Avoiding tech neck: adverting biomechanical dysfunction from the use of technological devices

CHIN UP! AVOIDING TECH NECK: ADVERTING

BIOMECHANICAL DYSFUNCTION FROM THE USE OF TECHNOLOGICAL DEVICES

www.f4cp.com

Special thanks to the following:•Dr. Heidi Haavik – Haavik Research•Dr. Steve Weiniger – BodyZone & PostureZone•Dr. Mark Wade - American Posture Institute•Dr. Krista Burns - American Posture Institute

Sherry McAllister, MS, DC, CCPSF4CP Executive Vice President

CHIN UP!SHERRY MCALLISTER MS DC CCSP

What I’m about to tell you is gonna change your Life forever. Are you really sure you want to know it?

WHAT IS TECH NECK?

Tech Neck is the term used to describe the injuries and pain sustained from looking down at wireless devices.

Tech Neck Symptoms include:

Chronic Headaches Upper Back Pain Shoulder Pain Neck Pain Curvature of the Spine

CURRENT STATE OF TECH EVOLUTION

By the time you leave here today you will BEAM the benefits of Posture for every patient:Bodies in Equilibrium will attain their Alignment and have greater Mobility

Image Source: http://www.33rdsquare.com/2013/04/computer-scientists-find-that-evolution.html

CURRENT STATE OF SMARTPHONE USAGE

Americans spend an average of 3.6 hours per day communicating and socializing on their phones.

The time looking down at their mobile devices.

Social Networks Messaging

Media

Games

Browsing

Source: Flurry Analytics, comScore, Pandora, Facebook,NetMarketShare Note: US June 2015

HOW OFTEN DO YOU SEE CASES OF TECH NECK?

Image source: http://erikdalton.com/

IT'S TIME

In 2013, 1.91 trillion text messages sent. Smartphone used 3.6 hours a day or about 1,300 hours a year High school students spend 5,000 hours a year forward flexed. Kaiser Family Foundation found that 8 to 18 year olds spend

7.5 hours on tech "entertainment media". Smartphone data usage tripled from 2010 to 2011. Tablets users use 3.4 times more data than Smartphone users.

Cisco's Global Mobile Data Traffic Forecast Update

PEW RESEARCH

IT'S TIME

More American's are using Smartphones 64% Trend is toward most adults owning a Smartphone. 2014 research shows growing use Smartphone only

internet access.

80% of the population will experience posture related pain in their life.

90% of that population has postural distortions right now that can lead to serious health problems."

AMERICAN POSTURE INSTITUTE

0%

20%

40%

60%

80%

Jan '10 Jul '10 Jan '11 Jul '11 Jan '12 Jul '12 Jan '13 Jul '13

Pew Research – 2014 Smartphone Usage

Email Browsing Internet

October 2104: http://www.pewinternet.org/fact-sheets/mobile-technology-fact-sheet/

Hansraj Kk Assessment Of Stresses In The Cervical Spine Caused By Posture And Position Of The Head. Surg Technol Int. 2014 Nov;25:277-9.

DR. KEN HANSRAJ M.D.

OLIVIA O'NEILL

Health experts have found: "sedentary epidemic” sweeping Britain. 60% 16 - 34 year olds suffer

from neck or back pain Due to the prolonged periods

of time they spend sitting down, often behind screens.

Olivia O’Neill The Telegraph Lifestyle Wellbeing Article Easy Ways to Prevent Tech Neck Apr 2014

WHAT IS THE SYMPTOMS RELATED TO FORWARD HEAD CARRIAGE

Restricted BreathingDegenerative Disc Disease

Disc CompressionKyphosis

Depression

Increased stress

Diminished Levels of Energy

Decreased Libido Tension Headaches

Digestive Symptoms

Constipation

Acid Reflux and Hernias

Obstructive Sleep Apnea Cardiovascular irregularities

(related to vagus nerve irritation)

AMY CUDDY, PHD – HARVARD BUSINESS SCHOOL

Poor Posture Affects:

Your physical body

Your mood

Your self-concept

How others perceive you

The Benefit of Power Posing Before a High-Stakes Social Evaluation

Cuddy, Amy J.C., Caroline A. Wilmuth, and Dana R. Carney. "The Benefit of Power Posing Before a High-Stakes Social Evaluation." Harvard Business School Working Paper, No. 13-027, September 2012.


Powerful Low Power



Findings supported by Dr. Kenneth Hansraj MD: Good posture is associated with “elevations in testosterone, increases in serotonin, decreases in cortisol, and increased feelings of power and tolerance for risk taking.”

25%

-20%

83%

-15%

15%

60%

-30%

-10%

10%

30%

50%

70%

90%

Testosterone Cortisol Risk Tolerance

Powerful Low Power


VLADIMIR JANDA

Hypokinetic Disease: The degeneration which occurs when a sedentary lifestyle causes the body to compensate subtly to maintain stability.

“Prolonged muscle tightness leads to fatigue, which ultimately decreases the force available to meet postural and movement demands”

Janda V, Kraus J. Neurologie pro rehabilitacni pracovniky [Neurology for Physiotherapists]. Prague: Avicenumzdravotnicke nakladatelstvi, 1987:126

BREATHING PATTERN DISORDERS AND FUNCTIONAL MOVEMENT

Helen Bradley, PT, Msc1 And Joseph Dr. Esformes, Phd, CSCS2 Int J Sports Phys Ther. 2014 Feb; 9(1): 28–39. Pmcid: Pmc3924606 Breathing Pattern Disorders And Functional Movement

Inefficient breathing could result in muscular imbalance, motor control alterations, and physiological adaptations that are capable of modifying movement.

Results demonstrate the importance of diaphragmatic breathing on functional movement.

SLEEP AND POSTURAL DISTORTION OF THE NECK

S E Martin, I Marshall, and N J Douglas “The effect of posture on airway caliber with the sleep-apnea/hypopnea syndrome.” American

Journal of Respiratory and Critical Care Medicine Vol. 152, No. 2 (1995), pp. 721-4. doi: 10.1164/ajrccm.152.2.7633733

50-70 million US adults have sleep disorders.

Most common OSA: blockage of the airway in the throat, closing off air supply and leaving the sufferer without air for up to a minute.

This can have significant outcomes: HBP/heart disease, stroke, depression…

Studies show that sleeping on ones back with high pillows puts the head forward closing off or restricting the airway.

HEADACHES

NIKOLAI BOGDUK BSC(MED) MB BS MD PHD

[i] Bogduk,N., Anatomy and Physiology of Headache, Biomedicine and Pharmacotherapy, Volume49, number10, pp.435-445 [ii] McCrory, Douglas C., Donald B. Penzien, Bic Hasselblad, and Rebecca N. Gray. Evidence report behavioral and physical treatments for tension type and cervicogenic headache. Durham, NC: Duke University Evidence-based Practice Center; 2001.

Trigeminocervical Nucleus (TN)

A main factor affecting nerves surrounding the Trigeminocervical Nucleus is the biomechanical aspects of the upper cervical spine.

Postural changes stimulate nerve endings connecting to nucleus. This happens through irritation of the nerves themselves, or

decreasing the level of inhibition of the nucleus itself.

Chiropractic care, specifically cervical spine adjustments, results in inhibition of triggering function mechanisms and ultimately results decreased central sensitization.

S. Goya Wannamethee, PhD; A. Gerald Shaper, FRCP; Lucy Lennon, MSc; Peter H. Whincup, FRCP, PhD, Arch Intern Med. 2006;166:2546-2552. December 19, 2006

Associated increase in Total Mortality Increased Incidence of Cardiovascular Disease If you loose height it was found that your

mortality risk increased up to 64%. Hypothesis slumping posture causes decrease

in the respiratory index and poor posture therefore creates a decrease in health.

2009 Annual International Conference of the EMBS Research: “Over time poor posture results in pain, muscle aches, tension and headache and can lead to long term complications such as osteoarthritis.”

OSTEOPOROSISPosture and Height Loss in Older Men

31st Annual International Conference of the IEEE Engineering in Medicine and Biology Society Minneapolis, Minnesota, USA, Sept, 2009.

S. Goya Wannamethee, PhD; A. Gerald Shaper, FRCP; Lucy Lennon, MSc; Peter H. Whincup, FRCP, PhD, Arch Intern Med. 2006;166:2546-2552. December 19, 2006

OSTEOPOROSIS

Strengthening Posture to Strengthen Motion

Posture and Motion are two sides of the same coin and both affect how we age.An effective protocol to address one must also address Balance, Motion and Alignment.The 5 Posture Principles is a framework to understand Bio-mechanics.

Motion Balance Patterns Compensation (functional) Adaptation (Structural)

PERFECT POSTURE

1956 Chicago Chiropractors Convention

Contestants pose with trophies and their X-rays.

Ages 16-26

WHAT IS CAUSING THE POSTURE EPIDEMIC?

PHOTOGRAPHIC MEASUREMENT OF HEAD AND CERVICAL POSTURE

When looking at mobile phone:

Head tilt angle increased74.55° to 95.22°

Neck angle decreased 54.68° to 38.77°

Guan X1, Fan G1, Wu X1, Zeng Y2, Su H1, Gu G1, Zhou Q1, Gu X1, Zhang H1, He S3.Eur Spine J. 2015 Dec;24(12):2892-8.

It's hot off the press: http://www.ncbi.nlm.nih.gov/pubmed/26206292

CHANGES IN UPPER-EXTREMITY MUSCLE ACTIVITIES DUE TO HEAD POSITION IN SUBJECTS WITH A FORWARD HEAD POSTURE

J Phys Ther Sci. 2015 Jun; 27(6): 1739–1742. Published Online 2015 Jun 30. Doi: 10.1589/Jpts.27.1739 Pmcid: Pmc4499973

The results corroborate the clinical notion that postural alterations related to an FHPRS can change scapular kinematics and muscle activities in individuals with such a posture.

Therefore, recovery of normal functions of the UT and SA plays an important role in correcting an FHPRS.

RAMESH BALASUBRAMANIAM PhD

“The control of standing is a complicated task that involves the action of muscles distributed over the whole body. Forces arising from gravity, external events or our own actions all tend to disturb the unstable equilibrium that preserves posture. For the central nervous system the problem of standing can be cast in terms of finding appropriate relations among body segments to maintain the desired position of the body as a whole with respect to the environment.

The control of upright stance involves predictable and unpredictable perturbations in the interplay of perceptual information, attention and cognitive processes in the control of standing."

Ramesh Balasubramaniam And Alan M. Wing, Trends In Cognitive Sciences, 2002, 6:12:531-536

Standing

RENE CAILLIET, MD

“Head in forward posture can add up to thirty pounds of abnormal leverage on the cervical spine. This can pull the entire spine out of alignment. Forward head posture (FHP) may result in the loss of 30% of vital lung capacity. These breath-related effects are primarily due to the loss of the cervical lordosis, which blocks the action of the hyoid muscles, especially the inferior hyoid responsible for helping lift the first rib during inhalation.”

Where your head goes, your body follows

Ages13-17 is the largest group of down lookers

Make up 50% of all texting.

Games, Apps and more is a recipe for forward posture

Health issues will appear later in life

Cailliet R, Gross L, Rejuvenation Strategy. New York, Doubleday and Co. 1987

RENE CAILLIET, MD

“Head in forward posture can add up to thirty pounds of abnormal leverage on the cervical spine. This can pull the entire spine out of alignment. Forward head posture (FHP) may result in the loss of 30% of vital lung capacity. These breath-related effects are primarily due to the loss of the cervical lordosis, which blocks the action of the hyoid muscles, especially the inferior hyoid responsible for helping lift the first rib during inhalation.”

Where your head goes, your body follows

Ages13-17 is the largest group of down lookers

Make up 50% of all texting.

Games, Apps and more is a recipe for forward posture

Health issues will appear later in life

Cailliet R, Gross L, Rejuvenation Strategy. New York, Doubleday and Co. 1987

MEMORY PATHWAY

Practice makes Permanent, and Nerves that fire together, wire

together: Nerves that play together stay together…

Sherry McAllister

The body learns what you teach it. Posture Patterns of

Compensation in Motion & Pain

Contemporary terminology for models of cellular learning and memory.

Use-dependent change in synaptic strength,

Synaptic plasticity

Synaptic long-term plasticity in nociceptive systems,

Use-dependent long term potentiation of synaptic strength

Injury induced hyperalgesia

Sandkuhler J. Learning and memory in pain pathways. Pain 2000; 88:113-118 Geronthology 2001 Jul-Aug;47(4):189-94

PANJABI AND WHITE - THREE SUBSYSTEMS OF MOTION

Connecting

Contracting

Control

All 3 work together – Connecting tissues, Contracting Muscles & Control Nerves

ConnectingPassive –Subsystem

BonesCreate the frame holding

the body up

LigamentsConnect bones at the

Joints & limit motion

TendonsHold muscles to the bone

Cartilage, Discs &

Synovial FluidProtect and lubricate joint

FasciaBinds everything together

ControllingControl –Subsystem

The BrainIn the computer

controlling everything

Spinal cord, nerves& mechano-receptors

Are the brain to body

Communication network

ContractingActive–Subsystem

MusclesContacts to create

Motion. Muscles pull

Bones like rope.

IndividualMuscle fibers are

Either fully contracted

or released

Panjabi and White : NMS three subsystems which we work with. Contracting muscle and connecting ligament and the Neurology which comprise the NMS. They must worked to

gather in order to move well. They compensate and adapt. There is mechanical and control. Unused muscle weakened and it will contract until something changes it.

BODY LEARNS WHAT YOU TEACH IT

Mechanical

Control factors for Motion Patterns

Contracting muscles strengthen as they

are used, and unused muscles weaken.

Once a muscle contracts, it remains

shortened unless something else

stretches it.

Body Zone Ralston-from Kendall p 270 Connecting ligaments adapt and stretch in the direction of strain

BODY LEARNS WHAT YOU TEACH IT

The body folds in predictable patterns

Designed to stand up

To look in front of us

To use our hands to manipulate, move

or otherwise affect things in our

environment.

Joint motion is specific and favors a

direction.

The body naturally "folds at 3 places

The pelvis – tilts forward

The shoulders – tilts forward

The head – tilts forward

Body Zone Ralston-from Kendall p 270 Connecting ligaments adapt and stretch in the direction of strain

MOTOR CONTROL LEARNING: CHRONIC LOW BACK PAIN

First study to add postural biofeedbackConventional Physiotherapy Chronic ofLow Back Pain Suffers.

Posture Training Reduces Chronic Low Back Pain…

Magnusson ML et Al. Spine July 15 2008 Vol 33 No. 16 pp E532-E538

POSTURAL DISTORTION

Physiologic Compromise of a Spinal Misalignment Complex

1. Unequal load creates increased load on one of the facets2. Elastic deformation of the muscles and tendons

a. Muscles: first to weaken and the first to heal. It takes 6 hours for atrophy to begin. Once atrophy begins, you lose 1.5% of muscle mass per day of non‐use

b. Tendons breakdown: unequal load of the muscle‐tendon junction, causes tendonitis

3. Plastic deformation of the ligaments (which is more likely to become permanent) a. Ligaments change due to the load applied. Loss of muscle tone decreases joint

tension and increases the load to the ligaments

The Principles of Posturology 2015 by Dr. Krista Burns DC, DrHA, CPE, CPEP Dr. Mark Wade DC, DrPH, CPE, CPEP

POSTURAL DISTORTION


4. Cartilage most severe damage can occur; heals the slowest and the least. Nutrition is critical for repair of cartilage

5. Vertebral discs degenerate causing decreased rotational torque. The spine may suffer from 25% less rotational ability at the effected joint complex

6. Spinal nerves demonstrate a lower threshold, meaning they fire easier.

7. Nerve pathways become de-facilitated with restriction, and the associated body part becomes weak and clumsy


POSTURAL DISTORTION


8. Vasculature becomes compromised causing hypoxia in certain tissues, and decreased circulation

9. Osteophyte formation: Adhesions and bony degeneration. Wolfe’s Law states that any abnormal stress to the bone creates bony abnormalities

10. Osteoarthritis or DJD is caused by improper biomechanics and mechanical stress of joints due to weight bearing forces or repetitive activities

11. Abnormal Stimulation to Brain: due to Joints abnormal movement result in abnormal stimulation by the surrounding muscle spindles. a. CNS: changes not controlling the movement of that spinal segment properly. Motor

control and stability is different at this level


VLADIMIR JANDA’S CROSS SYNDROME


POSTURAL ASSESSMENTS

Assessment is a clinical shortcut and confirmatory clinical modality.

Yanda describes the stereotypical “Antalgic Posture.”

We see similar changes with Tech Neck


Head: Neutral position or flexion/ ext. of the cervical

spine

Cervical: Normal cervical curve

Thoracic: Normal thoracic curve

Hip Joint: Neutral position of the hips, or if extended

or flexed

Pelvis: Neutral position, ASIS in the same vertical

plane as the pubic symphysis

Knee: Neutral position, or if they are extended or

flexed

Ankle: To determine if the ankle is in a neutral

position where the leg is vertical and at a right angle

to the sole of the foot

POSTURE

THE ABC’S OF GOOD POSTURE

Alignment Balance Corrective exercises and stretching

Corrective Exercises and Stretching

3 point touch at wall Neck retraction/protraction Pelvic tilt at wall Wall Angels L4VA: Live 4 Vitality Always

My Chiropractor asked me how flexible I was…

I said, “I can’t make it on Tuesdays and Thursdays”

CHIN UP!SHERRY MCALLISTER MS DC CCSP

CHIN UP!

www.f4cp.com

Sherry McAllister, MS, DC, CCPS

F4CP Executive Vice President

13th A n n i v e r s a r y

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Health & Medicine

Avoiding tech neck: adverting biomechanical dysfunction from the use of technological devices