To complement the MASSAGE Magazine article, “The New Generation of RSIs: Tablet Back, iPad Shoulder, Smartphone Thumb & Texting Tendonitis,” by Jeff Mahadeen, L.M.T., N.C.T.M.B., in the November 2013 issue. Article summary: New forms of repetitive stress injury (RSI) are sweeping the world, moving quickly on a tide of technological innovation. Tablet back, iPad shoulder, smartphone thumb and texting tendonitis are among the technology-related physical woes that are the new generation of RSIs.
Many conditions are created by the overuse of technology; among them are thoracic outlet syndrome, forward-heard posture and forearm-and-hand problems.
1. Thoracic outlet syndrome
One likely pathology that may occur with poor positioning of the scapula, head and neck is thoracic outlet syndrome, which is compression of the neurovascular bundle (brachial plexus and subclavian artery) that exits the cervical region, travels between the anterior and middle scalenes, goes under the clavicle, and continues deep to the pectoralis minor before it heads down the medial brachial arm.
The combination of forward-head posture and the scapula being pulled toward the anterior half of the body occurs because the scalenes and pectoralis minor muscles are locked in a shortened position.
2. Forward-head posture
The next postural problem from electronic devices is forward-head posture. When observing forward-head posture, imagine chains running vertically up the anterior and down the posterior cervical spine.
There are two posterior chains that run within the bilateral lamina grooves, starting at the level around T3, up to the occiput. The muscles that make up the links of the chain on the posterior side include the upper trapezius, splenius muscles, levator scapulae, the paraspinal group and the suboccipitals.
There are bilateral anterior chains starting on either side of the sternum/clavicle, the first rib area, and continuing up the anterior transverse processes, the bodies of the vertebrae, cranium and jaw. I bet you can guess most of the muscles on the anterior side: sternocleidomastoid, anterior scalenes, and the longus colli and capitis.
The question is, which are locked short? You guessed it: The anterior chain, which pulls the head forward and down. So that must mean the posterior chain is locked long, correct? Well, yes and no. The posterior chain from T2 up to approximately C2 is locked long, so you are correct there.
However, the last link or two at the atlantoaxial and atlantooccipital joints, which include the suboccipitals, are actually locked short, because the head rocks back into extension at that level. We rock back into extension so we can look forward and see where we are going, and not just stare down at the ground.
3. Forearm and hand problems
The largest problem at the forearm-and-hand level is at the carpometacarpal joint. This joint is between the first metacarpal (thumb) and the trapezium (carpel) of the wrist. Due to common, everyday nontexting movements, this area is already under excessive wear and tear.
The carpometacarpal joint is one of the highest osteoarthritic areas within the body, so adding the task of excessive texting obviously increases the risk. The overuse of the carpometacarpal joint also compromises muscle tissue, chiefly the extensor pollicis longus of the forearm and adductor pollicis of the hand.
Since these muscles work so hard with the act of texting, they would be locking short, reducing range of motion and adding compression of the carpometacarpal joint.
Jeff Mahadeen, L.M.T., N.C.T.M.B., practices structural integration and owns Muscular Wellness Institute (www.muscularwellnessinstitute.com) in New Hampshire. Mahadeen has taught continuing education classes throughout the U.S. since 1998. His specialties are skeletal muscle physiology and soft-tissue education. He serves on the state massage therapy board and was a lead developer of the Massage & Bodywork Licensing Exam.