iPad hand: the new RSIs

Our obsession with smartphones and tablets is becoming a real pain


 ipad hand

New technology is supposed to make improvements to our lives. With our tablets and smartphones we can now work on the move, find information instantly and be in constant contact.
But if your devotion to your gadget has started to be a pain in the neck — or the hand, the shoulder or the fingers, then you’re not alone, because our commitment to our devices has started to cause us repetitive strain injuries (RSI) — dubbed iPad shoulder, iPhone neck and the latest affliction, iPad hand.
“You get these problems from hunching over and holding a tablet like a plate and using your other arm to operate it without any support,” says Dr Tony Kochhar, consultant orthopaedic surgeon and shoulder, elbow, arm, hand and wrist specialist who set up the London RSI Clinic to deal with an increasing number of patients with RSI injuries.
“When you use a computer you put your forearm on the desk, so it is supported. But with a tablet you are suspending your arm in free air.
“You can get severe headaches from tension in the back of the neck; an aching from the tip of your shoulder down the upper, outer part of the arm; pain at the back of the wrist and fingers from continuously using them; or a pinched nerve,” says Kochhar, who is seeing six to 10 new patients a week with these types of injuries in a demographic that he says is “getting younger and younger because of the iPad and working while travelling”.
Kate Moss’s recent injury, a trapped ulnar nerve that caused her a temporary paralysis in one arm, is also a risk of using a tablet. “You could get this from using devices like the iPad if your posture is bad and if you are resting your arm on something unpadded and uncomfortable,” says Kochhar.
“Ultimately, you could suffer with a prolapsed disc,” he warns. “If it is very bad and remains untreated it can press on your spinal cord and you could end up incontinent or in a wheelchair.”
Noel Kingsley, who teaches the Alexander Technique, which aims to correct and realign posture without surgery, is equally concerned.
“If someone is sitting, dropping their head and neck downwards to peer at a screen, the head, which weighs four to five kilograms, is tugging down on your neck, putting you off balance and causing a lot of strain,” he says.
“If the back muscles are not working efficiently, then we will overcompensate by doing more with the hands, and constantly overstraining the hands will lead to RSI, joint pain and arthritis in the future.
“If you want a more permanent solution you need to realign your whole posture. You will get temporary relief from physiotherapy but if you revert to bad habits, the pain will return.”
Kochhar agrees: “With any new gadget, look after yourself first. Use them in the correct posture, take regular breaks, regular stretches and look out for the warning signs.”

Try the Alexander Technique

My mother recently chided me as I checked my smartphone. “You’ll become one of those women who looks at her phone more often than her children,” she said.
I’m not there yet but my phone fixation has started to cause me a pain in the neck. My yoga teacher tells me the bones at the top of my spine are jutting out after years of dropping my chin to my chest and slumping my shoulders forward to examine my emails.
A visit to Alexander Technique teacher Noel Kingsley confirms that throughout the day I’m making my neck and shoulders work far harder than they need to. Carry on like this and I’m risking injury or a severely warped spine as I get older.
Kingsley nudges and talks the tension out of my limbs as he guides me to move from standing to sitting in a properly aligned position and as I lie on a table to allow my muscles to let go and my spine to lengthen.
Rather than consciously move my body, I think about my shoulders dropping and my back lengthening.
He explains that I simply need to learn to allow my body to make less effort. Currently I hold my left shoulder higher than my right and crane my neck forward.
At first it feels odd to straighten. I feel unbalanced, but the mirror confirms that in fact I am now in balance.
A picture of Alexander on the wall shows him looking down at something in his hand. His eyes are downcast, head tilted on the top of the spine — at a point between the ears — but his posture is straight. This is what I’m aiming for when I use my phone.
As I leave, feeling lighter, I have the words: “Neck to be free, head going up, back to lengthen” on repeat in my head. Now I just have to keep them there.

Researcher evaluates Alexander Technique in pain clinics

pain research

Source: UWE News

A researcher from the University of the West of England is looking into the use of the Alexander Technique (AT) as a teaching method to help people with chronic back pain and to explore the role of a specific service in an NHS pain clinic.
UWE researcher Dr Stuart McClean will be working in collaboration with Dr Lesley Wye from the University of Bristol, health practitioners at St Michaels Hospital and STAT Alexander Technique teachers. Stuart explains that “The Alexander Technique uses hands-on to achieve greater ease and poise by removing unhelpful habits that get in the way of simple activities such as sitting, standing and walking. It is all about self management and awareness.”
He said, “Alexander Technique teaches people first to pause and to realise that there are conscious choices in everyday activities such as raising a hand, talking, using a computer, or playing a musical instrument.
“Alexander Technique requires significant effort on the part of the patient, which the AT teacher calls the ‘student’. For this reason the long term impact can be very positive. Once the technique is learned the ‘student’ can use and practice the technique themselves, emphasising self management so that the effects may last after any formal treatment.
The University of Bristol and University of Southampton carried out a randomised controlled trial, published in the BMJ, and found AT was both clinically and cost effective for the treatment of back pain in primary care. This research builds on that study, as the researchers are looking at what happens when AT is introduced into a hospital pain clinic.
A participant in the trial, Ann Downton, 67, said, “I suffered from arthritis in the spine. I began to feel the benefits after four or five lessons. If you want something other than tablets to help back pain it can be expensive. Alexander Technique should be available on the NHS.”
Dr Peter Brook, the lead consultant at St. Michael’s Pain Clinic in Bristol, said, “I was very interested to read the BMJ study on back pain. The results are very encouraging and something that should be further evaluated to ascertain its value in chronic back pain. The general ethos of the Pain Management Service at University Hospitals Bristol is to encourage a self management approach to long term conditions. If lessons in the Alexander Technique can contribute to this it will be a useful addition to our range of treatment options.”
If the study demonstrates that the AT service is feasible, acceptable, cost-neutral and beneficial to service users the AT teachers will seek longer term funding to extend the service. The findings will also be disseminated widely within the local Primary Care Trust and nationally at conferences. Stuart McClean concludes, “This is a scoping study but it could have a significant impact if AT is seen to demonstrate clear benefits to the service users as well as the NHS. The results will be widely published and used to inform future decisions surrounding pain management.”

Victoria Beckham fights poor posture with Alexander Technique

victoria beckham

Source: Marie Claire

She’s been wearing towering stilettos her whole life – but Victoria Beckham fears her love of lavish footwear may leave her with a hunchback look as she gets older.
Instead of ditching the heels in favour of a nice pair of flatties, however, Victoria has turned to the Alexander Technique, a famous regime which can help strengthen core muscles and re-align the spine.
Friends in LA recommended Victoria try the Alexander Technique after recent upset about her photos displaying a round-shouldered look.
A source explained, ‘Victoria has been working hard on getting a straight back and correcting her terrible posture’.
It seems years of bad postural habits have ‘caused her bones to be improperly aligned, with her muscles, joints and ligaments taking more stress than they should’.
The regime appears to be doing the trick. Said the source, ‘You can tell that something is working as the years of Victoria’s shoulders being slumped are now over’.
Many actors and dancers practice the correction regime in an attempt to improve movement and eliminate bad postural habits, which can be picked up over the years.
Actress Juliet Stevenson hailed the method as ‘miraculous’ while novelist Aldous Huxley claimed it cured him of ‘neurotic tendencies’.
Even Lenny Henry and Anthea Turner have had practitioner courses in the technique, which is said to drain stress and tension from the muscles, ease back pain and improve breathing problems. It also boosts physical endurance and flexibility, with claims it can improve women’s fertility.
Victoria, who is already said to be ‘walking straighter,’ is hoping for a double whammy of results for her twice-daily, post-gym efforts.
The designer also suffers problems with her feet. Recent reports say the workaholic mum-of-three refused a painful-sounding bunionectomy operation because the medical procedure would have left her out-of-action for weeks.

NHS News: Alexander Technique for back pain

back pain nhs

Source: NHS News

Extensive coverage has today been given to a study that found the Alexander technique – a method of teaching improved posture – is beneficial for easing back pain. The study on the technique involved over 500 people with chronic back pain from general practices across the UK. It found that people who received one-to-one instruction in the Alexander technique, along with exercise, had reduced back pain and improved disability after one year compared to those receiving standard care.
Low back pain is a highly prevalent condition in the UK, with many adults suffering at some point in their lives, some experiencing recurrent problems. It can also be highly disabling, cause significant work loss, and reduced quality of life for the individual. It is now well known that remaining active, rather than bed rest, is the best approach to back pain; however, there has been conflicting evidence about the effectiveness of posture or exercise education. These new findings are likely to promote further research into the benefits and possible limitations of the Alexander technique, the people for whom it would be most suitable, and the best approach to instructing sufferers.

Where did the story come from?

The research was carried out by Professor of Primary Care Research, Paul Little, and colleagues from the School of Psychology at the University of Southampton, the Academic Unit of Primary Care at the University of Bristol and the Society of Teachers of the Alexander Technique. The study was funded by the Medical Research Council. The study was published in the British Medical Journal.

What kind of scientific study was this?

This was a randomised controlled trial designed to examine the effectiveness of the Alexander technique, massage, exercise advice, and behavioural counselling for chronic and recurrent low back pain. The Alexander technique involves assessment of the individual’s normal posture and movements, aiming to release tension from the head, neck and spine, and improve musculoskeletal use when seated and moving.
Sixty-four GP surgeries from the south and west of England were recruited to the study. From each surgery a random selection of patients (aged 18 to 65) with chronic or recurrent back pain were invited to participate. Participants had presented to the surgery with back pain more than three months previously (this criteria excluded acute presentations), were suffering pain for three or more weeks and scored above four on the Roland disability scale. The researchers excluded anyone with potential spinal disease, a previous spinal surgery, nerve root pain in the leg, alcohol abuse, a history of psychosis, unable to walk 100m, or who had previous experience in the Alexander technique
People from each surgery (total of 579) were randomly allocated to one of eight treatment groups (average 72 in each group). Four of the groups were instructed to do extra exercise (doctor prescription of exercises and nurse-led behavioural counselling) along with one of the following treatments: normal care, six sessions of therapeutic massage, six lessons in the Alexander technique, or 24 lessons in the Alexander technique. The other four groups had the same treatments but with no added exercise.
A total of 152 teachers and therapists were involved in educating and carrying out the techniques. People were assessed by postal questionnaire at start of the study, three months, and one year after they had been allocated a treatment. The main outcome that the researchers examined was disability, assessed using the Roland Morris questionnaire and covering issues such as types of activities limited by pain. They also looked at other outcomes of quality of life and other back pain and disability scales.

What were the results of the study?

Of the 579 people who were allocated a group and completed the questionnaire at the beginning of the study, 80% of the study sample (463) completed the one-year follow-up. When they first enrolled in the study, the characteristics of the participants were similar across all treatment groups and the majority had chronic back pain, experiencing 90 or more days of pain over the past year.
At three months, after exercise had been taken into account, Roland disability score and average number of days with back pain over the past month had significantly decreased in all groups compared to control (massages and 6 or 24 Alexander technique lessons). At one year, 6 or 24 Alexander technique lessons had significantly decreased Roland disability score and average number of days with back pain compared to control, but massage no longer showed significant decrease in disability score. The greatest improvement was seen in the 24-lesson group. Compared to control, exercise, following adjustment for the other techniques, significantly decreased both Roland disability score and average number of days with back pain at three months, but at one year, exercise was only significantly effective on disability score.
When the researchers compared individual groups, they found that the effect of 24 Alexander technique lessons combined with exercise was no different to the effect of 24 Alexander technique lessons alone. Six Alexander technique lessons combined with exercise were 72% as effective as 24 lessons alone without exercise. No adverse effects were reported for the Alexander technique.

What interpretations did the researchers draw from these results?

The researchers conclude that one-to-one instruction in the Alexander technique by registered teachers has long-term benefits in chronic back pain. Six lessons combined with exercise had almost comparable effectiveness to 24 lessons in the Alexander technique.

What does the NHS Knowledge Service make of this study?

This well conducted randomised trial has strengths in that it involved a large number of participants with a sample size large enough to assess meaningful differences in the measured outcomes for each of the different treatments. It also followed the majority of these participants across the one year period. The study demonstrates the effectiveness of the Alexander technique, with and without exercise, in reducing disability score on a recognised scale. A few points to consider:

  • Instruction and education in the techniques involved a large number of trained professionals (152) and there may have been minor differences in the treatments given across the sample.
  • The fact that the Alexander technique requires education by a registered professional does mean that referral is going to be affected by local care arrangements and resources across the country.
  • Although the effectiveness was measured up to one year, longer follow-up would be valuable to assess longer-term outcomes and possible adverse effects.
  • Assessments were by postal questionnaire and disability, quality of life and pain are highly subjective measures. How one person views their level of pain and disability is going to be different from another.
  • All people in the groups had chronic back pain and fulfilled certain criteria. Many that the researchers contacted initially were not eligible for the study. Importantly, this study has no implications for care of acute low back pain.

Low back pain is a highly prevalent condition in the UK with many adults suffering at some point in their lives, some of whom experience recurrent problems. It can also be highly disabling, cause significant work loss, and reduced quality of life for the individual. It is now well known that remaining active, rather than bed rest, is the best approach to back pain. However, there has been conflicting evidence on the effectiveness of posture or exercise education. These new findings are likely to promote further research into the benefits and possible limitations of the Alexander technique, the people for whom it would be most suitable, and the best approach to instructing sufferers.