Almost everyday I have a new patient with complaints of neck, upper back, and/or arm pain. There is often no mechanism of injury, but maybe only a minor trigger that set things off. Most of the time the patient states, “I slept funny.” 90 percent of these patients are working adults that spend 40+ hours staring at a computer screen. After greeting the patient in the waiting room, and asking a few questions, it doesn’t take long to figure out what’s going on. I am seeing more of the cervical and upper extremity injuries from computers than car accidents. (No, it looks like SkyNet will not become self aware and computers will attack us.) So, what about computers is the cause of these insidious afflictions? I see it, and maybe others do too, (mom was telling you all the time!) and it’s probably been there for years… bad posture.
It’s no secret that Americans have become more and more sedentary, especially in the workplace. The majority of us are now working in offices that require long hours of sitting and using the computer. This is the new epidemic of occupational injury and it’s unlikely to get you worker’s compensation benefits.
Most people associate injury with an event: a fall, an impact, a sports injury. It’s a cut and dry, black and white… (I did this/this happened to me, hence the injury resulted.) Like a car accident, a high amount of force is absorbed at one time resulting in a failure of a ligament, a knee meniscus, lumbar disc, etc. No arguments or debate on cause there.
Posture problems and their resulting injuries are different for simple reason: time. There is no event, but usually a minor trigger that is not proportional to the injury. There is nothing we can look back on and definitively blame. These injuries are low load, long duration traumas. If a sports injury/car accident was the equivalent of punching a hole through dry wall, postural problems are like placing your fist on the wall and leaning for many years. Over the course of that time, the force you impart slowly deforms the molecular bonds holding the dry wall together. Maybe there are smaller events that occur along the way to accelerate this process, but never the less there’ll be a hole in the wall. It’s all a matter of time. This tissue begins to wear down, until a minor trigger, like turning too quickly, may be just enough to set a pathology in motion. The tissue has been preloaded with micro damage, and then the straw breaks the camel’s back.
Why does this happen? People begin relying on internal stability structures instead of muscles to hold them upright. In my opinion, people are not getting jostled enough. When the train stops short, somebody bumps against you, a little slip on an icy sidewalk has a tendency to perk up the muscles to protect the body. Sitting supported for long periods of time as a tendency to relax the muscles. Focusing straight ahead on a computer monitor has a tendency to decrease movement overall. Without movement to stimulate posture muscles, computer users begin to rely on structures like ligaments, spinal joint cartilage and discs to maintain an upright position against gravity. Over time, these tissues go through a process call “creep”, where the little collagen fibers they are made of slowly start to deform, break apart, and create large areas of damage. These are tissues that are highly susceptible to break and not heal as nicely muscles.
Anyone that is ever gone to the gym before for knows that you can get sore after a workout. The process of putting force across muscles causes microscopic tearing and the muscle fibers which then stimulates the body to heal and grow stronger: hypertrophy. Muscles are good like that, they are great shock absorbers, and can build resistance to force relatively quickly. unfortunately ligaments, disks, cartilage are not so great at this process. While there is evidence that ligaments and tendons can strengthen and become more resistant to aberrant forces, the continuous and repetitive manner in which these forces are imparted can overwhelm the system and overload to failure.
Simply put, we are loading less resistant internal stability tissues to maintain an upright posture vs gravity instead of using our tougher and more adaptive muscles to the work.
Use of computers in the workplace is not going to go away anytime soon. Nor should we expect people to have a mass migration to more active occupations. Therefore we have to find solutions in order to improve people’s ability to complete work with minimizing risk of injury. In part two of this series, I will discuss the techniques we can use to mitigate these risks.