Text neck: An adverse postural phenomenon.

BACKGROUND: The excessive use of hand-held mobile devices (HHMD) leads to a postural phenomenon known as text neck. OBJECTIVE: The aim of this paper is to discuss the anatomical, biomechanical and muscle activation changes within the cervical and thoracic regions associated with the sustained, forward, flexed neck posture, observed with excessive usage of hand-held mobile devices. Additionally, this paper examines the relationship of gender, as well as the effects of carrying backpack loads by youth, on this forward, flexed neck posture. METHODS: Multiple aspects of the text neck position that occur when an individual uses a HHMD are described. RESULTS: Prolonged use of hand-held mobile devices results in adverse anatomical and biomechanical changes in the cervical and thoracic spine, muscular imbalances, and postural compensations, all of which contribute to muscular overuse and fatigue resulting in pain. CONCLUSIONS: Physical therapists must educate their patients about proper posture while using hand-held mobile devices. Proper posture includes: holding the device close to eye level, using the device while standing or sitting and holding the device with a line of sight perpendicular to the surface of the device, using a larger screen, and texting with both hands. Also, because children are using hand held mobile devices at younger ages, parents and teachers must be educated about the dangers of prolonged use of hand-held devices.

A Meta-Analysis of Group-Based Pain Management Programs: Overall Effect on Quality of Life and Other Chronic Pain Outcome Measures, with an Exploration into Moderator Variables that Influence the Efficacy of Such Interventions.

OBJECTIVES: Group-based pain management programs (GPMPs) have been found to significantly improve quality of life and other pain outcome measures in patients with chronic musculoskeletal pain. The aims of this meta-analysis were to reevaluate the overall effect of GPMPs on various pain outcomes for individuals experiencing chronic musculoskeletal conditions and to explore moderator variables that potentially contribute to the overall efficacy of GPMPs. METHODS: Using the R package called metaphor and RevMan, we estimated the overall effectiveness of GPMPs on various pain outcome measures. The differential effectiveness of GPMPs was examined by conducting a mixed-effects meta-analytic model using various study-level characteristics. Moderator analyses included three content moderator variables and seven format moderator variables. Receiver operating characteristic curves investigated optimal points in some of the moderator variable analysis results. RESULTS: Significant overall main effects of GPMPs were found on all the explored outcome measures in this study (P < 0.05). In moderator analyses, it was found that the structure of GPMPs, rather than the content, significantly improved outcomes (P < 0.05). Receiver operating characteristic curve analyses identified the optimal number of GPMP sessions and number of participants per group. DISCUSSION AND CLINICAL RELEVANCE: GPMPs have a statistically significant overall effect on all explored pain outcome measures. The investigation into content and structural moderators suggests that certain GPMP design factors have a greater effect on pain outcomes than do content factors. Therefore, GPMP structural designs appear to be important in reducing pain and improving quality of life for patients with chronic pain and warrant further investigation.

A Meta-Analysis of Therapeutic Pain Neuroscience Education, Using Dosage and Treatment Format as Moderator Variables.

OBJECTIVES: This meta-analysis aimed to assess the overall effect of therapeutic pain neuroscience education (TPNE) on chronic musculoskeletal pain and to further assess whether such an effect differs by TPNE dosage as well as other treatment format components. Dosage included the number of TPNE sessions provided as well as the amount of time per TPNE session. Structural components included TPNE provided alone as treatment or combined with other pain management modalities, as well as the inclusion of group-based treatment sessions. METHODS: Electronic databases were utilized to search for randomized controlled trials that included TPNE. The overall effectiveness of TPNE was estimated on 4 pain outcome measures, including kinesiophobia, pain intensity, pain disability, and pain catastrophizing. The differential effectiveness of TPNE was examined using a mixed-methods moderator analysis on various study-level characteristics to identify potential moderators affecting the overall results. RESULTS: Significant effects of TPNE were found on all the outcome measures. The only moderator that displayed a significant effect was group-based treatment on kinesiophobia (z = -2.23, P < 0.05, 95% confidence interval [CI] -2.70 to -0.20). Between-group analysis revealed that only interventions that included group sessions were found to be statistically significant (z = 2.20, P < 0.05) and displayed a large effect size (d = 0.80, 95% CI 0.09 to 1.50). DISCUSSION: Therapeutic pain neuroscience education had a statistically significant impact on all the explored pain outcome measures. However, when investigating the treatment dosage and format moderator variables, they appeared to not have a statistically significant effect except for group-based interventions on kinesiophobia levels. CONCLUSION: This meta-analysis examined the efficacy of TPNE for patients with chronic pain. It assessed various pain outcome measures following intervention. In addition, this research identified that various moderator variables do not have and do have an impact on the treatment modality of TPNE.

Postural compensations and subjective complaints due to backpack loads and wear time in schoolchildren.

PURPOSE: This study investigated the effects of carrying weighted backpacks of up to 20% of body weight on the posture and pain complaints of elementary-school children. METHODS: Craniovertebral, forward trunk lean and pelvic tilt angles were measured from sagittal photographs of 62 children (8-11 years old) before and after walking while carrying backpacks containing 10%, 15%, or 20% of body weight. Pain severity after a 6-minute walk with the loaded backpack was recorded. Subjective complaints of pain were assessed using a visual analog scale after walking. RESULTS: Repeated-measures ANOVA revealed statistically significant differences in postural angles and increased complaints of pain after walking with increased backpack loads. CONCLUSION: These results indicate that typical backpack loads create worsening postural changes due to backpack loads and time spent carrying those loads, putting children at increased risk for injury and pain, the latter of which is a strong predictor for back pain in adulthood.

Effect of backpack load carriage on cervical posture in primary schoolchildren.

OBJECTIVE: This study examined the effects of various backpack loads on elementary schoolchildren's posture and postural compensations as demonstrated by a change in forward head position. SUBJECTS: A convenience sample of 11 schoolchildren, aged 8-11 years participated. METHODS: Sagittal digital photographs were taken of each subject standing without a backpack, and then with the loaded backpack before and after walking 6 minutes (6MWT) at free walking speed. This was repeated over three consecutive weeks using backpacks containing randomly assigned weights of 10%, 15%, or 20% body weight of each respective subject. The craniovertebral angle (CVA) was measured using digitizing software, recorded and analyzed. RESULTS: Subjects demonstrated immediate and statistically significant changes in CVA, indicating increased forward head positions upon donning the backpacks containing 15% and 20% body weight. Following the 6MWT, the CVA demonstrated further statistically significant changes for all backpack loads indicating increased forward head postures. For the 15 & 20%BW conditions, more than 50% of the subjects reported discomfort after walking, with the neck as the primary location of reported pain. CONCLUSIONS: Backpack loads carried by schoolchildren should be limited to 10% body weight due to increased forward head positions and subjective complaints at 15% and 20% body weight loads.

Impairment variables predicting activity limitation in individuals with lower limb amputation.

The purpose of this study was to determine whether measures of impairment (i.e., muscle strength, balance), personal factors (i.e., comorbidities, demographic information) and amputation specific variables (i.e., time since amputation, cause of amputation, level of amputation) were able to predict performance on the six-minute walk test, a measure of activity limitation, in individuals with lower limb amputation. A total of 72 individuals with lower limb amputation ranging in age from 21-83 were tested for balance, limb muscle strength and function. Medical comorbidities were recorded and activity limitation was measured using the six-minute walk test. Data were analyzed and multivariate relationships were examined using multiple linear regression. Impairment variables of strength, balance, subject demographics, time since amputation, cause of amputation and level of amputation were all significant predictors and explained 72% of the variance in the outcome variable. Strength of the hip extensors was the strongest predictor, accounting for 30.9% of the total variance. Multiple factors impact six minute walk scores in individuals with lower limb amputation. Impairments in hip strength and balance appear to be the two most significant. The findings of this study support the use of the six-minute walk test to underscore impairments of the musculoskeletal system that can affect ambulation ability in the amputee.

The reliability of hand-held dynamometry in measuring isometric strength of the shoulder internal and external rotator musculature using a stabilization device.

Although hand-held dynamometry is considered an objective method of measuring strength, the reliability of the procedure can be compromised by inadequate tester strength and insufficient stabilization of the dynamometer and subject. The purpose of this study was to investigate the test-retest reliability of a hand-held dynamometer with the use of a portable stabilization device while testing the shoulder internal and external rotator musculature. The isometric strength of the shoulder rotator musculature was tested twice in 30 asymptomatic adult volunteers (15 male and 15 female) between 18 and 63 years of age by using an intrasession design. Consistency of the testing protocol was maintained through the use of an arm stabilization apparatus, which fixed the arm in 30 degrees of the scapular plane and a portable dynamometer stabilization device. Intraclass correlation coefficients (ICC's) were high, ranging from ICC (3,1) = 0.971-0.972 for the test-retest trials of internal and external rotation. There was no significant difference between sessions one and two for maximum internal rotation (p = 0.431) and maximum external rotation strength (p = 0.780). The results indicate that the testing protocol with stabilization device is a reliable method for measuring strength of the internal and external rotator shoulder musculature.