wanted her opinion on the letter before I finalized
it. And she was like, no that like
that. All that all seems correct based
on, that's all correct based on my experience.
Thank you for mentioning all that.
And then she submitted the letter to the department that
she was submitting it to. And apparently they found the
clarity in my letter really helpful.
So if you're clinician listening to this, don't be shy to be
clear in letters when it comes to patients disability needs and
making sure that you're explaining to that workplace or
that school or whatever. This is exactly how things are.
And this is exactly what this person needs.
And this is exactly how you can support them because a lot of HR
departments, they don't even know when HEDS or HSDR.
So giving that clear support can really help people in accessing
what they need as well. We can think in terms of things
that I call like minimal bracing.
So there's a device called the body braid.
I have no financial relationship with them.
I bought one with my own money. I think it's pretty good.
But there are little braces and supports that people wear that
can sometimes help just support their tissue in terms of how
they're having to position their body at work.
And that's something which I do think people should certainly
look into. And we'll have to talk more
about that next time. Thank you so much for joining me
for today's episode. I hope that you've learned
something new. I hope that you've learned
something interesting. And hey, maybe you've learned
something that you're going to try out at your workplace or
your school or whatever. If you have any questions,
please do feel free to write in. And I look forward to seeing you
all or having you join me next time, whether that be listening
to me maybe through one of your apps or watching me on YouTube
because we now have video. Take care.
Bye.