Some shots from the past.

WORK-CHAIRS, a new breed with a reclined mode.

As predicted ,  back in 1998, this is begining to emerge.  We see a number of ‘work-station’ type models which include a reclined work mode and so are superior to the present (2016) upright conventional  models.  The models shown here are not 2T compliant and appear to ignore the science and are based on engineering.    They do not invite a great uptake, inspite of extensive PR.

P Bessey writes (30/6/2016) “It has taken time for the market to build, but there is definitely a movement toward other postures in the workplace. While some of that has derived from posture investigation and potential for beneficial effects on the user, other advances have emerged as a response to changing technology, new materials and a non-paper work method, as seen from the 60’s onward.   I suspect that a NASA effect is involved in some of this too. Numerous resources have been directed into space travel in recent decades and, for human travellers, that has mostly incorporated a reclined support system to encourage stress-reduction during high-load take-off and landing. So there has been a real effort to ensure that anthropomorphic needs are addressed properly when working from that position, to ensure equipment control systems can be operated successfully and without long-term harm.   There have been a number of attempts to create pod-like structures around reclined positions, to create controlled environments for audio enjoyment, meditation and relaxation. Perhaps those too, have influenced the current trend? But the main factor may well just simply be the instant communication and data access that today’s world now has available for sharing ideas.  Apart from that, it is likely that this trend has derived from the typical and gradual process in which increased knowledge, enlarged awareness and advance in technology brings. Stale markets, where things have remained much the same for decades and highly competitive markets where a cycle of fashion and small detail differences are all the consumer sees on offer, can drive the introduction of disruptive design ideas and encourage new entrants to challenge the existing status quo. 

Perhaps that is what we are beginning to see?
Best regards  Peter”



AltmarkNow, in 2015, a chair is proposed, the Altmark that has at least an upright and reclined work position as I had been recommending since 1998.  However deficient in biomechanics (ergonomic) optimisation, with reservations, it is  potentially the best work-chair in the market. (

Did they see my web-page for the 2T concept which has been in the public domain since 1998, later upgrade to the 3M (2T = 3M) & 4M the optimised default  against which the ergonomics of any chair can be assessed?  Or did they arrive at this independently?  I fear it was the latter and the chance of a simpler, more ergonomically optimised and more elegant model was missed.

It also has a ‘stand’ facility so in this respect is approaching the 4M workstation→.  I have not seen this chair and so cannot assess the reclined configuration.   It incorporates iliac support (at least, I hope iliac and not lumbar), which is required in the upright mode but might be excessive for the reclined mode.  The reclined configuration can be deeply adverse as can be found in some dental reclined chairs.

   From the photographs it does not seem to be 2T compliant.  There appears to be intermediate  position adjustment in the transitional mode, which at best, gives no biomechanic advantage and was probably intended to add comfort → .   Misled by ” that treacherous guide  which only turns up truthfully when the ergonomics are fully correct”.   If this mode becomes a part of the unstable intermediate mode it allows a faster transition and also gives the user the choice for dynamic motion and rehabilitation.   Scrapping a fixed intermediate mode reduces manufacturing costs.    Not having had an opportunity to see this chair, I cannot comment further on the ergonomics.

Screen Shot 2015-11-06 at 18.21.33Although an expensive ( $5,900),It looks over engineered, awkward  and too clunky  for an ‘object of desire’.   I have ignored a discussion of the aesthetics as I thought that this could safely be left to individual designers.     With the ergonomics correct this could be left to market choice.   Perhaps i was wrong and so hurriedly penned an effusion of which I am not proud!    ☛Altmark and Art→

Now have a look at the Cambridge student project on the 2T CONCEPT. Simple, elegant & cheap.  The Cambridge trials showed the elegance, simplicity, cost effectiveness  and greatly enhanced ergonomics of th 2T concept.2T Deskless office chair

It excited much comment along the lines “Gee!  That’s cool.  I want it”.  The lack of ‘familiarity bias’ is typical with the millennial generation.  Go consider.


Screen Shot 2016-06-24 at 12.34.17A good idea in that it achieves the 2 modes that I have been advocating since 1998, but what a terrible design!   Electrically operated.  With all possible bells and whistles It represents an almost opposite view to the 2T principle and it’s 4M workstation derivative.   This  with an emphasis on anatomy and spinal biomechanics leads to lack of adjustments and simplicity.  Obviously a huge misplaced engineering enterprise without awareness of what was possible and desirable.  Another example of what emerges when the the optimised default solution of the 2T concept is ignored.

Price: $5995

The CHOTTOScreen Shot 2017-05-20 at 11.14.27

This highly innovative chair was introduced to me by it’s designer,Thomas Stroman, the Founder of Stroman Design.   He wrote to me “I am an architect by training, but having experienced back surgery, my focus has been on ergonomic seating design for human-computer interaction.

At first glance I might be excused for thinking that it looked as if it were self mobile with caterpillar tracks.  Perhaps an exciting concept for the future. What fun to go charging around the workspace and bumping one’s colleagues!

Screen Shot 2017-05-20 at 11.11.16The importance of a reclined work position has been recognised.  It could be modified to become virtually 2t (4M) ergonomic compliant.  A foot rest has been incorporated,


Office health and stressors

A report, launched, in 2016, at the US Green Building Council’s Greenbuild conference, found that employees in high-performing, green-certified buildings had 26% higher cognitive function test scores than those in similarly high-performing buildings that were not green certified. 


Screen Shot 2016-05-04 at 11.41.10by Dr HA Sanford, MA, MB, BChir (Cantab), DPhys Med (Lond) Chief Medical Officer to OptEnCo.(Article published in EurOhs, European Occupational Health and Safety Journal, Dec 2002.)


Hitherto stress related illness has been thought to be due to psychogenic causes associated with changes in commercial practice. More recently it has been recognised that adverse indoor physical environmental factors actually account for the bulk of stressors in the office and work environment.  These potentiate the minor morbidity (illness) and the more overt psychosomatic expression.   Environmental stressors can be identified, quantified and relatively easily corrected. When addressed up to 40% increase in productivity is permanently achieved.

shortfall.  Secondly, illness and stress result in increased churn rates which carry extra costs to a firm  for staff replacement.

Thirdly, in the UK, there were 164,000  claims for stress-related conditions in 1999-2000, an increase of almost a third on the previous year. Litigation damages can be spectacular and in addition to these costs, media coverage of litigation results in damage to a firm’s reputation. It should also be remembered that under both HSE and pending EEC legislation management will have not only a civil but also a criminal liability.

The pressures of recession are adding to the ethos of business management which has resulted in ‘downsizing’ of the workforce which creates extra demands on surviving staff and added to long hours spent in a physiologically unfriendly environment, gives rise to anxiety, fatigue and to high levels of morbidity and breakdown.


Medical considerations

A consideration of the medical background show that three broadly overlapping and ill-defined medical conditions have been described.Screen Shot 2016-05-01 at 19.19.11

  • The first ‘stress related’ illness is generally regarded as a psychological response to anxiety and fatigue leading to a number of symptoms and even serious breakdown and illness.
  • The second is of more interest to doctors (not to mention their patients). As many as one in five new consultations in medical primary care fail to identify a recognised  organic medical condition. These include chest, back and abdominal pain; exhaustion, headaches, dizziness, insomnia, shortness of breathe – to name only a few.   Some prove to be transient; about 10-15% are shown to have an organic cause; some have an unrecognised organic cause – but most have symptoms that persist and are never explained in spite of appropriate investigation. A confusing terminology has developed around this poorly understood group. The most exact and nonjudgmental is ‘medically unexplained symptoms’ which many feel to be too unspecific. ‘Psychosomatic illness’ implies that psychogenic conditions results in a physical illness and ‘somatisation’ suggests a psychogenic condition which is expressed in physical symptoms. Some patients may have overt psychiatric disorders such as anxiety, depression or a phobic personality.   Most have a complex mix of etiological factors , biological, psychological, social and cultural.
  • The third, consisting of symptomatology associated with the environmental physiological stressors, may be the most important and is usually ignored.   In the last five years a simple standardised assessment has been developed for symptoms and environmental satisfaction and been related to a number of adverse parameters in the physical environment by OptEnCo in conjunction with Reading, University3 . A baseline normal has been established and it has found for 30,000 office workers in 300 buildings in the UK, USA and Europe that 80% of these workers experience excessive symptoms due to various physical stressors in the office environment4 . The top (worst) score is 20 and this can be permanently reduced to 2-0 if environmental stressors are eliminated.   An average unimproved modern office environment scores about 6 and a score of 12 shows a definite negative environmental impact on staff.

Stressors and physiological reaction

The common factors are a mix of adverse or threatening environmental condition which result in stimulation of neurohumeral mechanisms mediated through the hypothalamic-pituitary-adrenal axis which result in a widespread physiological response.   Stressors initiates a neuro-humeral cascade which finally affects the whole body. In the acute phase threatening environmental stressors result in the ’fright, flight, fight’ response. In evolutionary terms these are an important survival mechanism. In modern office conditions they can be the reverse.

Physiological (environmental) stressors

Stressors , in addition to excess temperature and humidity variations and ergonomically incorrect furniture, include less obvious environmental components.   Office equipment generate saw-tooth sounds which in nature are used by animals as aggressive warning signals and square wave sounds which are used for identification. Both cause alarm and are likely to be stressors in humans. At high and prolonged level, noise is rare in nature but poor acoustics in an office leads to raised voices, distraction and increased measurable levels of stress hormones.

Lighting by ordinary fluorescent tubes may appear white, but actually only emit light mainly in a narrow band at the yellow end of the spectrum. Only some 8% of the photo-receptors in the retina are stimulated (as compared to 79% in daylight). Added to this, and because of the ‘omni-directional’ nature of the light, some 25% of the light is lost as ‘glare’ – that is, light striking the eye directly and containing no visual information. A 52 cycle ‘flicker’ (in UK) is caused by the conventional ballast of fluorescent tubes. Refresh rate is detected by the eye although not registered by the conscious mind. In addition this rate interacts with that of the VDU screen (at 60-70 cps). This produces an even more deleterious flicker effect.

Micro-climatic conditions in most offices are equivalent to the stressful conditions that occur before a thunderstorm or during prolonged desert winds due to the positive ionisation caused by electrical and electromagnetic (EMF) emissions from the multiplicity of machines in the modern office.

Chemical and particulate pollutants are potentially pathogenic, and are therefore stressors. These are in low concentration in nature and easily dispersed by air currents or denatured by ultra violet light. The high levels found in industrial society are even higher in an enclosed office space where some are being produced.

Toxic Volatile Organic Compounds (VOCs) are produced by new carpets and furniture. Viruses, bacteria, moulds and their spores are provided with ideal culture habitats and also dispersal systems through inadequate air conditioning.

Microparticles.   Computers and in particular CRTs create microparticles of carbon derived from incinerated shed squame skin cells. These can penetrate the lining epithelium of the lungs and blood vessels and are thought to have an effect on the autoimmune system.

Healthy office

For ARCHITECTS. ‘Coolness’ is the word.

 For New offices ‘Coolness’ is the word to  excite media interest for both the company and the Architect/Designer.   Most firms aspire to project this cutting edge image.    A 2T chair answers this exactly and in addition reduces LBP and increases productivity by lessened morbidity and stress.

THE RELEVANCE OF THE 2t  (3M) concept

In order of importance :-

  1. Addresses the recogmized bio-mechanical (ergonomic) factors responsible for musculo-skeletal discomfort which include backache, LBP, and more derious breakdown.   (See the bio-mechanics    )
  2. Ensures maximum (optimised) comfort.  This depends on the ergonomics and NOT on short term opinion.  See COMFORT
  3. Subsidiary factors include relevance to the modern and future office environment, cost, brand image and user targeting.
  • I have always recognised the historical role played by architects in chair design.
  • Recently I have realised that they play an important part in development as they are able to dictate requirements for projects.
  • Health  and productivity, go in step, and should be a prime consideration in office design.
  • Architects can hardly be expected to be experts on ‘ergonomics’  (preferred the more scientific term ‘biomechanics’).
  • They rely on specialist advice and should know what questions to ask.  So who to ask?
  • Chair manufacturers.  Interested only in running the company, sales, etc.
  • Designers.  With a design team, become responsible for development of new models. Few, if any, have full overall understanding of medical issues, spinal biomechanics and anatomy and this results in misconceptions.
  • Office Managers. Responsible for purchases, rely on lists derived from suppliers and manufacturers hype. Often misconceived!
  • This work is intended to help correct these deficiencies from at least a bio-medical viewpoint and is therefore relevant to architects.
  • I have to admit, that, as a doctor,  the frequent  views of large offices shown by the BBC and others, supposedly showing the wonders of a hub layout, only excite in me “OMG!  That’s a factory for manufacturing Backache!”   Sorry. HAS.

Office ergonomics

Poor seating is a major stressor resulting in reduced performance and absenteeism.  At present I know of no chair in the market that fully remediates this.     New seating concepts are coming forward which will not only revolution seating but also impact on office design. In a few decades a chair set before a desk, and arranged in straight lines will be perceived as not only dated but hopelessly inefficient. There is an increasing interest in this direction.   See Mindset which with much hype describes GlaxoSmithKline’s purposed “deskless office”.(below).Screen Shot 2016-01-15 at 20.22.14

The designers of this layout obviously did not have the benefit of having seen this work.  The Jukes concept  of 2001 seem to be superior and were tested in the field.   The 2T concept, whether the 3M or 4M versions, are the front runners here as the only system that is fully ergonomically optimised for prolonged sitting (☛The Full Solution→) and also allows a better floor arrangement.

The only problem is that no such chair exists yet in the market.


Relevant to the development of a 4M office station and this model was developed as a project by a group of undergraduates at Cambridge.

 The new ‘millenial’ generation is less influenced by ‘familiarity bias’.


The ALTMARK Chair has both a reclined and upright mode which puts it ahead of the market.

But fails with 4M requirements to make it full bio-mechanically correct, particularly in the 2T intermediate mode. (See 4M workstations)

 “Desks are rather a thing of the past – Dickensian even. They evolved as tables with storage developed, alongside chairs. The whole combination seems a way of reducing/avoiding the need for floor sitting or squatting and a means to provide a convenient standing/sitting presentation of objects for working with at an ergonomically higher level.  They were there to support and present paper documents and the like. Hardware, since then, was largely developed to be used with/on them and has evolved through typewriters and similar devices to today’s electronics. Once that demand for physical documents has been reduced and even eliminated by ‘paperless’ office tech., then there is once more a blank page to draw on.”

The 4M workstation will be particularly relevant to the coming AI, VR & MR developments.  See   ☛ →, ☛ →                           

Screen Shot 2016-01-11 at 17.23.07

So, why not?  Don’t lose out .  It is already happening!    The boundaries between contract and home furniture  are decreasing and the division may be disappearing entirely.

Management Perceptions.

It is a view at the best end of the management spectrum, in the USA,   that highly paid, expert workers should have optimum working conditions to provide maximum productivity.  Anything less would be economic foolishness.  This is not the view held by many UK firms which employ a highly paid workforce in an environment which reduces their productivity by a  measurable percentage.  This is accentuated in the control room environment which operate on a full time basis and where mistakes can lead to a catastrophe.   This has been honourably recognised by such firms as Transco, BT, C&W and some police forces which have been careful to optimise the environment in such premises.   The offices of companies like Google, Skype and Facebook, are like a playground with innovative furniture which would have looked outrageous ten years ago.  This could include the 2T concept that I introduced in 1998.  It is now begining to look quite ordinary although designers still lose out, have difficulty in recognising the underlying bio-mechanical essentials.

The 2t & it’s 4M derivative exactly matches the requirements for the office of the future.

The OFFICE OF THE FUTURE (and maybe ‘near future’).

Sam Volkering – futurist and financial advisor – “In the last 50-odd years robotics has replaced a lot of labour-intensive roles. You see it a lot in manufacturing now: manufacturing plants use a lot of stationary robotics.    … automated systems are starting to eat their way into middle-class jobs. You’ve got robo-advisors providing financial recommendations based on a huge amount of data input.   That’s going to create more creative, highly skilled jobs, and jobs that perhaps don’t exist today that no one can predict. It’s going to be a shift of what we know as work. You might end up with three or four jobs on the go. There’s no such thing as a career anymore. You end up with several jobs as your work – micro-work. 

That’s going to mean a shift of where people go physically to work, and how they interact and communicate with each other on a daily basis.    Work is such an important part of our social fabric that when there’s a big shift in what it looks like, it’s going to create a lot of ancillary fluctuations in infrastructure: where we go, energy usage in various locations, etc. … It’s going to put a strain on economies, because they’re not going to be able to handle these people out of work, and there’s going to be a shortage of people needed for the high-skilled jobs that this change is going to create.”

(Quoted via Nick O’Connor (Publisher, Exponential Investor and recently published in his book … .

If interested, a personal view of the future can be seen →… Largely based on the research of Nick O’Connor.  .


For another view – Should chairs be banned? See  The end of sitting? →

Suggested by the interdisciplinary Dutch studio RAAAF (Rietveld Architecture-Art-Affordances) and lies at the crossroads of architecture, visual art and philosophy.   In our society almost the entirety of our surroundings have been designed for sitting.  Evidence from medical research suggests that prolonged sitting results in serious health deficits.   These are so widely studied and well-documented that they’re impossible to ignore and show that sitting increases lower back pain, slows our metabolisms, and shortens our life-spans, amongst other things. Not even daily exercise is enough to offset the damage.

Redesigning the workplace environment and home might manipulate an impact on sedentary behavior.  Their installations are mostly conceptual.  But they bring up an interesting idea: What if chairs were eliminated altogether? Is that even possible? And would that solve work and societal sitting problems or just open up the door to new problems?

A better solution

Screen Shot 2016-04-06 at 00.03.13


A digression….

Screen Shot 2016-06-05 at 15.25.14

MANUFACTURERS of ergonomic chairs

For MANUFACTURERS of ergonomic chairs new ideas can create both threats and opportunities , once both familiarity  and normalcy biases are overcome.  Screen Shot 2016-01-11 at 17.23.07Creative disruption works.  

This has happened many times in recent history: comfortable incumbents,  making incremental changes to their designs and then a disruptor emerges, and they’re dead.   Kodak is an example.   The car industry is an ongoing example. Performance has improved compared to that of a  car of only ten years ago. But the experience of driving is essentially the same and the gains are marginal. They are now threatened by the new technology of outsiders  who have very little to lose.  These can disrupt the market so fundamentally that everyone else has to change their business model or go bust. Traditional car firms are worried about the likes of Google (driverless cars). Tesla (driverless and long range electric). And Apple ( Project Titan?).



Screen Shot 2017-02-08 at 19.09.47

Business theorist Clay Christensen says :

“The reason [for why great companies failed] is that good management itself was the root cause. Managers played the game the way it’s supposed to be played. The very decision-making and resource allocation processes that are key to the success of established companies are the very processes that reject disruptive technologies: listening to customers; tracking competitors actions carefully; and investing resources to design and build higher-performance, higher-quality products that will yield greater profit.

“These are the reasons why great firms stumbled or failed when confronted with disruptive technology change.

Screen Shot 2016-03-18 at 19.28.20The 2Tilt concept.

  • Spinal bio-mechanics dictates that prolonged sitting should be performed in a reclined position.
    This involves a number of requirements.
  • To be effective these are detailed in the 2 Tilt (2T) concept.  By remediating the adverse bio-mechanical factors in prolonged sitting, the more 2T compliant the model becomes.
  • A fully 2T compliant chair is fully ergonomically optimised (and optimally comfortable).
  • This concept will inevitably and logically move into the mainstream of chair design.
  • Screen Shot 2015-12-16 at 14.03.18


The bias holdup

Normalcy biasFailure to understand familiarity and normalcy bias is likely to lead to serious problems for firms, however big.  We are hardwired to believe the world we live in today and to which we are acclimatised so that we become incapable of Screen Shot 2013-10-23 at 14.05.05comprehending and believing that change is coming (→Familiarity bias).  It’s a dangerous trap for manufacturers of ergonomic office chairs to fall into and it can blind recognition to a very real and credible threat.

  • Prospective manufacturers can be helped to leap ahead of the field.
  • ☛ For Implications & likely uptake→..
  •  Screen Shot 2015-11-27 at 14.04.202T chairs may become obligatory for prolonged sedentary use.  In this event there will be considerable loss to manufacturers and offices that use mid-upright chairs if they fail to upgrade.
  • Only a few firms wish to have a ‘retro’ look.   Most want to project a cutting edge image.  ‘Coolness’ is the word.  A 2T chair answers this exactly and in addition reduces LBP and increases productivity by lessened morbidity and stress.
  • Once a 2T chair hits the market there will be much media interest providing automatic PR.    Firms without a 2T model are likely to be disadvantaged.

Some MANUFACTURERS of ergonomic chairs  are mentioned in ‘ Various chairs. How do they measure up?  ‘  Intended only to illustrate points in relation to the 2T concept and include :-

The mention of these companies indicate that they are interesting for various reasons.

  • LBP (& 2T) is already of interest to Insurance.


With the advent of AI and robotics affices will be geared to the emotional and physiological requirements of the highly paid staff.   2 Tilt chairs and their 4M derivatives will be exactly relevant.

The Global environment.    Where does the 2T chair stand in relation to the global environment and recycling?

  • The 2T simplicity of design allows it to have the potential to be superior to any other equivalent task chair for impact on environmental factors like global warming, smog, resource depletion, and waste.
  • With virtually no, or fewer, complex moving parts, controls and widgets, manufacturing processes and costs  are reduced.
  • Manufacturing cost usually account for a large proportion of the energy cost of a product.
  • Any materials considered safe to the environment can be used.
  • Recycling. Components can be either used as biological nutrients or transformed into commercial commodities available for industry.
  • Disassembly. With fewer widgets and working parts this is easier than other high-end task chairs.
  • Large amounts of oil, gas, and coal is required to mine raw ores, crush them, transport them, smelt them down and turn them into stock, transport them again, and turn them into end-products. . . then transport them again.

Repetitive Strain Injury (RSI, WRULD).

Not only LBP but also Repetitive Strain Injury has to be taken into account in the design of chairs.

An article written for EurOhs (European Occupational Health & Safety  magazine ) 

by Dr Henry Sanford, Consultant Orthopaedic Physician and CMO of OptEnCo.    May 2003.


You can be forgiven for finding this  subject confusing.  It is confusing because it’s a mess!

There is no agreed terminology.  There are diametrically opposed views on its nature and aetiology. Treatment is, at best, simplistic and at worst non existent.   Although not life-threatening it is a condition that has the potential to wreck a career, curtail many activities and to give joy to lawyers.   However, nil desperandum est, light is begining to show and divergent views are often the first stage of a synthesis resulting in a breakthrough towards  understanding.


A history is helpful.    The condition was described by Bernadino Ramazzini , the father of occupational medicine, in 1713 as “Scriveners Palsy”,  Later it became commonly known as “Writers Cramp” related to “Shoemakers Cramp”, “Compositors Cramp”, “Semstresses Cramp”, “Milking Cramp” and “Musicians Cramp”.  This group of condition  were described by the neurologist Sir William Gowers  in 1892 as an “occupational neurosis” of a “primary central nervous system ‘derangement’”.  This implied a neurogenic origin – the concept of neurosis as a psychological entity came later, with Freud.  The designation “RSI” was coined by Stone  in 1983 denoting a “Repetitive Strain Injury” or “Repetition Strain Injury”.

The Australian epidemic which peaked in 1984/5 resulted in increased public and medical awareness.  A reaction to the large numbers and the ensuing litigation was that RSI was a condition characterised by “only one clinical criterion: namely, the complete absence of objective clinical signs of abnormality”1   and was iatrogenically determined.  It was all the fault of the doctors who too readily diagnosed the condition.

 Hutson (1992) dryly commented that this  theme was commonly expressed by other medical specialists “who may have been disadvantaged to the extent that they did not have a back-ground of expertise in musculo-skeletal medicine”.

We will return to this later.  The final word in 1987 from Professor David Ferguson  of the University of Sidney went further to describe the Australian epidemic as a “complex psychosocial phenomenon with elements of mass hysteria, which were superimposed on a basis of widespread discomfort, fatigue and morbidity”.  This view was reinforced by Barton et al. in a report on behalf of  the British Orthopaedic Association submitted to the Industrial Injuries Advisory Council in 1990.  The view that there is no physical, organic basis to these conditions is held by many mainstream doctors to this day although the pendulum is again swinging away.

What’s in a name? 

RSI is now classified as Work Related Upper Limb Disorder (WRULD) although RSI is still the popular term and will probably remain so.  After all, ‘Orthopaedics’ means ‘straight children’ although now not many in the speciality would regard the treatment of childhood scoliosis as their main concern.


If RSI is to be considered, rightly in my opinion, as a spectrum of conditions then the near end consist of localised or referred primary musculo- skeletal pathology which can overlap and develop into  the ‘primary central nervous system derangement’ postulated by Gowers over 50 years previously.

Musculoskeletal Medicine, or Orthopaedic Medicine as he called it, was developed by Cyriax  at St Thomas’ in the 1940/50s.  His importance lies in his systematic functional examination of the motor and neural systems, using ranges of joint movement and isometrics of each muscle group to arrive at a precise  anatomical localisation and hence effective treatment.   A raft of conditions could be precisely identified such as tendinitis and tenosynovitis of the wrist tendons, de  Quervain’s syndrome (long thumb tendons), and ligament sprains, disorders of tendon insertions (enthesopathies) including epicondylitis (lateral ‘tennis’ and medial ‘golfers’ elbow’), rotator cuff lesions and bursitis at the shoulder and the ‘Carpal tunnel syndrome’ at the wrist, to indicate but a few.  Many were described for the first time.    An added complication is that pain and misleading tenderness can be referred down the arm from derangements of joints, ligaments and  pressure on nerve roots and the dura mater in the neck.    These conditions can be assigned to the  WRULD Type I group. Accurate localisation and treatment should be prompt, and preferably by a doctor trained and experienced in Musculo-skeletal (orthopaedic) medicine.


If the physical signs were inconsistent or contradictory and inappropriate and the symptoms exaggerated in distribution, behaviour  or severity then Cyriax  noticed that treatment was likely to be ineffective. Being inexplicable in anatomical terms  he ascribed them to be  of psychogenic origin .   Active local treatment was found to be not only a waste of time but actually counter productive resulting in iatrogenic perpetuation and so he rightly referred these patients on to psychiatrists or pain clinics, then in their infancy.  They are now in the WRULD TypeII group.   The neural mechanisms are now better understood.  The normal increase of pain at a localised tissue injury, due to inflammatory products, can sometimes cause exaggerated sensitivity of the peripheral nerve fibres which is repeated up the spinal tracts to the brain.  The excited state of certain brain centres, associated with excess production of brain neuro-transmitters, makes them vulnerable to the input from other parts of the brain, whether individual such as various psychological depressive or obsessional states or external social factors and stress.  The resulting  expression can be varied and include  regional pain and fibromyalgic syndromes and allied conditions such as Reflex Sympathetic Dystrophy, Abnormal Illness Behaviour and frank psychiatric illness.


So, what are the practical implications for the management of RSI in the modern office?

The answer must be:   Avoidance.


ERGONOMICS.  Check and correct :-

  • •  The height of the desk in relation to the height of the chair and the individual. It is taken for granted that the desk is variable height adjustable.
  • That the wrists are supported in the  straight neutral position.  Slight wrist extension allows greater efficiency for finger flexion but can create the conditions for a carpal tunnel syndrome.
  • •  The forearms ensuring that elbows are at a right angle or slightly extended.  Elbow support allows relaxation of the shoulder girdle muscles.
  • •  The backrest of the chair as this will affect the posture of the neck.  Ideally the backrest should incorporate iliac (pelvic) support as opposed to lumbar support.  Sometimes it is possible to lower the lumbar support so that it supports the iliac crest.
  • The seat of the chair should be tilted forward (down).

 STRESS Avoidance: 

Type II sufferers characteristically have a high neurotic index so  that stress levels are likely to be of prime importance..  Of these background physiological stressors (noise, lighting, indoor air quality, humidity) found in the modern office environment are the most significant (Jukes) and easily corrected.   Check stress levels.  This assessment is simple and accurate.


It is important that early symptoms of RSI. are identified so that the causative acivity be immediately stopped

  • •  Observe, discreetly, if there is any behaviour which might indicate pain on certain activities..
  • •  Let it be known that work related symptoms should be reported immediately.
  • •  Do not pry. Overemphasis directs attention and can itself create a problem.
  • •  Check staff sickness rates including unreported 1/2 day absences to identify potential sufferers.


If work is to be resumed an alternative method must be found if recurrence is to be avoided.

  • •  Institute all the measures, urgently, described under ‘avoidance’.
  • •  Alter workstation layout and tools so that activities are performed using muscle groups differently.
  • •  Reconsider practices. study from Leeds found that pain was related to the tasks with the highest estimated daily loads (Helliwell et al).


(Omitted from this account).


1 Awerbuch, M. (1986) RSI. Med. J. Aust., 145, 362-3.

2 Hutson,  M.A. (1997) Work Related Upper Limb Disorders. Butterworth – Heinemann

Next return to Office stress→

Or see


Office work-stations are easily derived from the 2Tilt chair concept. Now renamed the ‘Quadri-Modal’  (4M)  concept as a sit/stand component is incorporated.   In a few decades a chair set before a desk, arranged in straight lines will be perceived as not only dated but hopelessly inefficient. There is an increasing interest in this direction.
 See Mindjet

“Desks are rather a thing of the past – Dickensian even. They evolved as tables with storage developed, alongside chairs. The whole combination seems a way of reducing/avoiding the need for floor sitting or squatting and a means to provide a convenient standing/sitting presentation of objects for working with at an ergonomically higher level.  They were there to support and present paper documents and the like. Hardware, since then, was largely developed to be used with/on them and has evolved through typewriters and similar devices to today’s electronics. Once that demand for physical documents has been reduced and even eliminated by ‘paperless’ office tech., then there is once more a blank page to draw on.”                             P.Bessey

The 2T concept is particularly relevant to the development of a desk-less office chair, described here as the ‘Quadri-Modal’  (4M)  concept.  So called as the concept requires 4 modes. 

  1. Screen Shot 2015-12-09 at 13.49.28Reclined for prolonged use→
  2. Upright for some short tasks→
  3. Unstable intermediate mode→
  4. A standing mode→ Screen Shot 2016-05-18 at 16.09.49(Yes! That’s John Gorman glowering in the background.)
  5. See   ☛

For another idea for a deskless office see ☛  Co.Exist→

A deskless work chair from America.  It looks like a 2T chair in its general configuration and Screen Shot 2014-02-14 at 17.42.47transition from the reclined to an upright position seems easy and there is a minimum of adjustments (did they see my web-page which has been present since 1998?).  The mid ranges are probably not unstable so that the user can adopt this adverse position for a prolonged time.  Its base probably precludes it from being an office chair and it looks as if it could tip sideways.  It could be upgraded to a 2T chair without great difficulty.

The Altmark station

AltmarkConsidered further under ☛ The transitional intermediate mode→ and in more detail in WORKCHAIRS, a new breed with a reclined mode.

The webpage shows a fixed intermediate  position in both the reclined and semi upright modes.    At best it gives no biomechanic advantage and was probably intended to add comfort → .   Misled by ” that treacherous guide  which only turns up truthfully when the ergonomics are fully correct”.   If this mode becomes a part of the unstable intermediate mode it allows a faster transition and also gives the user the choice for dynamic motion and rehabilitation.  A win-win.   Scrapping a fixed intermediate mode reduces manufacturing costs.


Screen Shot 2016-06-24 at 12.34.17A good idea that I have been advocating since 1998, but a terrible design!   Electrically operated.  With all possible bells and whistles It represents an almost opposite view to the 2T principle and it’s 4M workstation derivative.   This  with an emphasis on anatomy and spinal biomechanics leads to lack of adjustments and simplicity.  Obviously a huge misplaced engineering enterprise without awareness of what was possible and desirable.  Price: $5995

Steelcase Cyps036Steelcase

The Brody Worklounge.  The illustrations suggest a system that approaches the 4M concept.     It lacks the simplicity of the 4M and does not offer a Sit/Stand capability.   The accompanying diagram shows good design, as far as it goes. It looks familiar!  It differs from the 2T/4M concept which provide some learning points which are more relevant to the 3M concept..

Screen Shot 2016-06-13 at 17.47.21

Stand mode

Freed from the constraint of a worktop desk, a stand mode can be easily designed.  This may help staff to move about and relate to others.

Ergo sit:standFor a 4M the display and small worktop has to be adjusted for height and swung out for the user standing beside the chair or with a colleague.

Shown is an Ergotron 97-581-019 Worksurface.


But, on the other hand prologed standing is tiring and affects venous return and can adversely affect body and cognitive abilities. – Are Standing Desks The Biggest Sham Ever?→     

‘Sitting disease’

Compared to people who sit the least, those who spend most time in a chair have a 112 % higher risk of developing diabetes, a 147% higher risk of suffering “cardiovascular events” such as strokes and a 49%t increased risk of death from any cause.  ( Alarming but not entirely an effect of the bio-mechanics and not examined here.  However some posts are relevant.

If you are interested in a workplace environment and health in the office.


With the advent of AI and robotics affices will be geared to the emotional and physiological requirements of the highly paid staff.   2 Tilt chairs and their 4M derivatives will be exactly relevant, becoming an office work-station.  A sleep hood can be incorporated into the design and avoid the neccesity for a dedicated ‘nap-room’.


Global blue chip companies are throwing their weight into VR development (hardware and software),  Mark Zuckerberg believes “this kind of immersive, augmented reality will become a part of daily life for billions of people”.

Eliott Myers from Roto VR, which is a small, innovative firm with designs on the related accessories market claims that “Roto enhances the seated experience with haptic feedback so dramatically you feel like you’re really there, in another world. Once you’ve tried Roto, VR feels empty without it.  With Roto, you can add our Table accessory, so you can drive around 360 degrees with a steering wheel (and pedals). Roto also has “rumble shakers” which can be affixed to the underside and back of the chair for added sensations. It’s like 4D on steroids. Actually we should call it 360D!”

Sounds exciting! and should be relevant to 2T or 4M design.  Another ‘blank page to draw on’.


Next Return to ☛ 2T in the office← 

Office stress & Backache

Psychogenic and backache psychosocial factors.

The new office conditions which give rise to anxiety and fatigue, added to long hours spent in a physiologically unfriendly environment,  leads to high levels of morbidity and breakdown.    The simple explanations for this  state of affairs  is psychological ‘stress’.  An extreme expression of stress is described in America. Dotcom employees with excessive workloads in collapsing companies are found to be sabotaging equipment and systems and attacking fellow staff. This occured when Michael McDemott shot seven people at Edgwater technology.   Security and executive protection companies, such as Pinkertons and Interpahase International have found a recent business increase of 25%.

Psychosocial factors play a part in the aetiology of LBP.  But only a part.

This has received much attention since a Meta-analysis in Occupational Medicine (Waddell 2000).   Ignoring  the Cyriax diagnostic precision, suggests that most backache in the workplace is of psychosocial origin.

Screen Shot 2016-02-05 at 19.22.02

The pendulum of expert opinion is moving away from this extreme view.    Psycho-social factors are hardly a cause of LBP, predicting only 1-5% of new occurrences (  ) but are good predictors of back pain behaviour, as previously recognised by Cyriax.  Depending on the patient’s personality and the surrounding social input and by unsympathetic or inadequate medical, or alternative medical, practice may be important in the management of some cases and can be over emphasised. “Stop complaining and get back to work immediately” is an encouraging message for management in an industrial society which has an increasing problem with LBP and a penchant for litigation.  Psycho-social stress factors, independently of ergonomic stress, are universal and commonly recognised as a cause of office related minor morbidity, absenteeism and reduced productivity.

 Environmental factors,

Air quality, light & noise are stressors and operate on a more basic physio-pathogenic level.   These are probably more aetiologically significant, but less easily  identified by the individual, than psychological stress.   John Jukes, an engineer and productivity consultant  made an unexpected finding when asked to investigate why a Design and Construction Unit (DCU) with a staff of 235 was failing to meet an expected target of 25%  increase of productivity when a CAD system, costing £1.5 million, was installed. They were urged to work harder and productivity actually fell further.  A number of indoor environmental factors were identified.

  • The ergonomics of the chairs and workstations were improved.  Productivity rose.
  • Full spectrum polarised lighting was installed. Productivity rose further.
  • The indoor air  quality (IAQ) was improved with HEPA filters and negative ionisation.
  • The plants recommended by NASA were installed. Productivity rose further.
  • Electrostatic and electromagnetic fields were addressed. Production rose further.
  • The final cost was less per workstation, the 25% target was easily passed and the DCU was able to reduce its workforce by 40%.

Screen Shot 2013-10-23 at 14.10.49 Not only was there an improvement of conditions, likely to be due to environmental deficiencies, improved but also the seemingly psychogenic stress related symptoms. This suggests that if environmental stressors are removed then people can deal more easily with their ongoing psychological stresses.

Indoor environmental stress

 In the home a stress-free environment is at the command of the occupant and is easily achieved. The multi-occupancy workplace, such as an office, is commanded by management and staff, highly paid or not, have to fit in to an often stressful environment which has been determined by cost considerations. The effect this has on reducing productivity is only now slowly coming to be appreciated.

Physiologic Stressors and their remediation.

  • Sub optimal ergonomics.  The subject of this work.
  • Poor lighting.   Indoor lighting is, unlike outdoor lighting, unpolarised.   Lighting by ordinary fluorescent tubes may appear white, but actually only emit light mainly in a narrow band at the yellow end of the spectrum. Only some 8% of the photo-receptors in the retina are stimulated (as compared to 79% in daylight). Added to this, and because of the ‘omni-directional’ nature of the light, some 25% of the light is lost as ‘glare’ – that is, light striking the eye directly and containing no visual information. A 52 cycle ‘flicker’ (in UK) is caused by the conventional ballast of fluorescent tubes. Refresh rate is detected by the eye although not registered by the conscious mind. In addition this rate interacts with that of the VDU screen (at 60-70 cps). This produces an even more deleterious flicker effect.    Halogen lights  generate even more glare.
  •  LightingStress from lighting can be easily and cheaply corrected by the use of full spectrum polarised lighting which aproximates to overcast outdoor conditions, equivalent to the light outdoors on an overcast day (in Washington DC at midday, to be precise)..  As less power is required, running and environmental costs are reduced.
  • Indoor Air Quality (IAQ).  When air conditioning is replaced by HEPA filtration and negative ionisation, reduction in upper respiratory infections and the invigoration of mood has been shown to increase productivity. The system also has the advantage of eliminating modern small airborne particle pollution.   It is equivalent to mountain top air near a waterfall or the air quality that occurs following the electrical discharge of a thunderstorm.  Most offices have the positive ionisation  due to electrical and electromagnetic (EMF) emissions from the multiplicity of machines in the modern office that occurs before a thunderstorm or during prolonged desert winds.
  • Screen Shot 2016-02-05 at 19.09.00Acoustics.  Sound is a far  more common physiological stressor than most people realise. Artificial noises generated by lifts, office equipment and so on tend to cause the body to continuously tense and relax. Poor sound design often means straining to hear your telephone call whilst being over-aware of what’s being said on the other side of the office. A series of hard flat surfaces ( office walls and ceilings ) bounces sound waves into a series of chaotic reflections that are hard to interpret.
    Office equipment generate saw-tooth sounds which in nature are used by animals as aggressive warning signals and square-wave sounds which are used for identification.  A high and prolonged level of noise is rare in nature but poor acoustics in an office leads to raised voices and distraction.    The sounds from office equipment, although discounted by our intelligence, acts as an alarm signal on the primitive part of the brain resulting in a continuous state of unrecognised stress and activation of the hypothalamic-pituitry-adrenal neuro-humeral cascade.
  • Chemical and particulate pollutants are in low concentration in nature and easily dispersed by air currents or denatured by ultra violet light.   The high levels found in industrial society are even higher in an enclosed office space where some are being produced.   A  bewilderingly large array of Volatile Organic Compounds, such as formaldehyde, are given off by new furniture and carpets and are cumulative toxins which can give rise to a number of both mild and serious conditions.

Office environment

The modern air conditioned office is a surprisingly stressful environment. Long hours spent in a physiologically unfriendly environment, leads to high levels of morbidity and breakdown.  Although often not reported, minor morbidity undermines the efficiency and productivity of the individual. Dependent upon the environmental conditions occurring in a particular office this reduction in overall performance ranges from 18% to 52%.

HSE figures reveal that 1 in 11 of the work force suffer occupational health problems, involving 750,000 people, and 1.3 million lost days of production. These figures represent only the tip of an iceberg when considering the vast number of people suffering from minor symptoms which are ignored, being regarded as a part of normal working life. As a large percentage of employees are affected, a lower performance throughout an office can often go undetected if work task efficiency is not measured systematically. There were 164,000 claims for stress related conditions in1999-2000, an increase of a third on the previous year.  270, 000 people daily take a day of work . The cost to the UK is £7 billion a year (Sunday Times 25/3/01).  See ☛Prevalence and economic cost of LBP→

Screen Shot 2015-12-16 at 14.08.50The simple explanations and for this state of affairs is the general assumption that the increase of morbidity is due to emotional stress. Companies have therefore turned to a bewildering variety of stress management strategies. This has given scope to gurus of many hues, starting with stress counseling and release.   There is not yet a general appreciation that environmental factors, air quality, light , noise, are stressors and operate on a more basic physio-pathogenic level and are probably more aetiologically significant, but less easily identified by the individual, than psychological stress. Although psychogenic factors may play a part in the office environment these may not be of prime importance.

 In my experience there have been 2 ‘Paradigm changes’ in this field which are related.
      1. The Cyriax functional examination for soft tissue musculo-skeletal system disorders
      2. John Jukes found that by assessing and reducing indoor physiological stressors that psycho-social stress was reduced and productivity increased by 20-30%.

Cyriax,, in the early 1940s, developed the functional system for the clinical diagnosis of soft tissue musculo-skeletal system disorders at St Thomas’s Hospital, London. This helped us to arrive at an accurate and localised anatomical diagnosis. A number of pseudo- conditions, guesswork and hocus-pocus, that prevailed at that time, therefore became extraneous. At the same time it became possible for this systematic clinical examination to identify a proportion of patients whose symptoms and signs did not correlate and whose signs on examination conflicted and did not add up to anything that suggested an anatomical localisation. These were categorised as ‘psychogenic’ (or p-g, psycho-social) as distinct from a recognisable ‘organic‘ lesion. He found that these patients, even if backache psychosocial factors overlay an ‘organic’ lesion, would fail to respond to treatment. This had to be avoided as treatment tended to continue indefinitely and the symptoms  become perpetuated.      Later the concept of ‘regional pain syndrome’ was developed which might account for some of these conditions on a vague neuro-physiological basis.


Screen Shot 2016-05-04 at 11.41.10Environmental Improvements To Health and Productivity

By Stephen Bankler-Jukes, Managing Director, The Optimum Environment Co. Ltd.


Mankind evolved into Homo Sapiens Sapiens  (Modern Man) only some 237,000 years ago; according to recent mytochondrial DNA research conducted by Dr. Chris Stringer of the British Natural History Museum.

However, it’s only been in the last 200 years that any sizeable number of people have spent their working days indoors.  In the course of just the last 100 years, urbanisation has meant that increasing numbers of people have been forced to work indoors by artificial light.

In the last 25 years only have those self-same people been forced to work indoors – and in the presence of artificial flourescent light, air-conditioned heating and cooling, and in the presence of electro-magnetic fields generated by computers, faxes, telephones, printers, and other equipment.   In the same quarter of a century, state-of-the-art chemistry has provided the modern office with a whole range of artificial materials; – glues, finishes, carpeting and fabrics. They all utilise a mix of volatile organic compounds ( such as formaldehyde ) as a curing or hardening agent.  Though mankind does indeed possess a unique ability to mutate to deal with changed circumstances, the range and variety of new assaults on an individual’s physiology are not easily coped with – we simply can’t adapt fast enough. The transition from hunter and farmer, spending most daylight hours outdoors, to sedentary office worker has exacted a toll.   Spiralling rates of “stress-related” illnesses – from short-term problems of head-aches, upper-limb disorders, sore throats etc., – all the way to early morbidity  –  from hyper-tension, heart attacks, addiction, and even suicide… all are by-products of the modern office which have been listed by the (U.S.) Environment Protection Agency and the National Institute of Occupational Safety and Health .

Office Health (& RSI)

This lighthearted effusion, in European Office health & safety (EurOhs), enjoyed a certain success and many comments.  Somewhat dated, many of it’s views were new back in 2003.Screen Shot 2013-09-28 at 08.04.59Having avoided cholera and other enterics, once we had arrived at our Dickensian workplace we would have found that illumination would have been by full spectrum polarised daylight. This would have given us a 20% stress free advantage over our 21st century contemporaries who are still using conventional narrow spectrum fluorescent tubes with a flicker at 52 cycles/sec emitting a high level.of glare (veiled reflection). As dusk set in we would have returned home to our family or a riotous evening at the local hostelry. If daylight was too short we would have a candle with reflectors. I have one of these and they are perfectly adequate and there is certainly no glare although I would not recommend them for modern use in the ordinary way.


Our heating would have been by coal fire. These, in case you have forgotten, were cosy and comfortable and keep you active by need for attention. They provide ventilation by drawing in fresh air through cracks around the windows and doors. Further adjustment was by opening the aforesaid. The air movement seemed to address humidity. Of course coal fires raised the outside large size particulate count and S02 which blackened the buildings and had the Darwinian effect of killing a large number of the elderly and infirm when there was an inversion. The London fog was famous and actually romantic and loved by the young. Indoors there was no problem apart from some extra dusting and a raised particle count from the ingress of ambient air. These particles were mainly large and not the more deadly small particles (>0.54 microns) which are present in modern offices. Most air conditioning systems do not filter out these small particles which are derived from outside traffic emissions, power stations, industrial processors, and inside from printer inks and toners and small carbon particles. These last are derived from shed squame (skin) cells which are cooked down by the high tension circuitry in VDUs. Each person sheds about 2 kilos a year amounting to over a ton in an office of 100 people. These particles account for 80% of airborne particles in an office or home and have the ability to absorb and concentrate VOCs, another pollutant which affects modern mankind. The effect of these is carcinogenic and exacerbates Chronic Pulmonary Obstructive Disease (CPOD) particularly asthma. Our forebears would have avoided all of these problems.


In our early Victorian office, the clerks would probably be sitting on a high stool at a high desk. This is easy to step down from in order to stoke the fire, run errands, find papers and generally keep active. He will not be stuck immobile for long periods in a low chair which has considerable demerits for the spine and venous return. He will be sitting perched forward with his legs tucked under him with feet resting on a crossbar. This position allows the flexion angle of the hips to open up and the pelvis to tilt forward which results in lumbar spinal lordosis (extension). The lordotic position is the natural posture that the spine adopts when standing There are no records suggesting that he was plagued by Low Back Pain as are our modern contemporaries who have to sit for prolonged periods in ergonomically inappropriate chairs. To make matters worse in the modern office the desk may not be adjusted to the height of the chair or the occupant as is required by the recent EU regulations.


Our clerk could suffer from RSI – or more terminologically exact, Work Related Upper Limb Disorder (WRULD). It would have been called ‘writers cramp’ having previously been described in 1713 as “scriveners palsy’ by Bernadino Ramazzini who is credited as the founder of occupational medicine. In 1892 the neurologist Sir William Gowers described the condition as an ‘occupational neurosis’ and Professor David Ferguson of the University of Sidney went further to describe the Australian epidemic of 1984/85 as a “complex psychosocial phenomenon with elements of mass hysteria, which were superimposed on a basis of widespread discomfort, fatigue and morbidity”. This view was reinforced by Barton et al in a report on behalf of the British Orthopaedic Association submitted to the Industrial Injuries Advisory Council in 1990. The current critical view has changed in that certain specific anatomically localised lesion such as tenosynovitis of various tendons around the wrist, carpal tunnel syndrome and epicondylitis, of either the ‘tennis’ or ‘golfers’ variety, can be work related as well as the less certain ‘regional pain syndromes’ which are of complex neuropathic origin.

This latter group is unimaginatively described as ‘WRULD Type 2′ and is recognised as having a psycho social dimension and related to work stress. To this we will return.

Indoor office environment

Empirically it has been found that optimum remediation results in the indoor environment being made to approximate to an equable outdoor temperate environment. Lighting must either be by suitably adjusted daylight or by full spectrum polarised light which is nearly equivalent to daylight. Savannah and mountain top air is relatively free of pathogenic microbe, and certainly VOCs. In an office environment it is found that installation of HEPA filtration and negative ionisation results in reduced sickness and an increased sense of well being which is translated into increased productivity. This system has the added advantage of eliminating the small airborne particles. As mentioned, these are a product of industrial civilisation and they can be borne over large distances, including national boundaries, remediation cannot be effected by relocating to a ‘green field’ site. Another physiological stressor are the sounds produced by modern office machinery. These are of a type that are interpreted by our primitive brain as alarm signals and so, although discounted by our modern brain, act as stressors.

The aforementioned can be easily remediated as indicated. The cost is not great and will be recouped in 1-2 years by increased levels of productivity. An unexpected finding in the optimised office is that measurable stress levels are reduced. It would seem that removing the physiological stressors enables the individual to cope with the psychological stress that effects most people under modern working conditions.


The musclo-skeletal disorders which are so common in recent times are partly due to lack of exercise as well as to the production of artefacts to enable work to be done in an unphysiological sitting posture. This simply did not pertain to our Cro-Magnon ancestors. As an Orthopaedic Physician a large part of my work consists of dealing with spinal disorders and I would endorse Mandals conclusion that “without the slightest regard for man’s actual anatomy, a new human form has been contrived to fit the available furniture.” To which it could be added that chair designers and manufacturers continue, with great ingenuity, to make chairs to this design. The new design of chair incorporating iliac (or pelvic) support rather than ‘lumbar’ support is an advance, but we need to go further, with a fresh rethink, if our occupation continues to require prolonged sitting. Desking has to be considered in relation to the person sitting in the chair and the height of the chair adjustment. Variable desk height adjustment is therefore a minimal requirement. A new generation of desks is slowly coming on to the market which take into account the need for wrist support as well as easily accessed communications and even a localised optimum environment!


Screen Shot 2015-11-27 at 14.00.35As for RSI (OK, lets use the outdated terminology; everyone else does), a two prong approach is necessary. Firstly the ergonomic factors have to be corrected such as workstation layout, well designed tools, positioning and wrist supports as well as breaks for alternative activities (a computer programme called ‘Workpace’ is useful here). Secondly, as mentioned, psychosocial factors are paramount in the WRULD Type 2 condition. Interestingly, it has been found that in an environmentally optimised office not only are the obvious morbidity rates reduced but that also stress related symptoms largely disappear. This suggests that as the physiological stress is reduced the worker can manage their own psychological stresses. This is very relevant to the psychosocial aetiology of the WRULD Type 2. Finally it must be emphasised that RSI is a potentially serious condition in that it can permanently curtail the continuance of a career. The problem must be recognised early and steps taken to remedy any ergonomic and environmental cause. To be successful Type I treatment must also be undertaken early by someone trained in the treatment of soft tissue injuries. At a later stage, Type 2 treatment is often surprisingly complex and requires a ‘pain clinic’ approach.

Screen Shot 2013-09-28 at 08.18.28To conclude, a healthy office environment is one that approximates to the equitable outdoor environment for which Homo Sapiens was developed by natural selection. The further we depart from this the greater the morbidity levels rise.

Obvious, really.

Screen Shot 2013-09-28 at 08.19.24

Office env



Managing the Ergonomics

Managing the Ergonomics of Office Seating

 by John Jukes                       The Source Publishing Company Limited 

Ergonomics expert John Jukes asks is the Sit/Stand desk the answer to aches and pains in the office?

Research done by Dr Henry Sanford see, Orthopaedic Consultant at the Cromwell Hospital adds another dimension to the problem of ergonomic comfort in the office. Sitting in a semi reclined position at 45 degrees reduces the gravitational loading on the spine by 50%. This is similar to the astronaut position, which permits working under heavy G forces. A suitable headrest and positioning of keyboard and VDU screen makes this a perfectly practical working position without inducing sleep. Many programmers, CAD users, control room engineers and tall people are seen to adopt this position using an ordinary chair when  working for long periods – perching the tail on the front edge of the chair with their shoulder on the back and the legs out straight.

Sit/stand desks and pelvic support semi recline seating  in the UK have yet to become part of the normal office landscape. When they do there will be several million office workers that will be grateful to be free from daily debilitating pain.


He wrote

Dr Henry Sanford MA. MB. B Chir. (Cantab) D  Phys Med. (Lond) is a well known Consultant Orthopaedic Physician in London and Associate Consultant to the Department of Rheumatology, St Thomas’s Hospital, SE1.  Earlier he worked at St Thomas’s with Dr J H Cyriax who is regarded as the ‘Father’ of  Orthopaedic (or Musculo-skeletal) Medicine after following 2 years in the army finishing as a Captain in the RAMC.

He was a founder member of the Society of Orthopaedic Medicine (SOM), the British Society of Musculo-skeletal Medicine (BIMM) and was Chairman of the Cyriax Organisation..  He has run courses and lectured internationally                                                              John Jukes – 30/07/2001


HAS19.07.34HAS & M19.08.43                  





HAS in BAOR,1954

and with daughter, Marietta, in Cambridge, 2005.

2T Chair Desk interface

The 2T Chair Desk interface becomes largely redundant as desks become a thing of the past with new office workstations.   ☛ The deskless office chair→   Some solutions may still apply.     

The 2T chair cantilevered from a ‘Delta’ desk.  A solution.

This desk has variable height adjustment and its shape allows greater surface area and occupies 30% less floor space than conventional desks. The transparent shielding enables an environment friendly space to be contained. This can evolve into a pod design concept.

Screen Shot 2013-09-23 at 00.20.44This concept was suggested to me by the late John Jukes.  This design concept has a number of very considerable advantages.

  • The chair can rotate to face through 270 ̇ Cabling can be led straight to the chair(telephone, computer, adjustments).
  • The chair occupies no floor space. (zero footprint)
  • Chair height adjustment becomes irrelevant.
  • With flat screen VDU, split keyboards, and voice activation technology most of the computer hardware can be moved off the work top to the chair armrest.
  • Improves Office design and social interaction.
  • Adapts to any style of office layout whether formal or informal.
  • Allows the user a personal space and also view of colleagues.
  • Can be arranged in a reverse rosette to give immediate interaction with close colleagues.
  • Can be easily developed into a hub

⟶ For hubs, D-desks and layout see 2T IN THE OFFICE.

Next see ☛ The deskless office chair

Screen Shot 2013-09-24 at 18.22.50

Screen Shot 2013-09-23 at 00.22.31







An 8 desk rosette can be arranged as shown

Screen Shot 2015-04-14 at 13.02.45