Symptom-Guided Ergonomic Assessment: Questions, Observation, and Baselines

Why a Symptom-Guided Assessment?

A symptom-guided ergonomic assessment starts with what the person feels and when they feel it, then connects those patterns to how the task is performed. The goal is not to find a “perfect posture,” but to identify the smallest set of changes that measurably reduces symptoms and improves tolerance for real work demands.

This chapter provides a repeatable process you can use in a clinic, at a workstation, or via video call. It is organized into four parts: intake questions, symptom mapping, observation, and baselines. Each part produces specific, actionable notes rather than vague advice.

1) Intake Questions (Context First)

Intake questions clarify exposure (how much, how often, under what constraints) before you interpret symptoms. Ask in a neutral way that assumes the setup and workflow are modifiable.

Step-by-step intake flow

• Task duration and distribution: total hours/day, longest uninterrupted block, peak days, deadlines.
• Break patterns: how breaks happen in reality (not ideal), microbreaks, lunch, meetings, commute.
• Equipment and environment: chair type, desk height, monitor(s), laptop vs desktop, keyboard/mouse, headset, sit-stand use, lighting, temperature, footwear if standing.
• Work demands: precision work, heavy mouse use, phone calls, documentation volume, lifting/carrying, driving, patient handling.
• Stress and sleep: sleep duration/quality, stress peaks, recovery days, caffeine, workload control.
• Prior injuries and relevant health factors: previous neck/shoulder/back/wrist issues, surgeries, migraines, nerve symptoms, current exercise, medications that affect pain perception.

Example intake questions (ready to use)

• “Walk me through a typical workday from start to finish. When are you most ‘locked in’ at the desk?”
• “What’s the longest stretch you’ll go without getting up?”
• “What equipment do you use most—laptop only, external monitor, separate keyboard and mouse?”
• “When work gets busy, what changes first: your breaks, your pace, or your posture?”
• “How has sleep been in the last two weeks? Any nights that clearly make symptoms worse the next day?”
• “Any old injuries that flare with this, even if they seem unrelated?”

Non-blaming interview script

Use language that removes fault and invites experimentation:

• “This isn’t about doing it ‘wrong.’ Most setups are a compromise. We’ll find what your body tolerates best.”
• “If something I suggest doesn’t fit your workflow, tell me—our job is to make it workable.”
• “We’re going to test small changes and see what your symptoms do. Your feedback is the measurement.”

Actionable documentation template (intake)

Work context: [role/tasks], [hours/day], peak load [days/times]. Longest uninterrupted sitting: [min]. Break pattern: [microbreaks?], lunch [min]. Equipment: [chair/desk/monitor], input devices [keyboard/mouse], laptop use [%]. Phone: [handset/headset]. Stress/sleep: [sleep hrs, quality], stress peaks [times]. Prior injury: [region, year], current exercise: [type/frequency].

2) Symptom Mapping (What, Where, When, and Why It Changes)

Symptom mapping turns a complaint like “my neck hurts” into a pattern you can link to exposures and positions. Focus on location, intensity, behavior over the day, and specific aggravators/easers.

Continue in our app.

• Listen to the audio with the screen off.
• Earn a certificate upon completion.
• Over 5000 courses for you to explore!

Or continue reading below...

Download the app

What to map

• Location: precise area(s), one side vs both, local vs radiating.
• Quality: ache, sharp, burning, tingling, numbness, heaviness, fatigue.
• Intensity: current, best, worst (0–10 scale).
• Temporal behavior: morning vs afternoon, onset time after starting task, end-of-day pattern, next-day carryover.
• Aggravators: specific tasks/positions (e.g., mousing, laptop trackpad, looking down, reaching to a second monitor, prolonged standing).
• Easers: movement, heat, rest, changing chair, walking, stretching, switching hands, lying down.
• Red flags/medical referral cues: progressive neurological symptoms, severe night pain, unexplained weakness, systemic symptoms. Document and refer per local protocols.

Symptom mapping questions (examples)

• “Point with one finger to the main spot. Does it stay there or travel?”
• “When during the day does it start—how long after you begin work?”
• “If you keep working, does it plateau, steadily climb, or come in waves?”
• “What’s the smallest thing that reliably makes it better within 5–10 minutes?”
• “Which task is the worst: typing, mousing, phone, reading, meetings, driving?”

Simple symptom map you can document

Non-blaming symptom reflection script

Reflect patterns without implying fault:

• “It sounds like the symptoms build after about 30–45 minutes, especially with mousing. That gives us a clear target to test.”
• “You’re not imagining it—your body is giving us timing information. We’ll use that to set baselines.”

3) Observation Checklist (What You See and What You Verify)

Observation turns the symptom pattern into hypotheses. Use a checklist so you don’t miss basics, but keep it symptom-led: prioritize what plausibly matches the person’s aggravators and onset timing.

How to observe (in-person or video)

• Start with their normal setup: ask them not to “sit up straight” for the camera.
• Watch them do real tasks: 2–5 minutes of typing, mousing, reading, and a typical phone interaction.
• Ask for a 360° view: chair, desk surface, monitor height, under-desk leg space, where items are placed.
• Confirm with quick measurements: approximate elbow height relative to desk, screen top relative to eye level, distance to keyboard/mouse.

Observation checklist (chair/desk/monitor)

• Chair: seat height (feet supported?), seat depth (thigh support without pressure behind knees), back support use, armrests (helpful vs forcing shoulder elevation).
• Desk height: shoulders relaxed or elevated? forearms supported or hovering? clearance for knees.
• Monitor: height (head tipping down/up), distance (leaning forward?), centered vs rotated, dual monitor use (primary centered?).
• Laptop use: screen low? keyboard attached? external devices available?
• Lighting/glare: squinting, leaning, head rotation to avoid glare.

Observation checklist (reaching distances and layout)

• Mouse distance: reaching forward/side? shoulder abducted? wrist deviated?
• Keyboard position: too far causing forward reach? too close causing wrist extension?
• Frequently used items: phone, notebook, water bottle, reference documents—within easy reach or repeated long reaches?
• Second monitor or documents: repeated neck rotation or sustained side-bending?

Observation checklist (wrist/neck positioning and movement frequency)

• Wrist/hand: sustained extension, ulnar/radial deviation, resting on hard edge, gripping mouse tightly, trackpad overuse.
• Elbow/shoulder: elbows flared, shoulders elevated, lack of forearm support, scapular protraction with forward head.
• Neck/head: chin poking forward, sustained rotation, frequent craning toward screen.
• Movement frequency: long static holds, minimal posture variation, “freeze” during concentration.

Quick “test changes” during observation

Make one change at a time and ask what they feel within 30–90 seconds (comfort, effort, ease of task). Examples:

• Move mouse closer and slightly inward; add forearm support on desk.
• Raise monitor or bring it closer to reduce forward head drift.
• Center the primary monitor and align keyboard with it.
• Use a separate keyboard/mouse with laptop elevated.

Non-blaming coaching phrases during observation

• “Let’s keep your workflow the same and change the environment around you.”
• “I’m going to adjust the setup, not your body, and we’ll see what your symptoms do.”
• “If this feels awkward but reduces symptoms, we can refine it so it’s sustainable.”

Actionable documentation template (observation)

Observed task: [typing/mousing/reading/calls], duration observed: [min]. Chair: seat height [adequate/not], feet support [yes/no], back support used [yes/no]. Desk: height relative to elbows [low/ok/high], forearm support [none/partial/full]. Monitor: height [low/ok/high], distance [close/ok/far], alignment [centered/rotated]. Input devices: mouse position [close/far], wrist posture [neutral/extended/deviated], keyboard distance [close/far]. Movement: posture variation [low/mod/high], microbreaks observed [yes/no]. Immediate response to change: [change], symptom/effort response [better/same/worse].

4) Baselines (Make Progress Measurable)

Baselines convert “it feels better” into trackable data. Use two simple measures: a 0–10 discomfort score and a time-to-symptom measure. These allow you to judge whether an ergonomic change is meaningful and whether tolerance is improving.

Baseline A: 0–10 discomfort score

Define the scale so the person uses it consistently:

• 0 = no discomfort
• 3 = noticeable but easy to ignore
• 5 = distracting; affects concentration or pace
• 7 = must change position or take a break
• 10 = worst imaginable for them

Record: current, typical end-of-day, and worst in the last week.

Baseline B: time-to-symptom (TTS)

Time-to-symptom is the time from starting a specific task to reaching a defined symptom threshold (commonly 3/10 or 5/10). Pick one threshold and one task to keep it comparable.

• Choose the task: e.g., “continuous mousing,” “typing,” “reading on laptop,” “standing at counter.”
• Choose the threshold: e.g., “when discomfort reaches 4/10” or “when tingling begins.”
• Measure: use a timer for 1–3 work blocks over a day and take an average.

Example baseline script

• “On a 0–10 scale, what is it right now?”
• “What number usually makes you change position or stop?”
• “Let’s pick one task—mousing. Start a timer next time and note when you first hit 4/10.”

Baseline tracking table (simple and usable)

Putting It Together: A Repeatable Assessment Workflow

10–15 minute rapid assessment (clinic or video)

• Minute 0–3: intake highlights (duration, breaks, equipment, stress/sleep, prior injuries).
• Minute 3–6: symptom mapping (location, intensity, daily behavior, aggravators/easers).
• Minute 6–12: observe real tasks; run 1–2 test changes.
• Minute 12–15: set baselines (0–10 and TTS) and define what to track for one week.

Example “no-blame” summary to the person

“Based on what you told me, your symptoms build after about 30 minutes of mousing and peak late afternoon. Watching you work, the mouse is far enough away that your shoulder stays slightly lifted and your wrist is angled. Today, moving the mouse closer reduced effort right away. Let’s track two numbers this week: your discomfort at the end of a 30-minute block and the time it takes to reach 4/10 during mousing.”

Clear, Actionable Notes: Turning Findings into Next Steps

Your documentation should link symptom pattern → observed exposure → tested change → baseline to track. Avoid generic statements like “improve posture.”

Actionable note examples

Problem pattern: Neck ache R>L builds from 0–1/10 to 6/10 by 3 pm; onset ~45 min continuous typing; eased by walking 5 min. No neuro symptoms reported. Sleep reduced (5–6 hrs) during deadlines. Prior: episodic neck pain 2022.

Observation: Primary monitor off-center to left; frequent neck rotation during reading. Laptop low; forward head drift noted during concentration. Mouse placed 25–30 cm lateral to midline; shoulder abducted; wrist ulnar deviation during mousing. Movement frequency low (rare posture changes).

Tested changes today: Centered primary monitor + moved mouse closer/inward + forearm support on desk. Immediate report: reduced shoulder effort; neck feels “less tight” within 1 min.

Baselines to track (7 days): (1) Discomfort score end of 30-min mousing block (0–10). (2) Time-to-symptom to 4/10 during mousing. Goal: increase TTS by ≥25% and reduce end-of-block score by ≥2 points.

Checklist for “clear and actionable” documentation

• Names the task (not just the body region).
• Includes timing (onset and daily pattern).
• Records at least one modifiable exposure (reach distance, monitor position, support).
• States what was tested and the immediate response.
• Defines two baselines (0–10 and time-to-symptom) with a tracking plan.