Written by: Vanessa Truxal, MS, OTR/L
Virtual Hand to Shoulder Therapy Fellow '20
It’s 10am. I am rapidly typing out an email to my mentor teacher for my online fellowship program in hand therapy. My thumbs fly across the screen of my iPhone as I punch send, then briefly scroll through the news headlines and the newsfeeds of my Facebook and Instagram accounts. My husband is upstairs on a teleconference with his work team, all of whom are telecommuting for the foreseeable future. Later, from our home in New Jersey, we will all join in a virtual happy hour with family members in different places around the country. As I finally put down my phone and snuggle up on the couch with my husband, I shake out my hands and massage the sore thumb joint that has, increasingly begun to ache and occasionally creak or crack. My husband stretches and rolls his neck, then goes to grab the BioFeeze he often applies to his neck and upper shoulders. These minor aches we both have are not at all uncommon.
For a long time now, our lives have been increasingly spent in the virtual world. With the current COVID-19 pandemic crisis much of the country, much of the world, is taking measures to physically distance ourselves as much as possible to prevent the spread of the disease. Almost overnight this has dramatically increased our use of electronic devices to connect with the outside world.
That is why it is even more important to consider the effects of extended use of electronic devices on our bodies. A number of musculoskeletal conditions are associated with poor positioning, posture, and body mechanics when using electronic devices for extended periods of time. Much has been written about the effect of these factors on the body when seated at a desk using computers, both desktop and laptop. However, when in the comfort of our own home, many of us are more likely to opt for alternative seating when using portable or mobile devices. For example, sitting on a couch, bed, beanbag chair, floor, stool or even standing. We are more likely to assume awkward postures with shoulders hunched, curved spine, flexed neck, and fully bent elbows. We rapidly tap out texts or emails, often with only our thumbs. We, often forcefully, touch, swipe, scroll, click, pinch, and expand our screens with our fingers. One study found that people use up to 8 times greater force when typing on a touch screen than a traditional keyboard due to the lack of tactile feedback. We do this while sometimes holding the smartphone with the same hand that is typing or scrolling. We may hold a tablet pinched between our thumb and fingers. The fingers we are not actively using to engage in these tasks are often held in a hovering position just over the surface of the screen, careful to avoid accidently touching another section of the screen.
The combination of poor posture and body mechanics with these rapid, precise movements, over an extended period of time is a recipe for repetitive strain injuries. Related symptoms may be mild to severe and usually develop gradually over time. These often include:
· Pain, aching or tenderness
· Tingling or numbness
Research has linked a number of medical conditions with extended use of mobile electronic devices (smart phones, tablets) including:
· Forward head posture
· De Quervain Tenosynovitis
· Stenosing Tenosynovitis (trigger thumb)
· Myofascial pain syndrome
· Carpal tunnel syndrome
· Cubital tunnel syndrome
· Thoracic outlet syndrome
A number of small changes in posture, positioning, body mechanics and behavior can help to prevent or alleviate mild symptoms of repetitive strain injury due to extensive mobile device usage.
· Posture: The ideal body posture is one that maintains the natural curvature of the spine.
o Sit in a comfortable upright position with hips approximately at 90 degrees and feet on the floor.
o Keep your neck straight, your shoulders relaxed, and avoid excessive neck flexing.
o Keep your arms relaxed and positioned near your sides. Support your elbows on armrests or tuck them into your sides.
o If you tend to assume a forward head posture try this:
§ Place a finger on your chin
§ Without moving your finger or arm, pull your chin backwards away from your finger as far as you can.
§ Sit up as tall as you can
§ Now roll your shoulders backward and downward
§ Engage your abdominal muscles to support this improved posture
§ As you work, take frequent breaks to note your posture. Have you fallen back into the forward head posture slump?
o Avoid twisted or asymmetric postures. Place your device and accessories directly in front of your body.
o Use a stand to incline the mobile device. Many tablet cases have a built-in stand.
o Raise your device up to place the screen just below eye level with head in a neutral position. A stand can be used or any object around the house such as a box, yoga block, or textbooks.
o Instead of typing on a tablet, use a separate keyboard
o Don’t reach forward to the keyboard; instead bring the keyboard toward your hands and arms.
o If you find yourself leaning forward to view your device, enlarge the text
o If you need to hold your device, consider a case with hand strap or PopSocket for reducing the grip mechanism.
o For extended audio phone conversations, use headphones, ear buds, or a Bluetooth device rather than holding your phone at your ear. This will prevent placing excessive pressure on the nerve that runs behind your elbow. This also prevents holding the phone between your ear and shoulder; a position that places strain on both the muscles of your neck, back and shoulder as well as potential for compression of the nerve bundle that runs from your neck to your arm.
o Use speech recognition applications like Siri and Alexa, text shortcuts, or speech to text applications like Dragon Naturally Speaking.
· Body mechanics:
o If you cannot use external accessories, cradle your device in one hand, while using the touch screen with your other hand.
o Let the device rest in your open palm rather than pinching it between thumb and fingers or clawed hand.
o Use index fingers rather than thumbs.
o Pay attention to how much pressure you use when touching the screen. Try to press as lightly as you can.
o Try this to minimize forward neck flexion:
1. Bend elbows to bring device upwards
2. Then look down with your eyes
3. Finally bend just the top of your spine until you can see the screen
o Take frequent mini breaks to shift your posture, gaze away from the screen, relax and stretch your fingers.
o Stand up and stretch your hands, shoulders, and neck for 5 minutes after every 20-30 minute stretch of work or device usage
o Alternate hands and fingers when using your device
If pain continues despite making these adjustments, consider discussing your concerns with your healthcare provider. An occupational therapist is trained assess these conditions and provide conservative treatment. It may be necessary to seek treatment from a physician for more severe cases. Depending on where you live it may be necessary to receive a referral from a physician for therapy services.
Ali, M., et al. (2014). Frequency of De Quervain’s tenosynovitis and its association with SMS texting. Muscles Ligaments Tendons Journal, 4(1): 74–78.
Ashurst, J.V., Turco, D.A., & Lieb, B.E. (2010). Tenosynovitis caused by texting: an emerging disease. Journal of American Osteopathic Association, 110(5): 294-296.
Baabdullah, A., et al. (2020). The association between smartphone addiction and thumb/wrist pain: A cross-sectional study. Medicine, 99 (10): e19124
Berolo, S., Wells, R. et. al. (2011). Musculoskeletal symptoms among mobile hand-held device users and their relationship to device use. Applied Ergonomics. 42 (2), 371-378.
Cell Phone Ergonomics: How To Avoid The "Smart Phone Slump" https://breakingmuscle.com/fitness/cell-phone-ergonomics-how-to-avoid-the-smart-phone-slump
Dennerlein, J.T. (2015). The State of Ergonomics for Mobile Computing Technology. Work, 52 (2): 269 – 277.
Deepak, S., Mathankumar M., et. al. (2014). Musculoskeletal disorders of the upper extremity due to extensive use of handheld devices. Annals of Occupational and Environmental Medicine. 26 (22).
Hansraj. 2014. Assessment of stresses in the cervical spine caused by posture and position of the head. Surgical technology international, 25 (9): 277-279.
High-Tech Can Be a Pain in the Neck: How Smartphones Can Hurt Your Neck https://www.spineuniverse.com/conditions/neck-pain/high-tech-can-pain-neck
How to Hold and Use Your Phone Ergonomically - Smartphone Ergonomics San Diego. Whole Bodied Coaching. https://www.wholebodied.com/blog/how-to-hold-and-use-your-phone-ergonomically-smartphone-ergonomics-san-diego
Radwan, N.L., Ibrahim, M.M., & Mahmoud, W.S.E-D. (2020). Evaluating Hand Performance in Children with High Rates of Smartphone Usage: an Observational Study. Journal of Physical Therapy Science, 32 (1): 65-71.
Ruivo, R.M., Pezarat-Correia, P., & Carita, A.I. 2017. Effects of a Resistance and Stretching Training Program on Forward Head and Protracted Shoulder Posture in Adolescents. Journal of Manipulative and Physiological Therapeutics, 40 (1): 1-10.
Screen time stats 2019: Here’s how much you use your phone during the workday https://blog.rescuetime.com/screen-time-stats-2018/
Sharan, D., (2012). Risk factors and clinical features of text messaging injuries. Congress on Ergonomics. 41 (1), 1145-1148
Sharan, D., et al. 2014. Musculoskeletal disorders of the upper extremities due to extensive usage of hand held devices. Annals of Occupational and Environmental Medicine, 26 (22):
Tablet Use in Schools: Ergonomics, Posture and Screentime Recommendations. CEO Sydney http://mdrps-byod.weebly.com/uploads/1/0/9/9/109903955/ergonomics-posture-and-screentime-.pdf
Walsh, M.T. (2011.) Therapist’s Management of the Upper Quarter Neuropathies. Chapter 55. In Skirven, et al (Eds.), Rehabilitation of the Hand and Upper Extremity, 6th Ed. pp. 733-748. Philadelphia, PA: Mosby, Inc. a division of Elsevier, Inc.
Woo, White, & Lai. (2017). Effects of electronic device overuse by university students in relation to clinical status and anatomical variations of the median nerve and transverse carpal ligament. Muscle Nerve, 56 (5): 873-880.
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