Relieve and prevent neck stiffness and pain

Is your neck stiff, uncomfortable and painful?

When driving is it more difficult to turn your head?

Neck and shoulder pain affect more than 30% of people (Fejer et al, 2006; Cohen, 2015).  This blog explores some strategies to reduce or prevent neck stiffness and discomfort and suggests practices to reduce discomfort and increase flexibility if you already are uncomfortable.

Shifts in posture may optimize neck flexibility

In our modern world, we frequently engage in a forward head position while looking at electronic devices or typing on computers. Prolonged smart phone usage has the potential to negatively impact posture and breathing functions (Jung et al., 2016) since we tilt our head down to look at the screen. Holding the head in a forward position, as displayed in Figure 1, can result in muscle tension in the spine, neck, and shoulders.

head forward alignedFig 1. Forward head and neck posture in comparison to a neutral spine. Source: https://losethebackpain.com/conditions/forward-head-posture/

Whenever you bring your head forward to look at the screen or tilt it down to look at your cellphone, your neck and shoulder muscles tighten and your breathing pattern become more shallowly.  The more the head is forward, the more difficulty is it to rotate your  head as is describe in the blog, Head position, it matters! (Harvey et al, 2018). Over time, the head forward position may lead to symptoms such as headaches and backpain. On the other hand, when we shift to an aligned upright position throughout the day, we create an opportunity to relieve this tension as shown in Figure 2.

EMG head forward uprightFigure 2. EMG and respiration recording from a subject sitting with a forward head position and a neutral, aligned head position.  The neck and shoulder muscle tension was recorded from the right trapezius and left scalene muscles (Mason et all, unpublished).    .

The muscle tension recorded from scalene and trapezius muscles (neck and shoulder) in Figure 2 shows that as the head goes forward or tilts down, the muscle tension significantly increases. In most cases participants are totally unware that their neck tightens. It is only after looking at the screen or focus our eyes until the whole day that we notice discomfort in the late afternoon.

Experience this covert muscle tension pattern in the following video, Sensing neck muscle tension-The eye, head, and neck connection.

Interrupt constant muscle tension

One possible reason why we develop the stiffness and discomfort is that we hold the muscles contracted for long time in static positions. If the muscle can relax frequently, it would significantly reduce the probability of developing discomfort. Experience this concept of interrupting tension practice by practicing the following:

  • Sit on a chair and lift your right foot up one inch up from the floor. Keep holding it up? For some people, as soon as five seconds, they will experience tightening and the onset of discomfort and pain in the upper thigh and hip.

How long could you hold your foot slight up from the floor?  Obviously, it depends on your motivation, but most people after one minute want to put the foot down as the discomfort become more intense.  Put the foot down and relax.  Notice the change is sensation and for some it takes a while for the discomfort to fade out.

  • The reason for the discomfort is that the function of muscle is to move a joint and then relax. If tightening and relaxation occurs frequently, then there is no problem
  • Repeat the same practice except lift the foot, relax and drop it down and repeat and repeat. Many people can easily do this for hours when walking.

What to do to prevent neck and shoulder stiffness.

Interrupt static muscle neck tension by moving your head neck and shoulder frequently while looking at the screen or performing tasks.  Explore some of the following:

  • Look away from the screen, take a breath and as you exhale, wiggle your head light heartedly as if there is a pencil at reaching from the top of your head to the ceiling and you are drawing random patterns on the ceiling. Keep breathing make the lines in all directions.
  • Push the chair back from the desk, roll your right shoulder forward, up and back let it drop down and relax. Then roll you left shoulder forward up and back and drop down and relax. Again, be sure to keep breathing.
  • Stand up and skip in place with your hands reaching to the ceiling so that when your right foot goes up you reach upward with your left hand toward the ceiling while looking at your left hand. Then, as your left foot goes up your reach upward to the ceiling with your right hand and look at your right hand.  Smile as you are skipping in place.
  • Install a break reminder program on your computer such as Stretch Break to remind you to stretch and move.
  • Learn how to sit and stand aligned and how to use your body functionally such as with the Gokhale Method or the Alexander Technique (Gokhale, 2013; Peper et al, in press, Vineyard, 2007).
  • Learn awareness and control neck and shoulder muscle tension with muscle biofeedback. For practitioners certified in biofeedback BCB, see https://certify.bcia.org/4dcgi/resctr/search.html
  • Become aware of your collapsed and slouching wearing a posture feedback device such as UpRight Go on your upper back. This device provides vibratory feedback every time you slouch and reminds you to interrupt slouching and be upright and alighned.

Improve ergonomics

Arrange your computer screen and keyboard so that the screen is at eye level instead of having to reach forward or look down. Similarly, hold your cell phone so that it is at eye level as shown in Figure 3 and 4.

laptop ergonomicsFigure 3. Slouching forward to see the laptop screen can be avoided by using an external keyboard, mouse and desktop riser. Reproduced by permission from www.backshop.nl

Cellphone

Figure 4.  Avoid the collapsed while looking down at a cell phone by resting the arms on a backpack or purse and keeping the spine and head alighned. Photo of upright position reproduced with permission from Imogen Ragone, https://imogenragone.com/

Check vision

If you are squinting, bringing your nose to the screen, or if the letters are too small or blurry, have your eyes checked to see if you need computer glasses.  Generally do not use bifocals or progressive glasses as they force you to tilt your head up or down to see the material at a specific focal length. Other options included changing the display size on screen by making the text and symbols larger may allow you see the screen without bending forward.  Just as your muscle of your neck, your eyes need many vision breaks.  Look away from the screen out of the window at a distant tree or for a moment close your eyes and breathe.

What to do if you have stiffness and discomfort

My neck was stiff and it hurt the moment I tried to look to the sides.  I was totally surprised that I rapidly increased my flexibility and reduced the discomfort when I implemented the following two practices.

Begin by implementing the previous described preventative strategies. Most important is to interrupt static positions and do many small movement breaks. Get up and wiggle a lot. Look at the blog, Freeing the neck and shoulder, for additional practices.

Then, practice the following exercises numerous times during the day to release neck and shoulder tension and discomfort. While doing these practices exhale gently when you are stretching.  If the discomfort increases, stop and see your health professional.

 

REFERENCES

Cohen, S.P. (2015). Epidemiology, Diagnosis, and Treatment of Neck Pain. Mayo Clinic Proceedings, 90 (2), 284-299. https://doi.org/10.1016/j.mayocp.2014.09.008

Fejer, R., Kyvik, K.Ohm, & Hartvigesen, J. (2006). The prevalence of neck pain in the world population: a systematic critical review of the literature. European Spine Journal, 15(6), 834-848. https://doi.org/10.1007/s00586-004-0864-4

Gokhale, E. (2013). 8 Steps to a Pain-Free Back. Pendo Press.

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.

Mason, L., Peper, E., Harvey, R., & Hernandez, W. (unpublished). Healing headaches. Does success sustain over time?

Peper, E., Krüger, B., Gokhale, E., & Harvey, R. (in press). Comparing Muscle Activity and Spine Shape in Various Sitting Styles. Biofeedback.

 Vineyar, M. (2007). How You Stand, How You Move, How You Live: Learning the Alexander Technique to Explore Your Mind-Body Connection and Achieve Self-Mastery. Boston: Da Capo Lifelong Books.


Freeing the neck and shoulders*

Stress, incorrect posture, poor vision and not knowing how to relax may all contribute to neck and shoulder tension.   More than 30% of all adults experience neck pain and 45% of girls and 19% of boys 18 year old, report back, neck and shoulder pain (Cohen, 2015; Côté, Cassidy, & Carroll, 2003; Hakala, Rimpelä, Salminen, Virtanen, & Rimpelä, 2002).  Shoulder pain affects almost a quarter of adults in the Australian community (Hill et al, 2010). Most employees working at the computer experience neck and shoulder tenderness and pain (Brandt et al, 2014), more than 33% of European workers complained of back-ache (The European Agency for Safety and Health at Work, 2004), more than 25% of Europeans experience work-related neck-shoulder pain, and 15% experience work-related arm pain (Blatter & De Kraker, 2005; Eijckelhof et al, 2013), and more than 90% of college students report some muscular discomfort at the end of the semester especially if they work on the computer (Peper & Harvey, 2008).

The stiffness in the neck and shoulders or the escalating headache at the end of the day may be the result of craning the head more and more forward or concentrating too long on the computer screen. Or, we are unaware that we unknowingly tighten muscles not necessary for the task performance—for example, hunching our shoulders or holding our breath. This misdirected effort is usually unconscious, and unfortunately, can lead to fatigue, soreness, and a buildup of additional muscle tension.

The stiffness in the neck and shoulders or the escalating headache at the end of the day may be the result of craning the head more and more forward or concentrating too long on the computer screen. Poor posture or compromised vision can contribute to discomfort; however, in many cases stress is major factor.  Tightening the neck and shoulders is a protective biological response to danger.  Danger that for thousands of years ago evoke a biological defense reaction so that we could run from or fight from the predator.  The predator is now symbolic, a deadline to meet, having hurry up sickness with too many things to do, anticipating a conflict with your partner or co-worker, worrying how your child is doing in school, or struggling to have enough money to pay for the rent.

Mind-set also plays a role. When we’re anxious, angry, or frustrated most of us tighten the muscles at the back of the neck. We can also experience this when insecure, afraid or worrying about what will happen next. Although this is a normal pattern, anticipating the worst can make us stressed. Thus, implement self-care strategies to prevent the occurrence of discomfort.

What can you do to free up the neck and shoulder? 

Become aware what factors precede the neck and shoulder tension. For a week monitor yourself, keep a log during the day and observe what situations occur that precede the neck and should discomfort. If the situation is mainly caused by:

  • Immobility while sitting and being captured by the screen. Interrupt sitting every 15 to 20 minutes and move such as walking around while swinging your arms.
  • Ergonomic factors such as looking down at the computer or laptop screen while working. Change your work environment to optimize the ergonomics such as using a detached keyboard and raising the laptop screen so that the top of the screen is at eyebrow level.
  • Emotional factors. Learn strategies to let go of the negative emotions and do problem solving. Take a slow deep breath and as you exhale imagine the stressor to flow out and away from you. Be willing to explore and change ask yourself: “What do I have to have to lose to change?”, “Who or what is that pain in my neck?”, or “What am I protecting by being so rigid?”

Regardless of the cause, explore the following five relaxation and stretching exercises to free up the neck and shoulders. Be gentle, do not force and stop if your discomfort increases. When moving, continue to breathe.

1. WIGGLE. Wiggle and shake your body many times during the day.  The movements can be done surreptitiously such as, moving your feet back and forth in circles or tapping feet to the beat of your favorite music, slightly arching or curling your spine, sifting the weight on your buttock from one to the other, dropping your hands along your side while moving and rotating your fingers and wrists, rotating your head and neck in small unpredictable circles, or gently bouncing your shoulders up and down as if you are giggling. Every ten minutes, wiggle to facilitate blood flow and muscle relaxation.

2. SHAKE AND BOUNCE. Stand up, bend your knees slightly, and let your arms hang along your trunk.  Gently bounce your body up and down by bending and straightening your knees. Allow the whole body to shake and move for about one minute like a raggedy Ann doll. Then stop bouncing and alternately reach up with your hand and arm to the ceiling and then let the arm drop. Be sure to continue to breathe.

3. ROTATION MOVEMENT (Adapted from the work by Sue Wilson and reproduced by permission from: Gorter, R. & Peper, E. (2011). Fighting Cancer- A Nontoxic Approach to Treatment).

Pre-assessment:  Stand up and give yourself enough space, so that when you lift your arms to shoulder level and rotate, you don’t touch anything. Continue to stand in the same spot during the exercise as shown in figures 1a and 1b.

Lift your arms and hold them out, so that they are at shoulder level, positioned like airplane wings. Gently rotate your arms to the left as far as you can without discomfort. Look along your left arm to your fingertips and beyond to a spot on the wall and remember that spot. Rotate back to center and drop your arms to your sides and relax.

 

Figure 1Figures 1a and 1b. Rotating the arms as far as is comfortable (photos by Jana Asenbrennerova)

Movement practice. Again, lift your arms to the side so that they are like airplane wings pointing to the left and right. Gently rotate your trunk, keeping your arms fixed at a right angle to your body. Rotate your arms to the right and turn your head to the left. Then reverse the direction and rotate your arms in a fixed position to the left and turn your head to the right. Do not try to stretch or push yourself. Repeat the sequence three times in each direction and then drop your arms to your sides and relax.

With your arms at your sides, lift your shoulders toward your ears while you keep your neck relaxed. Feel the tension in your shoulders, and hold your shoulder up for five seconds. Let your shoulders drop and relax. Then relax even more. Stay relaxed for ten seconds.

Repeat this sequence, lifting, dropping, and relaxing your shoulders two more times. Remember to keep breathing; and each time you drop your shoulders, relax even more after they have dropped.

Repeat the same sequence, but this time, very slowly lift your shoulders so that it takes five seconds to raise them to your ears while you continue to breathe. Keep relaxing your neck and feel the tension just in your shoulders. Then hold the tension for a count of three. Now relax your shoulders very slowly so that it takes five seconds to lower them. Once they are lowered, relax them even more and stay relaxed for five seconds. Repeat this sequence two more times.

Now raise your shoulders quickly toward your ears, feel the tension in your upper shoulders, and hold it for the count of five. Let the tension go and relax. Just let your shoulders drop. Relax, and then relax even more.

Post-assessment.  Lift your arms up to the side so that they are at shoulder level and are positioned like airplane wings. Gently rotate without discomfort to the left as far as you can while you look along your left arm to your fingers and beyond to a spot on the wall.

 Almost everyone reports that when they rotate the last time, they rotated significantly further than the first time. The increased flexibility is the result of loosening your shoulder muscles.

 

4. TAPPING FEET (adapted from the work of Servaas Mes)

Diagonal movements underlie human coordination and if your coordination is in sync, this will happen as a reflex without thought. There are many examples of these basic reflexes, all based on diagonal coordination such as arm and leg movement while walking. To restore this coordination, we use exercises that emphasize diagonal movements. This will help you reverse unnecessary tension and use your body more efficiently and thereby reducing “sensory motor amnesia” and dysponesis (Hanna, 2004). Remember to do the practices without straining, with a sense of freedom, while you continue relaxed breathing. If you feel pain, you have gone too far, and you’ll want to ease up a bit. This practice offers brief, simple practices to avoid and reverse dysfunctional patterns of bracing and tension and reduce discomfort. Practicing healthy patterns of movement can reestablish normal tone and reduce tension and pain. This is a light series of movements that involve tapping your feet and turning your head. You’ll be able to do the entire exercise in less than twenty seconds.

Pre-assessment. Sit erect at the edge of the chair with your hands on your lap and your feet shoulders’ width apart, with your heels beneath your knees.

First, notice your flexibility by gently rotating your head to the right as far as you can. Now look at a spot on the wall as a measure of how far you can comfortably turn your head and remember that spot. Then rotate back to the center.

Practicing rotating feet and head. Become familiar with the feet movement, lift the balls of your feet so your feet are resting on your heels. Lightly pivot the balls of your feet to the right, tap the floor, and then stop and relax your feet for just a second. Now lift the balls of your feet, pivot your feet to the left, tap, relax, and pivot back to the right.

Just let your knees follow the movement naturally. This is a series of ten light, quick, relaxed pivoting movements—each pivot and tap takes only about one or two seconds.

Add head rotation. Turn your head in the opposite direction of your feet. This series of movements provides effortless stretches that you can do in less than half a minute as shown in figures 2a and 2b.

Figure 2Figures 2a and 2b. Rotating the feet and head in opposite directions (photos by Gary Palmer)

When you’re facing right, move your feet to the left and lightly tap. Then face left and move your feet to the right and tap.

  • Continue the tapping movement, but each time pivot your head in the opposite direction. Don’t try to stretch or force the movement.
  • Do this sequence ten times. Now stop, face straight head, relax your legs, and just keep breathing.

Post assessment. Rotate your head to the right as far as you can see and look at a spot on the wall. Notice how much more flexibility/rotation you have achieved.

Almost everyone reports being able to rotate significantly farther after the exercise than before. They also report that they have less stiffness in their neck and shoulders.

5. SHOULDER AWARENESS PRACTICE.  Sit comfortably with your hands on your lap.  Allow your jaw to hang loose and breathe diaphragmatically.  Continue to breathe slowly as you do the following:

  • Shrug, raising your shoulders towards your ears to 70% of maximum   effort and hold them up for about 10 seconds (note the sensations of tension).
  • Let your shoulders drop and relax for 10 to 20 seconds
  • Shrug, raising your shoulders towards your ears to 50% of maximum effort and hold them up for about 10 seconds (note the sensations of tension).
  • Let your shoulders drop and relax for 10 to 20 seconds
  • Shrug, raising your shoulders towards your ears to 25% of maximum effort and hold them up for about 10 seconds (note the sensations of tension).
  • Let your shoulders drop and relax for 10 to 20 seconds
  • Shrug, raising your shoulders towards ears to 5% of maximum effort and hold them up for about 10 seconds (note the sensations of tension).
  • Let your shoulders drop and relax for 10 to 20 seconds
  • Pull your shoulders down to 25% of maximum effort and hold them up for about 10 seconds (note the sensations of tension).
  • Allow your shoulders to come back up and relax for 10 to 20 seconds

Remember to relax your shoulders completely after each incremental tightening. If you tend to hold your breath while raising your shoulders, gently exhale and continue to breathe.  When you return to work, check in occasionally with your shoulders and ask yourself if you can feel any of the sensations of tension.  If so, drop your shoulders and relax for a few seconds before resuming your tasks.

In summary, when employees and students change their environment and integrate many movements during the day, they report a significant decrease in neck and shoulder discomfort and an increase in energy and health.  As one employee reported, after taking many short movement breaks while working at the computer, that he no longer felt tired at the end of the day, “Now, there is life after five”.

To explore how prevent and reverse the automatic somatic stress reactions, read Thomas Hanna‘s book, Somatics: Reawakening The Mind’s Control of Movement, Flexibility, and Health For easy to do neck and shoulder  guided instructions stretches, see the following ebsite:  http://greatist.com/move/stretches-for-tight-shoulders

References:

Blatter, B. M., & Kraker, H. D. (2005). Prevalentiecijfers van RSI-klachten en het vóórkomen van risicofactoren in 15 Europese landen. Tijdschrift voor gezondheidswetenschappen, 1, 83, 8-15.  

Brandt, M., Sundstrup, E., Jakobsen, M. D., Jay, K., Colado, J. C., Wang, Y., … & Andersen, L. L. (2014). Association between neck/shoulder pain and trapezius muscle tenderness in office workers. Pain research and treatment, 2014.

Cohen, S. P. (2015, February). Epidemiology, diagnosis, and treatment of neck pain. In Mayo Clinic Proceedings (Vol. 90, No. 2, pp. 284-299). Elsevier. 

Côté, P., Cassidy, J. D., & Carroll, L. (2003). The epidemiology of neck pain: what we have learned from our population-based studies. The Journal of the Canadian Chiropractic Association47(4), 284. http://www.pain-initiative-un.org/doc-

Eijckelhof, B. H. W., Huysmans, M. A., Garza, J. B., Blatter, B. M., Van Dieën, J. H., Dennerlein, J. T., & Van Der Beek, A. J. (2013). The effects of workplace stressors on muscle activity in the neck-shoulder and forearm muscles during computer work: A systematic review and meta-analysis. European Journal of Applied Physiology, 113(12), 2897-2912.

European Agency for Safety and Health at Work (2004). http://europa.eu.int/comm/employment_social/news/2004/nov/musculoskeletaldisorders_en.html

Gorter, R. & Peper, E. (2011). Fighting Cancer- A Nontoxic Approach to Treatment. Berkeley: North Atlantic.

Hakala, P., Rimpelä, A., Salminen, J. J., Virtanen, S. M., & Rimpelä, M. (2002). Back, neck, and shoulder pain in Finnish adolescents: national cross sectional surveys. Bmj325(7367), 743.

Hanna, T. (2004). Somatics-Reawakening The Mind’s Control Of Movement, Flexibility, And Health Boston: Da Capo Press.

Hill, C. L., Gill, T. K., Shanahan, E. M., & Taylor, A. W. (2010). Prevalence and correlates of shoulder pain and stiffness in a population‐based study: the North West Adelaide Health Study. International journal of rheumatic diseases13(3), 215-222.

Paoli, P., Merllié, D., & Fundação Europeia para a Melhoria das Condições de Vida e de Trabalho. (2001). Troisième enquête européenne sur les conditions de travail, 2000.

Peper, E. & Harvey, R. (2008). From technostress to technohealth.  Japanese Journal of Biofeedback Research, 35(2), 107-114.

*I thank Sue Wilson and Servaas Mes for teaching me these somatic practices.


Cellphone harm: Cervical spine stress and increase risk of brain cancer

It is impossible to belief that that only a few years ago there were no cell phones.

When I go home, I purposely put the phone away so that I can be present with my children.

I just wonder if the cell phone’s electromagnetic radiation could do harm?

Cell phone use is ubiquitous since information is only a key press or voice command away.  Students spend about many hours a day looking and texting on a cell phone and experience exhaustion and neck and shoulder discomfort (Peper et al, 2013).  Constant use may also have unexpected consequences:  Increased stress on the cervical spine and increased risk for brain cancer.

Increased cervical spine stress

As we look at the screen, text messages or touch the screen for more information, we almost always bend our head down to look down. This head forward position increases cervical compression and stress. The more the head bends down to look, the more the stress in the neck increases as the muscles have to work much harder that hold the head up. In a superb analysis Dr. Kennth Hansraj, Chief of Spine Surgery 0f New York Spine Surgery & Rehabilitation Medicine, showed that stress on the cervical spine increases from 10-12 lbs when the head is in its upright position to 60 lbs when looking down.

weight of headFigure 1. Stress on the cervical spine as related to posture. (From: 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.)

Looking down for a short time period is no problem; however, many of us look down for extended periods. This slouched collapsed position is becoming the more dominant position. A body posture which tends to decrease energy, and increase hopeless, helpless, powerless thoughts (Wilson & Peper, 2004; Peper & Lin, 2012). The long term effects of this habitual collapsed position are not know–one can expect more neck and back problems and increase in lower energy levels.

increased risk for brain cancer and inactive sperm and lower sperm count

Cell phone use not only affect posture, the cell phone radio-frequency electromagnetic radiation by which the cell phone communicates to the tower may negatively affect biological tissue. It would not be surprising that electromagnetic radiation could be harmful; since, it is identical to the frequencies used in your microwave ovens to cook food. The recent research by Drs Michael Carlberg and Lennart Hardell of the Department of Oncology, University Hospital, Örebro, Sweden,  found that long term cell phone use is associated by an increased risk of developing malignant glioma (brain cancers) with the largest risk observed in people who used the cell phone before the age of 20. In addition, men who habitually carry the cell phone in a holster or in their pocket were more likely to have inactive or less mobile sperm as well as a lower sperm count.

What can you do:

Keep an upright posture and when using a cell phone or tablet. Every few minutes stretch, look up and reach upward with your hands to the sky.

Keep your cell phone away from your body such as putting it in your purse or outer pocket of your coat

Use your speaker phone or ear phones instead of placing the phone against your head.

Enjoy the cartoon video clip, Smartphone Ergonomics – Safe Tips – Mobile or Smart Phone Use while Driving, Traveling on the Move.

References:

Agarwal, A., Singh, A., Hamada, A., & Kesari, K. (2011). Cell phones and male infertility: a review of recent innovations in technology and consequences. International braz j urol, 37(4), 432-454. http://www.isdbweb.org/documents/file/1685_8.pdf

Carlberg, M., & Hardell, L. (2014). Decreased Survival of Glioma Patients with Astrocytoma Grade IV (Glioblastoma Multiforme) Associated with Long-Term Use of Mobile and Cordless Phones. International journal of environmental research and public health, 11(10), 10790-10805.  http://www.mdpi.com/1660-4601/11/10/10790/htm

De Iuliis, G. N., Newey, R. J., King, B. V., & Aitken, R. J. (2009). Mobile phone radiation induces reactive oxygen species production and DNA damage in human spermatozoa in vitro. PloS one, 4(7), e6446.

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.

Peper, E. & Lin, I-M. (2012). Increase or decrease depression-How body postures influence your energy level. Biofeedback, 40 (3), 126-130.

Peper, E., Waderich, K., Harvey, R., & Sutter, S. (2013). The Psychophysiology of Contemporary Information Technologies Tablets and Smartphones Can Be a Pain in the Neck. In Applied Psychophysiology and Biofeedback, 38(3), 219.

Wilson, V.E. and Peper, E. (2004). The Effects of upright and slumped postures on the generation of positive and negative thoughts. Applied Psychophysiology and Biofeedback.29 (3), 189-195.


Adjust your world to fit you: Become the unreasonable person!*

 “Reasonable people adapt themselves to the world; unreasonable people persist in trying to adapt the world to themselves. Therefore all progress depends on unreasonable people.”             

–Paraphrased from Bernard Shaw

Man at deskPhoto by Erik Peper

Having the right equipment and work environment will reduce injury and improve performance. This is true for athletes as well as for people using computers, laptops, tablets and smartphones. We look down and curve our upper spine to read the tablet, crane our heads forward to read the screen, lift our shoulders, arms and hands up to the laptop keyboard to enter data, and we bend our heads down and squint to read the smartphone—all occurring without awareness (Straker et al, 2008; Asunda, Odell, Luce, & Dennerlein, 2010; Peper et al, 2014). We are captured by the devices and stay immobilized until we hurt. At the end of the work day, we are often exhausted and experience neck and shoulder stiffness, arm pain and eye fatigue. This stress immobility syndrome is the twenty first century reward for digital immigrants and natives.

We hurt because we fit ourselves to the environment instead of changing the environment to fit us. The predominant slouched position even affects our mood and strength (Peper and Lin, 2012). Experience how your strength decreases when you slouch and look downward as compared when you sit tall with your spine lengthened at your laptop, tablet or phone. You will need a partner to do this practice as shown in Figure 1.

Sit in your slouched position while looking down and extend your arm to the side. Have your partner stand behind you and gently press downward on your upper arm near your wrist while you attempt to resist the pressure. Now relax and let your arms hang along the side of your body. Now sit upright in a tall position with your spine lengthening while looking straight ahead. Again extend your arm and gently have your gently press downward on your upper arm near your wrist while you attempt to resist the pressure.

pressing down on arm slouched erect trimmedFigure 1. Measuring the ability to resist the downward pressure on the forearm while sitting in either slouched or tall position.

You probably experienced significantly more strength resisting the downward pressure when sitting erect and tall than when sitting collapsed as we discovered in our study at San Francisco State University in with students as shown in figure 2.

subject exp rating tall slouch

Figure 2. Change in perceived strength resisting a downward pressure on the extended arm while sitting. Reproduced by permission from Schwanbeck, R., Peper, E., Booiman, A., Harvey, R., and Lin, I-M. (in press).

Increase your power and take charge! Arrange your laptop, computer and tablet so it fits you. This usually means changing your home and office chairs and desks; since, they have been manufactured for the average person. Just like the average coach airplane seat – it is uncomfortable for most people. As my colleague Annette Booiman who is a Mensendiek practitioner has pointed out, “An incorrectly adjusted chair or table height will force you to work in a dysfunctional body position while an appropriately adjusted chair or table height offers you the opportunity to work in a healthy position.”

Become the unreasonable person and fit the world so that you are comfortable while using digital devices. There are solutions! Take responsibility and adjust your posture to a healthy one–it will make your life so much more energetic. Sit on your sit bones (ischial tuberosities) as if they are the feet of your pelvis and feel your spine lengthening as you sit tall. Alternatively, stand while working and adjust the desk height for your size. Regardless of whether you sit or stand while working, take many breaks to interrupt your immobilized posture. Install a software program on computer to remind you to take breaks and watch the YouTube  clips on cartoon ergonomics  for working at the computer.

Implement the following common sense ergonomic guidelines:

For working at a computer sit in a chair with your feet on the floor, the elbows bend at 90 degrees with the hands, wrists, and forearms are straight, in-line and roughly parallel to the floor so that the hands can be on the keyboard while the top of monitor is at eye brow level as shown in Figure 3.

Optimum sitting position

Figure 3. Optimum position to sit at a computer work station. From: http://bmarthur.files.wordpress.com/2009/03/good-posture-how-to-sit-at-a-desk.png

For working with a laptop you will always compromise body position. If the screen is at eye level, you have to bring your arms and hands up to the keyboard, or, more commonly, you will look down at the screen while at the same time raising your hands to reach the keyboard. The solution is to use an external keyboard so that the keyboard can be at your waist position and the laptop screen eye level as shown in Figure 4.

optimum laptop use

Figure 4. Optimum position to sit while using a laptop. From: http://www.winwin-tech.com/uploadfile/cke/images/6.jpg

For working with tablets and smart phones you have little choice. You either look down or reach up to touch the screen. As much as possible tilt and raise the tablet so that you do not have slouch to see the screen.

If you observe that you slouch and collapse while working, invest in an adjustable desk that you can raise or lower for your optimum height. An adjustable height desk such as the unDesk offers the opportunity to change work position from sitting to standing as shown in Figure 5.

unDesk

Figure 5. Example of a height adjustable desk (the unDesk) that can be used for sitting and standing.

Although office chairs can give support, we often slouch in them. While at home we use any chair that is available—again encouraging slouching. Reduce the slouching by sitting on a  seat insert such as a BackJoy® which tends to let you sit more erect and in a more powerful and energizing position see Figure 6.

backjoy insert sitting with spine markers a

Figure 6. Example how BackJoy® seat inserts allows you to sit more erect. Reproduced with permission from: http://www.backjoy.com/sit/

Finally, whether or not you can change your environment, take many, many short movement breaks– wiggle, stretch, get up and walk–to interrupt the muscle tension and allow yourself to regenerate. To remind yourself to take breaks while being captured by your work, install a reminder program on your computer such as Stretchbreak that pops up on the screen and guides you through short stretches to regenerate.

Suggested sources:

Cartoon videos on ergonomics: https://peperperspective.com/2014/09/30/cartoon-ergonomics-for-working-at-the-computer-and-laptop/

Healthy computing tips: http://biofeedbackhealth.files.wordpress.com/2013/01/health-computing-email-tips.pdf

Seat insert such as BackJoy®: http://www.backjoy.com/sit/

Height adjustable desk such as The unDesk: http://www.theundesk.com/

Interrupt computer program such as Stretchbreak: http://www.paratec.com

References:

Asundi, K., Odell, D., Luce, A., & Dennerlein, J. T. (2010). Notebook computer use on a desk, lap and lap support: Effects on posture, performance and comfort. Ergonomics, 53(1), 74-82.

Peper, E., & Lin, I. M. (2012). Increase or decrease depression-How body postures influence your energy level. Biofeedback, 40 (3), 126-130.

Peper, E., Booiman, A., Lin, I-M., & Shaffer, F. Making the Unaware Aware-Surface Electromyography to Unmask Tension and Teach Awareness. Biofeedback, 2(1), 16-23.

Schwanbeck, R., Peper, E., Booiman, A., Harvey, R., and Lin, I-M.  Posture changes with a seat insert: Changes in strength and implications for breathing and HRV. Poster submitted for the 46th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback.

Straker, L. M., Coleman, J., Skoss, R., Maslen, B. A., Burgess-Limerick, R., & Pollock, C. M. (2008). A comparison of posture and muscle activity during tablet computer, desktop computer and paper use by young children. Ergonomics, 51(4), 540-555.

 

* Adapted from: Peper, E. (in press). Become the unreasonable person: Adjust your world to fit you! Western Edition and Schwanbeck, R., Peper, E., Booiman, A., Harvey, R., and Lin, I-M. (in press). Posture changes with a seat insert: Changes in strength and implications for breathing and HRV.


Cartoon ergonomics for working at the computer and laptop

I finally bought a separate keyboard and a small stand for my laptop so that the screen is at eye level and my shoulders are relaxed while typing at the keyboard. To my surprise,  my neck and shoulder tightness and pain disappeared and I am much less exhausted.

How we sit and work at the computer significantly affects our health and productivity. Ergonomics  is the science that offers guidelines on how to adjust your workspace and equipment to suit your individual needs.  It is just like choosing appropriate shoes–Ever try jogging in high heels?  The same process applies to the furniture and equipment you use when computing.

When people arrange their work setting according to  good ergonomic principles and incorporate a healthy computing work style numerous disorders (e.g., fatigue, vision discomfort,  head, neck, back, shoulder, arm or hand pain) may be prevented (Peper et al, 2004). For pragmatic tips to stay health at the computer see Erik Peper’s  Health Computer Email Tips.  Enjoy the following superb video cartoons uploaded by Stephen Walker on YouTube that summarize the basic guidelines for computer, laptop and cell phones use at work, home, or while traveling.

Adult or Child Laptop Use at Home, Work or Classroom

Healthy use of laptops anywhere.

Mobile or Smart Phone Use while Driving, Traveling or on the Move.


Simple Ways to Manage Stress- An experiential lecture for people impacted by the March 11, 2011 Great East Japan Earthquake

Stress can be reduced by simple pragmatic exercises. This 99 minute participatory lecture was presented in Sendei, Japan, on July 20, 2013 to people who were impacted by the 2011 Tohoku earthquake and tsunami disaster.* The lecture includes practices that demonstrate 1) how thoughts, emotions and images affect the body, 2) how simple movements can reduce muscle tension, 3) how breathing can be used to reduce stress, 4) how changing posture can change access to positive or negative memories, 5) how acceptance is the beginning step for healing. This approach based upon a holistic evolutionary perspective of stress and health can be used to reduce symptoms caused or increased by stress such as neck, shoulder and back tension, digestive problems, worrying and insomnia. The video lecture is sequentially translated from English to Japanese.  Click on the link to watch the video lecture.

http://cat-vnet.tv/movie/medical_health/suimin_02/001_02.html

Presentation1

*The program was organized by Toshihiko Sato, Ph.D., Dept. Health and Social Services, Faculty of Medical Sciences and Welfare Tohoku Bunka Gakuen University, Sendai.


Improve health with fun movements: Practices you can do at home and at work

Physical fitness promotes health.    For one person it may be walking, for another jogging, bicycling or dancing. Increase the joy and pleasure of movement. In most cases about 20 minutes of continued activity is enough to keep in shape and regenerate. When the urge to watch TV or just to crash occurs, do some of the movement—you will gain energy. The exercises this article are are developed to reduce discomfort, increase flexibility  and improve health.  Practice them throughout the day, especially before the signals of pain or discomfort occur. First read over the General Concepts Underlying the Exercises  and then explore the various practices.

General Concepts Underlying the Exercises

While practicing the strength and stretch exercises, always remember to breathe. Exercises should be performed slowly, gently and playfully.  If pain or discomfort occurs, STOP. Please consult your health care provider if you have any medical condition which could be affected by exercise.

Perform the practices in a playful, exploratory manner.  Ask yourself:  “What is happening?” and “How do I feel different during and after the practice?” Practice with awareness and passive attention. Remember, Pain, No gain — Pain discourages practice.  Pain and the anticipation of pain usually induce bracing which is the opposite of relaxation and letting go.  In addition, many of our movements are conditioned and without knowing we hold our breath and tighten our shoulders when we perform an exercise.  Explore ways to keep breathing and thereby inhibit the startle/orienting/flight response embedded and conditioned with the  movements.  For example, continue to breathe and relax instead of holding your breath and tightening your shoulders when you initially look at something or perform a task.

Learn to reduce the automatic and unnecessary tightening of muscles not needed for the performance of the task.  As you do an exercise, continuously, check your body and explore how to relax muscles that are not needed for the actual exercise.  Become your own instructor in the same way that a yoga teacher reminds you to exhale when you are doing an asana (yoga pose). If you are unsure whether you are tightening, initially look another person doing the exercise to observe their bracing and breath holding patterns.  Ask them to observe you and give feedback.  In many cases, the more others are involved the easier it is to do a practice.

It is often helpful to perform the practice in a group.  Encourage your whole work unit to take breaks and exercise together.  Usually it is much easier to do something together, especially when you are not motivated—use social support to help you do your practices.

Problems with neck, back and shoulders

The number one overall work-related complaint is the back pain and this is also true for many people who work at the computer. In many cases there are correlations between backache and stress, immobility, and lack of regeneration. Back pain is often blamed on disk problems which may be aggravated by chronic tension that may have some psychological factors.  When you experience discomfort, explore some of the following questions:

  • Is there something for which I am spineless?
  • Who or what is the pain in my neck or back?
  • What is the weight I am carrying?
  • Am I rigid and not willing to be flexible?
  • What negative emotion, such as anger or resentment, needs to resolved?

Be willing to act on whatever answers you observe.  Back and neck pain is often significantly reduced after emotional conflicts are resolved (see the book by John Sarno, MD., Healing Back Pain: The Mind-Body Connection). The best treatment is prevention, emotional resolution, and physical movement. Allow your back to relax and move episodically.  Allow tensions to dissipate and explore the physical, psychological and social burdens you carry.  To loosen your neck practice  the following exercise.

Free your neck and shoulders[1]

This is a slightly complicated, but very effective process. You may want to ask a friend or co-worker to read the following instructions to you.

Pretest: Push away from the keyboard. Sit at the edge of the chair with your knees bent at approximately 90 degrees and your feet flat on the floor about shoulder width apart.  Do the movements slowly.  Do NOT push yourself if you feel discomfort.  Be gentle with yourself.

Look to the right and gently turn your head and body as far as you can go to the right. When you have gone as far as you can comfortably, look at the furthest spot on the wall and remember that spot.  Gently rotate your head and body back to center.  Close your eyes and relax.

Movement practice: Reach up with your right hand; pass it over the top of your head and hold on to your left ear. Then gently bend to the right lowering the elbow towards the floor.  Slowly straighten up. Repeat a few times, feeling as if you are a sapling flexing in the breeze as shown in Figure 1.

Slide2

Figure 1. Illustration of  side ways bending with hand holding ear.

Observe what your body is doing as it bends and comes back up to center. Notice the movements in your ribs, back and neck.  Then drop your arm to your lap and relax.  Make sure you continue to breathe diaphragmatically throughout the exercise.

Reach up with your left hand, pass it over the top of your head and hold on to your right ear.  Repeat as above, this time bending to the right.

Reach up with your right hand and pass it over the top of your head, now holding onto your left ear.  Then look to the right with your eyes and rotate your head to the right as if you are looking behind you. Return to center and repeat the movement a few times.  Then drop your  arm to your lap and relax for a few breaths as shown in Figure 2. Slide3Figure 2. Illustration of  rotational movement with hand holding ear.

Repeat the same rotating motion of your head to the right, except that now your eyes look to the left. Repeat this a few times, then drop your arm to your lap and relax for a few breaths.

Repeat the exercise except reach up with your left hand and pass it over the top of your head, and hold on to your right ear.  Then look to the left with your eyes and rotate your head to the left as if you are looking behind you.  Return to center and repeat a few times.  Then drop your arms to your lap and relax for a few breaths.

Repeat the same rotating motion of your head to the left, except that your eyes look to the right.  Repeat this a few times, then drop your arm to your lap and relax for a few breaths.

Post test: look to the right and gently turn your head and body as far as you can go. When you cannot go any further, look at that point on the wall. Gently rotate your head back to center, close your eyes, relax and notice the relaxing feelings in your neck, shoulders and back.

Did you rotate further than at the beginning of the exercise? More than 95% of participants report rotating significantly further as compared to the pretest.

For additional exercises on how to loosen your neck, shoulders, back, arms, hands, and legs, click on the link for the article, Improve health with movement: There is life after five or look at the somatic relaxation practices in part 3 of our book, Fighting Cancer-A Nontoxic Approach to Treatment.


[1] Adapted from a demonstration by Sharon Keane and developed by Ilana Rubenfeld