Episode 32 - Reduce Back Pain and Improve Posture with Active Sitting
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Episode Summary
With fifteen years of experience as a spine physician, Dr. Sanjiv Lakhia is always on the lookout for ways to help his patients improve their back health, particularly with natural, less invasive methods that can be easily integrated into their day-to-day lives. Today, we’re going to be discussing a common cause of back and neck pain, prolonged periods of sitting.
Joining us on this episode of Back Talk Doc is Dr. Turner Osler, a retired trauma surgeon, epidemiologist, entrepreneur, and founder of QOR360, a company designing chairs to improve posture and prevent back pain caused by conventional sitting.
Dr. Osler explains “Sitting Disease” and explores the negative affects sitting prolonged periods of sitting have on the body. “We think all the chairs that we have are normal, and they are not. Humans are not designed to sit all day… We're simply not set up to sit slumped in front of a PC all day.” (6:37) Many issues like headaches, neck and back pain, weight gain, and even mood disorders can be traced back to incorrect posture while sitting. Dr. Osler discusses the natural human posture (10:05) and how we have been letting our chairs shape our bodies, instead of shaping our chairs to fit our bodies. (11:34)
Dr. Osler then discusses the benefits of “active sitting” (a sitting experience that allows and/or encourages movement while seated), including reducing back pain and improving posture. (21:23)
Other topics discussed include negative effects of sitting in a slumped posture (14:03), contraindications for using an active sitting chair, (35:11) and a word of caution for those with lumbar disk herniations or acute back pain. (38:51)
Links and Resources
To learn more about Dr. Osler’s mission of educating the community about the benefits of active sitting, visit QOR360.com and ButtOnChairs.org, which promotes active sitting for children.
View Dr. Osler’s TED Talk.
The Gokhale Method: a system of healthy posture and movement to help restore your structural integrity, so you can live an active and pain-free life.
For more information on Dr. Sanjiv Lakhia and Back Talk Doc visit BackTalkDoc.com.
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
With fifteen years of experience as a spine physician, Dr. Sanjiv Lakhia is always on the lookout for ways to help his patients improve their back health, particularly with natural, less invasive methods that can be easily integrated into their day-to-day lives. Today, we’re going to be discussing a common cause of back and neck pain, prolonged periods of sitting.
Joining us on this episode of Back Talk Doc is Dr. Turner Osler, a retired trauma surgeon, epidemiologist, entrepreneur, and founder of QOR360, a company designing chairs to improve posture and prevent back pain caused by conventional sitting.
Dr. Osler explains “Sitting Disease” and explores the negative affects sitting prolonged periods of sitting have on the body. “We think all the chairs that we have are normal, and they are not. Humans are not designed to sit all day… We're simply not set up to sit slumped in front of a PC all day.” (6:37) Many issues like headaches, neck and back pain, weight gain, and even mood disorders can be traced back to incorrect posture while sitting. Dr. Osler discusses the natural human posture (10:05) and how we have been letting our chairs shape our bodies, instead of shaping our chairs to fit our bodies. (11:34)
Dr. Osler then discusses the benefits of “active sitting” (a sitting experience that allows and/or encourages movement while seated), including reducing back pain and improving posture. (21:23)
Other topics discussed include negative effects of sitting in a slumped posture (14:03), contraindications for using an active sitting chair, (35:11) and a word of caution for those with lumbar disk herniations or acute back pain. (38:51)
Links and Resources
To learn more about Dr. Osler’s mission of educating the community about the benefits of active sitting, visit QOR360.com and ButtOnChairs.org, which promotes active sitting for children.
View Dr. Osler’s TED Talk.
The Gokhale Method: a system of healthy posture and movement to help restore your structural integrity, so you can live an active and pain-free life.
For more information on Dr. Sanjiv Lakhia and Back Talk Doc visit BackTalkDoc.com.
Back Talk Doc is brought to you by Carolina Neurosurgery & Spine Associates, with offices in North and South Carolina. To learn more about Dr. Lakhia and treatment options for back and spine issues, go to backtalkdoc.com. To schedule an appointment with Carolina Neurosurgery & Spine Associates, you can call us at 1-800-344-6716 or visit our website at carolinaneurosurgery.com.
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Intro: 00:30
Welcome. You're listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health. Brought to you by Carolina Neurosurgery and Spine Associates, where providing personalized, highly skilled, and compassionate spine care has been our specialty for over 75 years. Now, it's time to understand the cause of back pain, and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.
Sanjiv Lakhia: 01:05
Being a spine physician now for almost 15 plus years, as many of you who listen to my show know, I'm always on the lookout for ways that I can help my patients improve the health of their back, particularly with natural methods, less invasive methods, and methods that can really be integrated into their day-to-day routine and their life. One of the things that I've been blessed with, as we started this podcast at Back Talk Doc, it's been over a year now, and some 30 plus episodes in, is I've had several people reach out to me with messages that they would like to share with the community. Today, it's my privilege to welcome to the show Dr. Turner Osler, who is a physician and, by trade, an academic trauma surgeon. He has a very interesting story and a message that he's trying to spread across the country, and if not farther, about the importance of proper sitting as it pertains to your back. So, Turner, welcome to the show today.
Turner Osler: 02:08 Sanjiv, it's great to be here.
Sanjiv Lakhia: 02:10
Let me start by introducing you to the listeners. I did have the pleasure earlier today of watching a TED Talk that you gave. I think it was back in May of 2019. So, now I know I am interviewing a celebrity. So, this puts some pressure on me. But for those of you who don't know Dr. Osler, Turner has academic trauma surgeon backstory. He had a bachelor of arts in neurobiology from Princeton. He went to the Medical College of Virginia, and then did a surgical residency through Columbia and Harvard, and a fellowship at the University of New Mexico. Then he spent 20 years as an academic trauma surgeon through the University of Vermont, and has over 300 peer reviewed papers and book chapters.
Sanjiv Lakhia: 02:52
About a decade ago though, he went off the script and got a master's in biostatistics and an NIH grant, and he abandoned the operating room to study trauma epidemiology. Somewhere in the last several years, he became obsessed with problems that come from sitting too much, and especially with sitting badly. Really, since there weren't many people in this space, Turner and some friends created a company to make active sitting chairs affordable enough for everyone. He lives in Colchester with his wife, son, and dog, who have been surprisingly tolerant of his mania, as he says, and are being gradually drawn into his madness. Except the dog. So, that is his background in bio. Anything you'd like to add to that, as the listeners tune in and get to know you a little better today?
Turner Osler: 03:37
That makes me sound more erudite than I am, but I'll take it. Thank you.
Sanjiv Lakhia: 03:43
To be honest though, he also, folks, he sent me his curriculum vitae, and we had to reload the printer with paper as the pages just kept coming out. This is one very accomplished physician, and it's a real pleasure to dive into the message he's trying to spread. I'll get right to it. You are founder of a company called QOR360, that essentially has developed technology for a chair that creates what you call an active sitting environment. So, before we dive into the company and the product, I'm really curious to know a little more about your path from academic, renowned trauma surgeon to a spine entrepreneur. Can you walk me through that a little bit?
Turner Osler: 04:32
Yeah. Well, it certainly wasn't planned. I had planned a calm retirement, wind surfing and practicing martial arts. But as I switched to epidemiology, suddenly I'm writing computer code all day, sitting in front of a computer instead of running from the OR to the ICU to the clinic, back and forth all day. I went from the peripatetic life of a trauma surgeon to just sitting in front of the computer. So, for the first time in my life, my back started to bother me. I thought, "Well, sheesh. What's up with that?" So, I bought basically every gizmo, ergonomic chair there was, the yoga ball, the kneeling chair, all that stuff. None of it really helped at all. So, I thought, "I wonder if anybody understands this."
Turner Osler: 05:16
So, I started reading the ergonomics literature and actually going to academic ergonomics conferences, and I was stunned at how little is understood about how sitting interacts with the human body. We've been sitting on the same old design of office chair now for 50, or maybe 100 years, depending on how you count. Still, 80% of America has back pain, at some point in their lives, bad enough to send them looking for professional help. So, if our ergonomic community understands the problem, how come they haven't solved it? It was a conundrum for me until I started reading the anthropologic literature.
Turner Osler: 05:55
It turns out in places where people don't sit in the Western way, with their ankles at 90 degrees, their knees at 90 degrees, and their hips trying to be at 90 degrees, these other cultures ... Think of Japan, or South Korea, or think of Sub-Saharan Africa, where people squat, or they sit [Seiza 00:06:15], or they sit with their legs crossed on the ground. These places don't have back pain. The clear epidemiologic implication is that it's our chairs that are causing the problem. It's not an easy problem to solve because everybody thinks our chairs are God-given. Chairs are part of our built environment. We just don't see them anymore than a fish sees the water it swims in.
Turner Osler: 06:37
We think all the chairs that we have are normal, and they are not. Humans are not designed to sit all day. It's completely outside our design envelope. We have the bodies of hunter-gatherers, that were developed over four billion years, if you counted all the prototypes, or maybe in daily use for three million years. We're simply not set up to sit slumped in front of a PC all day. So, if you can't arrange for people to stop sitting, how do you arrange for them to sit in a way that at least is non-destructive? That was the core problem that I came up against.
Turner Osler: 07:11
I wanted to solve it for myself, but as I got into it, it seemed like a much bigger problem, and one that was worth solving generally. Because it turns out, it's not just a matter of posture and back pain. There's also the whole issue of sitting disease. Turns out, when people sit for many hours a day, and in America, we sit, on average, eight or even 12 hours a day ... How is that even possible? It's breakfast, lunch, dinner in front of a computer at home, in front of a PC at work, in front of the television. It adds up. So, when we sit this much, our spines are pretty adaptable, but they aren't adapted for sitting slumped in an odd posture for 12 hours a day. It's a hard problem because we want to actually have people up and moving, hunting and gathering, which isn't going to happen.
Sanjiv Lakhia: 08:05
It sounds like it started in your mind with a simple question about sitting. I think this question is especially timely during the lifespan of COVID-19 and the pandemic, because I can tell you in my clinic, as a practicing out-patient physiatrist, I am seeing what you just called as sitting disease. It's not just back pain. I'm seeing neck pain. I'm seeing headaches. I'm seeing weight gain. I'm seeing mood disorder, relationship problems. I think a lot of it is from us becoming plastered to our chairs. The idea is what are we doing to our physiology?
Sanjiv Lakhia: 08:46
You're asking a terrific question. Actually, when I first heard about your approach, and the company, and the idea that other cultures don't have the back pain issues we do in the United States, what came to me was ... I don't know if you're familiar with the work of Esther Gokhale, the Gokhale Method. In her book, she is a ... I have not met her, but I've gone through her materials. Quite frankly, to help my patients, as well as myself! Because it's not too far ago that I went through some back issues, and actually had to get some injections. We're talking November. So, I'm always on the quest, as a spine physiatrist, to practice what I preach and find simple solutions. We'll link to her book. I'm going to link, as well, to your TED Talk, because I think it was a terrific TED Talk.
Sanjiv Lakhia: 09:34
In her text, she gives photographs of native people in India and other cultures, and just shows their posture versus ours, and how they can sit for hours, stand for hours, they can hold massive weights on the top of their head, and they don't have any back pain! Then you compare to what's going on in our modern culture, and it's really, really striking. I wondered if you were influenced a little bit by some of the work that she did, or perhaps you just stumbled upon the same anthropologic research, as you were asking your pertinent questions.
Turner Osler: 10:05
Oh, no. I read her book with great interest, of course, because I think I've read almost everything in this space. The photographs in her book are terrific. They really show the brilliant posture that humans are ... It really is our human birth right. Right? I mean, we're entitled to that beautiful posture. But it's taken from us by our chair-centric culture. When you think about it, kids, when they're born, are natural and beautiful squatters. If they lose their balance, they just sink into a squat quite comfortably. They can stay there and eat a peanut butter and jelly sandwich, and then get up and carry on.
Turner Osler: 10:42
Adults, pretty much, can't squat at all, and they certainly can't squat comfortably for an entire peanut butter and jelly sandwich. So, what is it that happens to kids that robs them of their ability to squat? Well, it's because we put them in chairs, and they lose the flexibility required for squatting. Squatting isn't an odd posture. It's how human beings rested for most of their hunter-gatherer career. Squatting is a great posture because it's an active rest posture, as [Lieberman 00:11:13] calls it, where people are balanced over their ankles. So, they have some muscular activity, but it's much more restful than standing up. To lose that posture is a very sad thing, that we've taken it basically away from all of our children when they're born with naturally perfect posture.
Turner Osler: 11:34
We can see that our chairs are shaping us. Winston Churchill said, "We shape our environment once, and then it shapes us forever." The idea is that we are in intimate contact with chairs for eight, or 10, or 12 hours a day. Our chairs are reshaping our anatomy and our physiology. While we love sitting on our chairs, our chairs do not love us back. Our chairs are killing us. There's good epidemiologic work to show that people who sit more than eight hours a day lose, on average, two life years.
Sanjiv Lakhia: 12:06
Yeah. One of the catch phrases now is that sitting is the new smoking. I think it's worse though because with smoking, you can take the cigarette out of your mouth. With sitting, you can't tell people to not sit at all. Now, your mission is to help people sit properly. Let's break it down a little bit though for some of the clinicians and physical therapists who listen to my show. I'll give you my take on where sitting can become a problem, and then you can add, subtract, or amplify this. Okay?
Sanjiv Lakhia: 12:34
One of the things that we know bio-mechanically, is that when you put pressure probes in lumbar disks, there's two positions that increase or jack up the reading substantially. The first one is just sitting, and the second one is sitting and leaning forward in a slightly flexed position. This is why, a lot of times, people will say, "All I did was lean over to tie my shoe, and my back went out." For listeners, that is one area to consider, is excessive amounts of sitting. What is it doing to your lumbar disks? Secondly though, I think there's a whole host of physiologic changes that go along with sitting for long periods of time. To me, one of the main detrimental effects is the effect on your breathing, and your inability to have diaphragmatic breathing, which then sets off a chain reaction of muscle tightness up the spinal axis into the head, neck, and shoulders.
Sanjiv Lakhia: 13:28
Certainly, if you're not breathing deeply, you are no longer living in a parasympathetic state, and you are now more in a stressed state. I could go on and on and on with that. That's the lens which I view a few of the major problems with prolonged sitting. What are your thoughts on what is the problem with the way we sit, and sitting in general right now?
Turner Osler: 13:51
So, I'm aware of that literature where they were putting pressure probes into spinal disks. How did they ever get that past the IRB? That must be ...
Sanjiv Lakhia: 13:59
This was rat studies.
Turner Osler: 14:01
How do you get a rat to sit in a chair?
Sanjiv Lakhia: 14:02
Right.
Turner Osler: 14:03
These are hard questions. But it is true, certainly, that when people sit in a slumped posture, everything changes. Their disks go, in very short order, from being disks to being wedges, of course, which is why when people get up from sitting for a few hours in front of their computer, slumped, the first few steps are pretty remarkable, as they're trying to wrestle their disks from wedges back into disks. So, you know that you've been really abusing your disks by squashing them into an unnatural position, and then keeping them there for hours. Disks need to imbibe fluid as they're compressed, and flexed, and extended, which doesn't happen when people are slumped in front of their computer for long periods of time.
Turner Osler: 14:47
As you point out, it also restricts the thoracic cage, so people aren't breathing as deeply. There are bigger problems afoot even than that. We also know that lipoprotein lipase, an important enzyme in the human [inaudible 00:15:02], as they say, goes down when people are sitting with their muscles electrochemically dark. Your muscles aren't just, as you know, mechanical units that move your bones. They're immensely metabolically active factories that spin off hormones and enzymes that affect our internal biochemistry. So, when your muscles go electrochemically dark, your bad cholesterol goes up, your good cholesterol goes down, your insulin goes up, and your baseline inflammation levels go up.
Turner Osler: 15:34
All of these things resulting in an increase in all-cause mortality. The business of sitting slumped in front of a computer is altering you in ways that predispose you to having back pain, but also take years off your life. I mean, your analogy to smoking, I think, is a very strict one. Sitting is the new smoking. Just as smoking was invisible to people in the 1950s because everybody smoked ... It was normal. Even physicians were smoking, so what's the problem? It was very hard to get people to buy into the idea that smoking was actually a public health catastrophe. Heart disease, emphysema, lung cancer. Statisticians, at the time, said, "Well, you could never actually do such a study. You'd have to assign people to smoke or not smoke. It wouldn't be a ..." They just needed better math.
Turner Osler: 16:25
It's embarrassing, what happened in the '50s. Fortunately, we've gotten past that now, and we pretty much all understand that smoking is a terrible idea. But now, it turns out that sitting is almost as bad an idea, in terms of its impact on our health, but just as with smoking, chairs are invisible to us because we think they're normal. You cannot look out of a window unless you are sitting on a chair. When you try sitting on the floor, you can't see out the window. Our very architecture presupposes you're sitting in a chair. So, what's to be done? Well, my mentor in public health was Susan Baker at the Bloomberg School of Public Health at Johns Hopkins. Sue taught us all that you can't shame people or berate people or belittle people into behaving better. They'll forget, or they'll ignore you. No one wants to be harassed.
Turner Osler: 17:16
What you must do is you must redesign the environment to make it safer for people. So, airbags are a great example. Your airbag works whether you're paying attention or not. Even, perhaps, before airbags, and even a better example is divided highways. By simply putting a mechanical divider down the middle of a highway, people can't run into each other head on at 60 miles an hour. The idea is to change the environment in a way that makes it safer for people, so that they don't have to make conscious decisions every day, or maybe many times a day, for better health. This is where the idea of if we can just change the way a chair interacts with a person, so that they stay in constant motion, we can make sitting healthful rather than destructive.
Sanjiv Lakhia: 18:01
Okay. So, again, if you're listening, and you're just curious, it's QOR360.com. Right on the homepage, you'll see a beautiful picture of the bright red chair. What's the model name?
Turner Osler: 18:16
So, we named it Ariel after a wife of one of our medical students, who was just in love with the thing. She loved it so much we named it after her.
Sanjiv Lakhia: 18:24
Well, folks, I did ask if they would send me one that I could try, so when I talked with Turner I could have a genuine feedback, and let me share my feedback with you. You haven't heard this yet, so you're probably sitting there, "I hope he says it's okay." Then we can talk a little more about it. The first thing I would say is it was very easy to put together. I was a little intimidated by the box coming in, and my staff brings this back to me like, "What do we do with this?" I said, "All right. Let's open it. Let's take a look." It was literally in five minutes, I had the thing put together. I'm good at a lot of things in life, but as my wife would attest, you give me screwdrivers, hammers, and nails, and I am basically looking to call someone. If I can do it, pretty much anyone can do it.
Sanjiv Lakhia: 19:08
Now, the accompanying brochures, they're very clear, very simple that, number one, this is not a toy. Number two, you want to take your time breaking it in, because it's a new way of sitting. I was a little concerned because I have dealt with a disk issue in my back as recently as November, and I missed some time from work. So, my staff was like, "Are you sure you want to try this?" So, I took your advice, and I titrated up. I started with five minutes and worked up a little bit longer, and this past week, I was actually doing a virtual conference. I'm a fellow at the Andrew Weil Center for Integrative Medicine. We had our residential week. So, I was on a computer a lot. So, I took this puppy home, and I alternated it with my other chair. I have to tell you, I was very impressed with it.
Sanjiv Lakhia: 19:55
The first thing it does is it makes you sit a little more forward and create a slight anterior pelvic tilt, which I found to be a little bit more comfortable, and probably more consistent with the wedge shape form of the L5-S1 disk. The second thing it does is it does make you activate some of your core muscles, because you are on an unstable surface, a slightly unstable surface, and it doesn't take a whole lot, I think, to get some activity firing. These are muscles that I know for a fact I don't fire when I sit in typical chairs. In particular, the three year old chair that I use from Costco is not giving me anything and is more like a recliner, at this point. So, my experience was pretty good. I probably sat in the chair, on average, over the last week, I would say probably two hours or so. I got through it. I wasn't worse. I actually feel pretty good coming out of that.
Sanjiv Lakhia: 20:47
I didn't have as much back fatigue by the end of the day. I did have a little muscle soreness, maybe in my transverse abdominis and my obliques a little bit, but it felt like muscle soreness from after doing physical therapy versus back pain. So, very, very encouraged by the product. I'd like to lead that into I want to know what your description is and what you mean by, and so the listeners can learn, when you say active sitting. Because I think that's what I did. I did active sitting on the chair for the last week. But for people who really don't understand that, can you break that down for us?
Turner Osler: 21:23
It's an interesting thing. Thanks so much for trying out one of our chairs. I just love that you wanted one before we did a podcast, because that wins my heart that people are interested in what this actually is about, rather than just going through the motions or whatever. It's terrific. All of your experiences are what I've heard many, many times before. Our chairs are more work than you might think. It comes as quite a surprise. Even people who are in pretty good shape find that the next day, they can be a little bit sore in the sense of a workout soreness, not pathologic soreness, because it really does activate your core muscles, as you discovered.
Turner Osler: 22:02
These are big muscles, the transverse [inaudible 00:22:05], the internal and external oblique, the multifidus. They're big muscles. They're not moving a lot, but they're moving constantly. So, your metabolic rate goes up by about 20%, which as I alluded to earlier, has really important metabolic consequences for warding off the heart attack that you were going to have 30 years from now. We take our chairs out on a sunny day in Burlington, Vermont when tourists are around, and we put some chairs out on the walking street in Burlington, Church Street, just to see what will happen. It's very interesting. People sit down on our chairs, and because they're a little bit unstable, they immediately lose their balance a little bit, and you may see a little bit of the whites of their eyes as they find their balance.
Turner Osler: 22:45
Then within one minute, certainly within two minutes, their sternum comes up and their shoulders come down, and the head comes back and balances on the atlas and axis, the first two cervical vertebrae. Really, within two minutes, people are sitting very good posture, like people sitting in meditation, the noble posture, their head balanced perfectly on the top of their spine, and all the rest of them balanced on their ischial tuberosis. This happens because our chairs, because they're a little bit unstable, allow the pelvis to try a whole lot of different configurations. Every time the pelvis moves to a new direction, the rest of the spine responds with spinal reflexes that were laboriously programmed over the first few years of a child's life, as they went from creeping, to crawling, to toddling, to walking.
Turner Osler: 23:34
Your spine knows what to do with gravity. It's hardwired at the spinal reflex level. So, if you just free people's pelvis, their spine then finds its own perfect posture by trying out several different, many, many different postures very quickly. It doesn't move to a new posture unless it feels better, and then by mathematics, you call this a Markov chain Monte Carlo simulation, where the spine can try out a lot of positions quite quickly until it finds a very natural, balanced position. It's not just about sitting. I love this story. Went out on Church Street in Burlington one day. Some 13 or 14 year old girl was sitting at the periphery on one of our chairs, just trying it out, just blissing out in the sun. No phone, just rocking back and forth for two minutes, four minutes, 10 minutes, 15 minutes.
Turner Osler: 24:27
Then she gets up and walks away. But she doesn't get 10 strides before she turns around and says, "I think it makes me walk better." The way her spine interacted with gravity had been, in some sense, reset, so that she could interact more naturally with better posture, and that better posture transferred from sitting to walking to whatever it is she was going to do next. I think of our chairs as a way of wordless pedagogy, about helping people find a better posture without having to read a book, or watch a video, or hire a trainer, go to the chiropractor. It just allows people's spinal reflexes to do what they do best, which is interact with gravity in a way that optimizes our bony architecture.
Sanjiv Lakhia: 25:15
One question I have for you. I did find, at times, a little discomfort, maybe around the ischial tuberosity region. Was I too far forward in the chair, or is that just something that you have to get used to?
Turner Osler: 25:25
No. You're completely normal. We wrestled with this. A lot of people have had input to this chair, [Feldenkrais 00:25:32] types, and Alexander Technique types, and martial artists, and Pilates people, and yoga people. They were quite firm with me that people needed to be able to feel their ischial tuberosities in order to know where their spine was in space, so they could organize their posture. If you want to make a chair firm enough that people can actually feel their ischial tuberosities, well, most people aren't accustomed to feeling their ischial tuberosities because they've been sitting in big, poofy couches, or yoga balls, or something where their ischial tuberosities never touch anything. Now, it's only the bicyclists who really have experience with where their ischial tuberosities touch down. I think it's within our design envelope that people's ischial tuberosities, they have bursae, like with bicyclists. At the beginning of the riding season, it's a little uncomfortable to be back on your saddle, but very shortly, your ischial tuberosities adapt to it.
Sanjiv Lakhia: 26:28
Yeah. You know what? That's a great analogy, to riding a bike, when you first start out. So, a couple questions here. I work at Carolina Neurosurgery and Spine. I don't know if you know much about us, but we're one of the largest ...
Turner Osler: 26:40
I looked at your website! Holy Toledo! You guys own neurosurgery in North Carolina.
Sanjiv Lakhia: 26:46
You just made the audiogram for the episode. That's fantastic. I'm very privileged to work at this group. We're one of the premiere neurosurgery groups in the country. Then we have a collection of physiatrists, like myself, that help treat non-operative spine care. We also have an extensive physical therapy department. So, as soon as the chair came in, I got it set up. I went down and grabbed Eleanor, one of my physical therapists here, and I had her take a look at it. She sat on it and gave me an interesting look, like, "Hm, this is good. Hm, I'm not sure."
Sanjiv Lakhia: 27:17
One of the questions that we had, and want to throw out to you ... Well, first, before I ask this question, I think let's describe the chair. Because unfortunately, this is audio, not video, and if people are driving and listening, I want to let you just visually describe the chair, and describe what's unique about the chair, and why it creates this active sitting process. Folks, if you have a chance, go watch his about 10-minute TED Talk. He has some nice slides that talk about this movable piece that creates a little bit of this instability, that seems to be the secret sauce to the chair. For someone who's driving, and they're like, "What are they talking about? I don't understand what they're talking about," paint a mental picture.
Turner Osler: 27:59
Right. So, the idea of active sitting is to make a chair that tips just a little bit, effortlessly, in every direction, eight or 10 degrees. So, it's not a lot of motion, but it's enough to make your spine have to think about where it is in space and organize itself in a way that's optimal. There are other active chairs out in the world. We're not the only one. Heck, one company took out a Super Bowl ad for their active chairs. You can find it if you look around on the web. We think ours are the best because we spent a lot of time on prototyping and developing them, and ours are, by far, the least expensive because, as an epidemiologist, I understand very clearly that if people can't afford a solution, there's no solution at all.
Turner Osler: 28:42
So, our company's mission is to not just make these things, but to make them as inexpensively as possible, so that everybody can have one. The way we did that was to make the mechanism that makes the chair unstable as drop dead simple as we could. So, after more prototypes than I can care to recall, came up with a geometric solid. It's hard to explain this, but it's the volume of intersection of two cylinders at right angles with non-coincident axes, and possibly different radii. It's a new geometric solid that looks like some kind of weirdo squashed Star Cruiser. It smooths curves in every direction, so that if you just slide it under ... It's only an inch and a half thick. So, if you slide it under the seat pan of the chair, now the chair tilts easily in every direction. Because it's just a geometric shape, it's inexpensive to manufacture, and it doesn't wear out. There are a lot of advantages to making a shape do all the work.
Turner Osler: 29:41
Surprising to me, you can own a shape. We have a patent on this shape. Archimedes sniffed around 2,000 years ago, but he was always examining structures with coincident axes, and we hit on the idea of a non-coincident axes situation. We got a whole new geometric solid. By sliding this thing under the seat pan of a chair, and you might not notice it if you weren't looking, you get a chair that tips easily in every direction, and that basically changes everything about sitting. Because now, rather than your posture being imposed from without by the headrest, the footrest, the backrest, the armrest, and the coup de grâce, lumbar support rammed into your low back, trying to restore something that looks like normal posture, our chairs allow, naturally, organic posture to emerge because you're constantly rejiggering your posture, really, millisecond by millisecond, as your spine responds to gravity.
Turner Osler: 30:36
I'll say one more thing. If you look around on the web, you can find a picture of a guy walking that's striking. It's on YouTube. Because he has no legs. He was born with congenital agenesis of his femur. So, he's got no legs, but he walks along quite comfortably because he's walking on his ischial tuberosities. Right? His strides are quite short, just two or three inches, but you can see he's walking with good balance and good posture, and quite confidently. He's striding along on his ischial tuberosities. When I saw this piece of video, the penny dropped for me. This guy is walking, and legs have nothing to do with walking. Walking is about your spine and your pelvis, and how they interact. Your legs are just an amplification system that let you get where you're going quicker.
Turner Osler: 31:23
Walking, per se, is something that happens with your spine and your pelvis. Our chairs allow people's spine and pelvis to walk, but without the burden of having to decide where you're going, because all of the freedom of walking is built into our chair. Basically, people can be walking the whole time they're sitting, but without needing a treadmill and having the overhead of, as you may know, if you get on a treadmill at more than about 1.5 miles an hour, you can't mouse or type accurately. Your cubicle mates will revolt because you're making a lot of racket. The treadmill desk, I think, is not going to happen. You get most of what's going on with walking nearly by making the seat pan of a chair unstable. That, to me, was a revelation.
Sanjiv Lakhia: 32:08
That is amazing. Okay. So, this leads me to the question from my physical therapist, which essentially is how is this different than sitting on a stability ball?
Turner Osler: 32:17
Right. So, the yoga ball was, of course, invented in Sweden. They were using them in neonatal intensive care units for posturally draining kids to try and keep them off the ventilator. Then they got bigger, and they got transferred to gyms, and yoga studios, and stuff like that. Then as people were revolting against the crappy office chairs that we're all forced to sit in, the yoga ball seemed like an obvious thing because if I can get 20 minutes on a yoga ball at the yoga studio or the gym, then having all day would be great. Wouldn't it?
Turner Osler: 32:50
It sounds like a great idea, but there are really serious issues with the yoga ball. The first is that yoga balls are made out of plastic, and they're inflated. Plastic, over time, loses its plasticizer. So, it's not a matter of if, but when, a yoga ball fails. Now, when they fail, they fail catastrophically. They just suddenly deflate and [inaudible 00:33:10] goes to ground. I talked to the head of HR at University of Michigan at an ergonomics conference, and discovered that they had banned the yoga ball throughout the University of Michigan because they'd had a head injury that needed burr holes, and workman's comp. They had five catastrophic ball failures. She said they just banned them outright. If you're going to allow yoga balls, you must throw them all out on January 1 and buy all new, because a yoga ball that's less than a year old is less likely to fail. So, that's the first thing. Even if you're a skilled martial artist, if somebody suddenly deflates the yoga ball you're sitting on, you're going to land pretty hard. That's the first thing.
Turner Osler: 33:51
The second thing is the height of your chair is really crucially important, because you need to have your hips higher than your knees, so you can have an open hip angle, and so your psoas can pull a little bit on your lumbar spine and reestablish your lumbar lordosis. The business of having your knees lower than your hips is crucial. It's hard to dial that in if you can't adjust the height of your chair. Nobody knows how tall a yoga ball is because it depends on how much the person sitting on it weighs, and the inflation pressure, and the barometric pressure of the room, and the temperature, all that. You can't really get the height of a yoga ball right because it's not adjustable.
Turner Osler: 34:30
The final thing to really hate about yoga balls is because they're inflated, your ischial tuberosities, as we discussed before, can't really feel where they are in space. So, they just get lost, and people wind up in the same old slump they would have been sitting in, in their crappy ergonomic chair. They're just now sitting on a yoga ball that might suddenly pop. So, as far as I can see, yoga balls are all downside, except they're very inexpensive.
Sanjiv Lakhia: 34:57
That's a good breakdown. I didn't think about some of those things. Do you feel like there's any contraindications or situations where someone maybe should not consider using a chair like this to promote active sitting?
Turner Osler: 35:11
This comes up a lot because I have an MD, and we've sold 5,000 of these things over the web. I get peppered with emails from people, saying, "I have scoliosis," or, "I have sacral agenesis," or, "I have this, or that, or the other thing. Is your chair good for me?" Of course, we don't have data on all these different conditions and how they might interact with our chair. It's very hard for me because the answer just isn't known. I would say this though. This is what I tell people, mostly. I say, "It's very unlikely that our chair will do any harm. It's unlikely to cause any mischief. If our chair should make your neck pain worse, or your elbow swell, or whatever, just stop. Send it back. We'll refund your money and pay postage both ways." We're not trying to stick you with a chair. We're trying to help people sit better. People think it's terrific and that I'm a generous guy by saying, "We'll pay the postage both ways," but really, only about four percent of our chairs come back. 96% of people love these things.
Sanjiv Lakhia: 36:09
The one scenario that I would envision a little bit of caution, and not necessarily caution forever, but some of our patients who have lumbar disk herniations, and the most common location would be L-4, 5, or L-5S1 ... Some of them are actually extension sensitive. Meaning, when they lean back or arch their back, it can trigger some nerve pain down the leg. That can be an initial phenomenon with the lumbar disk. Now, I would say most lumbar disks are flection sensitive, and do better in extension. This chair definitely puts you into a little bit more spinal extension, which probably is actually the right posture. Right? You want to take advantage of lumbar lordosis and the wedge shaped L-5 [inaudible 00:36:53] disk.
Sanjiv Lakhia: 36:54
I think if someone is in the initial acute to subacute phase of a disk herniation, with a radiculopathy, with a radiating pain down the back of the leg, it behooves them to ask a very, very simple question, I think, before they look to buy the chair, and that would be, "When I lay on my stomach, do I feel better, or do I feel worse?" If laying on your stomach makes you feel worse, then I think, in that stage, you probably want to avoid this type of sitting posture, at least until that calms down. I'm pretty much on board with the idea that creating an active sitting process, creating a scenario where you're on your sit bones, and you're more upright, and you're taking advantage of lordosis, it's probably how we should be doing it.
Sanjiv Lakhia: 37:39
It really resonated with me when you talked about ... I think it was in your talk. How the chairs we sit in now are designed to cushion us and provide comfort, and how that's harming us. In fact, I mentioned to an employee that I was interviewing you today, and I said, "He's started this company, and they made this chair that promotes better sitting," and she said, "Oh! Does it provide better support?" I said, "Actually, no. It doesn't provide better support. That's the point!" I don't know if you've had a chance to look. If you go on YouTube and look at your TED Talk, and go down into the comments, sometimes the comments are full of ... You don't want to read the comments, because it doesn't matter what you do in life, there's always going to be naysayers and haters.
Sanjiv Lakhia: 38:26
One of the comments says, "Where's the armrest?" You just missed the whole point of the TED Talk. Anyway. I think that would be the one scenario, would be extension sensitive disk herniation in the acute phase, but ultimately, with the goal of transitioning to a better sitting posture, for sure. What are your thoughts on that? Have you had any feedback with regards to acute disk herniations?
Turner Osler: 38:51
Right. No. So, people with acute back pain, initially, may be extremely uncomfortable because I think of our chair more as a prophylactic device, improving posture and core strength, so that they never have another bout of back pain. The idea that we try and treat an acute episode of anything with some tippy chair seems a little, we have no data, for sure. It's not necessarily the case that it wouldn't be helpful. But we do have CPM machines that we put people in, in the OR, before they even wake up from anesthesia to keep joints moving in a way that's helpful for healing. So, the idea that motion could be helpful, it's not completely foreign.
Turner Osler: 39:34
It's something that vexed me, and I thought to be on the safe side, we would say, "This is not for acute pain. This is to sit better, so that you don't develop such episodes." Well, you know these things, but I've had people begging me over the phone to drive to the UPS office at midnight and put a chair in the mail to them, because their back is killing them kind of stuff. These are pretty uncomfortable people, and they're looking for a way out of a very uncomfortable situation. Most people with back pain don't have herniated disks, or metastatic cancer, or any elaborately ... the sort of thing that you study in medical school. Most people have garden variety, musculoskeletal, non-specific back pain.
Turner Osler: 40:18
For those people, even if they're in the throes of acute pain, our chairs have proved quite helpful. I wouldn't necessarily believe this, except we've gotten many, many emails from people who talk about their non-specific back pain was killing them, our chair shows up, and they get on it, and they feel better within a day or two. They never look back, and they don't have that pain anymore. These kinds of testimonial emails make me extremely uncomfortable because I'm a lifetime academic researcher, I review for surgical journals, I have a master's in biostat, and I know, I guess, Richard Feynman, who has the Nobel Prize in particle ... no, quantum mechanics, from a couple of decades ago. Famously said, "The first thing is, you must not fool yourself. Unfortunately, you are the easiest person to fool."
Turner Osler: 41:08
I don't want to be drinking my own Kool-Aid. It makes me uncomfortable when people are talking about how great this is for non-specific acute back pain issues. But I'm gradually becoming persuaded that it might be true. So, I don't actually make that as a claim, but I'm suspicious that it might be true. That said, an acute disk herniation is a horse of a different color. It would be well to let that settle down.
Sanjiv Lakhia: 41:32
Have you guys done any sort of surface EMG studies, looking at which muscles are getting activated, from a data perspective?
Turner Osler: 41:42
We have some electrodes and some stuff that we're going to hook up and play with. We also found some great software that turns your pixel or your phone into an accelerometer. So, we can start measuring how much people are moving, and in what direction, stuff like that. But really, all of these objective measures require a lab and a lot of time, and I'm probably not the guy to be doing it because I'm not really a bench researcher. I'm an epidemiologist kind of guy. I really relied on the epidemiologic literature and the anthropologic literature to understand what's going on.
Turner Osler: 42:15
We're looking to partner with a couple of labs that do this kind of work. We're also very interested in how sitting on one of our active chairs changes the basal metabolic rate. It's been measured in some other chairs that aren't quite as active as ours. So, we have a pretty good idea of how our chairs affect the basal metabolic rate. We don't yet have research partners to do this kind of stuff. It's been hard in the era of COVID to do any research that requires subjects and so on.
Sanjiv Lakhia: 42:42
I think that's just fascinating that there's even a possibility that changing the chair I sit on could increase my basal metabolic rate. I mean, that right there is more fascinating even than the effect on back pain. Anyway. You've been very, very gracious with your time. I appreciate you reaching out. It really sounds, to me, like you're on a mission, and it's not necessarily to sell chairs as much as it is to reeducate the community and the culture about the benefits of active sitting. I did find your TED Talk to be compelling, in terms of its application for our youth. As a last talking point here before I let you go and enjoy the rest of your day, do you want to share a little bit about your vision moving forward with this adventure that you're involved in?
Turner Osler: 43:30
Yeah. So, people have tried to help me because I have no idea about any of this stuff, and the entrepreneur types say, "Who is your market," as though that were the crucial question to answer. For all I know, it is the most important question if you're trying to be an entrepreneur and make money. But I actually don't understand that question. I think sitting actively is really something that ought to be normal. I think everybody ought to be sitting on a chair that lets them move rather than be locked into a single position all day.
Turner Osler: 44:01
It is an issue. I want to make active chairs the norm. The chairs that we're stuck with, and really have been pushed on us by, I'll call them, big chair. There are only half a dozen companies in the country that make office chairs. They all make the same chair. All of those chairs have an 80% back pain rate. So, as far as I can tell, they're all failures. So, it's hard, as a tiny startup, to upend the idea of what a chair is. We were puzzled at first that when people land on our website, the bounce rate was 50%. People land on our website. Boing! They'd be gone in seconds. The problem was that they're looking for a chair, and they see what we're offering, and they say, "Well, that's not a chair. It doesn't have a backrest, or a headrest, or armrests, or footrests, or lumbar support. It doesn't have any of that stuff! I don't know how I got here, but it's a big mistake."
Turner Osler: 44:54
The answer is it's a big mistake, but what's a big mistake is the chair that you think you're looking for. It's hard if you're a little startup in Burlington, Vermont, to overturn over 50 years of big chair's message, "Oh, armrests, headrests, backrests, lumbar support." But it's essential if we're going to let people sit in a more natural way and get away from the epidemic of back pain.
Sanjiv Lakhia: 45:17
Turner, how can people get one?
Turner Osler: 45:18
Oh, yeah. Right. People say, "Where can I try this out?" The answer is, boy, we're a startup in Burlington, Vermont. We can't have bricks and mortar in every city in the country. But what we can do is this. We'll send you a chair. If you don't like it, send it back. We'll pay the postage both ways. We're quite confident that you'll almost certainly love it. To find us, it's Q, as in queen, QOR360.com. That's our website. We wanted to spell it with a C, but all the C words were taken. But the Qs were left. So, we got QOR360.com. We also give away a design for kids, or a chair for kids, that uses a lacrosse ball as the rocking mechanism. We give away the design. Anybody can make one if they have access to wood tools, and they can make them by the hundreds if they have access to a CNC router. That project has its own website, buttonchairs.org. B-U-T-T-O-N-C-H-A-I-R-S dot org. Butt on chairs. The double entendre, is intended for the middle school sect.
Sanjiv Lakhia: 46:22
Is this your full-time passion right now?
Turner Osler: 46:24
Well, it's growing. I'm still an emeritus professor at the University of Vermont, where I lead a COVID research group. I still do the experimental design and the statistical analysis for projects in the surgery department here at the University of Vermont. I still squeeze in some Tai chi. Once I get my second blast of vaccine, I'll be back to doing martial arts. This is gradually becoming a full-time project because as a surgeon, you can only touch 10,000 lives in your life. That's it. That's about as many people as you're going to operate on and get in and out of the ICU. As an epidemiologist, you can touch hundreds of millions of lives. So, my idea is that this is my last chance to really make a huge difference in people's health and comfort.
Sanjiv Lakhia: 47:16
Well, it's amazing what can happen and what can start by asking a simple question. In this case, the question is essentially how are we supposed to be sitting? Is the way we're sitting now serving us? So, I find the topic to be fascinating, and I appreciate you're reaching out to me, and it's been a pleasure getting to speak with you and share your message. Because anything that promotes better posture, less back pain, less suffering in the world, I'm all in favor of. Thank you again for your time today.
Turner Osler: 47:47
No. Thanks for your great questions. It's these kinds of conversations that help me think more deeply about how our chairs work.
Sanjiv Lakhia: 47:54
Yeah. Stay in touch. I really enjoy talking with you. [inaudible 00:47:58] fascinating, fascinating position, person. I love the mission of helping people.
Outro: 48:06
Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates, with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.
This podcast is sponsored by our partner, QXMD. QXMD builds mobile solutions that drive evidence-based medicine in clinical practice. Check out READ for easy access to research personalized for you, and Calculate for over 500 easy to use decision support tools. Try them today at QXMD.com/apps. Again, that is QXMD.com/apps.
Intro: 00:30
Welcome. You're listening to Back Talk Doc, where you'll find answers to some of the most common questions about back pain and spine health. Brought to you by Carolina Neurosurgery and Spine Associates, where providing personalized, highly skilled, and compassionate spine care has been our specialty for over 75 years. Now, it's time to understand the cause of back pain, and learn about options to get you back on track. Here's your Back Talk Doc, Dr. Sanjiv Lakhia.
Sanjiv Lakhia: 01:05
Being a spine physician now for almost 15 plus years, as many of you who listen to my show know, I'm always on the lookout for ways that I can help my patients improve the health of their back, particularly with natural methods, less invasive methods, and methods that can really be integrated into their day-to-day routine and their life. One of the things that I've been blessed with, as we started this podcast at Back Talk Doc, it's been over a year now, and some 30 plus episodes in, is I've had several people reach out to me with messages that they would like to share with the community. Today, it's my privilege to welcome to the show Dr. Turner Osler, who is a physician and, by trade, an academic trauma surgeon. He has a very interesting story and a message that he's trying to spread across the country, and if not farther, about the importance of proper sitting as it pertains to your back. So, Turner, welcome to the show today.
Turner Osler: 02:08 Sanjiv, it's great to be here.
Sanjiv Lakhia: 02:10
Let me start by introducing you to the listeners. I did have the pleasure earlier today of watching a TED Talk that you gave. I think it was back in May of 2019. So, now I know I am interviewing a celebrity. So, this puts some pressure on me. But for those of you who don't know Dr. Osler, Turner has academic trauma surgeon backstory. He had a bachelor of arts in neurobiology from Princeton. He went to the Medical College of Virginia, and then did a surgical residency through Columbia and Harvard, and a fellowship at the University of New Mexico. Then he spent 20 years as an academic trauma surgeon through the University of Vermont, and has over 300 peer reviewed papers and book chapters.
Sanjiv Lakhia: 02:52
About a decade ago though, he went off the script and got a master's in biostatistics and an NIH grant, and he abandoned the operating room to study trauma epidemiology. Somewhere in the last several years, he became obsessed with problems that come from sitting too much, and especially with sitting badly. Really, since there weren't many people in this space, Turner and some friends created a company to make active sitting chairs affordable enough for everyone. He lives in Colchester with his wife, son, and dog, who have been surprisingly tolerant of his mania, as he says, and are being gradually drawn into his madness. Except the dog. So, that is his background in bio. Anything you'd like to add to that, as the listeners tune in and get to know you a little better today?
Turner Osler: 03:37
That makes me sound more erudite than I am, but I'll take it. Thank you.
Sanjiv Lakhia: 03:43
To be honest though, he also, folks, he sent me his curriculum vitae, and we had to reload the printer with paper as the pages just kept coming out. This is one very accomplished physician, and it's a real pleasure to dive into the message he's trying to spread. I'll get right to it. You are founder of a company called QOR360, that essentially has developed technology for a chair that creates what you call an active sitting environment. So, before we dive into the company and the product, I'm really curious to know a little more about your path from academic, renowned trauma surgeon to a spine entrepreneur. Can you walk me through that a little bit?
Turner Osler: 04:32
Yeah. Well, it certainly wasn't planned. I had planned a calm retirement, wind surfing and practicing martial arts. But as I switched to epidemiology, suddenly I'm writing computer code all day, sitting in front of a computer instead of running from the OR to the ICU to the clinic, back and forth all day. I went from the peripatetic life of a trauma surgeon to just sitting in front of the computer. So, for the first time in my life, my back started to bother me. I thought, "Well, sheesh. What's up with that?" So, I bought basically every gizmo, ergonomic chair there was, the yoga ball, the kneeling chair, all that stuff. None of it really helped at all. So, I thought, "I wonder if anybody understands this."
Turner Osler: 05:16
So, I started reading the ergonomics literature and actually going to academic ergonomics conferences, and I was stunned at how little is understood about how sitting interacts with the human body. We've been sitting on the same old design of office chair now for 50, or maybe 100 years, depending on how you count. Still, 80% of America has back pain, at some point in their lives, bad enough to send them looking for professional help. So, if our ergonomic community understands the problem, how come they haven't solved it? It was a conundrum for me until I started reading the anthropologic literature.
Turner Osler: 05:55
It turns out in places where people don't sit in the Western way, with their ankles at 90 degrees, their knees at 90 degrees, and their hips trying to be at 90 degrees, these other cultures ... Think of Japan, or South Korea, or think of Sub-Saharan Africa, where people squat, or they sit [Seiza 00:06:15], or they sit with their legs crossed on the ground. These places don't have back pain. The clear epidemiologic implication is that it's our chairs that are causing the problem. It's not an easy problem to solve because everybody thinks our chairs are God-given. Chairs are part of our built environment. We just don't see them anymore than a fish sees the water it swims in.
Turner Osler: 06:37
We think all the chairs that we have are normal, and they are not. Humans are not designed to sit all day. It's completely outside our design envelope. We have the bodies of hunter-gatherers, that were developed over four billion years, if you counted all the prototypes, or maybe in daily use for three million years. We're simply not set up to sit slumped in front of a PC all day. So, if you can't arrange for people to stop sitting, how do you arrange for them to sit in a way that at least is non-destructive? That was the core problem that I came up against.
Turner Osler: 07:11
I wanted to solve it for myself, but as I got into it, it seemed like a much bigger problem, and one that was worth solving generally. Because it turns out, it's not just a matter of posture and back pain. There's also the whole issue of sitting disease. Turns out, when people sit for many hours a day, and in America, we sit, on average, eight or even 12 hours a day ... How is that even possible? It's breakfast, lunch, dinner in front of a computer at home, in front of a PC at work, in front of the television. It adds up. So, when we sit this much, our spines are pretty adaptable, but they aren't adapted for sitting slumped in an odd posture for 12 hours a day. It's a hard problem because we want to actually have people up and moving, hunting and gathering, which isn't going to happen.
Sanjiv Lakhia: 08:05
It sounds like it started in your mind with a simple question about sitting. I think this question is especially timely during the lifespan of COVID-19 and the pandemic, because I can tell you in my clinic, as a practicing out-patient physiatrist, I am seeing what you just called as sitting disease. It's not just back pain. I'm seeing neck pain. I'm seeing headaches. I'm seeing weight gain. I'm seeing mood disorder, relationship problems. I think a lot of it is from us becoming plastered to our chairs. The idea is what are we doing to our physiology?
Sanjiv Lakhia: 08:46
You're asking a terrific question. Actually, when I first heard about your approach, and the company, and the idea that other cultures don't have the back pain issues we do in the United States, what came to me was ... I don't know if you're familiar with the work of Esther Gokhale, the Gokhale Method. In her book, she is a ... I have not met her, but I've gone through her materials. Quite frankly, to help my patients, as well as myself! Because it's not too far ago that I went through some back issues, and actually had to get some injections. We're talking November. So, I'm always on the quest, as a spine physiatrist, to practice what I preach and find simple solutions. We'll link to her book. I'm going to link, as well, to your TED Talk, because I think it was a terrific TED Talk.
Sanjiv Lakhia: 09:34
In her text, she gives photographs of native people in India and other cultures, and just shows their posture versus ours, and how they can sit for hours, stand for hours, they can hold massive weights on the top of their head, and they don't have any back pain! Then you compare to what's going on in our modern culture, and it's really, really striking. I wondered if you were influenced a little bit by some of the work that she did, or perhaps you just stumbled upon the same anthropologic research, as you were asking your pertinent questions.
Turner Osler: 10:05
Oh, no. I read her book with great interest, of course, because I think I've read almost everything in this space. The photographs in her book are terrific. They really show the brilliant posture that humans are ... It really is our human birth right. Right? I mean, we're entitled to that beautiful posture. But it's taken from us by our chair-centric culture. When you think about it, kids, when they're born, are natural and beautiful squatters. If they lose their balance, they just sink into a squat quite comfortably. They can stay there and eat a peanut butter and jelly sandwich, and then get up and carry on.
Turner Osler: 10:42
Adults, pretty much, can't squat at all, and they certainly can't squat comfortably for an entire peanut butter and jelly sandwich. So, what is it that happens to kids that robs them of their ability to squat? Well, it's because we put them in chairs, and they lose the flexibility required for squatting. Squatting isn't an odd posture. It's how human beings rested for most of their hunter-gatherer career. Squatting is a great posture because it's an active rest posture, as [Lieberman 00:11:13] calls it, where people are balanced over their ankles. So, they have some muscular activity, but it's much more restful than standing up. To lose that posture is a very sad thing, that we've taken it basically away from all of our children when they're born with naturally perfect posture.
Turner Osler: 11:34
We can see that our chairs are shaping us. Winston Churchill said, "We shape our environment once, and then it shapes us forever." The idea is that we are in intimate contact with chairs for eight, or 10, or 12 hours a day. Our chairs are reshaping our anatomy and our physiology. While we love sitting on our chairs, our chairs do not love us back. Our chairs are killing us. There's good epidemiologic work to show that people who sit more than eight hours a day lose, on average, two life years.
Sanjiv Lakhia: 12:06
Yeah. One of the catch phrases now is that sitting is the new smoking. I think it's worse though because with smoking, you can take the cigarette out of your mouth. With sitting, you can't tell people to not sit at all. Now, your mission is to help people sit properly. Let's break it down a little bit though for some of the clinicians and physical therapists who listen to my show. I'll give you my take on where sitting can become a problem, and then you can add, subtract, or amplify this. Okay?
Sanjiv Lakhia: 12:34
One of the things that we know bio-mechanically, is that when you put pressure probes in lumbar disks, there's two positions that increase or jack up the reading substantially. The first one is just sitting, and the second one is sitting and leaning forward in a slightly flexed position. This is why, a lot of times, people will say, "All I did was lean over to tie my shoe, and my back went out." For listeners, that is one area to consider, is excessive amounts of sitting. What is it doing to your lumbar disks? Secondly though, I think there's a whole host of physiologic changes that go along with sitting for long periods of time. To me, one of the main detrimental effects is the effect on your breathing, and your inability to have diaphragmatic breathing, which then sets off a chain reaction of muscle tightness up the spinal axis into the head, neck, and shoulders.
Sanjiv Lakhia: 13:28
Certainly, if you're not breathing deeply, you are no longer living in a parasympathetic state, and you are now more in a stressed state. I could go on and on and on with that. That's the lens which I view a few of the major problems with prolonged sitting. What are your thoughts on what is the problem with the way we sit, and sitting in general right now?
Turner Osler: 13:51
So, I'm aware of that literature where they were putting pressure probes into spinal disks. How did they ever get that past the IRB? That must be ...
Sanjiv Lakhia: 13:59
This was rat studies.
Turner Osler: 14:01
How do you get a rat to sit in a chair?
Sanjiv Lakhia: 14:02
Right.
Turner Osler: 14:03
These are hard questions. But it is true, certainly, that when people sit in a slumped posture, everything changes. Their disks go, in very short order, from being disks to being wedges, of course, which is why when people get up from sitting for a few hours in front of their computer, slumped, the first few steps are pretty remarkable, as they're trying to wrestle their disks from wedges back into disks. So, you know that you've been really abusing your disks by squashing them into an unnatural position, and then keeping them there for hours. Disks need to imbibe fluid as they're compressed, and flexed, and extended, which doesn't happen when people are slumped in front of their computer for long periods of time.
Turner Osler: 14:47
As you point out, it also restricts the thoracic cage, so people aren't breathing as deeply. There are bigger problems afoot even than that. We also know that lipoprotein lipase, an important enzyme in the human [inaudible 00:15:02], as they say, goes down when people are sitting with their muscles electrochemically dark. Your muscles aren't just, as you know, mechanical units that move your bones. They're immensely metabolically active factories that spin off hormones and enzymes that affect our internal biochemistry. So, when your muscles go electrochemically dark, your bad cholesterol goes up, your good cholesterol goes down, your insulin goes up, and your baseline inflammation levels go up.
Turner Osler: 15:34
All of these things resulting in an increase in all-cause mortality. The business of sitting slumped in front of a computer is altering you in ways that predispose you to having back pain, but also take years off your life. I mean, your analogy to smoking, I think, is a very strict one. Sitting is the new smoking. Just as smoking was invisible to people in the 1950s because everybody smoked ... It was normal. Even physicians were smoking, so what's the problem? It was very hard to get people to buy into the idea that smoking was actually a public health catastrophe. Heart disease, emphysema, lung cancer. Statisticians, at the time, said, "Well, you could never actually do such a study. You'd have to assign people to smoke or not smoke. It wouldn't be a ..." They just needed better math.
Turner Osler: 16:25
It's embarrassing, what happened in the '50s. Fortunately, we've gotten past that now, and we pretty much all understand that smoking is a terrible idea. But now, it turns out that sitting is almost as bad an idea, in terms of its impact on our health, but just as with smoking, chairs are invisible to us because we think they're normal. You cannot look out of a window unless you are sitting on a chair. When you try sitting on the floor, you can't see out the window. Our very architecture presupposes you're sitting in a chair. So, what's to be done? Well, my mentor in public health was Susan Baker at the Bloomberg School of Public Health at Johns Hopkins. Sue taught us all that you can't shame people or berate people or belittle people into behaving better. They'll forget, or they'll ignore you. No one wants to be harassed.
Turner Osler: 17:16
What you must do is you must redesign the environment to make it safer for people. So, airbags are a great example. Your airbag works whether you're paying attention or not. Even, perhaps, before airbags, and even a better example is divided highways. By simply putting a mechanical divider down the middle of a highway, people can't run into each other head on at 60 miles an hour. The idea is to change the environment in a way that makes it safer for people, so that they don't have to make conscious decisions every day, or maybe many times a day, for better health. This is where the idea of if we can just change the way a chair interacts with a person, so that they stay in constant motion, we can make sitting healthful rather than destructive.
Sanjiv Lakhia: 18:01
Okay. So, again, if you're listening, and you're just curious, it's QOR360.com. Right on the homepage, you'll see a beautiful picture of the bright red chair. What's the model name?
Turner Osler: 18:16
So, we named it Ariel after a wife of one of our medical students, who was just in love with the thing. She loved it so much we named it after her.
Sanjiv Lakhia: 18:24
Well, folks, I did ask if they would send me one that I could try, so when I talked with Turner I could have a genuine feedback, and let me share my feedback with you. You haven't heard this yet, so you're probably sitting there, "I hope he says it's okay." Then we can talk a little more about it. The first thing I would say is it was very easy to put together. I was a little intimidated by the box coming in, and my staff brings this back to me like, "What do we do with this?" I said, "All right. Let's open it. Let's take a look." It was literally in five minutes, I had the thing put together. I'm good at a lot of things in life, but as my wife would attest, you give me screwdrivers, hammers, and nails, and I am basically looking to call someone. If I can do it, pretty much anyone can do it.
Sanjiv Lakhia: 19:08
Now, the accompanying brochures, they're very clear, very simple that, number one, this is not a toy. Number two, you want to take your time breaking it in, because it's a new way of sitting. I was a little concerned because I have dealt with a disk issue in my back as recently as November, and I missed some time from work. So, my staff was like, "Are you sure you want to try this?" So, I took your advice, and I titrated up. I started with five minutes and worked up a little bit longer, and this past week, I was actually doing a virtual conference. I'm a fellow at the Andrew Weil Center for Integrative Medicine. We had our residential week. So, I was on a computer a lot. So, I took this puppy home, and I alternated it with my other chair. I have to tell you, I was very impressed with it.
Sanjiv Lakhia: 19:55
The first thing it does is it makes you sit a little more forward and create a slight anterior pelvic tilt, which I found to be a little bit more comfortable, and probably more consistent with the wedge shape form of the L5-S1 disk. The second thing it does is it does make you activate some of your core muscles, because you are on an unstable surface, a slightly unstable surface, and it doesn't take a whole lot, I think, to get some activity firing. These are muscles that I know for a fact I don't fire when I sit in typical chairs. In particular, the three year old chair that I use from Costco is not giving me anything and is more like a recliner, at this point. So, my experience was pretty good. I probably sat in the chair, on average, over the last week, I would say probably two hours or so. I got through it. I wasn't worse. I actually feel pretty good coming out of that.
Sanjiv Lakhia: 20:47
I didn't have as much back fatigue by the end of the day. I did have a little muscle soreness, maybe in my transverse abdominis and my obliques a little bit, but it felt like muscle soreness from after doing physical therapy versus back pain. So, very, very encouraged by the product. I'd like to lead that into I want to know what your description is and what you mean by, and so the listeners can learn, when you say active sitting. Because I think that's what I did. I did active sitting on the chair for the last week. But for people who really don't understand that, can you break that down for us?
Turner Osler: 21:23
It's an interesting thing. Thanks so much for trying out one of our chairs. I just love that you wanted one before we did a podcast, because that wins my heart that people are interested in what this actually is about, rather than just going through the motions or whatever. It's terrific. All of your experiences are what I've heard many, many times before. Our chairs are more work than you might think. It comes as quite a surprise. Even people who are in pretty good shape find that the next day, they can be a little bit sore in the sense of a workout soreness, not pathologic soreness, because it really does activate your core muscles, as you discovered.
Turner Osler: 22:02
These are big muscles, the transverse [inaudible 00:22:05], the internal and external oblique, the multifidus. They're big muscles. They're not moving a lot, but they're moving constantly. So, your metabolic rate goes up by about 20%, which as I alluded to earlier, has really important metabolic consequences for warding off the heart attack that you were going to have 30 years from now. We take our chairs out on a sunny day in Burlington, Vermont when tourists are around, and we put some chairs out on the walking street in Burlington, Church Street, just to see what will happen. It's very interesting. People sit down on our chairs, and because they're a little bit unstable, they immediately lose their balance a little bit, and you may see a little bit of the whites of their eyes as they find their balance.
Turner Osler: 22:45
Then within one minute, certainly within two minutes, their sternum comes up and their shoulders come down, and the head comes back and balances on the atlas and axis, the first two cervical vertebrae. Really, within two minutes, people are sitting very good posture, like people sitting in meditation, the noble posture, their head balanced perfectly on the top of their spine, and all the rest of them balanced on their ischial tuberosis. This happens because our chairs, because they're a little bit unstable, allow the pelvis to try a whole lot of different configurations. Every time the pelvis moves to a new direction, the rest of the spine responds with spinal reflexes that were laboriously programmed over the first few years of a child's life, as they went from creeping, to crawling, to toddling, to walking.
Turner Osler: 23:34
Your spine knows what to do with gravity. It's hardwired at the spinal reflex level. So, if you just free people's pelvis, their spine then finds its own perfect posture by trying out several different, many, many different postures very quickly. It doesn't move to a new posture unless it feels better, and then by mathematics, you call this a Markov chain Monte Carlo simulation, where the spine can try out a lot of positions quite quickly until it finds a very natural, balanced position. It's not just about sitting. I love this story. Went out on Church Street in Burlington one day. Some 13 or 14 year old girl was sitting at the periphery on one of our chairs, just trying it out, just blissing out in the sun. No phone, just rocking back and forth for two minutes, four minutes, 10 minutes, 15 minutes.
Turner Osler: 24:27
Then she gets up and walks away. But she doesn't get 10 strides before she turns around and says, "I think it makes me walk better." The way her spine interacted with gravity had been, in some sense, reset, so that she could interact more naturally with better posture, and that better posture transferred from sitting to walking to whatever it is she was going to do next. I think of our chairs as a way of wordless pedagogy, about helping people find a better posture without having to read a book, or watch a video, or hire a trainer, go to the chiropractor. It just allows people's spinal reflexes to do what they do best, which is interact with gravity in a way that optimizes our bony architecture.
Sanjiv Lakhia: 25:15
One question I have for you. I did find, at times, a little discomfort, maybe around the ischial tuberosity region. Was I too far forward in the chair, or is that just something that you have to get used to?
Turner Osler: 25:25
No. You're completely normal. We wrestled with this. A lot of people have had input to this chair, [Feldenkrais 00:25:32] types, and Alexander Technique types, and martial artists, and Pilates people, and yoga people. They were quite firm with me that people needed to be able to feel their ischial tuberosities in order to know where their spine was in space, so they could organize their posture. If you want to make a chair firm enough that people can actually feel their ischial tuberosities, well, most people aren't accustomed to feeling their ischial tuberosities because they've been sitting in big, poofy couches, or yoga balls, or something where their ischial tuberosities never touch anything. Now, it's only the bicyclists who really have experience with where their ischial tuberosities touch down. I think it's within our design envelope that people's ischial tuberosities, they have bursae, like with bicyclists. At the beginning of the riding season, it's a little uncomfortable to be back on your saddle, but very shortly, your ischial tuberosities adapt to it.
Sanjiv Lakhia: 26:28
Yeah. You know what? That's a great analogy, to riding a bike, when you first start out. So, a couple questions here. I work at Carolina Neurosurgery and Spine. I don't know if you know much about us, but we're one of the largest ...
Turner Osler: 26:40
I looked at your website! Holy Toledo! You guys own neurosurgery in North Carolina.
Sanjiv Lakhia: 26:46
You just made the audiogram for the episode. That's fantastic. I'm very privileged to work at this group. We're one of the premiere neurosurgery groups in the country. Then we have a collection of physiatrists, like myself, that help treat non-operative spine care. We also have an extensive physical therapy department. So, as soon as the chair came in, I got it set up. I went down and grabbed Eleanor, one of my physical therapists here, and I had her take a look at it. She sat on it and gave me an interesting look, like, "Hm, this is good. Hm, I'm not sure."
Sanjiv Lakhia: 27:17
One of the questions that we had, and want to throw out to you ... Well, first, before I ask this question, I think let's describe the chair. Because unfortunately, this is audio, not video, and if people are driving and listening, I want to let you just visually describe the chair, and describe what's unique about the chair, and why it creates this active sitting process. Folks, if you have a chance, go watch his about 10-minute TED Talk. He has some nice slides that talk about this movable piece that creates a little bit of this instability, that seems to be the secret sauce to the chair. For someone who's driving, and they're like, "What are they talking about? I don't understand what they're talking about," paint a mental picture.
Turner Osler: 27:59
Right. So, the idea of active sitting is to make a chair that tips just a little bit, effortlessly, in every direction, eight or 10 degrees. So, it's not a lot of motion, but it's enough to make your spine have to think about where it is in space and organize itself in a way that's optimal. There are other active chairs out in the world. We're not the only one. Heck, one company took out a Super Bowl ad for their active chairs. You can find it if you look around on the web. We think ours are the best because we spent a lot of time on prototyping and developing them, and ours are, by far, the least expensive because, as an epidemiologist, I understand very clearly that if people can't afford a solution, there's no solution at all.
Turner Osler: 28:42
So, our company's mission is to not just make these things, but to make them as inexpensively as possible, so that everybody can have one. The way we did that was to make the mechanism that makes the chair unstable as drop dead simple as we could. So, after more prototypes than I can care to recall, came up with a geometric solid. It's hard to explain this, but it's the volume of intersection of two cylinders at right angles with non-coincident axes, and possibly different radii. It's a new geometric solid that looks like some kind of weirdo squashed Star Cruiser. It smooths curves in every direction, so that if you just slide it under ... It's only an inch and a half thick. So, if you slide it under the seat pan of the chair, now the chair tilts easily in every direction. Because it's just a geometric shape, it's inexpensive to manufacture, and it doesn't wear out. There are a lot of advantages to making a shape do all the work.
Turner Osler: 29:41
Surprising to me, you can own a shape. We have a patent on this shape. Archimedes sniffed around 2,000 years ago, but he was always examining structures with coincident axes, and we hit on the idea of a non-coincident axes situation. We got a whole new geometric solid. By sliding this thing under the seat pan of a chair, and you might not notice it if you weren't looking, you get a chair that tips easily in every direction, and that basically changes everything about sitting. Because now, rather than your posture being imposed from without by the headrest, the footrest, the backrest, the armrest, and the coup de grâce, lumbar support rammed into your low back, trying to restore something that looks like normal posture, our chairs allow, naturally, organic posture to emerge because you're constantly rejiggering your posture, really, millisecond by millisecond, as your spine responds to gravity.
Turner Osler: 30:36
I'll say one more thing. If you look around on the web, you can find a picture of a guy walking that's striking. It's on YouTube. Because he has no legs. He was born with congenital agenesis of his femur. So, he's got no legs, but he walks along quite comfortably because he's walking on his ischial tuberosities. Right? His strides are quite short, just two or three inches, but you can see he's walking with good balance and good posture, and quite confidently. He's striding along on his ischial tuberosities. When I saw this piece of video, the penny dropped for me. This guy is walking, and legs have nothing to do with walking. Walking is about your spine and your pelvis, and how they interact. Your legs are just an amplification system that let you get where you're going quicker.
Turner Osler: 31:23
Walking, per se, is something that happens with your spine and your pelvis. Our chairs allow people's spine and pelvis to walk, but without the burden of having to decide where you're going, because all of the freedom of walking is built into our chair. Basically, people can be walking the whole time they're sitting, but without needing a treadmill and having the overhead of, as you may know, if you get on a treadmill at more than about 1.5 miles an hour, you can't mouse or type accurately. Your cubicle mates will revolt because you're making a lot of racket. The treadmill desk, I think, is not going to happen. You get most of what's going on with walking nearly by making the seat pan of a chair unstable. That, to me, was a revelation.
Sanjiv Lakhia: 32:08
That is amazing. Okay. So, this leads me to the question from my physical therapist, which essentially is how is this different than sitting on a stability ball?
Turner Osler: 32:17
Right. So, the yoga ball was, of course, invented in Sweden. They were using them in neonatal intensive care units for posturally draining kids to try and keep them off the ventilator. Then they got bigger, and they got transferred to gyms, and yoga studios, and stuff like that. Then as people were revolting against the crappy office chairs that we're all forced to sit in, the yoga ball seemed like an obvious thing because if I can get 20 minutes on a yoga ball at the yoga studio or the gym, then having all day would be great. Wouldn't it?
Turner Osler: 32:50
It sounds like a great idea, but there are really serious issues with the yoga ball. The first is that yoga balls are made out of plastic, and they're inflated. Plastic, over time, loses its plasticizer. So, it's not a matter of if, but when, a yoga ball fails. Now, when they fail, they fail catastrophically. They just suddenly deflate and [inaudible 00:33:10] goes to ground. I talked to the head of HR at University of Michigan at an ergonomics conference, and discovered that they had banned the yoga ball throughout the University of Michigan because they'd had a head injury that needed burr holes, and workman's comp. They had five catastrophic ball failures. She said they just banned them outright. If you're going to allow yoga balls, you must throw them all out on January 1 and buy all new, because a yoga ball that's less than a year old is less likely to fail. So, that's the first thing. Even if you're a skilled martial artist, if somebody suddenly deflates the yoga ball you're sitting on, you're going to land pretty hard. That's the first thing.
Turner Osler: 33:51
The second thing is the height of your chair is really crucially important, because you need to have your hips higher than your knees, so you can have an open hip angle, and so your psoas can pull a little bit on your lumbar spine and reestablish your lumbar lordosis. The business of having your knees lower than your hips is crucial. It's hard to dial that in if you can't adjust the height of your chair. Nobody knows how tall a yoga ball is because it depends on how much the person sitting on it weighs, and the inflation pressure, and the barometric pressure of the room, and the temperature, all that. You can't really get the height of a yoga ball right because it's not adjustable.
Turner Osler: 34:30
The final thing to really hate about yoga balls is because they're inflated, your ischial tuberosities, as we discussed before, can't really feel where they are in space. So, they just get lost, and people wind up in the same old slump they would have been sitting in, in their crappy ergonomic chair. They're just now sitting on a yoga ball that might suddenly pop. So, as far as I can see, yoga balls are all downside, except they're very inexpensive.
Sanjiv Lakhia: 34:57
That's a good breakdown. I didn't think about some of those things. Do you feel like there's any contraindications or situations where someone maybe should not consider using a chair like this to promote active sitting?
Turner Osler: 35:11
This comes up a lot because I have an MD, and we've sold 5,000 of these things over the web. I get peppered with emails from people, saying, "I have scoliosis," or, "I have sacral agenesis," or, "I have this, or that, or the other thing. Is your chair good for me?" Of course, we don't have data on all these different conditions and how they might interact with our chair. It's very hard for me because the answer just isn't known. I would say this though. This is what I tell people, mostly. I say, "It's very unlikely that our chair will do any harm. It's unlikely to cause any mischief. If our chair should make your neck pain worse, or your elbow swell, or whatever, just stop. Send it back. We'll refund your money and pay postage both ways." We're not trying to stick you with a chair. We're trying to help people sit better. People think it's terrific and that I'm a generous guy by saying, "We'll pay the postage both ways," but really, only about four percent of our chairs come back. 96% of people love these things.
Sanjiv Lakhia: 36:09
The one scenario that I would envision a little bit of caution, and not necessarily caution forever, but some of our patients who have lumbar disk herniations, and the most common location would be L-4, 5, or L-5S1 ... Some of them are actually extension sensitive. Meaning, when they lean back or arch their back, it can trigger some nerve pain down the leg. That can be an initial phenomenon with the lumbar disk. Now, I would say most lumbar disks are flection sensitive, and do better in extension. This chair definitely puts you into a little bit more spinal extension, which probably is actually the right posture. Right? You want to take advantage of lumbar lordosis and the wedge shaped L-5 [inaudible 00:36:53] disk.
Sanjiv Lakhia: 36:54
I think if someone is in the initial acute to subacute phase of a disk herniation, with a radiculopathy, with a radiating pain down the back of the leg, it behooves them to ask a very, very simple question, I think, before they look to buy the chair, and that would be, "When I lay on my stomach, do I feel better, or do I feel worse?" If laying on your stomach makes you feel worse, then I think, in that stage, you probably want to avoid this type of sitting posture, at least until that calms down. I'm pretty much on board with the idea that creating an active sitting process, creating a scenario where you're on your sit bones, and you're more upright, and you're taking advantage of lordosis, it's probably how we should be doing it.
Sanjiv Lakhia: 37:39
It really resonated with me when you talked about ... I think it was in your talk. How the chairs we sit in now are designed to cushion us and provide comfort, and how that's harming us. In fact, I mentioned to an employee that I was interviewing you today, and I said, "He's started this company, and they made this chair that promotes better sitting," and she said, "Oh! Does it provide better support?" I said, "Actually, no. It doesn't provide better support. That's the point!" I don't know if you've had a chance to look. If you go on YouTube and look at your TED Talk, and go down into the comments, sometimes the comments are full of ... You don't want to read the comments, because it doesn't matter what you do in life, there's always going to be naysayers and haters.
Sanjiv Lakhia: 38:26
One of the comments says, "Where's the armrest?" You just missed the whole point of the TED Talk. Anyway. I think that would be the one scenario, would be extension sensitive disk herniation in the acute phase, but ultimately, with the goal of transitioning to a better sitting posture, for sure. What are your thoughts on that? Have you had any feedback with regards to acute disk herniations?
Turner Osler: 38:51
Right. No. So, people with acute back pain, initially, may be extremely uncomfortable because I think of our chair more as a prophylactic device, improving posture and core strength, so that they never have another bout of back pain. The idea that we try and treat an acute episode of anything with some tippy chair seems a little, we have no data, for sure. It's not necessarily the case that it wouldn't be helpful. But we do have CPM machines that we put people in, in the OR, before they even wake up from anesthesia to keep joints moving in a way that's helpful for healing. So, the idea that motion could be helpful, it's not completely foreign.
Turner Osler: 39:34
It's something that vexed me, and I thought to be on the safe side, we would say, "This is not for acute pain. This is to sit better, so that you don't develop such episodes." Well, you know these things, but I've had people begging me over the phone to drive to the UPS office at midnight and put a chair in the mail to them, because their back is killing them kind of stuff. These are pretty uncomfortable people, and they're looking for a way out of a very uncomfortable situation. Most people with back pain don't have herniated disks, or metastatic cancer, or any elaborately ... the sort of thing that you study in medical school. Most people have garden variety, musculoskeletal, non-specific back pain.
Turner Osler: 40:18
For those people, even if they're in the throes of acute pain, our chairs have proved quite helpful. I wouldn't necessarily believe this, except we've gotten many, many emails from people who talk about their non-specific back pain was killing them, our chair shows up, and they get on it, and they feel better within a day or two. They never look back, and they don't have that pain anymore. These kinds of testimonial emails make me extremely uncomfortable because I'm a lifetime academic researcher, I review for surgical journals, I have a master's in biostat, and I know, I guess, Richard Feynman, who has the Nobel Prize in particle ... no, quantum mechanics, from a couple of decades ago. Famously said, "The first thing is, you must not fool yourself. Unfortunately, you are the easiest person to fool."
Turner Osler: 41:08
I don't want to be drinking my own Kool-Aid. It makes me uncomfortable when people are talking about how great this is for non-specific acute back pain issues. But I'm gradually becoming persuaded that it might be true. So, I don't actually make that as a claim, but I'm suspicious that it might be true. That said, an acute disk herniation is a horse of a different color. It would be well to let that settle down.
Sanjiv Lakhia: 41:32
Have you guys done any sort of surface EMG studies, looking at which muscles are getting activated, from a data perspective?
Turner Osler: 41:42
We have some electrodes and some stuff that we're going to hook up and play with. We also found some great software that turns your pixel or your phone into an accelerometer. So, we can start measuring how much people are moving, and in what direction, stuff like that. But really, all of these objective measures require a lab and a lot of time, and I'm probably not the guy to be doing it because I'm not really a bench researcher. I'm an epidemiologist kind of guy. I really relied on the epidemiologic literature and the anthropologic literature to understand what's going on.
Turner Osler: 42:15
We're looking to partner with a couple of labs that do this kind of work. We're also very interested in how sitting on one of our active chairs changes the basal metabolic rate. It's been measured in some other chairs that aren't quite as active as ours. So, we have a pretty good idea of how our chairs affect the basal metabolic rate. We don't yet have research partners to do this kind of stuff. It's been hard in the era of COVID to do any research that requires subjects and so on.
Sanjiv Lakhia: 42:42
I think that's just fascinating that there's even a possibility that changing the chair I sit on could increase my basal metabolic rate. I mean, that right there is more fascinating even than the effect on back pain. Anyway. You've been very, very gracious with your time. I appreciate you reaching out. It really sounds, to me, like you're on a mission, and it's not necessarily to sell chairs as much as it is to reeducate the community and the culture about the benefits of active sitting. I did find your TED Talk to be compelling, in terms of its application for our youth. As a last talking point here before I let you go and enjoy the rest of your day, do you want to share a little bit about your vision moving forward with this adventure that you're involved in?
Turner Osler: 43:30
Yeah. So, people have tried to help me because I have no idea about any of this stuff, and the entrepreneur types say, "Who is your market," as though that were the crucial question to answer. For all I know, it is the most important question if you're trying to be an entrepreneur and make money. But I actually don't understand that question. I think sitting actively is really something that ought to be normal. I think everybody ought to be sitting on a chair that lets them move rather than be locked into a single position all day.
Turner Osler: 44:01
It is an issue. I want to make active chairs the norm. The chairs that we're stuck with, and really have been pushed on us by, I'll call them, big chair. There are only half a dozen companies in the country that make office chairs. They all make the same chair. All of those chairs have an 80% back pain rate. So, as far as I can tell, they're all failures. So, it's hard, as a tiny startup, to upend the idea of what a chair is. We were puzzled at first that when people land on our website, the bounce rate was 50%. People land on our website. Boing! They'd be gone in seconds. The problem was that they're looking for a chair, and they see what we're offering, and they say, "Well, that's not a chair. It doesn't have a backrest, or a headrest, or armrests, or footrests, or lumbar support. It doesn't have any of that stuff! I don't know how I got here, but it's a big mistake."
Turner Osler: 44:54
The answer is it's a big mistake, but what's a big mistake is the chair that you think you're looking for. It's hard if you're a little startup in Burlington, Vermont, to overturn over 50 years of big chair's message, "Oh, armrests, headrests, backrests, lumbar support." But it's essential if we're going to let people sit in a more natural way and get away from the epidemic of back pain.
Sanjiv Lakhia: 45:17
Turner, how can people get one?
Turner Osler: 45:18
Oh, yeah. Right. People say, "Where can I try this out?" The answer is, boy, we're a startup in Burlington, Vermont. We can't have bricks and mortar in every city in the country. But what we can do is this. We'll send you a chair. If you don't like it, send it back. We'll pay the postage both ways. We're quite confident that you'll almost certainly love it. To find us, it's Q, as in queen, QOR360.com. That's our website. We wanted to spell it with a C, but all the C words were taken. But the Qs were left. So, we got QOR360.com. We also give away a design for kids, or a chair for kids, that uses a lacrosse ball as the rocking mechanism. We give away the design. Anybody can make one if they have access to wood tools, and they can make them by the hundreds if they have access to a CNC router. That project has its own website, buttonchairs.org. B-U-T-T-O-N-C-H-A-I-R-S dot org. Butt on chairs. The double entendre, is intended for the middle school sect.
Sanjiv Lakhia: 46:22
Is this your full-time passion right now?
Turner Osler: 46:24
Well, it's growing. I'm still an emeritus professor at the University of Vermont, where I lead a COVID research group. I still do the experimental design and the statistical analysis for projects in the surgery department here at the University of Vermont. I still squeeze in some Tai chi. Once I get my second blast of vaccine, I'll be back to doing martial arts. This is gradually becoming a full-time project because as a surgeon, you can only touch 10,000 lives in your life. That's it. That's about as many people as you're going to operate on and get in and out of the ICU. As an epidemiologist, you can touch hundreds of millions of lives. So, my idea is that this is my last chance to really make a huge difference in people's health and comfort.
Sanjiv Lakhia: 47:16
Well, it's amazing what can happen and what can start by asking a simple question. In this case, the question is essentially how are we supposed to be sitting? Is the way we're sitting now serving us? So, I find the topic to be fascinating, and I appreciate you're reaching out to me, and it's been a pleasure getting to speak with you and share your message. Because anything that promotes better posture, less back pain, less suffering in the world, I'm all in favor of. Thank you again for your time today.
Turner Osler: 47:47
No. Thanks for your great questions. It's these kinds of conversations that help me think more deeply about how our chairs work.
Sanjiv Lakhia: 47:54
Yeah. Stay in touch. I really enjoy talking with you. [inaudible 00:47:58] fascinating, fascinating position, person. I love the mission of helping people.
Outro: 48:06
Thank you for listening to this episode of Back Talk Doc, brought to you by Carolina Neurosurgery and Spine Associates, with offices in North and South Carolina. If you'd like to learn more about Dr. Lakhia and treatment options for back issues, go to backtalkdoc.com. We look forward to having you join us for more insights about back pain and spine health on the next episode of Back Talk Doc. Additional information is also available at carolinaneurosurgery.com.