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  • Writer's pictureStephan Giuffrida, DC

Digital Disabilities - Text Next, Cellphone Elbow...YES, they are real!

Digital disabilities — text neck, cellphone elbow — are painful and growing

By Joanne Cavanaugh Simpson June 13, 2016

As I type these words, there’s nerve-tingling in my ring finger. My neck is fatigued. My forearms ache. Just like everyone else, I spend too much time typing on a keyboard or tapping on a screen. Devices out, heads down, thumbs scrolling.

I should know better. As a writer who relies on tech, I’m in the vanguard of the Digital Age’s physical fallout, a canary in the cyber coal mine.

“Text neck”? Got it. “Cellphone elbow” or cubital tunnel syndrome? Yep. Tendinitis? Check. For well over a decade, there have been months when I couldn’t type an email. Or pick up a piece of paper, let alone my children.

Pain is a great and terrible teacher. Few pay attention unless they too begin to suffer.

Research, meanwhile, hasn’t matched the pace of tech innovation. Still, nearly a decade after the smartphone’s arrival, evidence of tech-caused digital disabilities is emerging.

Among the studies: College students with high smartphone usage are more likely than those with low usage to experience impaired hand function, thumb pain and other issues, a 2015 study in the journal Muscle & Nerve found. Other recent articles associate the use of hand-held devices with discomfort, pain and repetitive-strain injuries.

A recent case study in JAMA Internal Medicine, for example, chronicled a 29-year-old man who played a match-3 puzzle video game (such as Candy Crush or Puzzle Quest) all day for six to eight weeks, one-handed while doing other tasks. Researchers at the Naval Medical Center San Diego said all this play on his smartphone was associated with chronic thumb pain and a ruptured tendon. They noted that gaming suppresses pain perception: In effect, people don’t notice their pain enough to stop before going too far.

Whether typing, swiping or tapping, people are stressing an array of muscles, nerves and tendons. Movements that might seem minor can wreak havoc when done repeatedly with force, experts say, and such usage is likely to increase, especially among youth.

By 2015, nearly two-thirds of American adults owned a smartphone, up from 35 percent in 2011, a Pew Research Center report found, and “smartphone ownership is especially high among younger Americans” at 85 percent.

“Text neck” has become a catchphrase describing neck pain and damage from “looking down at your cell phone, tablet, or other wireless devices too frequently and for too long,” chiropractor Steven Shoshany wrote recently on the peer-reviewed physicians’ website Spine-health. A head bent 45 degrees forward — a typical tilt while one is texting — exerts a force on the spine of nearly 50 pounds, noted a 2014 study in Surgical Technology International — weight that hangs off neck ligaments, muscles and bones.

In many ways, it’s about the angle. Occupational health and safety researcher Jack Dennerlein, of Harvard and Northeastern universities, found that the ways we torque our necks or twist and overextend wrists or thumbs — along with the length of time we spend on devices — can cause discomfort and pain. In a 2015 review article in the journal Work, Dennerlein wrote that the state of ergonomics, or safe design, “for mobile technology is a work in progress.”

Tablet stands, external keyboards, voice dictation, neck support and styluses could help prevent discomfort, he noted. In some ways, he said, we’re in the midst of a natural experiment: “Mobile devices allow us to use them in any type of configuration — to lay back in bed, upside down, in all sorts of awkward postures. A few minutes might be okay, but if you’re typing emails for three hours, that’s not good.”

Dennerlein is at the center of the emerging research. In 2012, he led a Harvard study that found that adjusting tablet viewing angle — to as straight ahead as possible — provides relief. His other recent research has evaluated the benefits of smaller smartphones and better icon placement for hand comfort and thumb access.

Most advice has not yet filtered down. “Tons of people come in with tendinitis and overuse injuries, and a lot of them are texting,” said Ryan M. Zimmerman, a Baltimore orthopedic surgeon and hand specialist. It’s hard to determine a sole cause, he said, because arthritis or other issues might factor in. What’s clear, he said, is this: “People spend a lot of time with their shoulders rounded forward, focused on this little, tiny device.”

Frequent texters might notice a painful snapping when bending the thumb. Other overuse symptoms include tenderness, pain, tingling and loss of sensation or strength. Treatment may include anti-inflammatories, heat or cold packs, and braces. Next steps: physical therapy, steroid injections or surgery.

For some patients in pain, Zimmerman advises taking a hiatus, especially to ease a thumb disorder known as de Quervain’s tenosynovitis, a.k.a. BlackBerry thumb. His advice often falls on deaf — or ear-bud-plugged — ears. “Kids are starting to have the same problems as adults,” Zimmerman said. “They’ll say, ‘It hurts when I text.’ And I say, ‘Stop doing that.’ But that’s a totally unacceptable proposition to them. It’s a ‘just-give-me-a-shot’ kind of thing.’”

Newer waves of digital natives might be at greater risk. Tech device use is increasing, even in schools. The Department of Education’s 2016 National Education Technology Plan urges higher integration of tech in K-12 classrooms. Yet the plan does not list ergonomic guidelines to prevent pain or injury.

In some parts of the Washington area, even elementary-age children increasingly work on tablets or laptops. Yet such districts, school officials note, offer scant ergonomic guidelines specific to new tech, especially tablets.

Yet a bent-neck posture, which is seen in many classrooms, is “implicated in neck pain,” according to a 2015 study in Ergonomics, which found that the mechanical demand on neck muscles is three to five times greater with such flexion than a neutral posture for seated tablet users.

Baltimore County Public Schools is leading Maryland with what some officials call a “digital learning environment.” Increased screen time is de rigueur, including software-based curricula. In a few years, under the schools’ plan, my children are to be among 110,000 students assigned their own laptop or tablet.

I’m among parents raising questions about the district’s lack of screen-time limits and other guidelines. Children could be especially susceptible to tech-related disorders, experts say, because they lack postural awareness and their bodies are growing. “It’s a big experiment,” Zimmerman said. Recently, the superintendent announced formation of a Baltimore County School Health Council to make recommendations.

Karen Jacobs, a Boston University clinical professor of occupational therapy, has authored several studies on tech ergonomics, with upcoming findings showing that ergonomic education significantly improves neck posture in middle school students using tablets.

Trained occupational therapists already based at some schools can offer guidance, Jacobs said. “Children don’t want to be in pain,” she added, noting that kids — some of whom experience headaches, eye strain or neck discomfort after using tech devices — need frequent breaks and physical movement, not static postures. “It’s really important that our children are doing lots of different things.”

Debra Milek, a University of Washington associate professor in environmental and occupational health sciences, noted that worn-out tendons, neck pain and carpal tunnel syndrome have plagued computer users and store cashiers, and ended the careers of guitarists. “Discomfort may be an early indicator of future injury,” Milek noted, “which is why it’s important to pay attention to how we use these devices.”

We might have predicted such problems. The Industrial Revolution created injuries specific to factories. With the PC revolution in the 1980s and the Internet boom in the 1990s, computer-specific injuries cropped up.

I know. Starting in my early 20s in the frenetically paced newsroom of the Miami Herald, I faced bouts of pain and disability. In the mid-1990s, a mini-epidemic of repetitive-strain injuries was reported by journalists who were tap-tap-tapping — shoulders hunched — for hours. Sound familiar?

Not everyone was affected. But the intensity and time spent typing were major factors. Media companies and other businesses responded with ergonomic workstations. Yet those seem quaint in the current age of on-the-fly media consumption.

As tech evolves, device designers should think outside the rectangle, physicians say. A hand-friendly smartphone might wrap around the palm, for example. As Zimmerman noted, “There’s nothing about a flat rectangle that’s great for a hand.”

Meanwhile, advice for digital device users: Limit screen time and take breaks. Close your eyes every 20 minutes or look to the distance to avoid vision problems. Gently stretch wrists and necks, and alter postures. Some pointers, however, resemble a ballet lesson: Keep shoulders relaxed and elbows close to your body, and your hands, wrists, forearms and thighs parallel.

How likely is all this when our minds are absorbed into the portal, our body awareness muted as we tap into free WiFi at Starbucks?

I know what I should do, and I still forget to do it. My iPad and iPhone 6s, which offer respite from the keyboard, also lure me in — until my neck has hit the 45-degree slouch for an hour. I try to support my head, tap on dictation or pick up a pen and write. I’ll dodge pain however I can and still use the tech that’s central to my work.

And, yes, I’ll also take a break from revising this essay soon, and look out the window at the skittering clouds in the sky beyond.



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