Digital Media and Developing Bodies: the musculoskeletal system

1. Digital Media and Developing Minds National Conference Cold Spring Harbor Laboratory October 17, 2018 Digital Media and Developing Bodies: the musculoskeletal system Cordelia W. Carter MD Pediatric Sports Medicine Program Director Hassenfeld Children’s Hospital NYU-Langone Medical Center

2. Digital Media and Developing Bodies Repetitive strain injury • Neck and shoulder pain • 50% youth report symptoms • Hand and wrist pain • 42% youth report symptoms • DeQuervain’s tenosynovitis • Other tendonitis, repetitive strain injury (e.g., EPL) • Other musculoskeletal disorders • Temporomandibular joint (TMJ) pain • Carpal tunnel syndrome • Back pain

3. Digital Media and Developing Bodies “text neck” • Cervical erector spinae • Trapezius • Shoulder protraction and elevation

4. Digital Media and Developing Bodies “text neck” • RULA • Rapid Upper Limb Assessment • 0 neck flexion • 0 head/neck tilt • Eyes straight ahead • Arms at sides • 91% > 10 degrees • Majority 20-40 degrees

5. Digital Media and Developing Bodies “text thumb”

6. Digital Media and Developing Bodies “text thumb” • 56 Swedish youth • 19-25 years • 41 sx, 15 no sx • Used electrogoniometer and EMG (electromyography) during texting • Symptoms correlate with: • Neck flexion • No forearm support • One-thumbed texting E Gustafsson, 2012. Ergonomic recommendations when texting on mobile phones.

7. Digital Media and Developing Bodies Initial recommendations for prevention • Support the forearms • e.g., use an armrest, thighs, table • Decreases trapezius activation • Use both thumbs • Do not sit with the head bent forward • Do not text with high velocity • Increases extensor muscle activity E Gustafsson, 2012. Ergonomic recommendations when texting on mobile phones.

8. Digital Media and Developing Bodies Initial recommendations for prevention • Avoid excessive total usage • Avoid prolonged static postures • Use opportunities to vary whole body, head/neck and upper extremity postures during use • Avoid awkward postures during prolonged or repetitive use • Position device at a height to balance head/neck and upper extremity stress • holding device at eye level encourages neutral head/neck posture but increases upper extremity loading • holding device at waist/lap level increases head/neck flexion but reduces upper extremity loading • For longer durations of use, support device at a tilt angle (e.g. with the use of device accessories) to balance head/neck and upper extremity stress • a higher tilt encourages neutral head/neck posture and is good for viewing only tasks • a lower tilt allows lower wrist and finger stresses and is good for tasks requiring finger or thumb input • Avoid high repetition of movements such as prolonged typing or swiping • Avoid forceful exertions such as holding larger or heavy device in one hand for long durations Toh et al, 2017. The associations of mobile touch screen device use with musculoskeletal symptoms and exposures: A systematic review.

9. Digital Media and Developing Bodies Opportunity costs • Physical literacy • Physical fitness

10. Digital Media and Developing Bodies Traumatic injury • Distracted walking and driving • Clear increased incidence in injury • Most affects youth (<30 years) • Mechanism typically a fall • Concussion • Musculoskeletal injuries • Fracture • Bruises • Lacerations

11. Digital Media and Developing Bodies It’s not all bad – tools for physical fitness

12. Digital Media and Developing Bodies unknowns • Growth plates • Reversibility