Workplace Set Up

Setting up your Chair

 Seat height adjustment and footrest.

Adjust the chair height so that your hips are higher than your knees and your feet are firmly on the floor or footrest. Try not to lower your chair to suit your desk height. If possible adjust your desk height. A footrest is to be used if the chair height has to be raised to meet the desk and your feet cannot touch the ground.

Seat depth adjustment

This needs to accommodate your thigh length to enable you to sit back into your chair to gain support from your backrest. Leave a gap of about the width of your fist between your knee and the front of your seat.

Seat forward tilt

This rotates the pelvis forward, which encourages the spine into an upright posture. *A forward tilt may not be suitable for certain conditions, e-mail or call for more specific advice.

Height adjustable arm rests

Height adjustable armrests provide additional support for the upper body when not keying. That should be adjusted so that elbows are supported but with shoulders relaxed. The armrests should not prevent you from sitting close to your desk. If they restrict desk access consider removing them completely.

Setting up your desk

The problems

Most desks are static and fixed at 72-75cm. This may not be the correct height for you when you have set up your chair correctly. A desk height that is too low can cause a ‘C’ shaped spine and musculoskeletal pain. A desk that is too high will cause the shoulders to shrug producing neck tension.

The solutions

Ideally a desk which is electronically adjustable, or some desks are adjustable by means of a peg or screw system. An alternative is desk raisers, which sit under the desk feet to increase height by 3cm increments.

Setting your desk height

So that your elbows are level with or just above the desk. Do not shrug your shoulders to meet the desk.

Setting up your desktop


Set the monitor screen at arms length and at the height where the top of the screen is eye level. Have the monitor in a central position on the desk so that you are not twisted to one side or another. Position the monitor at 90 degrees to any light source, this avoids glare.

Document/ Copyholder

When referring to paper work use a copyholder to position the data to prevent prolonged periods of neck flexion

Keyboard and mouse


Ensure that your upper arm and elbow are as close to the body and as relaxed as possible for mouse use to avoid over-reaching. Also ensure that the wrist is as straight as possible when using the mouse and that your arms fall relaxed at your side.


Cradling the phone between your neck and shoulder causes severe muscle tension. If you regularly use a phone consider a headset.



Sit tall

Don’t slouch

Take mini breaks from your desk regularly.

Now stop slacking off and get back to work!!!! : )

For more information on osteopathy or treatment at Bingham Osteopathic Clinic please call 01949 839 238 or e-mail




Tristan Hill B.Ost



A tendon is a tough yet flexible band of fibrous tissue. The tendon is the structure in your body that connects your muscles to the bones. Tendons come in many shapes and sizes. Some are very small, like the ones that cause movements of your fingers, and some are much larger, such as your Achilles tendon in your heel. When functioning normally, these tendons glide easily and smoothly as the muscle contracts.


What is tendonitis?


Sometimes the tendons become inflamed for a variety of reasons, and the action of pulling the muscle becomes irritating. If the normal smooth gliding motion of your tendon is impaired, the tendon will become inflamed and movement will become painful. This is called tendonitis, and literally means inflammation of the tendon.


What causes tendonitis?


The most common cause of tendonitis is overuse. Commonly, individuals begin an exercise program, or increase their level of exercise, and begin to experience symptoms of tendonitis. The tendon is unaccustomed to the new level of demand, and this overuse will cause an inflammation and tendonitis.

Another common cause of symptoms of tendonitis is due to age-related changes of the tendon. As people age, the tendons loose their elasticity and ability to glide as smoothly as they used to. With increasing age, individuals are more prone to developing symptoms of tendonitis. The cause of these age-related changes is not entirely understood, but may be due to changes in the blood vessels that supply nutrition to the tendons.


Sometimes, there is an anatomical cause for tendonitis. If the tendon does not have a smooth path to glide along, it will be more likely to become irritated and inflamed.

Tendonitis is almost always diagnosed on physical examination. Findings consistent with tendonitis include:


Tenderness directly over the tendon

Pain with movement of muscles and tendons

Swelling in the area of pain

Studies such as x-rays and MRIs are not usually needed to make the diagnosis of tendonitis, however if symptoms persist they may help clarify the cause of pain. Examples of tendonitis’ are:

Wrist Tendonitis

Wrist tendonitis is a common problem that can cause pain and swelling around the wrist. Wrist tendonitis is due to inflammation of the tendon sheath. It is commonly found in typists and labour intensive jobs.


Achilles Tendonitis

Achilles tendonitis causes pain and swelling in the back of the heel. Understanding this common problem can help with treatment and help to avoid serious complications such as Achilles tendon rupture. This is very common in racket sports such as squash.


Patellar (Kneecap) Tendonitis

Patellar tendonitis, or inflammation of the patellar tendon, is a condition often called Jumper’s Knee. Treatment of patellar tendonitis usually consists of rest and anti-inflammatory medication. Common in those who jog/ run.


Rotator Cuff Tendonitis

Many patients who have shoulder pain are suffering due to bursitis or rotator cuff tendonitis; shoulder position and posture play a large part in longstanding pain, with tasks such as driving stretching the joints and muscles for long periods.



Tristan Hill B.Ost


Sport Injuries

Welcome one and all to my 16th monthly column where I endeavour to answer your queries on a variety of aches, pains, restrictions and general concerns. This month I’m going to be discussing sports injuries. It’s that time of year again when the weekend sportsman jumps out of us and starts to demand more of our bodies. The weather is improving and we feel we should be out there, hitting a cricket ball for four, serving an ace, or rolling the first of the outdoor bowls down on one knee. This is a crucial time for the coming season, yes for good team results, but also for preparing our body for the rigours of sport.


Most injuries can be put down to 3 major causes; poor preparation, inadequate stretching, or just bad luck.


Poor Preparation: As a weekend sportsman myself I see many levels of preparation within a small group of people. Most of us begin our sporting careers in our teens, a time when muscles are supple, bones are very flexible and still growing, cartilage is thick and shiny, and work related idiosyncrasies are in the distant future. In short, you can get away with it! As your skeleton and muscles age you develop areas of weakness, which leave you prone to damage through these regions. Problems such as previous muscle tears, ligament sprains, and the fact that most people enter into relatively repetitive work patterns mean that the overall health of the musculo-skeletal system will diminish. In clinic, it is these idiosyncrasies that as an Osteopath I am trained to look out for and treat. To help limit the negative effects they have on your body whilst you exercise you must go through a gradual warm-up program to engage the muscles and joints that are normally left in a more dormant phase.


Inadequate Stretching: It is generally only wise to stretch muscles once they are warm, i.e. after exercising or at least warming up, as this prevents more severe muscle tears, tendon irritation and joint trauma. Specific areas on different people may need to hold more focus as posture and work can seriously alter individual morphology.


Bad Luck: No amount of warming up or stretching can prevent certain injuries, such as a sprained ankle due to an unexpected divot on the pitch, or broken bone due to trauma in a tackle. These are unlucky happens chance which should be dealt with correctly to prevent them becoming a future cause of something insidious and often more difficult to treat.


The important thing is to be aware that the longer an issue lasts the more impact it will have on the rest of your body, so the faster a condition is diagnosed and treated the better it is for the long term sports person in you.



Tristan Hill B.Ost


Shoulder Pain

Shoulder pain is a problem I see everyday in practice life. It is debilitating as it is often accompanied by restricted movement and, for most people, it is very difficult to shrug off. A recent study into shoulder pain by British Tameside founda substantial prevalence of around 14% of people questioned had current symptoms. Wider statistics show that only about 40-50% of people with shoulder pain consult a primarycare physician or GP for it.


Women seem to have more shoulder problems than men, with the frequency of shoulder pain increasing with age. People at high riskof shoulder pain include those working as cashiers, garment workers,welders, and bricklayers, often due to their repetitive nature, and those who work with pneumatic tools. Hairdressers, plasterers,packers, and people who work for long hours at computers, are also at highrisk, this relates to repetition and maintained shoulder elevation.


The shoulder complex is actually made up of 4 joints, not just 1. Most of the movement comes from the large ball and socket joint at the top of the arm bone, allied to that is the joint between the chest bone and the collar bone, the collar bone and the shoulder blade, and finally the shoulder blade and the rib cage. These joints allow the shoulder to achieve huge ranges and types of movement whilst also being supportive in times of need. Where the shoulder differs from the hip is this large range of unrestricted movement, but this comes at the cost of some loss of strength, particularly when it is used incorrectly.


To help keep the shoulder supple the normally strong ligaments have been replaced by muscles that are designed not for movement, but for active support. These you may have heard of, they are the rotator cuff muscles. They are designed to contract/ support the ball and socket joint where ever the arm happens to be, be it unscrewing a light bulb or just reading a newspaper.


Shoulder pain is, more often than not, in some way linked to one or more of these muscles, either because they are too weak, to short, to stretched or perhaps damaged in some way through poor use or trauma. Shoulder position and flexibility are paramount to shoulder health. For specific advice on shoulder pain please contact me via the details below.


For more information on clinic gift vouchers, osteopathy or treatment at Bingham Osteopathic Clinic please call me, Tristan Hill B.Ost, on 07835596870



Tristan Hill B.Ost



Many of my patients at one time or another have mentioned to me that they have or do suffer with sciatica, but what does this mean? Of course logic would dictate that the sciatic nerve would be involved, but how and why does this nerve, of all the nerves in the body, cause so many people so much trouble. Lets find out…


The Sciatic nerve is a very large nerve that starts in the low back (being created by five smaller nerves leaving the spine),which then travels through the the pelvis, into the buttocks and then runs down the backs of the legs. At its largest the nerve is roughly the same thickness as your thumb, making it the largest nerve in the body.


Sciatica is a set of symptoms including pain that may be caused by general compression and/or irritation of one of five nerve roots that give rise to the sciatic nerve, or by compression or irritation of the sciatic nerve itself. The pain can be felt in the lower back, buttock, and/or various parts of the leg and foot, with predominance to the back of the leg. In addition to pain, which can be severe, there may be numbness, muscular weakness, and difficulty in moving or controlling the leg. Typically, the symptoms are only felt on one side of the body, apart from in some severe cases. Although sciatica is a relatively common form of low back pain and leg pain, the true meaning of the term is often misunderstood. Sciatica is a set of symptoms rather than a medical diagnosis for what is truly causing the symptoms.. This point is important, because treatment for sciatica or sciatic symptoms will often be different, depending upon the underlying cause of the compression. So, the correct diagnosis of the cause of your pain is of paramount importance to your overall management and recovery.


Here are a few of the more common causes osteopaths, such as myself, see in clinic;


Disc prolapse or herniation (slipped disc)– this compression happens in the spine when the fluid centre of the disc escapes and puts pressure on the nerve as it leaves the spinal cord. Pain is often marked in the back of the legs and will often last for many months.


Arthritis in the spine – as the spine gets older it is normal to see signs of wear and tear, however the changes occuring can cause the holes that the nerves leave through to reduce in size, which increases the likelihood of compression. Although the arthritis is not reversible, corrective treatment can drastically reduce the pressure in the affected area and will often relieve even the most severe symptoms.


Piriformis compression – this is a muscle in the buttock which when tight can cause pressure on the nerve giving nagging leg pain. It can occur due to long periods of stretch or in response to joint aggravation.


Sacroiliac joint problems– these are two very large joints between the pelvis and the spine which can become locked or painful producing muscle spasm and difficulty with particular movements. Females are particularly prone to this around pregnancy due to wieght and hormone changes.


Trigger points – are points in muscles that mimick pain caused by a nerve. This is not true sciatic compression at all. When muscles are tight for long periods they start to suffer with a lack of oxygen as blood is unable to enter them. This causes pain, which can often radiate all the way to the foot, even if the muscle in question is located in the buttock. This type of pain is very easily treatable using massage and other techniques to increase blood flow.


These examples are only a few of the more common causes of “sciatica” and help to outline that in many cases this term is incorrectly used. The only way to be sure of the cause of your pain is to have a trained medical practitioner, such as myself, assess the area in question and this will allow treatment to be specific for your complaint.


For more information on osteopathy or treatment at Bingham Osteopathic Clinic please call me, Tristan Hill B.Ost, on 01949 839 238, e-mail, or visit



Tristan Hill B.Ost


Neck Pain and Posture

Welcome to my monthly column on a variety of symptoms and ailments. In a former column I touched on the ill effects that bad posture can have on the production of headaches. This month I thought it might be beneficial to discuss pain located in the neck itself, as so many of my patients currently seem to be suffering with this type of complaint.


The majority of adults will, at some point, be affected by neck or upper shoulder pain. It is an area we all use a great deal in our day-to-day lives, and for many of us is the location where we hold much of our stress and tension. Indeed, the first thing that many patients say is “I’m particularly stressed at the moment, do you think that’s why my neck has started to hurt?” and for some this may have been a trigger for a recent bout of neck pain. But, it is important to understand that it is very uncommon for stress alone to be a cause of pain. It is usually an indicator that there is a longer standing problem underneath, which prior to the increase in stress hadn’t yet manifested as neck pain.


Posture is the usually the first and most obvious cause of any spinal pain. Now, that doesn’t just involve those that sit at desks all day whilst working, it relates to all tasks and movements of the body. Everything we do is reflected in our tissues from head to toe, and since we mainly contact the ground through our feet any thing above there will have to fall in to line with the area directly below it, and at the end of that chain is the neck and head.


Located in the head are the eyes, ears, nose and mouth, inlets and outlets for the senses which we so vitally need to function. One of the bodies main concerns is to keep those senses level so that we have an even perspective on the world around us. The last line of defence for this movement is located in the neck, particularly the top 3 joints. If the body is felt to be too bent forward or backward the 1st joint will compensate, if there is a twist through the back then the 2nd joint will reverse this and if there is a side ways movement occurring the 3rd joint will help level it up.


This is an important concept to understand as when things go wrong we are looking at a break down in the body’s inherent ability to compensate. This fits perfectly with the saying ‘the straw that broke the camels back’. So, what seems like a sudden episode of neck pain may have been building up for many years and eventually with a very small change in use or a very small injury someone can suffer pain that just won’t clear on its own.

As an osteopath I am trained to look at all aspects of a persons body, their movements, and their day-to-day tasks, to reduce the negative parts which are contributing and encourage tasks which promote even movement.

As with all medical conditions a correct diagnosis is of paramount importance for the appropriate treatment and management of the condition. For more information on the clinic, to discuss a particular case, or to book and appointment please call Tristan Hill on 01949 839 238



Tristan Hill B.Ost


Lifting Techniques Posture

Hello again, as Harry Enfield’s annoying character used to say “Only Me!”


This month I’ll be discussing manual handling, an area very close to my heart, as I have taught it in varying environments for the last few years. I’ve been privileged enough to visit many different work arenas including TV studios, factories, refuse centres, and endless types of office set-ups. Although the people working in these areas would describe their lifting needs as different, it became evident that there were key principles in training that were important to all.


We’ve all heard the old adage ‘bend your knees, keep your back straight’, but this is a rather out dated notion. As we improve our understanding of human mechanics and damage, we see that leverage and spinal curves are more relevant for a healthy lift.


Firstly we’ll look at leverage. If you imagine a seesaw with an even distance to each end from the centre or pivot point it will sit flat and still. If you then move the pivot toward one end it will tip toward the long side, unless something strong holds the short side down. This is leverage. Still with me? Good. Now imagine that your back is that seesaw, and the bottom of your back is the pivot, as you bend forward you create the long lever with you upper back, head and arms. Already your back muscles are holding you up. Now also realise that 2/3rds of your body weight is above this pivot, so your back muscles are holding up an enormous weight without you even picking anything up. To give you a typical scenario for an average male of 90kg (14st 2lb)


2/3rds of 90kg = 60kg

As they bend, the seesaw will look like this:


Low back muscles upper back, arms, head, load

ß3cm-à pivotß————-30cm—————à


There is a difference of 10 to 1 for the load and an average of 5 to 1 for the 60kg torso. If the load is something relatively light, i.e. 10kg then the total lift is calculated around (10x 10= 100kg) + (60 x 5= 300kg) = 400kg (63st)With these figures we can see how easy it is to damage the low back with very little effort. This why when I teach manual handling I stress the importance of getting the load as close to the body as possible, therefore limiting any levers.


Secondly, spinal curves matter to prevent damage to the discs and muscles of the low back. If the normal low back curve is maintained then the spinal muscles are only supporting the spines posture and not taking part in the lift which will lead to there damage. It will also more likely promote use of the correct leg muscles for the lift itself.


For more information on manual handling or the clinic, to discuss a particular case, or to book an appointment, please call Tristan Hill on 01949 839 238 or e-mail Please feel free to visit



Tristan Hill B.Ost


Knee Pain

This month we’ll be exploring the knee and those structures within that cause my patients and you so much discomfort! So how does a knee work?


The knee joints are essentially four bones held together by ligaments. The thighbone (femur) makes up the top part of the joint, and two lower leg bones, the tibia and the fibula, comprise the lower part. The fourth bone, the patella (or kneecap), slides in a groove on the end of the femur. Each surface that comes into contact with another is covered in cartilage to allow the joint to glide more smoothly. This is all contained within a fluid filled bag to aid lubrication.


Ligaments are large bands of tissue that connect bones to one another. In the knee joint, four main ligaments link the femur to the tibia and help stabilize your knee as it moves through its arc of motion. These include the collateral ligaments along the inner and outer sides of your knee, and the cruciate ligaments, which cross each other as they stretch diagonally from the bottom of your thighbone to the top of your shinbone. Damage to these structures is most commonly after strong trauma, and most often related to sports. It can leave the knee swollen, painful, and very unstable. Bursae. A number of these fluid-filled sacs surround your knee. They help cushion your knee joint so that ligaments and tendons slide across it smoothly. Bursitis, sometimes called housemaid’s knee or carpet layer’s knee, is an inflammation of these sacs. Prepatellar bursitis often occurs after an activity that requires you to kneel for long periods — scrubbing floors, gardening, or installing tile or carpet, for example. It can also result from an infection or as one of the signs of arthritis or gout.


Iliotibial band syndrome (ITB). This is a common cause of outer knee pain in runners. The ITB is a strong structure running up your outer thigh from the knee to the hip. Competitive runners are especially susceptible, but amateurs aren’t exempt. You’re more likely to develop iliotibial band syndrome if you have problems such as unequal leg length or weak hip muscles. Exercising on concrete surfaces or uneven ground, increasing the intensity or duration of your exercise too quickly, wearing worn or ill-fitting shoes, and excessive uphill or downhill running also can contribute to iliotibial band syndrome.


Tendon injuries. Inflammation of the quadriceps tendon (tendonitis) can occur in people who run, bicycle or ski. It can also result from inflammatory diseases that occur throughout your body, most notably rheumatoid arthritis. Middle-age weekend warriors are more likely to rupture their quadriceps tendon than seasoned athletesare. Patellar tendon ruptures frequently occur in active younger people who have a history of tendonitis or who have had steroid injections in their knees.


The majority of patients I see in clinic have had no specific cause for there knee pain, which is often more frustrating than a sports related injury. These often occur due to a gradual weakening of some muscles, an over-use of others and inflexibility in the surrounding joints. The most important thing with knee pain is the correct diagnosis, to allow prescription of the right course of treatment, and the correct exercises that will strengthen and stretch the problem structures, otherwise the problem will get worse.


For more information on osteopathy or treatment at Bingham Osteopathic Clinic please call 01949 839 238, visit or e-mail



Tristan Hill B.Ost


Joint Replacement

Welcome to my monthly column on the world of health. This month we’ll be discussing a common part of orthopaedic surgery, or surgery to the joints, bones, ligaments and muscles. One of the most common areas is joint replacement, particularly to the hip or knee joints. Wear and tear to joints can reach a point where pain is consistent and restriction of movement becomes so limited it begins to prevent the individual completing even the most, simple tasks. 


At this point they become a candidate for joint replacement surgery. A number of factors will decide whether or not they are eligible for the actual replacement. Age plays an important role, if the person is too young the surgery will be left to the last possible moment as most prosthetic joints have around a 20 year lifespan, and it is best not to have to re-do the surgery. Other factors include, expected usage of the joint, i.e. what tasks the individual is hoping to do post-surgery, weight of the candidate, are they within the strict weight guidelines for surgery patients, and if they currently suffer with any other medical conditions, will they affect the surgery, to name but a few.


Surprisingly many joint replacement operations are now performed while the patient is awake, so surgeons are using a local anaesthetic such as an epidural rather than a general anaesthetic. This is better for several reasons, firstly it allows the surgical team to check the patients status much more efficiently, secondly the risk of a negative reaction to the anaesthetic in older individuals is much less likely, and thirdly recovery time is much faster which allows the patient to be up and moving, which will prevent too much loss of muscle strength in the affected area.


Aftercare of the joint replacement is of great importance for wound healing and also for rehabilitation of the joint area. The program of care should include physiotherapy to strengthen the joint and build confidence with everyday tasks. However, this will generally focus on the joint that has been replaced and not on all of the surrounding joints and how they have been affected. It is perhaps even more important when a patient has a joint replacement to ensure that the rest of the body is performing at an optimum level, as the prosthetic joint will never be as strong or as flexible as the real thing. Therefore any excessive load on that joint may decrease its lifespan, and will increase the chance of a second operation in the future.


For more information on the clinic, to discuss a particular case, or to book and appointment please call Tristan Hill on 01949 839 238



Tristan Hill B.Ost


Heel Pain

The heel bone is the largest of the foot bones. It is designed to form a firm support for the weight of your body and to absorb the impact when your feet hit the ground during running and walking. Due to the amount of force that goes through your heel it is not surprising that heel pain is such a common occurrence.


Although heel pain can be mild and will sometimes disappear on its own, in some cases the pain persists and can become a chronic problem. There are a variety of causes for heel pain. The most common cause is a condition called plantar fasciitis. Plantar fasciitis is the inflammation of the plantar fascia, which causes pain on the underside of the heel. 


The plantar fascia works like a very strong rubber band between the heel and the ball of your foot to form the arch of your foot. If the band is short, you’ll have a high arch, and if it’s long, you’ll have a low arch, this is what some people call flat feet. The later stages plantar fasciitis can often cause a heel spur, which is a calcium deposit in the plantar fascia attachment due to a constant strain on the heel bone. The heel spur does not usually cause pain but can be a sign of severe plantar fascia problems.


There are a number of things that can predispose you to developing plantar fascitis. For example:


A sudden increase in activity such as taking up a new sport or an unusually long walk in unsuitable shoes. I have noticed an increase in heel pain due to the recent trend of very flat shoes for men and women.


Weight gain, for example during pregnancy, puts greater pressure on the plantar fascia.Conditions such as over pronation causes the feet to roll-in excessively putting greater pressure on the plantar fascia. (This is often referred to as flat-footed.) This rolling is caused by a change to the walking pattern (for example walking with toes pointing out) and also in response to a flattening of the front part of the foot over the balls of the feet. Patients may notice a bunion forming on the inside surface of their big toe due to these issues.


Running on hard pavements and increasing your hill work can also cause plantar fasciitis. 

Stretching before and after exercise is often neglected yet it is one of the most important steps to help prevent injuries and heel pain. If you are a reasonably regular runner it is also important to wear the correct shoe for your body. Shoes are divided in to two main types, supportive and shock absorbing. If you are a fast runner then shoes that absorb a lot of shock are better for you, where as if you are a slow, longer distance runner then your should aim for as much support as is comfortable. Also, stretching the bottom of the foot, as well as the calf can significantly reduce strain throughout the foot. When easing into a new or increasingly difficult routine is also important to limit the amount of sudden pressure on the foot.


An inactive lifestyle that is centred around a desk job will decrease your calf muscle flexibility which can be a underling cause of heel pain. This leaves you very prone to injury and aggravation around the heel with only a slight increase in activity, such as a sudden dash for the bus.


There are many other causes of pain in and around the heel that we have not discussed. As with all medical conditions a correct diagnosis is of paramount importance for the appropriate treatment and management of the condition.



Tristan Hill B.Ost