Alternative Seating: What the Research Actually Says (And What We've Been Getting Wrong)

Kneeling chairs. Saddle seats. Active chairs. Exercise balls. You've probably been asked about all of them, and maybe you've given answers based on incomplete information.

In this episode, we dig into what the research actually shows and more importantly, what it doesn't. We examine a critical flaw in one of the most-cited studies on alternative seating that changes how you should interpret the findings. We explore why "fixing the pelvis" doesn't automatically fix the neck.  

Key insight: The ideal sitting posture isn't "upright" or "neutral." It's variable. And that reframe changes everything about how you approach seating recommendations.

If you want to be the ergonomist who understands this category at a level your competitors don't, this episode is for you.

If you're a healthcare professional and this episode got your wheels turning about office ergonomics - good. I've got free resources to help you take the next step at ergonomicshelp.com/resources. 

Transcript

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Darcie 0:00

Hey there. Welcome back to the Business of Ergonomics podcast. Today we are going deep on alternative seating. We're looking at kneeling chairs, saddle chairs, active chairs, everything in this category, including stability balls or exercise balls. As a chair too. But here's the thing, we're not doing another surface level. Pros and cons, rundown. If you wanted that, you could look at any chair manufacturer's website or read any blog post. Today we're gonna be talking about what the research actually shows, where we as ergonomics service providers may have been misreading it, and then how to position yourself as the expert who understands this category at a level. Your competitors don't. Most agonists either dismiss these types of chairs entirely or they recommend it without understanding the system level implications. Both approaches leave money on the table and clients underserved. So we're gonna fix that today on this episode.

1:03

Welcome to the Business of Ergonomics podcast. I'm your host, Darcy Jeremy. I'm a board certified professional agonist with over 15 years of experience delivering ergonomics programs to employers of all different types. In this podcast, I share what other healthcare professionals are already doing and being with ergonomics assessments and how to land those clients that you dream of. Without further ado, let's jump into this episode right now.

Darcie 1:34

I wanna start with a quote that should fundamentally change how you think about seeding and this quote I stumbled upon when I was putting together an infographic for members of the Accelerate Business of Ergonomics program. If you haven't heard about this program yet, this is where we provide time saving tools and resources to allow ergonomics professionals get more clients and spend less time. In their business so they can spend more time on their business and building the processes and the systems to bring in more clients and build those relationships that actually bring in more billable work or more cash. So every month we put together an infographic that our members can put their own logo on, and it's so cool. We have over a hundred at this point in time, and we give them three different sizes this month. We're looking at unconventional chairs, so the saddle chairs and exercise balls, and kneeling chairs, all of those things that you typically don't see and experienced ergonomists recommend because the science on them isn't as clear as a typical task chair. However, what I stumbled upon was eyeopening, and that's why we're here today talking about this, because if me who's been doing this for a while can be pleasantly surprised with the research, I know my listeners to this podcast will definitely feel the same, right? So let's dive into it. Callaghan and McGill 2001. The ideal Sitting Posture is a variable one. Now I know that if you're listening to the show, you already know that even the most optimal sitting posture. Shouldn't it be held for the entire duration of the shift? It's obvious, but it's worth repeating again. The research document that people naturally adopt three to four different sitting angles throughout the day to avoid fatigue. Healthy individuals. People without back pain change their sitting posture up to 13 times per hour. That's 13 times. That's if you do the math, which I did. That's roughly every. Four to five minutes, they're sitting in a slightly different position. The common things that you hear, especially with those who are first starting out with office ergonomics assessments, or maybe what you've been taught back in the day in school, You can hear the idea of a correct posture. And if you're like me and you're based in the research, you know that it's a slightly reclined posture with the workstation that matches that optimal slightly reclined sitting posture. Back in the day, you might adjust their workstation and say, Hey, there it is. That's your position. Maintain it, and then wonder why. And six months later, that person's still in some discomfort. The research is telling us something important, which may surprise you, but bears repeating again. The body doesn't wanna be held in any single position, no matter how correct or optimal that position is. Obviously the body wants to move, it needs to move, and I'm gonna dive into the research again because it's just so fascinating. Your intervertebral discs, specifically the nucleus pulposus don't have a direct blood supply. They rely on a process called inhibition, which is essentially compression and decompression cycles that pump nutrients in and waste products out. Think of it like a sponge. You have to squeeze a sponge to absorb water, and you have to compress and release a disc to nourish it. So that static posture in that chair, even if it's the most. Ergonomically neutral and optimal. It's essentially starving the disc so you may think that we're solving one problem of having a neutral sitting position. However, at the end of the day, we could be causing even more issues for that client if you're only showing them one posture. Home and Naamen published this back in 1983, Johnson in 1978, and Ted in 1990 documented the muscle fatigue mechanisms. So it's not new research, but somehow the ergonomics industry, specifically with ergonomic task shares have been off on a tangent with how to find that right static posture, especially, in the past 20 years. So here's the reframe for your deliverables. Stop thinking of yourself as someone who finds the correct posture. Start thinking of yourself as a movement architect. I know. It's corny, but we're just gonna hold that thought. So your job isn't to lock someone into position. Obviously, we are all about education, and your job is to design a system that enables beneficial movement throughout the day in a workstation that allows that person to work in a neutral and optimal posture too. And that's where you put on your thinking cap unconventional seating. When really understood what the pros and cons and how that reflects in the entire workstation is a tool in that toolkit. It's not gonna be a magic solution. It's not gonna be a be all and all. It's a tool that can be used under certain parameters. Okay, so now we're gonna dive into the specific research on different types of seating. I'm gonna cover the major categories, and this is gonna include kneeling chairs, saddle chairs, active and dynamic chairs, and. Those exercise balls that sometimes you see as a last resort for folks that just can't get comfortable on chairs. I'm gonna go deeper on each of these. I'm gonna dive into the research, and this is gonna be so useful for you. If you need more information, if any of these topics, then just check out the blog. I'm gonna list it in the show notes and it's gonna be real. Gonna be real awesome kneeling chairs. The foundational study here is the Bethany OV Etal in 2008. 20. Subjects compared a kneeling chair at 20 degrees. Inclination to a standard computer chair. The finding that gets cited everywhere. Kneeling chairs maintain lumbar lordosis closer to standing posture than standard chairs. That's the headline. That's what the manufacturers put in the marketing, and it's true. The research supports it. After all. But here's what the research also shows, and this is from the Nettes Etal study. In 2012, published in the European Spine Journal, when they measured neck posture on kneeling chairs, they found increased forward head position, an upper cervical extension. Now most people read that and think. Okay. Kneeling chairs are good for the lower back, but bad for the neck. Case closed. But I want us to dive a little bit deeper for a second. The Annette study, they kept the desk at standard height for the kneeling chair users. They didn't raise the monitor. Us as agonists, we would wanna keep that relative. Position where the monitors in an ideal position no matter where they're sitting. Think about what happens biomechanically. If you put someone in a kneeling chair, their seated height changes. Their eye height is now different relative to the monitor. What do they do? Obviously they're gonna tilt their head down to see the screen the research even acknowledged this. They wrote, and I'm quoting, it is postulated that the head tilt increased in response to the increased neck angle in order to maintain the eyes in a horizontal position. In other words, the neck posture finding might not be about the chair at all. It might be about the workstation setup. And there we go. That's ergonomics 1 0 1. Here's what's fascinating. In the same study, the saddle chair showed better neck posture than the kneeling chair. And guess what? For the saddle chair and only the saddle chair, they raised the desk height as the manufacturer recommended. Do you see what happened? The saddle chair got a proper workstation adjustment. The kneeling chair did it, and then we compared the neck posture results as if they were measuring the same thing. This is a critical insight for your practice when you read research on unconventional seating. You have to ask, did they adjust the workstation? Because if they didn't, they're not measuring the chair's effect. They're measuring the mismatch between the chair and the workstation. You have to put on your ergonomics detective's hat and your ergonomics monocle to take a deep dive into some of these studies. But don't worry, I got your back here. This is exactly what I did. I love this stuff. We're gonna change the subject a bit, and with that lovely segue, we're gonna dive into saddle chairs. Saddle seats have some of the strongest research for Lumbo pelvic posture. Gail Etal in 1989 showed increased lumbar lordosis, multiple studies in dentistry, and there's a lot of dental ergonomics. Research on saddle seats show lower ergonomic risk scores compared to conventional stools. The mechanism is straightforward. The saddle shape opens the hip angle to. 120 to 135 degrees. This tilts the pelvis anteriorly, which encourages lumbar lordosis. You're basically creating a supported standing posture while seated. And personally anecdotally, when I talk to folks that have lower back discomfort, especially chronic, they have reported without a shadow of the doubt that saddle chairs help their lower back. However, when we're looking at. The computer workstation, and this is so important. Saddle chairs only work within a specific height relationship to the work surface. Yeah, this is a particularly interesting insight. Most saddle chairs are height adjustable, which is a major plus. However, there's something inherent about this that we have to consider as ergonomics professionals so you can lower them. But if you lower a saddle chair to work at a standard 28 to 30 inch desk, you are compressing that hip angle back towards 90 degrees. So this is big. You're essentially eliminating the very thing that makes a saddle chair beneficial. The manufacturers know this. That's why Bombach and others recommended raising their desks. It's not optional. It's integral to the chairs function. So when a client asks you about saddle chairs, don't just say a yes or a no. As we all know, any ergonomists that's worth their salt will always say something along the lines of, it depends. So with saddle chairs, we need to ensure that the saddle chair has a desk height component that matches a higher hand working height in order for that saddle chair to be ergonomically optimal. So if they can't raise the desk or use a sit stand desk, a saddle chair may not be appropriate in the office, and this has nothing to do about the merits of a saddle chair. A saddle chair is. So awesome for so many reasons as we just discussed, but it's because the system won't support it. So as an agonist, you may need to look at a different type of chair or a different type of desk to get that solution to fit them ergonomically, which is a huge insight. Let's move on to active and dynamic chairs. This is a category that includes chairs with wobble bases, split seat pans, rocking mechanisms, anything designed to allow or encourage movement while seated. The research here is genuinely promising. Custer etal. In 2016, published in human factors, found that spinal motion during active sitting is similar to walking in terms of the lateral flexion pattern. That's significant because it suggests active chairs might provide some of the movement benefits that we lose when we sit. And interestingly enough, over the years of being in this industry, I have found there's been a gradual shift between more active and dynamic chairs, especially there's some really unique chairs coming out of Europe. However, in corporate America, I find that the buy-in on these types of chairs is a little bit slow. However, the research on this is obviously intriguing. A 2020 study in PLOS one looked at a dynamic chair with a movable seat and found characteristic cyclic loading and unloading of the lumbar truck muscles. This is exactly the kind of variation that prevents the static fatigue that we talked about earlier in this episode. But here's the specifics with this. The same research shows that backless dynamic chairs, things like a wobble stool, if you've ever seen those, these can actually increase spinal flexion and require continuous lumbar activity that leads to fatigue over time. So active and dynamic are automatically good, or they're not automatically bad. The overall design is so important here, and a well designed active chair with appropriate support can promote. Beneficial movement and a poorly designed one can create new problems with fatigue. And that's one of the most sided ergonomic concerns with unsupported back seating in that it's a good idea in theory, but in reality, if you come and you see those folks on wobble stools or exercise balls. They are hunched over. They're talking about aching backs and it might even be a health and safety concern 'cause they're falling off chairs. I have done this before and I have seen this before too, as an agonist. This is where your expertise becomes so valuable. Here. You can evaluate specific products and make informed recommendations rather than just saying that all active sitting is good or active sitting is bad. And with that segue, we're talking about exercise balls. You know what I'm talking about here? Stability balls, physical therapy balls. You might see these in a clinic for rehab. Sometimes you might see them in the office too. I'll be brief here because the research is pretty clear. Exercise balls as a primary seating chair are not supported by the evidence for prolonged use period. They increase so many ergonomic concerns. Specifically, they increase the load on the lower back. They don't provide consistent postural benefits. They're not height adjustable in any meaningful way too. Can they be useful for short term therapeutic processes? Yeah, sure, absolutely. But as a primary work chair for eight hours, no, we gotta do something better for our client. If a client asks about exercise balls, you can confidently say that the research doesn't support it for extended work. You can explain why, and then you can move on to some of these other solutions that may address the root cause of their concerns. At the end of the day, they're probably gonna be happier because they're not in pain. Because they're in less discomfort at the end of the day, and from an ergonomics perspective, they're in a more optimal working position too. Let me give you a framework for assessing clients who are considering. Different types of seating. This is what separates a professional recommendation from a product sales pitch. If you catch my drift, the first thing you wanna do is identify the problem you're solving, and this is ergonomics 1 0 1. If you are new to the ergonomics process, I wanna recommend my highly Rated. Program called The Ergonomics Blueprint that shows you how to do a thorough office ergonomic assessment and how to make awesome recommendations for your clients as well. One of the things that we talk about in this program is the value of doing a root cause analysis. And before you even talk about shares, you have to get clear on the actual issue. Where is the mismatch? Where is the discomfort? Is it fatigue? Is it a desire for more movement, different problems, point to different solutions. Someone with knee pain shouldn't go on a kneeling chair. Obviously, someone who needs to move frequently might benefit from an active chair. Someone with caucus pain might do well with a saddle seat. If you don't know the problem, then you can't evaluate solutions. The second thing that you wanna look at, and this is definitely ergonomics 1 0 1, so useful, is to assess the workstation constraints. Can the desk height be adjusted? Is there a sit stand option here? Can the monitor be raised or repositioned? Is there adequate space for a different chair footprint? This matters because as we discussed, many alternative chairs only work within specific height relationships to the work surface. If the workstation can't be modified, your options are really narrow here. I've seen ergonomists recommend saddle chairs to clients who have fixed height desks in cubicle farms. That's setting up a client for failure. The chair can't do its job if the system doesn't support it. Step three, consider the work tasks. What does this person actually do all day? Are they typing reading documents? On video calls, do they need to reach for materials? Do they file? Do they move between workstations? Kneeling chairs, for example, aren't great for tasks that require a lot of lateral movement or reaching. Saddle chairs work well for tasks with a forward orientation. Think dentists, lab technicians, people doing detailed work in front of them, match the chair to the work and not the person, which is ergonomics 1 0 1. Step four, evaluate individual factors. For instance, knee problems, they would rule out kneeling chairs. Obviously hip issues may complicate saddle seats. Vestibular problems might make active chairs impossible or problematic. What's their experience with alternative seating? Someone who's never used anything but a standard office chair may need a transition period. Am I right? I definitely would because change can be difficult. Throwing them directly into a backless wobble stool for eight hours is a recipe for complaints. And us as ergonomists, we do not want complaints from our customers. We want them to be happy. What we want them to be using, our recommendations, Some people want a chair that fixes their posture passively. Alternative seating generally requires active engagement. If they're not willing to participate in their own postural health a different intervention might be more appropriate, perhaps even showing. They're showing them how to use the various mechanisms on their current task chair. One of my favorite things is using the synchro tilt and unlocking that synchro tilt with reducing the chair tension because the combination of both of those, we'll put the chair in. A rocking chair format, however, we're to the wiser. If you're gonna be changing this setup for that person, they have to be really clear on how to make the adjustments themselves, and they gotta be ready for what zero tension on a chair feels like in a free float setup. It can be a little bit crazy just warning you. However, perhaps if they're not engaged with what would be required to use more of an active setup, using their ergonomic task chair in this type of method may be more appropriate. And educating them on the value of changing their back angle and their posture throughout the day is so useful as well. I've certainly done that many times in my career. Okay, let's move on to step five, plan for implementation. This is where a lot of recommendations fail, so you might identify the right chair per se. The client buys it and then nothing changes because no one taught them how to use it. Alternative seating requires training. How do you sit on it correctly? How long should you use it initially, how do you progress? What adjustments need to be made to the rest of the workstation so they can be working with that workstation optimally? There's a couple of aspects that may be useful for you as agonist, but this requires clarity from you and that decision maker in the company, whether it's HR or putting it in a contract, what that ergonomics assessment requires. So you might wanna build implementation support in your recommendation. It might be really clear instructions. It could be a video if you have this handy, or it might include a follow-up as well. This works whatever your practice model is set up. However, if you are gonna be including a follow up, I strongly suggest that you are being paid for your time. It's not just something that you add willy-nilly here. If you're traveling to that workstation, if you're providing expertise, then that has to be reflected in the contract. At the end of the day, you don't just wanna say, buy this chair. And totally bounce. It's not gonna work that way. Let's move on to step six, the follow up. So this goes back to how you set up your contract. Are you scheduling a follow up email or. Are you scheduling a follow-up or a check-in with email? With call physically, are they actually using the chair? Has their pain or discomfort changed? Are there any new issues that have emerged? This is where you catch problems early and reinforce and reinforce your value. It also gives you data on what's actually working too, which improves your future recommendations. Okay. We're gonna shift gears a bit here. Talk about how you communicate this to people who write the checks, hR directors and facilities managers have a different set of concerns than your individual clients. They are thinking about cost, scalability, liability, and let's be honest, whether this purchase is going to generate complaints, here's the language that works. Don't lead with the chair. When HR asked, should we buy kneeling chairs for our office? The temptation is to answer the question directly. I want you to try with all your might to resist that. Instead, reframe it. Maybe something like unconventional or alternative. Seating can be beneficial for certain employees and certain tasks, but the research shows it only works when the workstation is adjusted to match a blanket purchase without individual assessments often creates new problems while solving others. This positions you as the expert, right? So critical. And you understand that it's not gonna be a vendor just pushing products down their throats, really. It's gonna be a nuanced approach, and it really depends. And I want you to consider using this system language. HR people understand systems, they manage complex organizations. Speaking their language can be really useful here. You could say something like, A chair is part of a system, not a standalone fix. When you change the chair, you change the employee's position relative to the monitor, their desk, their keyboard. Without adjusting those elements, you're solving one problem while creating another. That's why individual assessments is essential. So what I love about that statement and straight up, if you wanna copy that, I totally recommend that. Head to my blog and you're gonna get the complete script there. So this makes sense. Why I love this so much is that it makes a case for your services, not just a product. So one question from an HR decision maker may mean that you have a number of one-on-one assessments or trainings that you can provide value, maybe even more value than you originally anticipated from a random question. And at the end of the day, that is huge for your business, and that's huge for the client. The next thing that I want you to consider is to address the failure mode. HR has probably seen this before. Someone bought an alternative chair. Employees complained that chairs ended up in a closet. I want you to address this directly, and what you can say here is that the most common reason that alternative seating fails is implementation. Without assessment, the employee gets a new chair, doesn't know how to use it, the workstation isn't adjusted, and within a month they're back to their old chair with a new complaint. Professional assessments prevent that. The next thing I wanna address is quantify when possible. If you have data from previous engagements, whether it's reduced complaints, decreased workers' compensation claims, improved employee satisfaction scores, use it, HR response to metrics, it makes their decision process simpler if you don't have your own data. Reference the research you can say something like, studies show that proper ergonomic interventions can reduce musculoskeletal complaints by 50 to 70%. The word is proper, that means match to the individual and implemented correctly One aspect that I really love to offer clients is a pilot. Human resources love pilots because it's a lower risk for the organization to see if something may actually work, especially for organizations that are hesitant to commit. A pilot program works really good. You can assess just a small group, implement alternative seating when appropriate, measure the outcome, and then scale based on the results. This reduces their perceived risk and gets your foot in the door. Once they see results, the full engagement becomes easy to. All right. Got it. How is that going so far for you? There's a couple of aspects here that were so valuable. The scripts are useful, as ergonomics consultants, so that we can not only reframe their question and manage objections, there's something that we can say too about putting our foot in the door for the other services and the value that we bring to the table as. Ergonomics professionals. But before we wrap up, I wanna hit a few common mistakes I see ergonomics practitioners make with alternative seating. Mistake number one, recommending based on category, not specifics. So a statement like kneeling chairs are good for back pain is too general, which kneeling chair for what type of back pain. With what workstation setup, at what duration of use. If you can get specific, it's so useful. Here you can evaluate actual products. Understand the difference between a 50 buck, Amazon's kneeling stool and a $500 barrier balances. They are not the same and they do not perform the same. Mistake number two, ignoring the transition period. So obviously when you're looking at this, someone who sat in a standard chair for 20 years cannot immediately switch to eight hours on a kneeling chair. Their muscles are not adapted, I want you to consider to build in a transition. Start with 30 minutes to an hour increase, gradually alternate with their existing chair. This presents the, I tried it, but it hurt. Response that kills. Mistake number three, forgetting the neck. We've talked about this and it bears repeating. Most alternative seating research focuses on the lumbar spine. The cervical implications are often ignored or understudied. Always assess the entire workstation, especially the neck posture. You can adjust and monitor height. However I wanna be really certain here, don't let a good lumbar outcome create a bad cervical outcome. Mistake number four, not following up. Let's say you make a recommendation. The client buys the chair, you never hear from them again. Is that success? You dunno? Maybe they love it. Maybe it's collecting dust. Maybe they developed a new problem and they blamed you. Can you follow up? What's an easy way that you can do this? Follow up, measure the outcomes, adjust as needed. This is how you build a reputation for results, not just recommendations. One thing that holds many gons back from following up is the administrative burden with this, because it adds another level of. Workload that many of us simply, we don't have the time for. And that's why I've included in my program accelerate the Business of Ergonomics. This is the program for professional ergonomists who want to become the go-to ergonomists in their cities. This is why we've included an AI course. AI does 80% of the heavy burden so that you can focus on the most important part of your business, and we show you how to effectively use those tools. If you want more information about how to sign up for the next time we launch Accelerate, then I want you to go to ergonomics help.com/biz, and you can sign up for the wait list for the next time that we open enrollment, which will be sometime in the later part of Q2. Let me bring this back to where we started. The fundamental insight from the research is that movement matters more than any single posture or any single chair. The ideal sitting posture is a variable. One static loading, even in a perfect position, is the enemy of spinal health. And Alternative seating is a tool that can facilitate movement and improve posture in specific contexts for specific people, that's a mouthful, but as professional agonists, these are the details that make a difference because. These are not magic solutions. It's not universally appropriate for every client that you see, and it absolutely requires system level thinking. You can't change the chair without changing the workstation, so there must be an element of workstation adjustability to make this work for your client. However, if you're thinking about this and being like, yo, I don't wanna get started in ergonomics because this sounds that it's a little bit over my head in terms of complexity. This complexity is actually your opportunity. Anyone can Google best kneeling chair, but what they can't do is assess an individual's. Ergonomic setup, evaluate their workstation constraints, match a specific solution to their specific situation, implement it properly and follow up to ensure that it's working. That's what you do as an ergonomists, and that's why you are the go-to ergonomics consultant in your city. This is what makes you so valuable. So the next time someone asks you about alternative seeding, don't give them a simple answer. Give them that nuanced evidence-based, professionally considered answer that demonstrates your expertise. That's how you become the best in your city at what you do. Thank you for listening. I'll see you next time.