Neck Pain From Using Cell Phones, Tablets and Laptops

My son, a personal trainer, told me that one of his clients was complaining of neck pain. He asked her how often she used her new Kindle Fire. It turned out that excessive tablet use coupled with poor posture was the source of her pain.

When using a cell phone for text messaging, anchor your upper arms close to your body and bend your elbows to raise the phone closer to your face. Then lower your eyes, instead of tilting the head down, to see the screen. Avoid bending the neck forward and down; if you still must tilt your head, use the top-most “hinge” joint of the neck. But do try to have your arms and eyes do most of the work.

A handheld tablet with keyboard seems like it would be very awkward to type with (needs thumb-typing or one-handed typing). So a tablet is probably placed on a surface for that. My son says the Apple Ipad has dictation capability; maybe typing is not so necessary. Then there’s the stylus, a one handed implement for note-taking. [update: one needs to speak very clearly for Ipad dictation to be accurate (good speech therapy for those who need it!). My son bought a case that tilts the Ipad up so he doesn’t need to tilt his head down as much. He also says a case is available that comes with a separate keyboard and also elevates the Ipad. Essentially the Ipad becomes a desktop.]

Typing on a laptop rather than a tablet should be easier on the neck, as long as it is on a surface like a table top, which it seems most people do. But still the monitor cannot often be raised to comfortable eye level so see people bending their necks down all the time. As with cell phones, it is better to roll the eyes down. Better still would be if the laptop screen could be separated and hung at eye level. (Do any laptops come with separatable screens?). For now I am sticking to my desktop computer. At least the monitor can be adjusted to a comfortable height, which for me is just below eye level, so I can see it in the reading part of my eyeglass lenses without tilting my head up. (First I adjust my chair height so my feet rest firmly on the ground and my lower legs are perpendicular to the ground. If the monitor needs to be higher, I use a large book or two to raise the monitor further.)

For an informative video on improving sitting posture to avoid neck and shoulder pain due to prolonged desk work, computer and mobile device use; see Sitting At Your Computer on Dr. Robert Kelty’s Chiropractic Wellness Center Website

 

Habit Formation, Exercise and Posture

As much as possible, the brain converts repeated actions into automatic routines or habits in a process called chunking. Once chunked, behavioral routines require minimal attention or mental energy to perform. All that’s needed is a cue (or trigger) that switches the brain to autopilot and starts the routine; and then at the end, a reward tells the brain if this particular routine (may be physical, mental, or emotional) is worth doing again. The cue and the reward become associated so that when the cue is present, a craving to perform the sequence emerges. Cues and rewards can be obvious; e.g. doing the grocery shopping every Saturday morning (cue) and afterwards buying a coffee at Starbuck’s (reward). Or not so obvious: washing up before bedtime (cue) triggers toothbrushing, and afterwards the feeling of a clean mouth serves as the reward. Some cues and rewards are so slight that one may hardly be aware of them, but our neural systems certainly are.

Trying to change a habit sequence once it’s triggered is difficult because the conscious brain is not actively involved. One approach in particular seems to help; a study on exercise habits showed that when participants were educated about habit formation and then asked to identify cues and rewards that might increase participation in exercise routines, they exercised twice as much as those who only received lessons on the importance of exercise. Simple cues seemed to be most effective. For example, I put a pedometer (a Fitbit) in my pocket after dressing in the morning (the cue) and take one walk then. Checking how many steps are recorded, gives me a little rush of satisfaction (the reward). (A second walk is cued by my dogs, who won’t leave me alone until we head out the door in the afternoon.)

For an interesting article on habits see the New York Times Article, How Companies Learn Your Secrets (they want to know when a life changing event, such as impending marriage or childbirth will occur, in order to get a headstart sending out advertising. Otherwise one’s spending habits aren’t very open to change and advertising has minimal effect. This article is based on the book by Charles Duhigg, “The Power of Habit: Why We Do What We Do in Life and Business

So how can cues and rewards be applied to improving posture? My experience has been that the feeling of slumped posture can become a cue, and when I become aware of it, I tighten and straighten my mid-back, which lifts my chest and gives me a feeling of release from chest constriction (a reward) and I take a deep breath. Then I do a rep of the Fix the Shoulder Blades Exercise, during which I often remember how much better my profile looks (even when I’m not anywhere near a mirror) and how good my neck feels now versus how miserable it used to be (more rewards). Finding and appreciating those rewards required that I become more aware of how my body looks (especially from different points of view), and also more sensitive to how my body feels, not just pain, but muscle tension, joint position, limitations imposed by poor posture, awareness of shoulder blade anchoring, spine position, posture during movement etc., or everything that comes under the classification of kinesthetic senses. Sometimes I wonder why I didn’t naturally have those sensitivities when I was younger. Perhaps it was my sedentary life. And perhaps also because poor posture develops so slowly there’s never enough difference to notice; and meanwhile the body memory of good posture is slowly lost. As well there’s often little feedback from other sources of information, such as visual (generally only face forward view in a mirror is available and that doesn’t help in seeing the entire body’s alignment), or comments from family and friends (who often don’t want to say anything upsetting, even my mother had stopped criticizing), or advice from medical professionals, fitness professionals and physical education teachers (of all the many I had contact with, none ever said anything about my posture). And perhaps also, poor posture itself, and any pain from poor posture, deadens sensitivity to body state. Is it any wonder that a person’s posture seems to be a relatively unchanging part of his or her physical appearance, except to slowly get worse with age? In order for a person to improve posture, an epiphany of some sort is needed. And once some improvement has been experienced, the body becomes more sensitive to what a healthy postural state feels like, and strives to maintain that state.

However, there is a matter of backsliding into poor posture, and I do find myself slouching, but only when working long hours at the computer, not when standing, walking or other more physical activities. The good thing is though, that I’m more aware of slumped posture, and I put more effort into correcting it. So why is slumping more likely at the computer? Perhaps because computer work takes a great deal of mental energy, and the mind and body tires quickly. And being tired means less energy for the back extensors, which are the critical muscles keeping our backs erect against gravity. Our body structure doesn’t help either. The spine tends to bend forward because the bulk of body weight, is in front of the spine. The thoracic spine, in particular, supports the ribcage and attached muscles and organs, which are a major part of the body’s mass. No wonder the thoracic spine, which naturally has a rounded, kephotic curve, tends to curve even more forward under that weight if the back extensors aren’t kept strong.

Ultimately, maintaining good posture is a continuous challenge, but it is a challenge that can be won, if one becomes aware that it feels so much better (the reward) than slumped posture. The reward is even greater if one has suffered years of pain from it.

Fighting the Fatigue of Chronic Illness

Chronic illness may cause severe fatigue,  leaving little energy for work, exercise, or just getting out of the house to enjoy a pleasant day. And fatigue deteriorates posture, predisposing to neck, shoulder and upper back pain.  How to fight fatigue?   Here are some tips (modified from Ellen Greenlaw’s article, Fighting Lupus Fatigue and Boosting Energy,  at webmd.com.)

1. Treat Underlying Conditions that may be causing the fatigue.  These might include anemia, nutrient deficiency, depression, hypothyroid,  kidney disorders or one of a myriad of possible conditions.  Side effects of medication are a special case.   A change in dose or medication may help.(this is what helped me)  See a doctor for help finding an underlying condition.

2. Exercise Regularly to Boost Energy.  Start slow. Exercise during the time of day you have the most energy. Choose an exercise you like doing. Maybe a 5 minute walk in the park, exercise-cycling to a movie, cleaning the house to your favorite music and adding a few dance steps while your’re at it. Of course don’t overdo it.

3. Get Enough Good Quality Sleep.  Night-time sleep is important for healing.  Go to bed early, even if you have to drag yourself away from TV or the computer (something I have to do all the time). Avoid alcohol (which makes you sleepy but later disturbs sleep) caffeinated drinks, and overeating or eating a late dinner.
Try using a white noise machine at night. I have a Marpac. But there are several brands, many of which feature sounds like rain or waterfalls or heart beats. I found that the rain sound was okay (radio static is okay too) but couldn’t get to sleep with the other sounds. (For me with mast cell activation disorder, I discovered that the white noise machine lessened  my mast cell reactions to bad dreams. This may be so for  people with normal mast cells as well, thus lessening inflammatory mediator release at night and allowing for better sleep.)
If night-time sleep isn’t enough, then rest during the day. An afternoon nap or siesta can be refreshing. More frequent naps may help, but not too close to evening, which may interfere with night-time sleep.

4. Prioritize Activities.  Make an activity schedule for daily basics so you can plan rest periods and still get done what needs doing. Keeping to a schedule also helps avoid the stress of hurrying to get important things done on time.  Try to do the most strenuous things first when you have the most energy.  It may help to  break bigger projects into smaller, more manageable tasks. Then get done what you can, and what’s left, leave for a better time. Don’t stress over what you can’t do. You’ll get to it, as your energy allows.

5. Learn to Say No.  Your first priority is healing. After that are the activities that mean the most to you. If you know an activity will leave you exhausted, find another way, or say NO. Also avoid activities that increase your stress level.  Along with that, avoid people who add more stress to your life.  (Some people are just plain toxic.)

6. Keep a diary (or simply a daily graph) of your symptoms and  how you feel.  This little “research project” can help you figure out what activities or meds or time of day etc. make you feel better, and which make you feel worse. If you want to track your health online (some neat tools)  and want to join a social health network, you might consider www.patientslike me.com. (This site has a research staff (PhDs), who mine the data for research purposes and publish research articles in well regarded medical journals.

Droopy Shoulders Syndrome

An exception to use of part 1 of Fix the Shoulder Blades Exercise is a condition called Droopy Shoulders Syndrome (DSS) that is mainly present in women with low set, steeply sloping shoulders and long, swan necks. Their collar bones (clavicles) slope down at the outer ends rather than the usual slope up. In lateral neck x–rays, all of the 7th cervical vertebra, the 1st thoracic and sometimes part of the 2nd are easily seen when usually the shoulders prevent visualization. Pain in neck, shoulder, arms, hands is aggravated by downward traction on shoulders and relieved by propping up the arms, and may involve Thoracic outlet syndrome. In DSS the shoulder blades are already held too low on the back and don’t need to be lower. Maintaining a slight lift of the shoulders so they are more squared helps. Part 2, Pinch the Shoulder Blades Together is still useful if shoulder blades are wider apart than 4 inches. Consult your physician or physical therapist. See “The Droopy Shoulder Syndrome,” L. Clein, and “The Droopy Shoulder Syndrome” by Swift and Nichols]

My neighbor had neck, shoulder and arm pain (around the biceps muscle). Her shoulders were obviously very sloped down, and her neck seemed very long. I urged her to see a physical therapist, which she did. Luckily the head physical therapist (not the assistant) knew how to help her. The advice was to keep her shoulders raised a bit. I recently talked to her and noticed her shoulders are more squared and she says her pain is gone. It has only been recently that I realized the clavicle (collar bone) in front in most people slopes up toward the outside ends., showing that the shoulder blades, which are attached to the clavicle near the shoulder joint are held a little higher.  But hers are straight horizontal. Wish I’d noticed whether her clavicles were downwardly sloped before she got the therapists advice to lift her shoulders.

Poor Posture Everywhere

Having experienced and then overcome the chronic pain that poor posture caused me, I tend to think that everyone with poor posture will eventually develop some form of musculo-skeletal pain problem from it. But like a former smoker who rails against smoking, I tend to be over zealous.  I can’t help but see examples of poor posture; like the tall slender preteen in line at the grocery store with her father. From the looks of her uniform, she’s just come from playing a sport like soccer, so she’s not a couch potato, but her high thoracic hunch and rounded shoulders is a mirror image of her father’s posture. I get to wondering how bad his neck pain is, and how bad hers will be in the future.  Or there’s the checker, a young woman with the long, rounded swayback, exceedingly curled-in shoulders and a caved-in chest. I have this desire to snap their photos and show them what I see. I want to ask them, don’t you know your posture is ugly, and you’re messing your body up? But of course, it’s not my place to say anything. I know what comes of butting in. And really, these people don’t look like they’re in pain. (What does a person in pain look like?  When I was in the midst of my pain-filled days, could you see the pain in my eyes?) In fact some studies have been done (I have to find the references) that found that many people with poor posture don’t have spinal pain. But on the other hand those with back and neck pain, often do have poor posture. So there’s a question of what comes first, the injury, whether acute or repetitive, that “caused” the pain or the poor posture? But as I’ve said before, my posture was bad from the beginning. It was only after a bad neck strain at age 21 that my neck pain began and never went away. So it would be easy to say that the bad neck strain and accelerated arthritic deterioration seen in my MRIs were the cause of my worsening neck pain. If I hadn’t overcome that neck pain by improving my posture and strengthening shoulder blade stabilizers, I wouldn’t have known that the root cause was poor posture, and not the spinal arthritis.

Mattresses

When my back was painful and spasmed because I had to sleep motionless on my back all night long (because of my neck), my new Beautyrest mattress was just as hard on my back as the old Sealy Posturepedic. I could feel every little dip of the pattern stitched into the pillowtop…darn uncomfortable. I tried a thick visco-elastic foam topper and after one night—my back spasmed like crazy. The only help would be to sleep on my side, but that had to wait until I’d fixed my neck pain.

The neck/pain support group I belong to has discussed mattresses. The Select Comfort Sleep Number bed seemed to be the mattress of choice. Having separate controls to adjust firmness on either side of the bed for couples was mentioned as a great help. But one member said the massage feature was not helpful and noisy besides. He found the local reps to be very helpful. But of course the sleep number bed is more expensive than most. The Tempurpedic mattress has been mentioned. One woman’s comment was that it felt great in the store but once home, did not give support—it seemed to sag—and by the second night she was “crying in pain.” But she wasn’t helped by an old Select Comfort a friend lent her, either. (This woman was concerned about customer complaints about the pump on the Select Comfort breaking after the 2 year warranty period expired.) Another woman said her Tempurpedic made all the difference in giving her pain relief. And another was sore the next day after trying it in store.

There seems to be back pain patients on both sides—Tempurpedic vs. Sleep number. So which is the best mattress for back pain? Some advice included giving the mattress a try for an hour or two in the store, and then not to consider buying it until after you know how your back feels the next day. As with pillows, a lot depends on the state of one’s back. But how do you improve the state of one’s back if sleeping doesn’t rest it? What will help? Changing sleeping position, improving posture during the day, muscle relaxants, sleeping aids, having surgery if needed? It’s a major puzzle and a “pain” to go through trying to figure out.

Of note: one support group member highly recommends an adjustable “hospital” type bed. Check out if either Tempurpedic or Sleep number comes with adjustable head and foot controls.