Digital disabilities are painful and growing

Conditions such as text neck and cellphone elbow are becoming common, and experts advise frequent breaks and correct posture to avoid them

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

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

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“Text neck”? Got it. “Cellphone elbow” or cubital\r\ntunnel syndrome? Yep. Tendinitis? Check. For well more than a decade, there\r\nhave been months when I couldn’t type an e-mail. Or pick up a piece of paper,\r\nlet alone my children.

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

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

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Among the studies: college students with high\r\nsmartphone usage are more likely than those with low usage to experience\r\nimpaired hand function, thumb pain and other issues, a 2015 study in the\r\njournal “Muscle & Nerve” found. Other recent articles associate the use of\r\nhand-held devices with discomfort, pain and repetitive-strain injuries.

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A recent case study in “JAMA Internal Medicine”, for\r\nexample, chronicled a 29-year-old man who played a match-3 puzzle video game\r\n(such as Candy Crush or Puzzle Quest) all day for six to eight weeks,\r\none-handed while doing other tasks.

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Researchers at the Naval Medical Center San Diego\r\nsaid all this play on his smartphone was associated with chronic thumb pain and\r\na ruptured tendon. They noted that gaming suppresses pain perception: in\r\neffect, people don’t notice their pain enough to stop before going too far.

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

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“Text neck” has become a catchphrase describing neck\r\npain and damage from “looking down at your cellphone, tablet, or other wireless\r\ndevices too frequently and for too long”, chiropractor Steven Shoshany wrote\r\nrecently on the peer-reviewed physicians’ website Spine-health. A head bent 45°\r\nforward — a typical tilt while one is texting — exerts a force on the spine of\r\nnearly 23 kilograms, noted a 2014 study in “Surgical Technology International”\r\n— weight that hangs off neck ligaments, muscles and bones.

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

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Tablet stands, external keyboards, voice dictation,\r\nneck support and styluses could help prevent discomfort, he noted. In some\r\nways, he said, we’re in the middle of a natural experiment: “Mobile devices\r\nallow us to use them in any type of configuration — to lay back in bed, upside\r\ndown, in all sorts of awkward postures. A few minutes might be OK, but if\r\nyou’re typing e-mails for three hours, that’s not good.”

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Most advice has not yet filtered down. “Tonnes of\r\npeople come in with tendinitis and overuse injuries, and a lot of them are\r\ntexting,” said Ryan M. Zimmerman, a Baltimore orthopaedic surgeon and hand\r\nspecialist. It’s hard to determine a sole cause, he said, because arthritis or\r\nother issues might factor in. What’s clear, he said, is this: “People spend a\r\nlot of time with their shoulders rounded forward, focused on this little, tiny\r\ndevice.”

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Frequent texters might notice a painful snapping\r\nwhen bending the thumb. Other overuse symptoms include tenderness, pain,\r\ntingling and loss of sensation or strength. Treatment may include\r\nanti-inflammatories, heat or cold packs and braces. Next steps: physical\r\ntherapy, steroid injections or surgery.

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

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

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

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

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

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

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

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

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We might have predicted such problems. The\r\nIndustrial Revolution created injuries specific to factories. With the PC\r\nrevolution in the 1980s and the internet boom in the 1990s, computer-specific\r\ninjuries cropped up.

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

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Meanwhile, advice for digital device users: limit\r\nscreen time and take breaks. Close your eyes every 20 minutes or look to the\r\ndistance to avoid vision problems. Gently stretch wrists and necks, and alter postures.\r\nSome pointers, however, resemble a ballet lesson: keep shoulders relaxed and\r\nelbows close to your body, and your hands, wrists, forearms and thighs\r\nparallel.

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I’ll dodge pain however I can and still use the tech\r\nthat’s central to my work.

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

Joanne Cavanaugh\r\nSimpson – Washington Post