IN CASE YOU MISSED IT

Pain in the neck

This story was first published in The Straits Times on Feb 6, 2014

You might love that smartphone of yours but it sure does not love you back.

All that bending over to peer at the screen for long periods may well be causing serious repetitive stress injuries to the neck. The bad posture can also lead to injuries in other parts of the body. There is now a whole new assortment of pain, no thanks to technology.

With Singapore having one of the most mobile-savvy populations in South-east Asia, the number of people with neck, shoulder, wrist and finger pain from using mobile devices is also on the uptick, said Ms Ruby Poh, senior physiotherapist at Singapore General Hospital (SGH).

Overall, repetitive stress injury is fairly common, with a prevalence of 5 per cent to 10 per cent in the general population, but rising to 30 per cent for specific groups such as people working in the manufacturing industry, said Dr Darren Tay, a consultant at the department of orthopaedic surgery at SGH.

Also, there are more young people now complaining of neck ache, he said.

Magnetic resonance imaging scans are likely to show that things are normal as there is no structural damage to their bones, unlike in the elderly, who may have degenerative changes because of diseases such as osteoarthritis.

However, there may be damage to the tendons and muscles in the neck, said Dr Tay.

The head weighs about 4kg, he said. If it is bent forward 3cm when a person is peering at a screen, its weight is doubled. When bent even further forward, the weight could be tripled.

All this time, the muscles at the back of the neck have to constantly pull the head back.

"The continuous strain is not felt until you feel tired at the end of the day or week. Over time, you can get what is known as 'text neck', a chronic neck ache that results from repetitive stress injury," said Dr Tay.

Repetitive stress injury is among the most common musculoskeletal injuries in the United States.

According to the US Department of Labor, Occupational Safety and Health Administration, repetitive stress injuries are the nation's most common and costly occupational health problem, affecting hundreds of thousands of American workers and costing more than US$20 billion (S$26 billion) a year in workers' compensation.

In the Netherlands, 8 per cent of the working population take time off work every year due to symptoms from repetitive stress injuries.

In Canada, its prevalence has been increasing steadily, with a 2 per cent increase (500,000 additional cases) reported in 2001 compared with 1996.

REPEATED STRESS ADDS UP

Repetitive stress injury is a family of disorders, said Dr Mohamed Fadzil, resident physician at the Changi Sports Medicine Centre at Changi General Hospital.

Collectively known as cumulative trauma disorders, they refer to musculoskeletal conditions or injuries of the upper and lower limbs, back and neck caused by repetitive tasks carried out on a daily basis for a period of time.

Risk factors include: Doing an activity for a long time without rest; doing an activity frequently that involves force, such as lifting heavy objects; having poor posture; or carrying out activities that require the person to work in an awkward position, said Dr Fadzil.

Stress can also be a contributing factor, he added. This occurs when the body part is called on to work harder, stretch further or otherwise function at a level beyond what it is prepared for, he said.

The immediate impact may be indiscernible, but when it occurs repeatedly, the constant stress will wreak damage, usually to the muscle, bone, tendon or bursa of the joint and other surrounding structures such as the nerves.

A bursa is a fluid-filled structure present between the skin and tendon or tendon and bone. Its main function is to reduce friction between adjacent moving structures.

A variety of jobs can lead to such injuries, for example, working at an assembly line or as a supermarket cashier, as well as typing at a computer, said Dr Fadzil.

Some of the more common disorders that fall under repetitive stress injuries include carpal tunnel syndrome, tennis elbow, trigger finger and chronic neck ache, said Dr Tay.

SYMPTOMS DEVELOP GRADUALLY

The symptoms of repetitive stress injury usually develop gradually.

They can range from mild to severe and may vary depending on the site of the injury as well as the structures involved.

They often include pain or tenderness in the muscles or joints, stiffness, throbbing, tingling sensations, numbness, weakness and cramps, said Dr Fadzil.

At first, one might only notice the symptoms when carrying out a particular repetitive action, for example, pain at the finger joints or wrist when typing on a keyboard or clicking on a mouse at work.

The symptoms may improve once the activity is stopped. However, if left untreated, the symptoms are likely to get worse and cause longer periods of pain.

There may also be swelling in the affected area, which can last for several months, said Dr Fadzil.

Without treatment, the symptoms can become chronic.

At this stage, the condition may be irreversible, especially if structures such as tendons and cartilage are damaged.

Some people may eventually get a chronic pain syndrome that affects every aspect of their life, he said.

When one has repetitive stress injury, it is advisable to temporarily stop doing the task or activity that is causing the symptoms.

Otherwise, the symptoms may be aggravated and there is a risk of further damage to the affected joint or tissues, thus making the injury permanent, said Dr Fadzil.

EARLY DETECTION IMPORTANT

Treatment options for repetitive stress injury all aim to relieve pain and enable the person's strength and mobility to return.

Generally, patients can be managed with rest, pain medication, exercise, physical therapy and workplace ergonomic modifications, said Dr Tay.

Surgery is seldom recommended but can be considered if all other methods do not work, he added.

Some people may find that regular exercise, such as walking or swimming, can help to ease their symptoms.

This condition can be reversed if it is detected and managed early with exercise, said Dr Tay.

Several studies have shown that exercise has positive effects for those suffering from repetitive stress injuries, especially for shoulder and neck aches, he said.

wanching@sph.com.sg

This story was first published in The Straits Times on Feb 6, 2014

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