Overuse and misuse of cellular phones and other electronic devices are putting a strain on our bodies and causing us pain—as well as repetitive stress injuries (RSI).
Health risks related to this technology include a series of injuries, especially to the upper extremities. Recent research from Sweden, for example, shows that almost 50% of people who work with computers claim RSI-related pain in the hand, wrist, shoulders or neck.
Even so, time spent using cell phones is likely to increase due to the levels of multi-functionality they provide.
Computers and mobile devices are integral for work, education, socializing, entertainment, access and connection. Daily tasks are more convenient thanks to the vast presence and availability of digital content.
Cell Phone Elbow: The Most Prevalent RSI of the Upper Limb
Musculoskeletal dysfunction can be caused by muscle activity while utilizing a cell phone. Positioning and posture, prolonged use of a device, and lifestyle create various troubles, including those specifically pertaining to the elbow. Cell phone elbow is derived from constant stress on the elbow and its surrounding structures.
Repetitive stress injury, or RSI, is caused by repeated movements which ultimately damage tendons, nerves and soft tissues. These risk factors due to cell phone use disrupt our ability to enjoy pain-free daily life.
Posture, when interacting with technology, is a factor that can make or break the future of our elbow health. Posture plays a role in the impairment of the elbow from cell phone operation.
Holding a phone up to the ear or mouth can create long-term injury; it is one of the most damaging positions for device usage. The best position for the elbow joint during operation of a mobile handheld device is 0°- 45° of elbow flexion and supination. It is important to avoid excessive elbow flexion with pronation.
Elbow flexion with pronation puts the cubital anatomy in danger. This position decreases motor conduction velocity of the ulnar nerve, the largest unprotected nerve in the human body. This nerve allows coordinated movement in the fingers to occur by facilitating communication from the brain to the hand. The ulnar nerve also takes information about sensation of the ring finger and the pinky finger back to the brain.
When compression of the ulnar nerve occurs, it is no longer able to properly function. Ulnar nerve neuropathy can cause numbness, burning, and tingling in the fingers. Irritation of the nerve leads to inflammation, in turn, crowding its path at the elbow. The flexed elbow posture also puts pressure on the nerve path, eliciting injury.
Prolonged compression of the ulnar nerve can also lead to cubital tunnel syndrome, a very common injury. This condition occurs when the ulnar nerve is trapped in the cubital tunnel, or from repetitive trauma between the medial epicondyle of the humerus and the olecranon process of the ulna.
There are methods to avoid cubital tunnel syndrome or to remedy the condition once it has already occurred. Cubital tunnel syndrome is the second most prevalent RSI in the upper limbs, after carpal tunnel syndrome.
Carpal tunnel syndrome is also a very common peripheral nerve disorder relating to cell phone handling. Carpal tunnel syndrome is the most prevalent RSI injury in the upper limbs. Carpal tunnel syndrome occurs when the median nerve becomes compressed and the wrist begins to swell. This condition is often associated with burning, tingling, or numbness in the wrist.
Repeated Activity Leads to Dysfunction
Lifestyle choices play a role in the build-up of RSI. Simply capturing a selfie photo can cause injury to the primary elbow being used for self portrait photography. Selfie elbow is caused by repeatedly activating the capture button on a cell phone. Much like golfer’s or tennis elbow, this repeated activity leads to dysfunction of musculoskeletal structures, creating a rough load on muscles around the elbow.
This can lead to micro-ruptures, causing pain, inflammation and scarring. Recurrent or chronic pain can persist in the elbow and begin to affect other muscles by causing weakness and loss of function. It is recommended to monitor and balance the time spent taking selfies to avoid this problem.
Phone mechanics can also cause dysfunction through the forearm and thumb from the act of excessive texting. This scenario creates an environment for the development of tendonitis, tenosynovitis, and first carpometacarpal arthritis. Using one hand for text messaging increases stress on the body. It is best to hold the phone with both hands when texting.
Pay Attention to Pain
An important aspect of avoiding long-term issues or pain is to know when something is wrong. Symptoms of repetitive strain injury occur to alert you that a hazard is present. Symptoms of RSI include tightness, discomfort, soreness, burning, aching, tingling, coldness, numbness, clumsiness, loss of strength or coordination, atrophy and pain. Leaving symptoms unchecked, or ignoring the pain, can lead to more serious injury or disability.
Massage therapist aren’t immune to lifestyle-related RSIs. If you find that symptoms are present, seek professional assistance.
There are opportunities to improve the condition of RSI. As you know, massage therapy is a holistic route for treatment, in contrast to other options, such as medications and surgery. A holistic approach can help you — and your clients — avoid having to heal from surgery and decrease the chances of having to rely on medication. Massage therapists are well versed in RSI and can support their clients’ mending process.
Massage therapy can improve range of motion in affected joints, alleviate pain, break up scar tissue, promote circulation, and make the recovery process more efficient. Massage can create muscular balance and strengthen muscle weakness, thus decreasing the risk of chronic or retrogressing injury. Massage therapy can be coupled with other modalities to further affect change.
Self-Care for RSIs
There are several ways to remedy an RSI while at home. Rest and the use of ice is helpful in reducing inflammation. Be sure to include the lateral portion of the elbow when applying ice. Avoid resting the elbow on hard surfaces such as tables and chairs. Sleeping with an extended elbow can help to take stress off of an injury site. A splint can be made at home by wrapping a large towel around the arm and elbow. This holds the elbow in place during a slumber, thus avoiding elbow flexion.
Since the ulnar nerve runs behind the posterior pectoralis muscles and through some of the neck muscles, poor posture in those areas can create tension causing nerve compression. It is a good habit to release the stress from the shoulders and neck to generate more space for the ulnar nerve. Stretch and mobilize the neck and shoulders to decrease muscular tension.
Wrist extensors and flexors are heavily involved in cell phone engagement, so be sure to stretch them in order to address the range of motion that may have become limited with injury. Self-massage can be performed if inflammation is not present. Taking deep breaths is helpful, as it encourages muscles to relax.
The best way to avoid cell-phone -elated strain is to prevent injuries. Here are some tips to prevent repetitive stress injury from phone usage:
• Begin by limiting phone use. Turn the phone to silent notifications, plan to check it only every few hours, and take breaks when it is in use.
• Stretch and avoid being sedentary.
• Utilize proper posture when handling your phone. Limit elbow flexion and pronation.
• Use headphones or earbuds to avoid faulty body mechanics.
• Hold the phone with both hands and support the wrist and forearms.
Your body will let you know if there is a problem, so pay attention to the signals. If injury does happen, be prepared to seek professional help and take action. The goal of preserving elbow health while using a cell phone is in your hands.
Touching, Typing, Tingling: Texting Thumb
Tech-savvy lifestyles put ease into living, and disease into our thumbs. With breakneck advancements in technology and a multitude of willing participants, the use of text messaging is increasing exponentially. Digital technology enables people to learn, work and chat from the comfort of their homes. It seems everything is easily achievable by simply touching the screen of a smartphone, so texting has become a fundamental aspect of life.
Health-conscious choices are sometimes forfeited for social and economic prosperity. Despite the prevalence of text thumb injury, cell phone use continues to increase. Even when it’s not what we would choose, digital technology may be required for our education and occupational commitments.
Especially now, with the focus on distance learning and telecommuting, our thumbs are busier than ever. Texting allows learners to connect with virtual resources and other students. Instructors and administrators have become privy to the increased responsiveness when text messaging is an option. All this has greatly increased the number of texts dispatched daily. Although benefits of texting are endless, one cannot ignore the physical toll of Repetitive Stress Injuries, or RSIs.
Recipe for an RSI
Workplace RSIs are extremely common, due to the high demand being put on thumbs in professional settings. Office-based work can be completed at home if a device is handy. Time is saved from traveling to in-person meetings when telecommunication can do the job. Although texting is convenient, it introduces a threat to our physical well-being. With the constant handling of cell phones, overuse injuries often develop.
Text messaging requires repetitive motion of the thumbs. This is a perfect recipe for the development of Cumulative Trauma Disorder. Overuse injuries often occur when joints undergo improper care. Although damage materializes over an extended period of time, this scenario stresses tendons, muscles, nerves and other tissues.
Poor posture always puts unnecessary stress on the body. Most people use their thumbs, the least dextrous of all the fingers, for text messaging. Holding a phone with one hand, versus two, increases the risk of disability. Using a singular thumb to text increases the likelihood of injury on that side of the body, including thumb, hand, wrist, elbow, arm, shoulder and neck.
Too Much Texting
Factors that exacerbate RSIs of the thumbs include: prolonged use of the phone; duration and frequency of texting; thumb size in relation to the keypad; phone size; and keypad design (shape, texture and arrangement of the keys). Range of motion of the thumb and muscle strength play a role in functionality, based on the design of the phone. Larger thumbs have less space and often hit the wrong keys, creating additional work for the thumb to correct the errors. Some thumbs have difficulty reaching keys, causing discomfort in the first joint of the thumb.
RSIs affected by texting include De Quervain’s tenosynovitis and carpal tunnel syndrome. Additional injuries include carpometacarpal arthritis and tendonitis. De Quervain’s tenosynovitis is characterized by pain in the wrist and the thumb adductors around the radial styloid process.
Ulnar deviation of the hand can further exacerbate symptoms. This condition is triggered by inflammation of the tendon sheath in the first dorsal compartment of the wrist. Injury of this sort is common due to the many professions that utilize thumb pinching and wrist moving.
De Quervain’s disease has additionally been nicknamed as first dorsal compartment tenosynovitis, texting tenosynovitis, and Blackberry thumb. A Finkelstein test can be administered to assess for De Quervain’s disease.
Instructions are as follows:
• Make a fist with the thumb inside, keep the forearm stable, then deviate the wrist passively.
• If there is pain at the radial portion of the wrist, over the adductor pollicis longus and extensor pollicis brevis tendons, and if they are more tender than the other wrist, it is a positive assessment.
Carpal tunnel syndrome is a frequently diagnosed RSI that can also occur from texting. The carpal tunnel contains flexor tendons and the median nerve. CTS is a result of a compressed or malfunctioning median nerve, often due to inflammation.
Overuse irritation has a tendency to cause inflammation. Carpal Tunnel Syndrome is associated with wrist pain, aching, burning, numbness, tingling and motor impairment. Prevention of this injury can save a career in which thumb and wrist use is vital.
Chronic RSIs
Cell phone related RSIs can start simple and become chronic or serious. If symptoms arise, it is best to get professional attention sooner than later, to prevent disability.
Once injury becomes an issue, it can be challenging to relieve. Be aware of the symptoms that correlate with RSI: cramping, burning, hypersensitivity, poor coordination, inflammation, joint stiffness, thumb weakness, tingling, fatigue of the thumb muscles, numbness, difficulty extending the thumb, and radiating pain to the wrist, shoulder or forearm.
While RSIs can be daunting illnesses, options are available to ease the discomfort and work toward wellness. Applicable treatments include massage therapy, medication, steroid injections and surgery.
How Can Massage Help?
Massage therapy is a natural remedy that assists in trauma recovery. It is a recommended regimen prior to more invasive treatments, such as surgery. Massage is known to improve joint mobility and reduce muscle soreness and pain. It can help loosen up tense muscles, which in turn improves posture.
Massage aids in the release of endorphins and allows the client to feel good, which further alleviates pain.
While medication and injections are sometimes needed to ease pain, they do not address the root of the problem. Massage directly tackles the issue, rather than just masking discomfort. Although massage can sometimes be challenging, it is a pain-free treatment opportunity with minimal side effects.
Prevention is Key
Once an injury develops, it can be challenging to eradicate. Therefore, it’s best to focus on prevention by changing habits. As therapists, we tell our clients to follow these guidelines, but at the same time we must stay healthy as well. Let’s keep the following in mind: Promote ergonomics, commit to massage therapy treatments, and minimize repetitive thumb movements.
Recommendations for texting safely include employing voice commands to cut down on typing, and increasing font size to avoid hunching and stressing the body. Also, hold your phone with two hands, use a light touch and try not to type too fast. Support the forearms and back; relax the shoulders and neck; maintain parallel forearms; keep wrists straight, not bent upward; and be sure to keep your hands and arms warm.
Try to avoid excessive hand use, especially if you already have a joint condition, or if you feel strain and discomfort. Take stretch breaks, and when possible, silence the phone and try to unplug. Helpful home remedies include icing inflamed areas and stretching to restore range of motion. Your massage therapist can recommend safe, effective stretch routines.
Looking Down Too Much: Text Neck
Neck pain has become a common complaint of smartphone users, due to habits that are unconsciously formed while using our devices. Although text communication is easy, musculoskeletal disorders that arise from it can be arduous. The term text neck came about because of our inefficient neck posture while engaging in messaging and phone activity. This term was coined by an American chiropractor by the name of Dean Fishman, DC.
Text neck is considered to be a repetitive stress injury. RSIs or overuse injuries, are caused by maintaining recurring motions over an extended period of time. The consequence of these habits are impairments to muscles, tendons, nerves, ligaments, and joints.
Looking Down
Turtle neck results from poor posture transmuting into forward head position, ultimately resulting in neck pain. In this posture, the neck is anterior to the shoulders and considered to be a health hazard. Forward head often pulls the shoulders in the same direction, which creates a rounded upper back called kyphosis.
Neck flexion reinforces text neck. As phone usage increases, neck flexion becomes more prominent as well. When texting in the standing position, neck flexion is decreased; when sitting, neck flexion is increased. Neck flexion directly affects the vertebral column. If this postural arrangement also includes a lack of arm support, additional static muscular load on the neck and shoulders ensues.
The Resulting Damage
When necks are out of alignment, back muscles are forced to exert undue energy to fight gravity. Muscular weakness can in turn be associated with the trapezius, rhomboids, and shoulder external rotators. Furthermore, tight suboccipitals can lead to tension headaches.
Prolonged shearing of vertebrae from faulty neck positioning irritates the small facet joints in the cervical region of the axial skeleton. This irritation can result in neck pain that radiates through the upper back and shoulder blades, awaking trigger points in the soft tissues.
Permanent damage such as flattening of the cervical spinal curve can emanate from overuse syndrome. Additional risk effects include spinal misalignment, spinal degeneration, disc compression, disc herniation, and nerve damage.
Musculoskeletal illness causes symptoms that include decreased range of motion, muscle weakness, and difficulty in performing daily activities. These conditions can be accompanied by stiff neck, soreness, and muscle fatigue. Text neck, in particular, typically causes upper back, shoulder, and neck pain. Pain is the most prevalent symptom of RSI. This pain is generally an indication of injury.
Although the neck is the star of the show pertaining to overuse syndrome, additional pathologies tend to rear their heads. For instance, cervical nerve pinching can feel like radiating pain down the arm into the hand. Tingling or numbness can also be felt in the affected area. Shoulders can be disturbed by muscle spasms, tightness, and pain. Trigger points incite hyperirritability, referred sensation, and poor coordination. No matter where the discomfort is experienced, remember that it is a warning sign advising you to take heed.
How Massage Can Help
Rehab can be effective in repairing stress injury. Conservative treatment is often recommended for treating text neck syndrome. Medical care for most neck pain is typically non-surgical. Massage therapy is an alternative and holistic approach.
Massage can assist with RSI to reduce pain. Luckily, as we know, it is non-invasive and can be blended with other therapeutic interventions for improving ROM and muscle strength. Amicable modalities include stretching and muscle energy technique. Massage also goes hand-in-hand with heat or ice applications.
Stretching actively and passively restores muscle strength and recovers range of motion. It also increases the pain threshold and creates an analgesic effect. Stretches can be performed for 30 seconds using lateral flexion and rotation of the neck.
Muscle energy technique is a gentle isometric resistance exercise. The effects of MET include increased strength where weak, lengthening where short, and improvement of circulation. It can also lead to increased lymphatic fluid movement and decreased local edema formation.
As far as massage goes, deep friction and static stretches are great for reducing neck pain and improving ranges of neck movement. The combined techniques soothe muscle tension and spasms. Passive stretches are useful for progressing muscle strength.
Massage supports pain-free joint movement and loosens tight muscles. Because massage triggers the release of endorphins, it further aids in the alleviation of pain. Massage nourishes the muscles, tendons and ligaments. This helps the body to heal more quickly while promoting tissue regeneration. Receiving massage promotes relaxation.
When stress is down, the body has more resources for healing. This permits a sooner return to regularly scheduled activities.
Additional Treatments
Additional treatments for RSIs include oral medications and drug injections. These drugs are to be used with caution and only under a doctor’s recommendation. Taking a substance-based route, instead of a holistic approach, can result in a variety of unwanted side effects, and may only mask the symptoms.
In contrast, physical therapy and acupuncture are supplementary services in accordance with a holistic approach to RSI redress.
Do This Now
Home care can enhance the body’s performance and decrease joint and muscular stress. Pain relief is the goal. It can be achieved by keeping up with regular neck exercises and shoulder stretches.
Try this:
• Tuck your chin toward the neck, then slowly raise your nose to point at the sky.
• Next, rotate your neck to look over each shoulder, one at a time.
• Lastly, roll the shoulders in a clockwise direction then counterclockwise while keeping the arms at your sides. Progressive shifting keeps the body warm and breaks the monotony of fixed positioning.
Ice, heat, and rest are also helpful to use at home when injured. First things first, take it easy for a few days and allow your body to heal. Apply ice to decrease inflammation and pain. Be sure not to exceed 20 minutes if using a cold pack. Once swelling subsides, heat can be applied. Be aware that too much heat can cause more swelling. For safety stay under 20 minutes of heat application.
When faced with a choice, prevention is the best option. It is certainly more favorable to avoid pain than to alleviate it. Early management of conditions can avoid injury and decrease the risk of developing RSIs. Following are health conscious suggestions, to aid in the better practice of cell phone use.
Avoid excessive phone use and holding large or heavy devices for a long duration. Turn notifications to silent and check messages only every few hours. When texting, take frequent breaks, increase text font size to avoid hunching over, and use a light touch on the keyboard.
Don’t tuck the phone between your shoulder and ear. Use voice command to bypass thumb use and neck flexion. Constantly look up, bringing the neck into a neutral position, hold the phone to align with the eyes, and decrease forward head position. Try texting while laying on your back, to support your neck, or stand as an alternative.
Learn to sleep on your back with a supportive pillow and mattress. Create a posture-friendly workstation that allows for proper body alignment. Observe an upright position aligning the ears with the center of the shoulders. Warm up your neck muscles with exercise, be sure to stretch, and make massage a priority.
Ultimately, listen to your body and take action.
Enjoy Technology
Technology has blossomed into an overarching phenomenon that affects all aspects of our lives. This has both pros and cons. Our existence is simpler because of cell phones, our jobs more accessible. The world is at our fingertips. As a result, we often spend much of our time holding, typing on and staring down at our devices. This unfortunately accelerates injury to our bodies.
With mindfulness, participating in the journey of technology is not a risk. Through self-discipline and with the help of professionals, we can enjoy the benefits of virtual communication while avoiding injury. Just remember, when your body talks to you, listen.
About the Author:
Niccole Anthony, LMT, became a licensed massage therapist in 2009. After graduating from Atlanta School of Massage, she became an instructor of massage therapy. Anthony is certified as a massage and bodywork educator through the Alliance for Massage Therapy Education and an approved continuing education provider. She owns a wellness business in Atlanta, where she currently resides. Autumn Davis contributed to this article.