Reversing Pandemic-Related Increases in Back Pain

Reversing Pandemic-Related Increases in Back Pain

By: Chris Graf

Reproduced by permission from: https://www.paintreatmentdirectory.com/posts/reversing-pandemic-related-increases-in-back-pain

Back pain increased significantly during the pandemic

Google searches for the words “back pain” reached an all-time high in January 2022. In a Harris Poll in September 2021, 56% of respondents said they had chronic pain, up from about 30% before the pandemic. There are probably multiple reasons for the uptick in pain in general and back pain in particular related to COVID, including added stress and ongoing symptoms of long COVID. Poor posture while working at home is another likely contributor.

Back pain and Ergonomics

According to Dr. Erik Peper, co-author of Tech Stress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics, It is likely that poor ergonomics in the home office are partially to blame for the apparent rise in back pain. “With COVID, ergonomics have become a disaster—especially with people who use laptops.” Peper, an internationally known expert in biofeedback and Professor of Holistic Health Studies at San Francisco State University, said that it is “almost impossible” to sit correctly when using a laptop. “In order for the hands to be at the correct level for the keyboard, the head must be tilted down. The more the head tilts forward, the most stress that is placed on the cervical spine,” he said, noting that the arms will no longer be in the proper position if the laptop is placed on a stand to raise it to eye level.

For laptop users, Peper recommends using either an external monitor or external keyboard. When using an external keyboard, a laptop stand can be used to elevate the screen to the proper eye level. University of California at Berkeley recommends other tips for ergonomic laptop positioning. 

When using both laptops and desktops, attention should be focused on proper sitting posture. Ergonomic chairs are only part of the equation when it comes to achieving proper posture.

 “A good chair only gives you the opportunity to sit correctly,” Peper said. The goal is to achieve anterior pelvic tilt by having the seat pan slightly lower in the front that in the back. He recommends using a seat insert or cushion to achieve proper positioning (see figure 1).

Figure 1.  A small pillow or rolled up towel can be placed behind the back at kidney level in order to keep the spine slightly arched (see figure 2).

Figure 2. Sitting Disease: Cause of Back Pain and Much More

According to Peper, people who spend extended periods of time at their computers are at risk  of developing   sitting disease—a  condition of increased sedentary behavior associated with adverse health effects. A  study   that appeared in the American Journal of Preventative Medicine found that prolonged sitting was associated with an increased risk of 34 chronic diseases and conditions including chronic back and musculoskeletal pain. According to the study, “Being seated alters the activation patterns of multiple weight-bearing muscles and, therefore, excessive desk use is associated with adverse back curvature, back pain and upper extremity problems such as carpel tunnel syndrome.”

To Avoid Back Pain, Don’t Slouch!

Sitting for prolonged periods of time can cause back, neck, arm, and leg pain, but slouching is even worse and can damage spinal structures. “Most people slouch at computer, and when you slouch, our spine becomes more like the letter C, our abdomen is compressed, the diaphragm goes up which causes us to shallow breathe in our upper chest,” Peper said. “That impacts our back and digestion and many other things.”

According to Peper, slouching can also impact our mood. “Slouching is the posture associated with depression and low energy. That posture collapse may evoke negative and hopeless emotions. If I sit up and look up, I have less of that. I can have more positive and uplifting thinking.”

 Peper recommends a simple device to help people improve their posture. Called an Upright Go, it attaches to the neck and provides vibrational feedback when slouching occurs. “Every time it starts buzzing, it’s a reminder to stop slouching and to get up, wiggle, and move,” he said. “We have published some studies on it, but I have no investment in the company.”

Peper’s 4 Basic Tips for Avoiding Back Pain and Other Sitting Diseases:

#1 Get Up and Move

“Rule one is to take many breaks—wiggle and move,” he said. “People are unaware that they slightly raise their shoulders and their arm goes slightly forward—in their mousing especially. By the end of the day, they feel stiffness in their shoulders or back. So, you need to take many wiggly breaks. Get up from your chair every 15 minutes.”

Use Stretch Break or one of the other apps that remind people to get up out of their chairs and stretch. 

Walk around while on the phone and wear a headset to improve posture while on the phone. 

For back pain, skip in place or lift the right arm at the same time as the left knee followed by the left arm and right knee–exercises that cause a diagonal stretch along the back.

#2 Just Breathe

  • “Learn to practice lower breathing,” Peper said. “When you sit, you are forced to breath higher in your chest. You want to practice slow diaphragmatic breathing. Breathe deeply and slowly to restore a natural rhythm. Take three deep breaths, inhaling for five seconds, then exhale very slowly for six seconds.” For more instructions on slower diaphragmatic breathing visit Peper’s blog on the subject. 

#3 Take Visual Breaks:

  • Our blinking rate significantly decreases while looking at a screen, which contributes to eye strain. To relax the eyes, look at the far distance. “Looking out into the distance disrupts constant near-focus muscle tension in the eyes,” he said. By looking into the distance, near-focus muscle tension in the eyes is disrupted.
      
  • If you have children, make sure they are taking frequent visual breaks from their screens. According to Peper, there has been a 20 percent increase in myopia (nearsightedness) in young children as a result of COVID-related distance learning. “The eyes are being formed and shaped during childhood, and if you only focus on the screen, that changes the muscle structure of our eyes over time leading to more myopia.”

#4 Pay Attention to Ergonomics

  • “If you are working on a desktop, the top of screen should be at eyebrow level,” Peper said. “Your feet should be on the ground, and the angle of the knees should be about 110 degrees. You should feel support in mid back and low back and be able to sit, lean back, and be comfortable.”
      
  • Peper recommends adjustable sit/stand desks and regularly alternating between sitting and standing.  
     

For more specific guidance on ergonomics for prolonged sitting, UCLA School of Medicine offers detailed guidelines. And don’t forget to check out Dr. Peper’s book  on ergonomics as well as his blog, The Peper Perspective, where you can use the search feature to help you find exactly what you are looking for. 

But in the meantime, Dr. Peper said, “It’s time for you to get up and wiggle!”

Find a Provider Who Can Help with Back Pain

Christine Graf is a freelance writer who lives in Ballston Lake, New York. She is a regular contributor to several publications and has written extensively about health, mental health, and entrepreneurship.    


Freedom of movement with the Alexander Technique

Erik Peper and Elyse Shafarman

After taking Alexander Technique lessons I felt lighter and stood taller and I have learned how to direct myself differently.  I am much more aware of my body, so that while I am working at the computer, I notice when I am slouching and contracting. Even better, I know what to do so that I have no pain at the end of the day. It’s as though I’ve learned to allow my body to move freely.

The Alexander Technique is one of the somatic techniques that optimize health and performance (Murphy, 1993). Many people report that after taking Alexander lessons, many organic and functional disorders disappear. Others report that their music or dance performances improve. The Alexander Technique has been shown to improve back pain, neck pain, knee pain walking gait, and balance (Alexander technique, 2022; Hamel, et al, 2016; MacPherson et al., 2015; Preece, et al., 2016). Benefits are not just  physical. Studying the technique decreases performance anxiety in musicians and reduces depression associated with Parkinson’s disease (Klein, et al, 2014; Stallibrass et al., 2002).

Background

The Alexander Technique was developed in the late 19th century by the Australian actor, Frederick Matthias Alexander (Alexander, 2001).  It is an educational method that teaches students to align, relax and free themselves from limiting tension habits (Alexander, 2001; Alexander technique, 2022).  F.M Alexander developed this technique to resolve his own problem of becoming hoarse and losing his voice when speaking on stage.

Initially he went to doctors for treatment but nothing worked except rest. After resting, his voice was great again; however, it quickly became hoarse when speaking.  He recognized that it must be how he was using himself while speaking that caused the hoarseness.  He understood that “use” was not just a physical pattern, but a mental and emotional way of being. “Use” included beliefs, expectations and feelings. After working on himself, he developed the educational process known as the Alexander Technique that helps people improve the way they move, breathe and react to the situations of life.

The benefits of this approach has been documented in a large randomized controlled trial of one-on-one Alexander Technique lessons which showed that it significantly reduced chronic low back pain and the benefits persisted a year after treatment (Little, et al, 2008).  Back pain as well as shoulder and neck pain often is often related to stress and how we misuse ourselves.  When experiencing discomfort, we quickly tend to blame our physical structure and assume that the back pain is due to identifiable structural pathology identified by X-ray or MRI assessments. However, similar structural pathologies are often present in people who do not experience pain and the MRI findings correlate poorly with the experience of discomfort (Deyo & Weinstein, 2001; Svanbergsson et al., 2017). More likely, the causes and solutions involve how we use ourselves (e.g., how we stand, move, or respond to stress). A functional approach may include teaching awareness of the triggers that precede neck and back tension, skills to prevent the tensing of those muscles not needed for task performance,  resolving psychosocial stress and improving the ergonomic factors that contribute to working in a stressed position (Peper, Harvey & Faass, 2020). Conceptually, how we are use ourselves (thoughts, emotions, and body) affects and transforms our physical structure and then our physical structure constrains how we use ourselves.

Watch the video with Alexander Teacher, Elyse Shafarman, who describes the Alexander Technique and guides you through practices that you can use immediately to optimize your health while sitting and moving.

See also the following posts:

References

Alexander, F.M. (2001). The Use of the Self. London: Orion Publishing. https://www.amazon.com/Use-Self-F-M-Alexander/dp/0752843915

Alexander technique. (2022). National Health Service. Retrieved 19 April, 2022/.  https://www.nhs.uk/conditions/alexander-technique/

Deyo, R.A. & Weinstein, J.N. (2001). Low back pain. N Engl J Med., 344(5),363-70. https://doi.org/10.1056/NEJM200102013440508

Hamel, K.A., Ross, C., Schultz, B., O’Neill, M., & Anderson, D.I. (2016). Older adult Alexander Technique practitioners walk differently than healthy age-matched controls. J Body Mov Ther. 20(4), 751-760. https://doi.org/10.1016/j.jbmt.2016.04.009

Klein, S. D., Bayard, C., & Wolf, U. (2014). The Alexander Technique and musicians: a systematic review of controlled trials. BMC complementary and alternative medicine14, 414. https://doi.org/10.1186/1472-6882-14-414

Little, P.  Lewith, W G., Webley, F.,  Evans, M., …(2008). Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. BMJ, 337:a884. https://doi.org/10.1136/bmj.a884

MacPherson, H., Tilbrook, H., Richmond, S., Woodman, J., Ballard, K., Atkin, K., Bland, M., et al. (2015). Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial. Ann Intern Med, 163(9), 653-62. https://doi.org/10.7326/M15-0667

Murphy, M. (1993). The Future of the Body. New York: Jeremy P. Tarcher/Perigee.

Peper, E., Harvey, R. & Faass, N. (2020). TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books.

Preece, S.J., Jones, R.K., Brown, C.A. et al.  (2016). Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis. BMC Musculoskelet Disord 17372.  https://doi.org/10.1186/s12891-016-1209-2

Stallibrass, C., Sissons, P., & Chalmers. C. (2002). Randomized controlled trial of the Alexander technique for idiopathic Parkinson’s disease. Clin Rehabil, 16(7), 695-708. https://doi.org/10.1191/0269215502cr544oa

Svanbergsson, G., Ingvarsson, T., & Arnardóttir RH. (2017). [MRI for diagnosis of low back pain: Usability, association with symptoms and influence on treatment]. Laeknabladid, 103(1):17-22. Icelandic. https://doi.org/10.17992/lbl.2017.01.116

Tuomilehto, J., Lindström, J., Eriksson, J.G., Valle, T.T., Hämäläinen, H., Ilanne-Parikka, P., Keinänen-Kiukaanniemi, S., Laakso, M., Louheranta, A., Rastas, M., et al. (2001). Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N. Engl. J. Med., 344, 1343–1350. https://doi.org/10.1056/NEJM200105033441801

Uusitupa, Mm, Khan, T.A., Viguiliouk, E., Kahleova, H., Rivellese, A.A., Hermansen, K., Pfeiffer, A., Thanopoulou, A., Salas-Salvadó, J., Schwab, U., & Sievenpiper. J.L. (2019). Prevention of Type 2 Diabetes by Lifestyle Changes: A Systematic Review and Meta-Analysis. Nutrients, 11(11)2611. https://doi.org/10.3390/nu11112611


A breath of fresh air: Breathing and posture to optimize health

Most people breathe 22,000 breaths per day. We tend to breathe more rapidly when stressed, anxious or in pain. While a slower diaphragmatic breathing supports recovery and regeneration. We usually become aware of our dysfunctional breathing when there are problems such as nasal congestion, allergies, asthma, emphysema, or breathlessness during exertion.  Optimal breathing is much more than the absence of symptoms and is influenced by posture. Dysfunctional posture and breathing are cofactors in illness. We often do not realize that posture and breathing affect our thoughts and emotions and that our thoughts and emotions affect our posture and breathing. Watch the video, A breath of fresh air: Breathing and posture to optimize health, that was recorded for the 2022 Virtual Ergonomics Summit.


Reduce anxiety

The purpose of this blog is to describe how a university class that incorporated structured self-experience practices reduced self-reported anxiety symptoms (Peper, Harvey, Cuellar, & Membrila, 2022). This approach is different from a clinical treatment approach as it focused on empowerment and mastery learning (Peper, Miceli, & Harvey, 2016). 

As a result of my practice, I felt my anxiety and my menstrual cramps decrease. — College senior

When I changed back to slower diaphragmatic breathin, I was more aware of my negative emotions and I was able to reduce the stress and anxiety I was feeling with the deep diaphragmatic breathing.– College junior

Background

More than half of college students now report anxiety (Coakley et al., 2021). In our recent survey during the first day of the spring semester class, 59% of the students reported feeling tired, dreading their day, being distracted, lacking mental clarity and had difficulty concentrating.

Before the COVID pandemic nearly one-third of students had or developed moderate or severe anxiety or depression while being at college (Adams et al., 2021. The pandemic accelerated a trend of increasing anxiety that was already occurring.  “The prevalence of major depressive disorder among graduate and professional students is two times higher in 2020 compared to 2019 and the prevalence of generalized anxiety disorder is 1.5 times higher than in 2019” As reported by Chirikov et al (2020) from the UC Berkeley SERU Consortium Reports.

This increase in anxiety has both short and long term performance and health consequences. Severe anxiety reduces cognitive functioning and is a risk factor for early dementia (Bierman et al., 2005; Richmond-Rakerd et al, 2022). It also increases the risk for asthma, arthritis, back/neck problems, chronic headache, diabetes, heart disease, hypertension, pain, obesity and ulcer (Bhattacharya et al., 2014; Kang et al, 2017).

The most commonly used treatment for anxiety are pharmaceutical and cognitive behavior therapy (CBT) (Kaczkurkin & Foa, 2015).  The anti-anxiety drugs are usually benzodiazepines (e.g., alprazolam (Xanax), clonazepam (Klonopin), chlordiazepoxide (Librium), diazepam (Valium) and lorazepam (Ativan).  Although these drugs they may reduce anxiety, they have numerous side effects such as drowsiness, irritability, dizziness, memory and attention problems, and physical dependence (Shri, 2012; Crane, 2013).

Cognitive behavior therapy techniques based upon the assumption that anxiety is primarily a disorder in thinking which then causes the symptoms and behaviors associated with anxiety. Thus, the primary treatment intervention focuses on changing thoughts.

Given the significant increase in anxiety and the potential long term negative health risks, there is need to provide educational strategies to empower students to prevent and reduce their anxiety.  A holistic approach is one that assumes that body and mind are one and that soma/body, emotions and thoughts interchangeably affect the development of anxiety. Initially in our research, Peper, Lin, Harvey & Perez (2017) reported that it was easier to access hopeless, helpless, powerless and defeated memories in a slouched position than an upright position and it was easier to access empowering positive memories in an upright position than a slouched position. Our research on transforming hopeless, helpless, depressive thought to empowering thoughts, Peper, Harvey & Hamiel (2019) found that it was much more effective if the person first shifts to an upright posture, then begins slow diaphragmatic breathing and finally reframes their negative to empowering/positive thoughts. Participants were able to reframe stressful memories much more easily when in an upright posture compared to a slouched posture and reported a significant reduction in negative thoughts, anxiety (they also reported a significant decrease in negative thoughts, anxiety and tension as compared to those attempting to just change their thoughts).

The strategies to reduce anxiety focus on breathing and posture change. At the same time there are many other factors that may contribute the onset or maintenance of anxiety such as social isolation, economic insecurity, etc. In addition, low glucose levels can increase irritability and may lower the threshold of experiencing anxiety or impulsive behavior (Barr, Peper, & Swatzyna, 2019; Brad et al, 2014). This is often labeled as being “hangry” (MacCormack & Lindquist, 2019). Thus, by changing a high glycemic diet to a low glycemic diet may reduce the somatic discomfort (which can be interpreted as anxiety) triggered by low glucose levels.  In addition, people are also sitting more and more in front of screens.  In this position, they tend to breathe quicker and more shallowly in their chest. 

Shallow rapid breathing tends to reduce pCO2 and contributes to subclinical hyperventilation which could be experienced as anxiety (Lum, 1981; Wilhelm et al., 2001; Du Pasquier et al, 2020).  Experimentally, the feeling of anxiety can rapidly be evoked by instructing a person to sequentially exhale about 70 % of the inhaled air continuously for 30 seconds. After 30 seconds, most participants reported a significant increase in anxiety (Peper & MacHose, 1993).  Thus, the combination of sitting, shallow breathing and increased stress from the pandemic are all cofactors that may contribute to the self-reported increase in anxiety.

To reduce anxiety and discomfort, McGrady and Moss (2013) suggested that self-regulation and stress management approaches be offered as the initial treatment/teaching strategy in health care instead of medication. One of the useful approaches to reduce sympathetic arousal and optimize health is breathing awareness and retraining (Gilbert, 2003).  

Stress management as part of a university holistic health class

Every semester since 1976, up to 180 undergraduates have enrolled in a three-unit Holistic Health class on stress management and self-healing (Klein & Peper, 2013).  Students in the class are assigned self-healing projects using techniques that focus on awareness of stress, dynamic regeneration, stress reduction imagery for healing, and other behavioral change techniques adapted from the book, Make Health Happen (Peper, Gibney & Holt, 2002).

82% of students self-reported that they were ‘mostly successful’ in achieving their self-healing goals. Students have consistently reported achieving positive benefits such as increasing physical fitness, changing diets, reducing depression, anxiety, and pain, eliminating eczema, and even reducing substance abuse (Peper et al., 2003; Bier et al., 2005; Peper et al., 2014).

This assessment reports how students’ anxiety decreased after five weeks of daily practice. The students filled out an anonymous survey in which they rated the change in their discomfort after practicing effortless diaphragmatic breathing. More than 70% of the students reported a decrease in anxiety. In addition, they reported decreases in symptoms of stress, neck and shoulder pain as shown in Figure 1.

Figure 1. Self-report of decrease in symptoms after practice diaphragmatic breathing for a week.

In comparing the self-reported responses of the students in the holistic health class to those of the control group (N=12), the students in the holistic health class reported a significant decrease in symptoms since the beginning of the semester as compared to the control group as shown in Figure 2.

Figure 2. Change in self-reported symptoms after 6 weeks of practice the integrated holistic health skills as compared to the control group who did not practice these skills.

Changes in symptoms Most students also reported an increase in mental clarity and concentration that improved their study habits. As one student noted: Now that I breathe properly, I have less mental fog and feel less overwhelmed and more relaxed. My shoulders don’t feel tense, and my muscles are not as achy at the end of the day.

The teaching components for the first five weeks included a focus on the psychobiology of stress, the role of posture, and psychophysiology of respiration. The class included didactic presentations and daily self-practice

Lecture content

  1. Diadactic presentation on the physiology of stress and how posture impacts health.
  2. Self-observation of stress reactions; energy drain/energy gain and learning dynamic relaxation.
  3. Short experiential practices so that the student can experience how slouched posture allows easier access to helpless, hopeless, powerless and defeated memories.
  4. Short experiential breathing practices to show how breathing holding occurs and how 70% exhalation within 30 seconds increases anxiety.
  5. Didactic presentation on the physiology of breathing and how a constricted waist tends to have the person breathe high in their chest (the cause of neurasthemia) and how the fight/flight response triggers chest breathing, breath holding and/or shallow breathing.
  6. Explanation and practice of diaphragmatic breathing.

Daily self-practice

Students were assigned weekly daily self-practices which included both skill mastery by practicing for 20 minutes as well and implementing the skill during their daily life.  They then recorded their experiences after the practice. At the end of the week, they reviewed their own log of week and summarized their observations (benefits, difficulties) and then met in small groups to discuss their experiences and extract common themes. These daily practices consisted of:

  1. Awareness of stress.  Monitoring how they reacted to daily stressor
  2. Practicing dynamic relaxation. Students practiced for 20 minutes a modified progressive relaxation exercise and observed and inhibit bracing pattern
  3. Changing energy drain and energy gains. Students observed what events reduced or increased their subjective energy and implemented changes in their behavior to decrease events that reduced their energy and increased behaviors that increase their enery
  4. Creating a memory of wholeness practice
  5. Practicing effortless breathing. Students practiced slowly diaphragmatic abdominal breathing for 20 minutes per day and each time they become aware of dysfunctional breathing (breath holding, shallow chest breathing, gasping) during the day, they would shift to slower diaphragmatic breathing.

Discussion

Almost all students were surprised how beneficial these practices were to reduce their anxiety and symptoms. Generally, the more the students would interrupt their personal stress responses during the day by shifting to diaphragmatic breathing the more did they experience success. We hypothesize that some of the following factors contributed to the students’ improvement.

  • Learning through self-mastery as an education approach versus clinical treatment.
  • Generalizing the skills into daily life and activities. Practicing the skills during the day in which the cue of a stress reaction triggered the person to breathe slowly. The breathing would reduce the sympathetic activation.
  • Interrupting escalating sympathetic arousal. Responding with an intervention reduced the sense of being overwhelmed and unable to cope by the participant by taking charge and performing an active task.
  • Redirecting attention and thoughts away from the anxiety triggers to a positive task.
  • Increasing heart rate variability. Through slow breathing heart rate variability increased which enhanced sympathetic parasympathetic balance.
  • Reducing subclinical hyperventilation by breathing slower and thereby increasing pC02.
  • Increasing social support by meeting in small groups.  The class discussion group normalized the anxiety experiences.
  • Providing hope. The class lectures, assigned readings and videos provide hope; since,  it included reports how other students had reversed their chronic  disorders such as irritable bowel disease, acid reflux, psoriasis with behavioral interventions.

Although the study lacked a control group and is only based upon self-report, it offers an economical non-pharmaceutical approach to reduce anxiety. These stress management strategies may not resolve anxiety for everyone. Nevertheless, we recommend that schools implement this approach as the first education intervention to improve health in which students are taught about stress management, learn and practice relaxation and diaphragmatic breathing and then practice these skills during the day  whenever they experience stress or dysfunctional breathing.

I noticed that breathing helped tremendously with my anxiety. I was able to feel okay without having that dreadful feeling stay in my chest and I felt it escape in my exhales. I also felt that I was able to breathe deeper and relax better altogether. It was therapeutic, I felt more present, aware, and energized.

See the following blogs for detailed breathing instructions

References

Adams. K.L., Saunders KE, Keown-Stoneman CDG, et al. (2021). Mental health trajectories in undergraduate students over the first year of university: a longitudinal cohort study. BMJ Open 2021; 11:e047393. https://doi.org/10.1136/bmjopen-2020-047393

Barr, E. A., Peper, E. & Swatzyna, R.J. (2019).  Slouched Posture, Sleep Deprivation, and Mood Disorders: Interconnection and Modulation by Theta Brain Waves. Neuroregulation, 6(4), 181–189 https://doi.org/10.15540/nr.6.41.181

Bhattacharya, R., Shen, C. & Sambamoorthi, U. (2014). Excess risk of chronic physical conditions associated with depression and anxiety. BMC Psychiatry 14, 10 (2014). https://doi.org/10.1186/1471-244X-14-10

Bier, M., Peper, E., & Burke, A. (2005). Integrated stress management with ‘Make Health Happen: Measuring the impact through a 5-month follow-up. Poster presentation at the 36th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback. Abstract published in: Applied Psychophysiology and Biofeedback, 30(4), 400. https://biofeedbackhealth.files.wordpress.com/2013/12/2005-aapb-make-health-happen-bier-peper-burke-gibney3-12-05-rev.pdf

Bierman, E.J.M., Comijs, H.C. , Jonker, C. & Beekman, A.T.F.  (2005). Effects of Anxiety Versus Depression on Cognition in Later Life. The American Journal of Geriatric Psychiatry,13(8),  686-693, https://doi.org/10.1097/00019442-200508000-00007.

Brad, J., Bushman, C., DeWall, N., Pond, R.S., &. Hanus, M.D. (2014).. Low glucose relates to greater aggression in married couplesPNAS, April 14, 2014.  https://doi.org/10.1073/pnas.1400619111

Chirikov, I., Soria, K. M, Horgos, B., & Jones-White, D. (2020). Undergraduate and Graduate Students’ Mental Health During the COVID-19 Pandemic. UC Berkeley: Center for Studies in Higher Education. Retrieved from https://escholarship.org/uc/item/80k5d5hw

Coakley, K.E., Le, H., Silva, S.R. et al. Anxiety is associated with appetitive traits in university students during the COVID-19 pandemic. Nutr J 20, 45 (2021). https://doi.org/10.1186/s12937-021-00701-9

Crane,E.H. (2013).Highlights of the 2011 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits. 2013 Feb 22. In: The CBHSQ Report. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK384680/

Du Pasquier, D., Fellrath, J.M., & Sauty, A. (2020). Hyperventilation syndrome and dysfunctional breathing: update. Revue Medicale Suisse, 16(698), 1243-1249. https://europepmc.org/article/med/32558453

Gilbert C. Clinical Applications of Breathing Regulation: Beyond Anxiety Management. Behavior Modification. 2003;27(5):692-709. https://doi.org/10.1177/0145445503256322

Kaczkurkin, A.N. & Foa, E.B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues Clin Neurosci. 17(3):337-46.  https://doi.org/10.31887/DCNS.2015.17.3/akaczkurkin

Kang, H. J., Bae, K. Y., Kim, S. W., Shin, H. Y., Shin, I. S., Yoon, J. S., & Kim, J. M. (2017). Impact of Anxiety and Depression on Physical Health Condition and Disability in an Elderly Korean Population. Psychiatry investigation14(3), 240–248. https://doi.org/10.4306/pi.2017.14.3.240

Klein, A. & Peper, W. (2013). There is Hope: Autogenic Biofeedback Training for the Treatment of Psoriasis. Biofeedback, 41(4), 194–201. https://doi.org/10.5298/1081-5937-41.4.01

Lum, L. C. (1981). Hyperventilation and anxiety state. Journal of the Royal Society of Medicine74(1), 1-4. https://journals.sagepub.com/doi/pdf/10.1177/014107688107400101

MacCormack, J. K., & Lindquist, K. A. (2019). Feeling hangry? When hunger is conceptualized as emotion. Emotion, 19(2), 301–319. https://doi.org/10.1037/emo0000422

McGrady, A. & Moss, D. (2013). Pathways to illness, pathways to health. New York: Springer. https://link.springer.com/book/10.1007/978-1-4419-1379-1

Peper, E., Gibney, K.H., & Holt, C.F. (2002). Make health happen: Training yourself to create wellness. Dubuque, IA: Kendall/Hunt Publishing Company. https://he.kendallhunt.com/make-health-happen

Peper, E., Harvey, R., Cuellar, Y., & Membrila, C. (2022). Reduce anxiety. NeuroRegulation, 9(2), 91–97. https://doi.org/10.15540/nr.9.2.91  https://www.neuroregulation.org/article/view/22815/14575

Peper, E., Harvey, R., & Hamiel, D. (2019). Transforming thoughts with postural awareness to increase therapeutic and teaching efficacy.  NeuroRegulation, 6(3),153-169.  doi:10.15540/nr.6.3.1533-1   https://www.neuroregulation.org/article/view/19455/13261

Peper, E., Lin, I-M., Harvey, R., & Perez, J. (2017). How posture affects memory recall and mood.  Biofeedback.45 (2), 36-41. https://doi.org/10.5298/1081-5937-45.2.01

Peper, E., Lin, I-M, Harvey, R., Gilbert, M., Gubbala, P., Ratkovich, A., & Fletcher, F. (2014). Transforming chained behaviors: Case studies of overcoming smoking, eczema and hair pulling (trichotillomania). Biofeedback, 42(4), 154-160. https://doi.org/10.5298/1081-5937-42.4.06

Peper, E., MacHose, M. (1993). Symptom prescription: Inducing anxiety by 70% exhalation. Biofeedback and Self-Regulation 18, 133–139). https://doi.org/10.1007/BF00999790

Peper, E., Miceli, B., & Harvey, R. (2016). Educational Model for Self-healing: Eliminating a Chronic Migraine with Electromyography, Autogenic Training, Posture, and Mindfulness. Biofeedback, 44(3), 130–137.  https://doi.org/10.5298/1081-5937-44.3.03

Peper, E., Sato-Perry, K & Gibney, K. H. (2003). Achieving Health: A 14-Session Structured Stress Management Program—Eczema as a Case Illustration. 34rd Annual Meeting of the Association for Applied Psychophysiology and Biofeedback. Abstract in: Applied Psychophysiology and Biofeedback, 28(4), 308. Proceeding in:  http://www.aapb.org/membersonly/articles/P39peper.pdf

Richmond-Rakerd, L.S., D’Souza, S, Milne, B.J, Caspi, A., & Moffitt, T.E. (2022). Longitudinal Associations of Mental Disorders with Dementia: 30-Year Analysis of 1.7 Million New Zealand Citizens. JAMA Psychiatry. Published online February 16, 2022. https://doi.org/10.1001/jamapsychiatry.2021.4377

Shri, R. (2012). Anxiety: Causes and Management. The Journal of Behavioral Science5(1), 100–118. Retrieved from https://so06.tci-thaijo.org/index.php/IJBS/article/view/2205

Wilhelm, F.H., Gevirtz, R., & Roth, W.T. (2001). Respiratory dysregulation in anxiety, functional cardiac, and pain disorders. Assessment, phenomenology, and treatment. Behav Modif, 25(4), 513-45. https://doi.org/10.1177/0145445501254003


Get Well & Stay Well: Technology’s effect on our mind and body with Wayne Jonas, MD and Erik Peper, PhD

Enjoy the conversations, Get Well & Stay Well, with Wayne Jonas, MD, Former Director NIH Office of Alternative Medicine, and Erik Peper, PhD of San Francisco State University (SFSU) recorded November 30, 2021. They discuss technology’s effect on our mind and body and holistic approaches to managing stress and pain from chronic illness. Have patience when you watch the video–it takes 5 seconds for the program to begin. Click on the link to watch: https://fb.watch/9Cbkw9GZw8/

For more information, see the following blogs:


Addicted to your phone?  How to separate from your phone for a healthy lifestyle[1]

Erik Peper, PhD[2] and Monica Almendras

Our evolutionary traps with technology

Maintaining and optimizing health at the computer means re-envisioning our relationship with technology—and reclaiming health, happiness, and sanity in a plugged-in world.  We have the ability to control everything from our mobile phones without needing to get up from our seat. Work, social life and online learning all involve the mobile phone or some type of smart devices.

A convenient little device that is supposed to simplify our lives has actually trapped us into a vicious cycle of relying on it for every single thing we must do.  We spend most of our day being exposed to digital displays on our smartphones, computers, gaming consoles, and other digital devices, immersing ourselves in the content we are viewing. From work related emails or tasks, to spending our free time looking at the screen for texting, playing games, and updating social media sites on a play-by-play of what we are eating, wearing, and doing. We click on one hyperlink after the other and create a vicious cycle trapped for hours until we realize we need to move. We are unaware how much time has frittered away without actually doing anything productive and then, we realize we have wasted another day. Below are some recent estimates of ‘daily active user’ minutes per day that uses a screen.

  • Facebook about an hour per day
  • Instagram just under an hour per day
  • Texting about 45 minutes per day
  • Internet browsing, about 45 minutes per day
  • Snapchat, about 30 minutes per day
  • Twitter, about 25 minutes per day

Adolescents and college students interact with media for over 40 hours per week, or around 6 hours per day. That is a lot of hours spent on staring at the screen, which it is almost impossible not to be distracted by the digital screen. In time, we rehearse a variety of physical body postures as well as a variety of cognitive and behavioral states that impact our physical, mental, emotional, and social health. The powerful audiovisual formats override our desires to do something different, that some of us become enslaved to streaming videos, playing virtual games, or texting. We then tell ourselves that the task that needs to be done, will be finished later. That later becomes never by the end of the day, since the ongoing visual and auditory notifications from our apps interrupt and/or capture our attention. This difficulty to turn away from visual or auditory stimuli roots in our survival instincts.

Each time visual or auditory stimuli occur, we automatically check it out and see if it is a friend or foe, safety or danger. It is such an automatic response that we are unaware are reacting. The good news is that we all have experienced this compelling effect. Even when we are waiting for a response and the notifications has not arrived, we may anticipate or project that there may be new information on our social media accounts, and sometimes we become disappointed when the interval between notification is long. As one student said, “Don’t worry, they’ll respond. It’s only been 30 seconds”. Anticipating responses from the media can interrupt what we are otherwise doing. Rather than finishing our work or task, we continuously check for updates on social media, even though we probably know that there are no new important messages to which we would have to respond right away.

Unfortunately, some forms of social media interactions also lead to a form of social isolation, loneliness–sometimes called phoneliness (Christodoulou, G., Majmundar, A., Chou, C-P, & Pentz, M.A., 2020Kardaras, 2017). Digital content requires the individual to respond to the digital stimuli, without being aware of the many verbal and nonverbal communication cues (facial expressions, gestures, tone of voice, eye contact, body language, posture, touch, etc.) that are part of social communication (Remland, 2016). It is no wonder that more and more adolescents experience anxiety, depression, loneliness, and attention deficit disorders with a constant ‘digital diet’ that some have suggested that include not only media, but junk food as well.

In my class survey of 99 college students, 85% reported experiencing anxiety, 48% neck and should tension, and 41% abdominal discomfort.

We are not saying to avoid the beneficial parts of the digital age. Instead, it should be used in moderation and to be aware of how some material and digital platforms prey upon our evolutionary survival mechanisms. Unfortunately, most people -especially children- have not evolved skills to counter the negative impacts of some types of media exposure. Parental control and societal policies may be needed to mitigate the damage and enhance the benefits of the digital age.

Zoom Fatigue- How to reduce it and configure your brain for better learning

Zoom became the preferred platform for academic teaching and learning for synchronous education during the pandemic. Thus, students and faculty have been sitting and looking at the screen for hours end. While looking at the screen, the viewers were often distracted by events in their environment, notifications from their mobile phones, social media triggers, and emails; which promoted multitasking (Solis, 2019). These digital distractions cause people to respond to twice as many devices with half of our attention- a process labeled semi-tasking’ -meaning getting twice as much done and half as well.

We now check our phones an average of 96 times a day – that is once every 10 minutes and an increase of 20% as compared to two years ago (Asurion Research, 2019). Those who do media multitasking such as texting while doing a task perform significantly worse on memory tasks than those who are not multitasking (Madore et al., 2020).  Multitasking is negatively correlated with school performance (Giunchiglia et al, 2018). The best way to reduce multitasking is to turn off all notifications (e.g., email, texts, and social media) and let people know that you will look at the notifications and then respond in a predetermined time, so that you will not be interrupted while working or studying.

When students from San Francisco State University in the United States chose to implement a behavior change to monitor mobile phone and media use and reduce the addictive behavior during a five-week self-healing project, many reported a significant improvement of health and performance. For example one student reported that when she reduced her mobile phone use, her stress level equally decreased as shown in Fig 1 (Peper et al, 2021).

Figure 1. Example of student changing mobile phone use and corresponding decrease in subjective stress level. Reproduced by permission from Peper et al. (2021).

During this class project, many students observed that the continuous responding to notifications and social media affected their health and productivity. As one student reported,

The discovery of the time I wasted giving into distractions was increasing my anxiety, increasing my depression and making me feel completely inadequate. In the five-week period, I cut my cell phone usage by over half, from 32.5 hours to exactly 15 hours and used some of the time to do an early morning run in the park. Rediscovering this time makes me feel like my possibilities are endless. I can go to work full time, take online night courses reaching towards my goal of a higher degree, plus complete all my homework, take care of the house and chores, cook all my meals, and add reading a book for fun! –22-year-old College Student

Numerous students reported that it was much easier to be distracted and multitask, check social media accounts or respond to emails and texts than during face-to-face classroom sessions as illustrated by two student comments from San Francisco State University.

“Now that we are forced to stay at home, it’s hard to find time by myself, for myself, time to study, and or time to get away. It’s easy to get distracted and go a bit stir-crazy.”

“I find that online learning is more difficult for me because it’s harder for me to stay concentrated all day just looking at the screen.” 

Students often reported that they had more difficulty remembering the material presented during synchronous presentations. Most likely, the passivity while watching Zoom presentations affected the encoding and consolidation of new material into retrievable long-term memory. The presented material was rapidly forgotten when the next screen image or advertisement appeared and competed with the course instructor for the student’s attention. We hypothesize that the many hours of watching TV and streaming videos have conditioned people to sit and take in information passively, while discouraging them to respond or initiate action (Mander, 1978Mărchidan, 2019).

To reduce the deleterious impact of media use, China has placed time limits on cellphone use, gaming, and social media use for children. On February 2021 Chinese children were banned from taking their mobile phones into school, on August 2021 Children under 18 were banned from playing video games during the week and their play was restricted to just one hour on Fridays, weekends and holidays, and beginning on September 20, 2021 children under 14 who have been authenticated using their real name can access Douyin, the Chinese version of Tik Tok, for maximum of 40 minutes a day between the hours of 6:00 and 22:00.

Ways to avoid Zoom

Say goodnight to your phone

It is common for people to use their mobile phone before going to bed, and then end up having difficult falling asleep. The screen emits blue light that sends a signal to your brain that says it is daytime instead of night. This causes your body to suppress the production of the melatonin hormone, which tells your body that it is time to sleep. Reading or watching content also contributes, since it stimulates your mind and emotions and thereby promote wakefulness (Bravo, 2020). Implement sleep hygiene and stop using your phone or watching screens 30-minutes before going to bed for a better night’s sleep.

Maintaining a healthy vision

We increase near visual stress and the risk of developing myopia when we predominantly look at nearby surfaces. We do not realize that eyes muscles can only relax when looking at the far distance. For young children, the constant near vision remodels the shape of eye and the child will likely develop near sightedness. The solutions are remarkably simple. Respect your evolutionary background and allow your eyes to spontaneously alternate between looking at near and far objects while being upright (Schneider, 2016Peper, 2021Peper, Harvey & Faass, 2020).

Interrupt sitting disease

We sit for the majority of the day while looking at screens that is a significant risk factor for diabetes, cardiovascular disease, depression and anxiety (Matthews et al., 2012; Smith et al., 2020). Interrupt sitting by getting up every 30 minutes and do a few stretches. You will tend to feel less sleepy, less discomfort and more productive. As one of our participants reported that when he got up, moved and exercised every 30 minutes at the end of the day he felt less tired.  As he stated, “There is life after five”, which meant he had energy to do other activities after working at the computer the whole day. While working time flies and it is challenging to get up every 30 minutes.  Thus, install a free app on your computer that reminds you to get up and move such as StretchBreak (www.stretchbreak.com).

Use slouching as a cue to change

Posture affects thoughts and emotions as well as, vice versa. When stressed or worried (e.g., school performance, job security, family conflict, undefined symptoms, or financial insecurity), our bodies tend to respond by slightly collapsing and shifting into a protective position. When we collapse/slouch, we are more at risk to:

When stressed, anxious or depressed, it is challenging to change. The negative feelings, thoughts and worries continue to undermine the practice of reframing the experience more positively. Our recent study found that a simple technique, that integrates posture with breathing and reframing, rapidly reduces anxiety, stress, and negative self-talk (Peper, Harvey, Hamiel, 2019). When you are captured by helpless defeated thoughts and slouch, use the thought or posture as the trigger to take change.  The moment you are aware of the thoughts or slouched posture, sit up straight, look up, take a slow large diaphragmatic breath and only then think about reframing the problem positively (Peper, Harvey, Hamiel, 2019).

When we are upright and look up, we are more likely to:

The challenge is that we are usually unaware we have begun to slouch. A very useful solution is to use a posture feedback device to remind us, such as the UpRight Go (https://www.uprightpose.com/). This simple device and app signals you when you slouch. The device attaches to your neck and connects with blue tooth to your cellphone.  After calibrating, it provides vibrational feedback on your neck each time you slouch. When participants use the vibration feedback to become aware of what is going on and interrupt their slouch by stretching and sitting up, they report a significant decrease in symptoms and an increase in productivity. As one student reported: “Having immediate feedback on my posture helped me to be more aware of my body and helped me to link my posture to my emotions. Before using the tracker, doing this was very difficult for me. It not only helped my posture but my awareness of my mental state as well.”


[1] Adapted from the book by Erik Peper, Richard Harvey and Nancy Faass, TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics, North Atlantic Press.  https://www.penguinrandomhouse.com/books/232119/tech-stress-by-erik-peper-phd/ 

[2] Correspondence should be addressed to:

Erik Peper, Ph.D., Institute for Holistic Healing Studies/Department of Recreation, Parks, Tourism and Holistic Health, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA 94132   COVID-19 mailing address:  2236 Derby Street, Berkeley, CA 94705   Email: epeper@sfsu.edu  web: www.biofeedbackhealth.org  blog: www.peperperspective.com


Rest Rusts: Increase dynamic movement to improve health

In hunting and gathering cultures, alternating movement patterns was part of living and essential for health. This shift from dynamic movement to static or awkward positions is illustrated in Figure 1.  

Figure 1. The shift from dynamic movement to immobility and near vision as illustrated by the Hadzabe men in Tanzania returning from a hunt to our modern immobilized work and pleasure positions (Reproduced by permission from Peper, Harvey & Faass, 2020).

Dynamic movement promotes blood and lymph circulation and reduces static pressures.  At present times our work and leisure activities increase  immobility and static positions as we predominantly have shifted to a sitting immobilized position. This significantly increases musculoskeletal discomfort, cardiovascular disease, diabetes etc. The importance of movement as a factor to enhance health is illustrated in the recent findings of 2110 middle aged participants who were followed up for ten years.  Those who took approximately 7000 steps per day or more experienced significantly lower mortality rates compared with participants taking fewer than 7000 steps per day (Paluch et al., 2021). Just having the head forward while looking at the cellphone significantly increases the forces on the muscles holding the head up as illustrated in Figure 2.

Figure 2. The head-forward position puts as much as sixty pounds of pressure on the neck muscles and spine (reproduced by permission from Dr. Kenneth Hansaraj, 2014).

For background and recommendations on what how to reduce static positions, look at our book, TechStress-How technology is hijacking our lives, strategies for coping and pragmatic ergonomics. and the superb article, Static postures are harmful – dynamic postures at work are key to musculoskeletal health, published by the European Agency for Safety and Health at Work (EU-OSHA, Sept 16, 2021) and reproduced below.

Static postures are harmful – dynamic postures at work are key to musculoskeletal health

Our bodies are built for movement – it’s a central part of maintaining a healthy musculoskeletal system and the less we move, the more chance we have of developing health issues including musculoskeletal disorders (MSDs), type 2 diabetes, cardiovascular disease, cancer and more. However, the negative effects of sedentary work can be mitigated by paying attention to the postures we adopt when we work.

Whether workers are standing or seated while working, maintaining a good ergonomic posture is essential when it comes to preventing MSDs. Poor or awkward postures put unnecessary strain on the musculoskeletal system and, over time, can cause the deterioration of muscle fibres and joints.

Poor or awkward postures include those which involve parts of the body not being in their natural position. More muscular effort is needed to maintain unnatural postures, which increases the energy used by the body and can cause fatigue, discomfort and pain. Unnatural postures also put strain on tendons, ligaments and nerves, which increases the risk of injury. For example, the risk of neck pain increases when the neck is rotated more than 45 degrees for more than 25% of the working day.

These postures, including slouching, rotation of the forearms, or prolonged periods of sitting or standing in the same spot, can cause pain in the lower back and upper limbs. The risk increases when combined with repetitive work, static muscle load, or the need to apply force or reach. And even natural or good postures maintained for any length of time become uncomfortable and eventually painful. Everyone has experienced stiffness after being in the same position for any length of time.

What do we mean by ‘good posture’?

For workers, especially those in sedentary jobs such as office work, factory work or driving, it is important to recognise and adopt good postures. A good posture should be comfortable and allow the joints to be naturally aligned. The segments of our body can be divided into three cross-sectional anatomical planes: the sagittal plane, which concerns bending forwards and backwards; the frontal plane, which concerns bending sideways; and finally the transverse plane, which refers to rotation or twisting of the body parts. A good posture is one that ensures that all three of these planes are set at neutral positions as much as possible, in that the worker is not leaning backwards, forwards or to any particular side, and their limbs and torso are not rotated or twisted. Adopting neutral postures will help to lessen the strain on the worker’s muscles, tendons and skeletal system, and reduces the risk of them causing or aggravating an MSD.

In practice, workers can consider the following checklist to ensure that they’re standing or sitting in a neutral position:

  • Keep the neck vertical and the back in an upright position.
  • Ensure the elbows are below the chest and avoid having to reach excessively.
  • Keep the shoulders relaxed and use back and arm rests where possible and ensure that they are adjusted to the size and shape of the worker.
  • Avoid rotating the forearms or excessively moving the wrists.
  • Ensure that any work tools can be held comfortably, and that clothing doesn’t restrain or prevent movement.
  • Allow room to comfortably move the legs and feet and avoid frequent kneeling or squatting.
  • Ensure that long periods of standing or sitting in the same posture can be broken up.

Employers can assist workers in adopting good postures by communicating checklists such as this one, and by promoting physical activity where possible, encouraging the fair rotation of tasks between employees to avoid them consistently making repetitive movements, and ensuring that workers have the capacity to take regular breaks.

Why our next posture is the best posture

However, maintaining a good posture at all times is not enough to reduce the risk of MSDs, and can even be harmful. Static postures, even if ergonomic, are still a risk factor if over-used. Our body requires movement and variety, which is why the best approach is to use a variety of ergonomic postures in rotation, breaking up long periods of static working with stretching, exercise, and movement. This is known as adopting dynamic positions’.

It is important not only for workers who spend much of their day seated, but also for workers who primarily stand – such as factory workers in assembly lines. In both cases, sitting and standing are not opposites. The opposite of both is movement. Changing postures between sitting and standing is not sufficient for any worker – the working environment must still offer ways of varying their postures and incorporating movement into their daily working routines. What’s more, if standing work cannot be avoided, workers do not need lots of space in order to adopt dynamic positions in a healthy way. Blood flow propulsion mechanisms can still work correctly even if the worker is only moving around in one square metre. However it is still the case that they should have a break after 30 minutes of standing.

Work should therefore not only facilitate good postures, but ensure that good, ergonomic postures are also dynamic. Switching between sitting, standing and moving while ensuring that the musculoskeletal frame is not under any unnecessary tension can help sedentary workers avoid the onset of MSDs and other health problems. For more information visit the priority area on sedentary work.

References

EU-OSHA. (September 16, 2021). Static postures are harmful – dynamic postures at work are key to musculoskeletal health. https://healthy-workplaces.eu/en/media-centre/news/static-postures-are-harmful-dynamic-postures-work-are-key-musculoskeletal-health?

Hansraj, K. K. (2014).  Assessment of Stresses in the Cervical Spine Caused by Posture and Position of the Head. Surgical Technology International, 25, 277–79. https://pubmed.ncbi.nlm.nih.gov/25393825/

Paluch, A.E., Gabriel, K.P., Fulton, J.E., et al.(2021). Steps per Day and All-Cause Mortality in Middle-aged Adults in the Coronary Artery Risk Development in Young Adults Study. JAMA Netw Open, 4(9):e2124516. https://doi.org/10.1001/jamanetworkopen.2021.24516

Peper, E., Harvey, R. & Faass, N. (2020). TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics. Berkeley: North Atlantic books. https://www.penguinrandomhouse.com/books/232119/tech-stress-by-erik-peper-phd/ 


Reactivate your second heart

Monica Almendras and Erik Peper

Adapted from: Almendras, M. & Peper, E. (2021). Reactivate your second heart. Biofeedback, 49(4), 99-102. https://doi.org/10.5298/1081-5937-49.04.07

Have you ever wondered why after driving long distances or sitting in a plane for hours your feet and lower leg are slightly swollen (Hitosugi, Niwa, & Takatsu, 2000)? It is the same process by which soldiers standing in attention sometimes faint or why salespeople or cashiers, especially those who predominantly stand most of the day, have higher risk of developing varicose veins.  By the end of the day, they feel that their legs being heavy and tired?  In the vertical position, gravity is the constant downward force that pools venous blood and lymph fluid in the legs. The pooling of the blood and reduced circulation is a contributing factor why airplane flights of four or more hours increases the risk for developing blood clots-deep vein thrombosis (DVT) (Scurr, 2002; Kuipers et al., 2007).  When blood clots reaches the lung, they can cause a pulmonary embolisms that can be fatal. In other cases, they may even travel to the brain and cause strokes.[1]  

Sitting without moving the leg muscles puts additional stress on your heart, as the blood and lymph pools in the legs. Tightening and relaxing the calf muscles can prevent the pooling of the blood.  The inactivity of your calf muscles does not allow the blood to flow upwards. The episodic contractions of the calf muscles squeezes the veins and pumps the venous blood upward towards the heart as illustrated in figure 1.  Therefore, it is important to stand, move, and walk so that your calf muscle can act as a second heart (Prevosti, April 16, 2020). 

Figure 1. Your calf muscles are your second heart! The body is engineered so that when you walk, the calf muscles pump venous blood back toward your heart. Reproduced by permission from Dr. Louis Prevosti of the Center for Vein Restoration (https://veinatlanta.com/your-second-heart/).

To see the second heart in action watch the YouTube video, Medical Animation Movie on Venous Disorders, by the Sigvaris Group Europe (2017).

If you stand too long and experienced slight swelling of the legs, raise your feet slightly higher than the head, to help drain the fluids out of the legs.  Another way to reduce pooling of fluids  and prevent blood clots and edema is to wear elastic stockings or wrap the legs with intermittent pneumatic compression (IPC) devices that periodically compresses the leg (Zhao et al., 2014). You can also do this by performing foot rotations or other leg and feet exercises. The more the muscle of the legs and feet contract and relax, the more are the veins episodically compressed which increases venous blood return.  Yet in our quest for efficiency and working in front of screens, we tend to sit for long time-periods.

Developing sitting disease

Have you noticed how much of the time you sit during the day? We sit while studying, working, socializing and entertaining in front of screens. This sedentary behavior has significantly increased during the pandemic (Zheng et al, 2010). Today, we do not need to get up because we call on Amazon’s Alexa, Apple’s Siri or Google’s Hey Google to control timers, answer queries, turn on the lights, fan, TV, and other home devices. Everything is at our fingertips and we have finally become The Jetsons without the flying cars (an American animated sitcom aired in the 1960s). There is no need to get up from our seat to do an activity. Everything can be controlled from the palm of our hand with a mobile phone app. 

With the pandemic, our activities involve sitting down with minimum or no movement at all. We freeze our body’s position in a scrunch–a turtle position–and then we wonder why we get neck, shoulder, and back pains–a process also observed in young adults or children. Instead of going outside to play, young people sit in front of screens. The more we sit and watch screens, the poorer is our mental and physical health (Smith et al., 2020Matthews et al., 2012). We are meant to move instead of sitting in a single position for eight or more hours while fixating our attention on a screen.

The visual stimuli on screen captures our attention, whether it is data entry, email, social media, or streaming videos (Peper, Harvey & Faass, 2020).  While at the computer, we often hold up our index finger on the mouse and wait with baited breath to react.  Holding this position and waiting to click may look harmless; however, our right shoulder is  often elevated and raised upward towards our ear. This bracing pattern is covert and contributes to the development of discomfort. The moment your muscles tighten, the blood flow through the muscle is reduced (Peper, Harvey, & Tylova, 2006). Muscles are most efficient when they alternately tighten and relax. It is no wonder that our body starts to scream for help when feeling pain or discomfort on our neck, shoulders, back and eyes.

Why move?

Figure 2a and 2b Move instead of sit (photos source: Canva.com).

The importance of tightening and then relaxing muscles is illustrated during walking.  During the swing phase of walking, the hip flexor muscles relax, tighten, relax again, tighten again, and this is repeated until the destination is reached. It is important to relax the muscles episodically for blood flow to bring nutrients to the tissue and remove the waste product.  Most people can walk for hours; however, they can only lift their foot from the floor (raise their leg up for a few minutes) till discomfort occurs. 

Movement is what we need to do and play is a great way to do it. Dr. Joan Vernikos (2016) who conducted seminal studies in space medicine and inactivity physiology investigated why astronauts rapidly aged in space and lost muscle mass, bone density and developed a compromised immune system. As we get older, we are hooked on sitting, and this includes the weekends too. If you are wondering how to separate from your seat, there are ways to overcome this. In the research to prevent the deterioration caused by simulating the low gravity experience of astronauts, Dr. Joan Vernikos (2021) had earthbound volunteers lie down with the head slightly lower than the feet on a titled bed. She found that standing up from lying down every 30-minutes was enough to prevent the deterioration of inactivity, standing every hour was not enough to reverse the degeneration.  Standing stimulated the baroreceptors in the neck and activated a cardiovascular response for optimal health (Vernikos, 2021).

We have forgotten something from our evolutionary background and childhood, which is to play and move around.  When children move around, wiggle, and contort themselves in different positions, they maintain and increase their flexibility. Children can jump and move their arms up, down, side to side, forward, and backward. They do this every day, including the weekends.

When was the last time you played with a child or like a child? As an adult, we might feel tired to play with a child and it can be exhausting after staring at the screen all day. Instead of thinking of being tired to play with your child, consider it as a good workout. Then you and your child bond and hopefully they will also be ready for a nap. For you, not only do you move around and wake up those muscles that have not worked all day, you also relax the tight muscles, stretch and move your joints. Do playful activities that causes the body to move in unpredictable fun ways such as throwing a ball or roleplaying being a different animal. It will make both of you smile–smiling helps relaxation and rejuvenates your energy.

It is not how much exercise you do, it is how long you sit.  The longer you sit without activating your second heart the more are you at risk for cardiovascular disease and diabetes independent of how much exercise you do (Bailey et al., 2019).

Use it or lose it! Activate your calves!

  • Interrupt sitting at your desk/computer every 30-minutes by getting up and walking around.
  • Stand up and walk around when using your phone.
  • Organize walking meetings instead of sitting around a table.
  • Invest in a sit-stand desk while working at the computer.  While working, alternate positions. There should be a balance between standing and sitting, because too much of one can lead to problems. By taking a short standing up break to let your blood pump back to the heart is beneficial to avoid health problems. Exercise alone, a fancy new ergonomic chair or expensive equipment is not enough to be healthy, it is important to add those mini breaks in between (Buckley et al, 2015).

For a holistic perspective to stay healthy while working with computers and cellphones, see the comprehensive book by Peper, Harvey and Faass (2020), TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics.

References

Bailey, D.P., Hewson, D.J., Champion, R.B., & Sayegh, S.M. (2019). Sitting Time and Risk of Cardiovascular Disease and Diabetes: A Systematic Review and Meta-Analysis, American Journal of Preventive Medicine, 57(3), 408-416.

Buckley, J.P., Hedge, A., Yates, T., et al. (2015). The sedentary office: an expert statement on the growing case for change towards better health and productivity British Journal of Sports Medicine, 49, 1357-1362.

Hitosugi, M., Niwa, M., & Takatsu, A. (2000). Rheologic changes in venous blood during prolonged sitting. Thromb Res.,100(5), 409–412.

Kuipers, S., Cannegieter, S.C., Middeldorp, S., Robyn, L., Büller, H.R., & Rosendaal, F.R. (2007) The Absolute Risk of Venous Thrombosis after Air Travel: A Cohort Study of 8,755 Employees of International Organisations, PLoS Med 4(9): e290.

Mahase, E. (2021). Covid-19: Unusual blood clots are “very rare side effect” of Janssen vaccine, says EMA. BMJ: 373:n1046. 

Matthews, C.E., George, S.M., Moore, S.C., et al. (2012). Amount of time spent in sedentary behaviors and cause-specific mortality in US adults. Am J Clin Nutr, 95(2), 437-445. 

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[1] We even wonder if excessive sitting during the COVID-19 pandemic is a hidden risk factor of the rare negative side effects of blood clots in the brain, that can occur with the  AstraZeneca and Johnson and Johnson coronavirus vaccine (Mahase, 2021).


Are you encouraging your child to get into accidents or even blind when growing up?

Erik Peper and Meir Schneider

Adapted in part from: TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics by Erik Peper, Richard Harvey and Nancy Faass   

As a young child I laid on the couch and I read one book after the other.  Hours would pass as I was drawn into the stories. By the age of 12 I was so nearsighted that I had to wear glasses.  When my son started to learn to read, I asked him to look away at the far distance after reading a page. Even today at age 34, he continues this habit of looking away for a moment at the distance after reading or writing a page.  He is a voracious reader and a novelist of speculative fiction. His vision is perfect. –Erik Peper

How come people in preliterate, hunting and gatherer, and agricultural societies tend to have better vision and very low rates of nearsightedness (Cordain et al, 2003)? The same appear true for people today who spent much of their childhood outdoors as compared to those who predominantly stay indoors. On the other hand, how come 85% of teenagers in Singapore are myopic (neasighted) and how come in the United States myopia rate have increased for children from 25% in the 1970s to 42% in 2000s (Bressler, 2020; Min, 2019)? 

Why should you worry that your child may become nearsighted since it is easy correct with contacts or glasses?   Sadly, in numerous cases, children with compromised vision and who have difficulty reading the blackboard may be labeled disruptive or having learning disability. The vision problems can only be corrected if the parents are aware of the vision problem (see https://www.covd.org/page/symptoms for symptoms that may be related to vision problems). In addition, glasses may be stigmatizing and  children may not want to wear glasses because of vanity or the fear of being bullied.

The recent epidemic of near sightedness is paritally a result of disrespecting our evolutionary survival patterns that allowed us to survive and thrive. Throughout human history, people continuously alternated by looking nearby and at the distance.  When looking up close, the extraocular muscles contract to converge the eyes and the ciliary muscles around the lens contract to increase the curvature of the lens so that the scene is in focus on the retina — this muscle tension creates near visual stress.

The shift from alternating between far and near vision to predominantly near vision and immobility

Figure 2. The traditional culture of Hdzabe men in Tanzania returning from a hunt. Notice how upright they walk and look at the far distance as compared to young people today who slouch and look predominantly  at nearby screens.

Experience the effect of near visual stress. 

Bring your arm in front of you and point your thumb up.  Look at your thumb on the stretched out arm.  Keep focusing on the thumb and slow bring the thumb four inches from your nose.  Keep focusing on the thumb for a half minute.  Drop the arm to the side, and look outside at the far distance.

What did you experience? Almost everyone reports feeling tension in the eyes and a sense of pressure inside around and behind their eyes.  When looking at the distance, the tension slowly dissipates.  For some the tension is released immediately while for others it may take many minutes before the tension disappears especially if one is older. Many adults experience that after working at the computer, their distant vision is more fuzzy and that it takes a while to return to normal clarity.

When the eyes focus at the distance, the ciliary muscles around lens relaxes so that the lens can flatten and the extra ocular muscles relax so that the eyes can diverge and objects in the distance are in focus.  Healthy vision is the alternation between near and far focus– an automatic process by which the muscles of the eyes tightening and relax/regenerate.

Use develops structure and structure limits use

If we predominantly look at nearby surfaces, we increase near visual stress and the risk of developing myopia. As children grow, the use of their eyes will change the shape of the eyeball so that the muscles will have to contract less to keep the visual object into focus.  If the eyes predominantly look at near objects, books, cellphones, tablets, toys, and walls in a room where there is little opportunity to look at the far distance, the eye ball will elongate and the child will more likely become near sighted. Over the last thirty year and escalated during COVID’s reside-in-place policies, children spent more and more time indoors while looking at screens and nearby walls in their rooms. Predominantly focusing on nearby objects starts even earlier as parents provide screens to baby and toddlers to distract and entertain them. The constant near vision remodels the shape of eye and the child will  likely develop near sightedness.  

Health risks of sightedness and focusing predominantly upon nearby objects

  • Increased risk of get into an accident as we have reduced peripheral vision.  In earlier times if you were walking in jungle, you would not survive without being aware of your peripheral vision. Any small visual change could indicate the possible presence food or predator, friend or foe.  Now we focus predominantly centrally and are less aware of our periphery. Observe how your peripheral awareness decreases when you bring your nose to the screen to see more clearly.  When outside and focusing close up the risk of accidents (tripping, being hit by cars, bumping into people and objects) significantly increases as shown in figure 3 and illustrated in the video clip.

Pedestrian accidents (head forward with loss of peripheral vision)

Figure 3. Injuries caused by cell phone use per year since the introduction of the smartphone (graphic from Peper, Harvey and Faass,2020; data source: Povolatskly et al., 2020).

Source: https://media.giphy.com/media/308cQ2vXnA5X8Ou3jo/giphy.mp4
  • Myopia increases the risk of eye disorder. The risk for glaucoma, one the leading causes of blindness, is doubled (Susanna, De Moraes, Cioffi, & Ritch, R. 2015). The excessive tension around the eyes and ciliary muscles around the lens can interfere with the outflow of the excess fluids of the aqueous humour through the schlemm canal and may compromise the production of the aqueous humour fluid. These canals are complex vascular structures that maintains fluid pressure balance within the anterior segment of the eye. When the normal outflow is hindered it would contribute to elevated intraocular pressure and create high tension glaucoma (Andrés-Guerrero, García-Feijoo,  & Konstas, 2017).  Myopia also increases the risk for retinal detachment and tears, macular degeneration and cataract. (Williams & Hammond, 2019).

By learning to relax the muscles around the lens, eye and face and sensing a feeling of soft eyes, the restriction around the schlemm canals is reduced and the fluids can drain out easier and is one possible approach to reverse glaucoma (Dada et al., 2018; Peper, Pelletier & Tandy, 1979).

WHAT CAN YOU DO?

The solutions are remarkable simple. Respect your evolutionary background and allow your eyes to spontaneously alternate between looking at near and far objects while being upright (Schneider, 2016; Peper, 2021; Peper, Harvey & Faass, 2020).

For yourself and your child

  • Let children play outside so that they automatically look far and near.
  • When teaching children to read have them look at the distance at the end of every paragraph or page to relax the eyes.
  • Limit screen time and alternate with outdoor activities
  • Every 15 to 20 minutes take a vision break when reading or watching screens.  Get up, wiggle around, move your neck and shoulders, and look out the window at the far distance.
  • When looking at digital screens, look away every few minutes. As you look away, close your eyes for a moment and as you  are exhaling gently open your eyes.
  • Practice palming and relaxing the eyes. For detailed guidance and instruction see the YouTube video by Meir Schneider.

Create healthy eye programs in schools and work

  • Arrange 30 minute lesson plans and in between each lesson plan take a vision and movement breaks. Have children get up from their desks and move around.  If possible have them look out the window or go outside and describe the furthest object they can see such as the shape of clouds, roof line or details of the top of trees.
  • Teach young children as they are learning reading and math to look away at the distance after reading a paragraph or finishing a math problem.
  • Teach palming for children.
  • During recess have students play games that integrate coordination with vision such as ball games.
  • Episodically, have students close their eyes, breathe diaphragmatically and then as they exhale slowly open their eyes and look for a moment at the world with sleepy/dreamy eyes.
  • Whenever using screen use every opportunity to look away at the distance and for a moment close your eyes and relax your neck and shoulders.

BOOKS TO OPTIMIZE VISION AND TRANSFORM TECHSTRESS INTO TECHHEALTH

Vision for Life, Revised Edition: Ten Steps to Natural Eyesight Improvement by Meir Schneider.

TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics by Erik Peper, Richard Harvey and Nancy Faass   

YOUTUBE PRESENTATION, Transforming Tech Stress into Tech Health.

ADDITIONAL BLOGS THAT FOCUS ON RESOLVING EYES STREAN AND TECHSTRESS

REFERENCES

Andrés-Guerrero, V., García-Feijoo, J., & Konstas, A.G. (2017). Targeting Schlemm’s Canal in the Medical Therapy of Glaucoma: Current and Future Considerations. Adv Ther, 34(5), 1049-1069.

Bressler, N.M. (2020). Reducing the Progression of Myopia. JAMA, 324(6), 558–559.

Chen, S. J., Lu, P., Zhang, W. F., & Lu, J. H. (2012). High myopia as a risk factor in primary open angle glaucoma. International journal of ophthalmology5(6), 750–753.

Cordain, L.,  Eaton, S.B., Miller, J. B., Lindeberg, S., & Jensen, C. (2003). An evolutionary analysis of the aetiology and pathogenesis of juvenile‐onset myopia. Acta Ophthalmologica Scandinavica, 80(2), 125-135.

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Harvey, R., Peper, E., Booiman, A., Heredia Cedillo, A., & Villagomez, E. (2018). The effect of head and neck position on head rotation, cervical muscle tension and symptoms. Biofeedback. 46(3), 65–71.

Min, L.P. (2019). Speech by Dr. Lam Pin Min, Senior Minister of State for Health, Singapore, at the opening of the Sangapore National Eye Centre’s Myopia Center, 16 August, 2019.

Peper, E. (2021). Resolve eyestrain and screen fatigue. Well Being Journal, 30(1), 24-28.

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Peper, E., Harvey, R. & Faass, N. (2020). TechStress: How Technology is Hijacking Our Lives, Strategies for Coping, and Pragmatic Ergonomics. Berkeley: North Atlantic Books.

Peper, E., Lin, I-M., Harvey, R., & Perez, J. (2017). How posture affects memory recall and mood.  Biofeedback.45 (2), 36-41.

Peper E., Pelletier K.R., Tandy B. (1979) Biofeedback Training: Holistic and Transpersonal Frontiers. In: Peper E., Ancoli S., Quinn M. (eds) Mind/Body Integration. Springer, Boston, MA.

Povolotskiy, R., Gupta, N., Leverant, A. B., Kandinov, A., & Paskhover, B. (2020). Head and Neck Injuries Associated With Cell Phone Use. JAMA Otolaryngology–Head & Neck Surgery, 146(2), 122-127.

Schneider, M. (2016). Vision for Life, Revised Edition: Ten Steps to Natural Eyesight Improvement. Berkeley, CA: North Atlantic Books.

Schneider, M. (2019). YouTube video Free Webinar by Meir Schneider: May 6, 2019.

Susanna, R., Jr, De Moraes, C. G., Cioffi, G. A., & Ritch, R. (2015). Why Do People (Still) Go Blind from Glaucoma?. Translational vision science & technology4(2), 1.

Williams, K., & Hammond, C. (2019). High myopia and its risks. Community eye health32(105), 5–6.