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.    


Hope for insomnia, depression, anxiety, ADHD, exhaustion, and nasal congestion -Breathe light, slow and deep

Anxiety, depression, insomnia, exhaustion, ADHD, allergies, poor performance have all increased (Barendse et al., 2021; London & Landes, 2021; Peper et al, 2022a; Peper et al, 2022b; Vasileiadou et al, 2021). One of the unrecognized contributing factor is dysfunctional mouth breathing (McKeown, 2022). Improve health by learning to breathe in and out through the nose during the day and night. Listen to the inspiring presentation by Patrick McKeown, author of the superb book, The breathing cure-Develop  new habits for a healthier, happier & long life (McKeown, 2022). In this presentation, he describes the science behind these disorders, the rationale for breathing light, slow and deep and offers simple breathing exercises to reduce symptoms and improve performance.

References

Barendse, M., Flannery, J., Cavanagh, C., Aristizabal, M., Becker, S. P., Berger, E., … & Pfeifer, J. (2021). Longitudinal change in adolescent depression and anxiety symptoms from before to during the COVID-19 pandemic: A collaborative of 12 samples from 3 countries. https://doi.org/10.31234/osf.io/hn7us

London, A.S. & Landes, S.D. (2021). Cohort Change in the Prevalence of ADHD Among U.S. Adults: Evidence of a Gender-Specific Historical Period Effect.  Journal of attention disorders, 25(6), 771-782. https://doi.org/10.1177/1087054719855689

McKeown, P. (2022). The breathing cure-Develop  new habits for a healthier, happier & long life.  West Palm Beach, FL: Humanix Books.

Peper, E. (2022). Reduce anxiety. the peperperspective. https://peperperspective.com/2022/03/23/reduce-anxiety/

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

Vasileiadou, S., Ekerljung, L., Bjerg, A., & Goksor, E. (2021). Asthma increased in young adults from 2008–2016 despite stable allergic rhinitis and reduced smoking. PLoS ONE, 16(6): e0253322. https://doi.org/10.1371/journal.pone.0253322    


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.


Support the healing process: Be a gardener not a mechanic

Six years ago, I had a bilateral hernia repair, the surgeon was highly recommended and recognized as an expert in his field. Although the surgery was a mechanical success, the failure of the post-operative care resulted in severe urinary retention, multiple emergency room visits, and ongoing urinary difficulties. Six weeks after the surgery, I was still lugging a Foley catheter with a leg collection bag that drained my bladder. The surgeon had stated I could be back doing physical activities with a week (Peper, 2019).   From my perspective the surgeon was a mechanic and not a gardener. The moment the mechanical structure was fixed in surgery, he had completed his work even if post-surgical complications arose.

Being a mechanic in medicine is an important role. The concept of being a mechanics is not limited to surgery, it can be applied to any treatment strategy when the practitioner focuses narrowly only on the presenting issue. A broken bone > align and put on a cast; hip pain due to the breakdown of cartilage > hip replacement surgery; depression > prescribe antidepressant medication; diabetes > prescribe medications to reduce blood sugar; hypertension > -prescribe anti-hypertensive medication; pain > prescribe opioids, etc. In many cases, healing is much more than mechanical interventions, it often includes post-operative care, exploring factors that may have contributed to disease onset, and retraining such as ongoing physical therapy for hip replacement surgery or teaching stress management, exercise, diet and lifestyle changes for people with diabetes.

Much of healing, especially for the treatment of chronic conditions, needs  much more than a mechanical intervention.  For example, type 2 diabetes, depression, or hypertension are triggered and maintained to a large extent by socio-economics inequalities and stressful lifestyles. Treatment needs to focus on healing and reduce the factors that created or now maintains the illness and support those factors that enhance healing.  This is similar to the role of a gardener.  Once planted, a successful gardener needs to be aware of, and support, all the factors that facilitate the plants growth (enough sunlight at the right time, appropriate watering and fertilizer, soil conditions, etc.). 

These concepts are discussed in the superb article by Gavin Francis, MD and seminal book by Wayne Jonas, MD that describes how medicine needs to change and incorporate an holistic perspective to support and nurture the healing process.

Superb article by Gavin Francis, MD:  ‘We need to respect the process of healing’: a GP on the overlooked art of recovery. (Francis, 2022)

Seminal book by Wayne Jonas, MD: How healing works (Jonas, 2018).

Additional resource to optimize health and healing when needing surgery

References

Gavin, F. (2022). ‘We need to respect the process of healing’: a GP on the overlooked art of recovery. The Guardian. https://www.theguardian.com/world/2022/jan/04/we-need-to-respect-the-process-of-healing-a-gp-on-the-overlooked-art-of-recovery

Jonas, W. (2018). How healing works. New York: Lorena Jones Books

Peper, E. Surviving and preventing medical errors. (2019). Townsend Letter-The Examiner of Alternative Medicine. 429, 63-69. https://www.townsendletter.com/article/429-surviving-and-preventing-medical-errors/


Healing from paralysis-Music (toning) to activate health

Madhu Anziani and Erik Peper

In April 2009, Madhu Anziani, just one month prior to graduation from San Francisco State University with a degree in Jazz/World music performance, fell two stories and broke C5 and C7 vertebras.  He became a quadriplegic (tretraplegia) and could not breathe, talk, move his arms and legs and was incontinent.  He also could not remember anything about the accident because of retrograde amnesia.  Even though he was paralyzed and the medical staff suggested that he focussed on how to live well as a quadriplegic, he transcended his paralysis and the prognosis and is now a well-known vocal looping arts and ceremonial song leader/composer.

His recovery against all odds provides hope that growth and healing is possible when the mind and spirit focus on possibilities and not on limitations.  Alongside physical thereapy he utilized energy healing and toning/sound vibrations to recover mobility.  Toning, the vocalization of an elonggated monotonous vowel sound susteained for a number of minutes tends to vibrate specific areas in the body where the chakras are located (Crowe & Scovel, 1996; Goldman, 2017). Toning compared to mindfulness meditation reduces intrusive thoughts and mind wandering. It also increases body vibration sensations and heart rate variability much more than mindfulness practice (Peper et al, 2019). The body vibrations induced by toning and music could be one of the mechanisms by which recovery can occur at an accelerated rate as it allows the person’s passive awareness and sustained attention to feel the paralyzed body and yet be relaxed in the present without judgement.   

Watch Madhu’s inspirational presentation as part of the Holistic Health Lecture Series by the Institute for Holistic Health Studies, San Francisco State University. In this presentation, he describes the process of recovery and guides the viewer through toning practices to evoke quieting of mind, bliss within the heart, and a healing state of being.

For an additional discussion and guided practice in toning, see the blog, Toning quiets the mind and increases HRV more quickly than mindfulness practice.

Madu Anziani is a sound healer who endured being a tetraplegic (paralysis affecting all four
limbs) and used sound and energy healing to recover mobility. He is a SFSU graduate and most
well-known as a vocal looping artist and ceremonial song leader/composer.

http://www.firstwasthesound.com

http://madhu.bandcamp.co

REFERENCES:

Crowe, B.J. & Scovel, M. (1996). An Overview of Sound Healing Practices: Implications for the Profession of Music Therapy, Music Therapy Perspectives, 14(1), 21-29.

Goldman, J. (2017). The 7 Secrets of Sound Healing. Carlsbad, CA: Hay House Inc.

Peper, E., Pollack, W., Harvey, R., Yoshino, A., Daubenmier, J. & Anziani, M. (2019). Which quiets the mind more quickly and increases HRV: Toning or mindfulness? NeuroRegulation, 6(3), 128-133.


Digital fatigue and what to do

Erik Peper, PhD and Monica Almendras

The article was adapted from the recent book, How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics, and was originally published on the Big Q  https://www.thebigq.org/2021/08/02/why-do-we-have-zoom-fatigue-and-what-can-we-do-about-it/

Why is it that after studying, working, entertaining and socializing at the computer screen or looking at texts, Instagram, Facebook, Tiktok or responding to notifications on the cellphone, we often feel exhausted (zoom fatigue) and experience neck, back and shoulders discomfort, or eye irritation? Time disappears as we surf the web and go down the rabbit hole by clicking on one and then another link or responding to social media. As time flies, we tend to be unaware that our muscles tighten, our breathing become shallow and quicker, our blinking rates decreases and our posture slouches forward as we bring our nose close to the screen to see the text more clearly.

Become aware what happens when you do the following experiential practices

Observe what happens when you mouse

Sit comfortable in an erect posture as if you are in front of your computer and hold a small object that you can use to simulate mousing to the side of the keyboard. With an actual mouse (or the sham mouse), pretend to draw the letters of your name and your street address backward, right to left. Be sure each letter is very small (less than half an inch in height). After drawing each letter, right click. Draw the letters and numbers as quickly as possible without making any mistakes for fifteen seconds.  Stop and observe what happened in your body.

If you are like almost all participants you tightened your neck and shoulders, stiffened your trunk, held your breath and most did not blink.  All this occurred without awareness. Over time, this covert tension can contribute to discomfort, soreness, pain, or eventual injury.

Observe the effect of low static muscle tension

You probably felt discomfort in the muscles of your hip.  As you lifted your knee up, you most likely also held your breath and tightened your neck and back.  Holding your muscles in a static position for more than a few minutes creates discomfort. Yet, when you walk you use the same muscles and usually do not experience discomfort.  The main difference is that during walking you sequentially tighten and relax these muscles. Each time the muscle relaxes, blood flow is restored to remove the waste produces of metabolism and supply nutrients and oxygen to the muscle tissue. For more information, see the blog, Reactivate your second heart.

From the evolutionary perspective, people typically shifted between sitting, walking, and moving in varied ways during specified forms of labor which tends to tighten and relax different muscles.  Therefore, incorporate dynamic movement’ during the day: Stand up, wiggle and move several times an hour. To avoid sitting disease, install a break reminder program such as StretchBreak on your computer or other digital devices.  When people implement taking breaks, they report having much more energy at the end of the day.  As one participant stated: “There is now life after five”.  What he meant was that at the end of the day when he got home, he still had energy to other things.

Observe how breathing and opening eyes affect tearing

Inhale with a gasp as you open your eyes. Close your eyes, then exhale and inhale with a gasp as if you are surprised and at the same time open your eyes then look as if you are quickly responding to a notification. Repeat one or two time and be sure to open your eyes wide the moment you gasp as you inhale

Exhale and slowly open your eyes. Close your eyes, then inhale by allowing your abdomen to expand and begin exhaling and slowly open your eyes. Repeat one or two more times as you open your eyes midway through the exhalation, while your shoulders relax. What did you experience?

Most likely when you opened your eyes while exhaling you found that your eyes felt more relaxed with more tearing moisture in the eyes, while gasping and looking the eyes felt tense and more dry.  In most cases when we focus without awareness intensely at the screen we create eye tension. Thus, practice blinking by resting and closing your eyes then gently open your eyes as you exhale and then looking at the far distance relax the muscles of the eyes. For detailed instructions see the blog, Are you encouraging your child to get into accidents or even blind when growing up?

We are usually unaware that our bodies respond automatically and that these patterns occur covertly and totally without awareness while working at the computer or responding to texts. We only notice when symptoms of discomfort occur. Fortunately, it is possible to monitor the degree of muscle tension with an electromyograph (EMG).  The unaware muscle tension can be identified by physiological recording of the electrical activity produced when they contract.  With biofeedback and coaching people can learn to become aware of the covert tension and as shown in Figure 1.

Figure 1. A representative recording of a person working at the computer. Note the following: 1) forearm and shoulder (deltoid/trapezius) muscle tension increased as the person rests her hands on the keyboard without typing; 2) respiration rate increased during typing and mousing; 3) shoulder muscle tension increased during typing and mousing; and, 4) there were no rest periods in the shoulder muscles as long as the fingers are either resting, typing, or mousing. Reproduced by permission from Peper & Harvey, 2008.

Even though the physiological recording showed increase tension when the hands were resting on the keyboard, the person reported being relaxed.  The person was also not aware that her neck and shoulder muscles stayed contracted without any momentary rest and recovery periods nor that her breathing rate and heart rate significantly increased.  The covert muscle activity and shallow breathing will also interact with the person’s stress level, as well as ergonomic equipment use and the posture throughout the day.  Similarly, we tend to be unaware that we slouch which would increase neck and back tension as well as, affect breathing as illustrated in figure 2. 

Figure 2. The effect of slouching on neck and shoulder muscle tension and breathing. Reproduced by permission from Peper, E., Harvey, R. and Faass, N. (2020). TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics, Berkeley, CA. North Atlantic Books.

Maintaining and optimizing health at the computer means re-envisioning our relationship with technology—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. A typical thing to do on our devices is to click on one hyperlink after the other and create a vicious cycle in which we are trapped for hours until we realize we need to move. As we do this, we are unaware how much time has frittered away without actually doing anything productive and then, we realize we have wasted another day.

Transform digital fatique into digital health (adapted from https://news.sfsu.edu/news-story/professors-share-tips-healthy-tech-usage-during-pandemic)

Get up and move                              

About every 20 minutes, stand up and move your body. Consider doing a quick dance to a favorite song or taking a walk around the block. “It will feel silly, yet actively moving is one of the quickest energizers,” Stretching and moving will also relax those muscles that you tense constantly when working at a desk. Think you’ll forget to take a break? Install the free Stretch Break app as a great tool to remind you. For more background information, see the blog, Sitting disease is the new health hazard.

Blink and look far off

Our blinking rate significantly decreases while looking at a screen, which contributes to eye strain. A good way to address this is by blinking every time you click on a hyperlink or after you finish typing a paragraph. To relax the eyes, look at the far distance. “Looking out into the distance disrupts constant near-focus muscle tension in the eyes.” For more suggestions, see the blog, Resolve Eyestrain and Screen Fatigue.

Avoid phones and screens right before bed

Many people use their phones before bed, which can make it more difficult to sleep. Take a break from your phone half an hour or more before bedtime. Electronic screens emit blue light, which can send a signal to your brain that it’s daytime. This suppresses your body’s production of the hormone melatonin, which helps your body know when it’s time to sleep. In addition, keeping up with social media and watching digital media tends to be thought-provoking or anxiety-inducing may stimulate the mind and promote wakefulness. For more suggestions, see the blog, Are LED screens harming you?

Optimize ergonomics

Make sure your computer setup is ergonomically friendly. Your desktop keyboard should be positioned so that your forearms are a few inches above your waist. The top of your screen should be around eyebrow level, which should naturally cause your eyes to look slightly downward at the screen.

Unfortunately, using a laptop or a phone causes people to look down in an unhealthy way that can make them slouch and induce neck or back pain. The solution is to get an external keyboard along with a laptop stand. Getting an external monitor can also help. For more detailed suggestions, see the blogs, Cartoon ergonomics for working at the computer and laptop and Reduce TechStress at Home.

Sit erect and stop slouching

As we work at the computer, we unknowingly tend to slouch which increases the risk of neck and shoulder discomfort and evoking thoughts and feelings. Take control of your slouching with a posture feedback device and app such as UpRight Go [3] that reminds you when you slouch as shown in Figure 3. Each time you the device signals you that you slouch, sit up straight, move, breathe, and think of a positive thought. For more suggestions, see the blog, “Don’t slouch!” Improve health with posture feedback.

Figure 3.  Using posture feedback to become aware of slouching. Reproduced by permission from Peper, E., Harvey, R. and Faass, N. (2020). TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics, Berkeley, CA. North Atlantic Books.

Practice slow diaphragmatic breathing

Breathe deeply and slowly to restore a natural rhythm. As we work, we tend to breathe more shallowly, which increases anxiety and our heart rate. To counteract this, take three deep breaths for five seconds, then exhale very slowly for six seconds. For more instructions on slower diaphragmatic breathing, see the blog, Healing irritable bowel syndrome with diaphragmatic breathing.

Give undivided attention and be present

Phones have become so ingrained in our lives that we use them constantly throughout the day. Harvey stresses that people should make a conscious effort to limit phone usage, especially when socializing. When we respond to a phone notification during a Zoom hangout with friends or while talking to our family members, people may feel dismissed. This often increases a sense of social isolation, so give people your total attention when interacting with them. For more suggestions, see the blog, Configure your brain to learn and avoid Zoom fatigue.



Useful resources about breathing, phytonutrients and exercise

Dysfunctional breathing, eating highly processed foods, and lack of movement contribute to development of illnesses such as cancer, diabetes, cardiovascular disease and many chronic diseases.  They also contributes to immune dysregulation that increases vulnerability to infectious diseases, allergies and autoimmune diseases. If you wonder what breathing patterns optimize health, what foods have the appropriate phytonutrients to support your immune system, or what the evidence is that exercise reduces illness and promotes longevity, look at the following resources.

Breath: the mind-body connector that underlies health and illness

Read the outstanding article by Martin Petrus (2021). How to breathe.

https://psyche.co/guides/how-to-breathe-your-way-to-better-health-and-transcendence

You are the food you eat

Watch the superb webinar presentation by Deanna Minich, MS., PHD., FACN, CNS, (2021) Phytonutrient Support for a Healthy Immune System.

Movement is life

Explore the summaries of recent research that has demonstrated the importance of exercise to increase healthcare saving and reduce hospitalization and death.


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.

Dada, T., Mittal, D., Mohanty, K., Faiq, M.A., Bhat, M.A., Yadav, R.K., Sihota, R., Sidhu, T,, Velpandian, T., Kalaivani, M., Pandey, R.M., Gao, Y., Sabel, B,A., & Dada, R. (2018). Mindfulness Meditation Reduces Intraocular Pressure, Lowers Stress Biomarkers and Modulates Gene Expression in Glaucoma: A Randomized Controlled Trial. J Glaucoma, 27(12), 1061-1067.

Hansraj, K. K. (2014). Assessment of stresses in the cervical spine caused by posture and position of the head. Surgical Technology International, 25, 277–279.

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.

Peper, E., Booiman, A., Lin, I.M., & Harvey, R. (2016). Increase strength and mood with posture. Biofeedback. 44(2), 66–72.

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.