I just participated in an extended discussion about "ball chairs", and I'm interested to learn what others think about this subject. As some background, you might want to read what has become one of the most consistently read articles in our Ergonomics Today(TM) news service, "Opinion: Balls as Office Chairs a Bad Idea"
(http://www.ergoweb.com/news/detail.cfm?id=1091), which is a summary of discussions that took place here, in the Ergoweb Forum.

Here are some questions to consider.

In your experience:
1. Are "ball chairs" becoming more common in the workplace?
2. If so, are more employers actually purchasing them for employees, or are employees bringing the balls to work on their own?
3. Have you heard of any related mishaps occurring either in schools or in offices (e.g., people falling off the ball, balls rupturing, etc.)?
4. Do you consider the ball to be a replacement for an ergonomic office chair?

Best regards,

We have had some inquiries from employees about bringing them into the workplace, but will not allow them and most of this is based on previous discussions in this forum, plus other information.

All good questions. This topic that is receiving lot of attention and from our experience, employers are reluctant to purchase these for workers. It is generally the worker, often an injured one, that is looking to their employer to purchase one for them. I have attached an article from a WorkSafeBC publication that outlines our position on this.


Peter Goyert CCPE
Senior Ergonomist
WorkSafeBC
peter.goyert@worksafebc.com
(604) 279-7472

Attached is the copy of article referenced above.


Peter Goyert
Senior Ergonomist
WorkSafeBC
peter.goyert@worksafebc.com
(604) 279-7472

I have observed office workers using these, and for the most part, ends up being worse than even the worst office chair. Workers often tend to think that the seating choice absolutely makes the workstation and that the physioball will facilitate better posture. According to observation, however, the ball is worse because it offers no lumbar support and people end up with hyper-kyphotic postures due to paraspinal muscle fatigue and posterior pelvic tilt. I think that these balls can be good for a variety of exercises, and maybe used for short periods throughout the day to help with core muscle strengthening, but not as a primary choice in office seating.

Mark Hank

At my work place we don't allow them for safety reasons (falliing off) as well as lack of evidence they do any good (and growing evidence they don't). No real problems yet, but there have been two hard pushes by employees who have had personal experiences with their home office that they saw as very positive. So far though we have been able to hold the line and no exercise balls outside of our fitness rooms.

Jeff Budau, CEA

I appreciate the article from Peter Goyert, Senior Ergonomist at WorkSafeBC on why not to use fitness balls in the workplace. I'm going to send it to our HR director and wellness program coordinator once again, to warn them of the dangers of using the Swiss balls in the workplace. Unfortunately, we offer these balls to our employees. They pay for them but our wellness person orders them. She also provide a basic introduction to exercises that can be done on them. I have not supported using these balls from the first mention of the idea, but the wellness person likes them and ignores the risks. I haven't heard of anyone falling off the ball and getting injured but I have consulted with workers who developed back pain that is caused or exacerbated by prolonged sitting on the balls without back support and awkward twisting to reach other areas of their desk. Luckily our tech dept, who are the main users of the balls, recently moved into smaller cubicles that make it more difficult to use the balls.

I consult part-time for a mid-sized company in the SF Bay Area (1500 employees) and we recommend fitness balls for some people. Actually, we give one to anybody that asks to try one. We are picky about what balls are used. We order and supply anti-burst balls from Body Trends (www.bodytrends.com) and we haven't had one burst yet. There are various different sizes of balls and the website has sizing charts, but basically, for shorter people, we use the 55 cm ball, for mid-height people we use the 65 cm ball, and for tall people we use the 75 cm ball. The Maxafe ball comes in a lot of sizes. The ball should be inflated until it is quite firm, but there is a fair amount of leeway for adjusting the inflation so the height is correct for the individual. As with any seating, inflation should be adjusted so that the person sits with their feet comfortably on the floor and in an upright posture.

Use of a fitness ball for seating is good for people who slump because it tends to force them to sit up straight. Also, it's great as an active seating solution. The requirement for constant balancing means you can't sit still, and it's fun to sit on, so encourages bouncing!

With that said, however, we do not recommend this to be the only seating available. Most people have fairly weak back muscles, so sitting on a ball without any back support is very tiring at first. We recommend that people start with 1/2 hour and gradually work up as their back muscles get stronger. We have found that people are generally pretty good judges of when their backs are tired and it's time to move back to a chair with back support.

If a person needs to move around a lot, for instance moving from the computer to an adjacent file cabinet, the ball is a problem. It's not easy to navigate on a ball, so it's really best for people who sit at a computer for hours each day. We have not had any mishaps or accidents with people falling in the 3 or 4 years we have been using balls in the offices.

Finally, I do not recommend the balls that come on frames with wheels and backrests. The backrests are not adjustable, the balls only come in one size, and it defeats the purpose of sitting on the ball to encourage balancing and active seating.

Be advised that this is coming from someone (me) who sells ergonomic seating (Neutral Posture and Office Master)! I am obviously a great believer in good ergonomic chairs, but they do not tend to encourage active sitting the way a ball does. (Yes, I'm one of those evil people who consults and sells products. In a rural area, it's the only way to get great products.)

Tamara Mitchell
Have A Nice Fit Ergonomics
www.nice-fit.com

Use of a fitness ball for seating is good for people who slump because it tends to force them to sit up straight. Also, it's great as an active seating solution. The requirement for constant balancing means you can't sit still, and it's fun to sit on, so encourages bouncing!

With that said, however, we do not recommend this to be the only seating available. Most people have fairly weak back muscles, so sitting on a ball without any back support is very tiring at first. We recommend that people start with 1/2 hour and gradually work up as their back muscles get stronger. We have found that people are generally pretty good judges of when their backs are tired and it's time to move back to a chair with back support.

We have not had any mishaps or accidents with people falling in the 3 or 4 years we have been using balls in the offices.

Tamara Mitchell
Have A Nice Fit Ergonomics
www.nice-fit.com



Hi Tamara,

From what you're saying, you must be using one yourself as you are making some fairly positive endorsements! For those of us who are 'evidence based' and also look at how these balls meet the purpose of allowing people to interact safely and comfortably with a computer, monitor and keyboard, I think that there are issues you haven't covered.

My concern with adapting any of these exercise products or even stretching programs for whole populations is that there is no apparent concern for who may be at risk of injury. I guess that being a health professional, we are influenced by the one line of the Hippocratic oath "I will prescribe regimen for the good of my patients according to my ability and my judgement and never do harm to anyone".

With the balls, I agree that some of the working population will benefit - which it appears you have found in your consultancy. I also agree that the population who are likely to benefit are those who are very young (under 30), have no pre-existing conditions, and are only doing computer based tasks. And although I fully agree that we do have a problem with people sitting all day because of the lack of dynamic activity, I believe that activity should be built into daily tasks rather than relying on a ball as a chair. If we want to incorporate regular daily exercise for working populations, there are other ways to do it under more controlled condtions.

My other concerns:

The focus on the ball is only what is happening at the low back - what is really happening to the thoracic and cervical spine without back support for 8+ hours? Yes, multifidus and some of the other core musculature are firing with the instability brought about by the ball, but they do not extend the whole length of the spine.

Balls come in 5 cm increments - is this adequate for the anthropometrics of the user population?

The biggest advocates of these balls appear to be from exercise backgrounds, who generally (due to my review of course curricula) have limited training in pathology and effects of aging/injury on the spine and musculature of the spine. I have yet to see good studies in situ of what happens to scapular stabilisers, cervical musculature, etc, when using the balls and keying at the same time - or studies where representative samples of age groups in the working population have been undertaken based on stringent research methodology. In other words, would this promotion of balls as chairs hold up to a Cochrane review when some ergo studies haven't?

The line about it 'forcing them to sit up straight' is one that the majority of proponents will use - but is that borne out during the whole day, or as the muscles fatigue (especially with 10-12 hour days) does posture change?

So, in conclusion, the evidence coming from studies done on use of sit stand tables, forearm supports etc outweighs what I could find for the evidence supporting balls as chairs for large populations. There may be subsectors of the population that will benefit (and not be harmed) but as ergonomists I feel we need to be rigorous in our ability to look at evidence and knowledge when making recommendations.

Maybe you missed my point that I don't recommend the balls for a full day?

I do agree that working for 8 hours at a computer is less that optimal, but in reality, that is what a huge number of people are asked to do at their jobs. We encourage breaks, standing while talking on the phone, etc. But active seating is a very good approach to improving circulation and preventing injury.

The ergonomics program where I consult started out cautiously with the ball 3 or 4 years ago, just giving them to a few people. Many people found them to be very beneficial, so we started using them more. The population at this company is not generally young people.

So far, the people speaking out loudest against the fitness balls seem to be people paid by the chair companies to badmouth them. I have hopes that we will eventually see some real unbiased research on this topic, but as you point out, it will need to be longitudinal and conditions will need to be highly controlled.

Balls will never replace chairs, but they can be a very healthy supplement.

I have used the gym ball as a rehab tool for over 10 years in that time have had several patients use them as a chair in the office and at home. I have had no recorded incidence of a patient falling off the ball. The results of patients using the ball as a chair have been positive.

Hi Tamara,

Yes, I missed where you said the balls were not used for full days. I saw where you start them off for 1/2 hour, and let them judge when they moved back to a regular chair, but I wasn't clear on if this was part of a graduated move towards use of the ball all day.

With your comment, and that of pgchiro, I can see that there would be divergence of recommendations of the ball as a chair based on whether you were a consultant/health practitioner/fitness practitioner vs. internal health and safety manager for the company. As I have been both a consultant and an internal OHS advisor, I can say that the decisions are made from very different perspectives. That was part of the point of my previous posting.

From an internal company perspective (or even sometimes a gov't regulatory perspective) you have to consider liability, evidence, and risk management of all health and safety issues, managing 'expectations' of the staff, as well as assisting supervisors manage the inevitable use and abuse of any program. As a consultant, you will usually have a very good idea of the positive benefits of the intervention, but won't have to deal with the day to day issues - or complaints.

I want to make it clear that when I was an OHS advisor we had a number of staff who used the ball - but it was always seen as part of a rehabilitation program (or prevention program) with a specific plan for it's use. We also had a number of them in the 'break out' areas for staff who wanted to use them on breaks, or if they wanted to try them out. We lent them to staff as well to use at home- again only once they had been assessed and were clear on how to use them. I think that once the company reviewed it's liability, they weren't lent to staff unless our physio had found they needed to do home exercises, or build their tolerance. As you can see, we had a very proactive approach for early intervention and the organisation has continued to provide on site physio, exercise rooms for meditation, tai chi, yoga etc (no gym) as well as access to a number of discounted health programs. The use of the balls was seen as part of an overall plan of matching the needs of the person to the activity that suited them and their lifestyle - hmmn sounds like ergonomics doesn't it?

I can't comment on the statement that the main detractors of the ball were chair manufacturers- mainly because I think most ergonomists should be able to review the appropriateness of the intervention and see through the salesmen and rhetoric. But as I've stated in previous posts, I have very high expectations of ergonomists.

Swiss 'therapy' balls were developed as a therapeutic modality, to be used in gyms under the guidance of a therapist or as part of a home exercise program. The ultimate goal is to improve core strength to where the person can stabilize their back and pelvis at all times and with all activities. A person shouldn't exercise on the ball for part of the day and then walk, shop, vacuum, do dishes etc with poor stabilization. The ball is like training wheels on a bike that are eventually removed when balance and strength are achieved and can be maintained. If people want to use the ball for ongoing strengthening, why not do it at home while watching TV, or while at the gym? The ball wasn't designed for doing prolonged desktop work with arms extended in front. An hour/day on the ball at work may be too much. If people don't use the ball at therapy or home for 1 or 2 hours at a time, why should they do it at work? I'm beginning to view the use of swiss balls in the workplace as another a symptom of our frenetic, multitasking lifestyles.

Regarding balls failing or popping... I have heard of instances in which the ball popped... or rather exploded, while a pt was exercising on it. It's a good thing they were in a gym where they weren't severely hurt when they fell. If they had been in an office, they could easily fall against any of the sharp edges, desks, file cabinets etc surrounding them.

Tamara,

I'm confused by your comment that the balls help workers to sit up straighter. In my observations, people tend to slump forward more often while sitting on a therapy ball. The reason, I think, and I do not have any studies to back this, but as the paraspinal muscles fatigue, the user will increase thoracic flexion, the pelvis will roll into posterior tilt, and the person ends up in a slumped posture with kyphotic lumbar and hyperkyphotic thoracic spine segments.

I agree that these balls can be a good tool for exercise and core strengthening, but not as a primary seating choice. I think that changing postures is best encouraged by using sit to stand workstations for people who are bound by call center work or otherwise do not have an opportunity to vary their tasks by attending meetings, or doing other little tasks away from the computer.

Mark Hank, OTR/L, CEA

For “some real unbiased research on this topic” (as requested by Tamara), see the following:
McGill, S.M. et al (2006) Sitting on a chair or an exercise ball: Various perspectives to guide decision making. Clinical Biomechanics, 21, 353–360.


As to Tamara's assertion that “the people speaking out loudest against the fitness balls seem to be people paid by the chair companies to badmouth them”, my experience (and as already seen in this discussion) is that those who speak most loudly against them appear to be ergs/OHS professionals who require more than assertions about efficacy and who have seen some related problems first hand.


As long as there is no comprehensive body of objective evidence (the above-cited paper is only a beginning), there will be room for speculation, opinion and bias to dominate the discussion. The onus should always be on those making claims for a product (or any other intervention) to provide objective evidence for its efficacy.


If, as claimed, those who support “ball chairs” have frequently seen their benefits, then why not systematically record these observations, along with details of how the observations were taken and any potential confounders, and publish it. Then others are able to scrutinise those claims and lodge their own objections, counter-claims or studies. It’s called science. It is (or should be) the basis for the practice of human factors and ergonomics.


As to the objection that such a study would “need to be longitudinal and conditions will need to be highly controlled”, this is not always that difficult to achieve, nor is it always necessary. But before anyone would fund intensive studies, there needs to be at least some preliminary indication that there is a sound basis for the expenditure. Even low quality studies might, if you’ll pardon the pun, get the ball rolling…..

Max Hely
CPE (HFESA)

I would like to make several comments on using the gym ball as a chair. First it is being used more as a chair and that is because some people are finding that it is better for them than a chair. I have heard that some employers have paid for their employees gym ball or ball chair. In ten years of recommending gym balls I have not recorded any incidents of patients falling off the ball or one exploding although some have developed slow leaks.

My experience has shown that some patients have found relief from back pain and neck pain when using the gym ball as a chair. Some have used it all day and some for only part of the day. Because the gym ball exercises the muscles, it may need to be introduced slowly.

Some of the benefits of the ball are; improved posture, improved muscle tone, improved balance, and for some reduced back and neck pain. For those individuals that want research, I suggest that the most effective way to learn about the benefits of the gym ball is to purchase one. Remember when you begin, introduce it slowly
The gym ball will not solve all problems and it is not appropriate for all workers but it will help many and therefore should not be dismissed without consideration.
Larry

What about the flat pancake like bladders that one places on a seat. These seem interesting to me and I have no experience beyond a couple minutes at a trade show.

I have recommended the stability discs (flat pancake like bladders) to employees instead of purchasing or using fitness balls. This keeps everyone in a chair, yet allows the user a core workout. The user must lower their chair approximately two inches to compensate for the height the disc adds... and then I recommend they use it one hour in the morning and one hour in the afternoon.

Using a stability disc usually satisfies the want of the employee and the concern of the employer.

I have never seen these. Do you have a vendor reference or website?

Thanks.
.

Currently, although we've had inquiries from employees about bringing fitness balls into their workplaces to use as chairs, we do NOT allow it. Here are some of our reasons: If the company will be liable (as it probably will) for any injuries related to the seating used by employees at work, then the company will provide necessary, appropriate, and safe seating. Fitness balls introduce an additional hazard into the workplace -- the fall hazard created by an unstable seating surface -- which may put the company out of compliance with applicable state and federal safety laws, such as OSHA. Fitness balls have minimal adjustability which will not fit the large range of sizes and shapes of our workers. Sitting on a fitness ball all day can contribute to physical fatigue because of the continuous muscular activity needed to maintain a "neutral" seated posture and not fall of the ball. Physical fatigue can lead to decreased safety and poor performance by workers.
Lynn Arbogast, CSP, ARM
Corporate Safety Specialist
Allstate Insurance Co.