Supported in part by Arkansas Blue Cross and Blue Shield and the Office of the Arkansas Drug Director and in partnership with the Arkansas Academy of Family Physicians (AAFP), the Arkansas Medical Society (AMS), the Arkansas State Medical Board (ASMB), the Arkansas Department of Health (ADH) and its Division of Substance Misuse and Injury Prevention (Prescription Drug Monitoring Program—PDMP) Continuing Education Credit: TEXT: 501-406-0076 Event ID: 28352-24581

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Faculty Disclosure of Financial Relationships: The planners of this RSS, Corey Hayes, Michael Cucciare, Johnathan Goree, Leah Tobey, Teresa Hudson, Marti Morrison and Cathy Buzbee have no financial relationships with commercial interests to disclose. A planner of this RSS, Shona Ray-Griffith, MD, has a financial relationship with a commercial interest to disclose: Neuronetics, Inc. – Contracted Research. The speaker of this RSS has no financial relationships with commercial interests to disclose. The accreditation compliance reviewers of this RSS, Karen Fleming and Courtney Bryant, have no financial relationships with commercial interests to disclose.

Continuing Education Accreditation: In support of improving patient care, University of Arkansas for Medical Sciences is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Credit Designation: The University of Arkansas for Medical Sciences designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. The University of Arkansas for Medical Sciences designates this live activity for a maximum of 1 ANCC contact hour. Nurses must attend the entire session in order to receive credit. This knowledge-based activity will provide pharmacists up to 1.0 contact hours or 0.1 CEU. ACPE# JA0000298-0000-18-040-L01-P AAFP Credit: Submit your AMA credit Pharmacists: Please email us your NABP number and month and day of birth

Other General Information CISCO IPhone App CISCO Meeting Information Please mute your microphone in CISCO Able to ask questions through CISCO Chat

Non-pharmacological care of Tech-Neck Heads up! How to reboot (your tech-neck) Non-pharmacological care of Tech-Neck

Objectives What is tech-neck (aka text-neck)? Simple tips & tricks to reduce improper mechanical load of cervical spine Review corrective ergonomic desk setup

https://www.polleverywhere.com/multiple_choice_polls/IhP0PHjYN7vfwN7

https://www.polleverywhere.com/multiple_choice_polls/RNL0VoCy2XM0Wyk

Leah Tobey, PT, DPT Physical Therapist UAMS Physical Therapy Clinics: Spine Center 501.661.7955 Autumn Clinic 501.320.7777 Colonel Glenn 501.406.9234

Tech/Text Neck? Overuse syndrome involving the head, neck and shoulders A position with rounded shoulders where the neck is protracted at an uncomfortable angle Usually results from excessive strain on the spine from looking in a forward & downward position at any hand-held mobile device

https://www.polleverywhere.com/free_text_polls/EJS0iZByqQbQr2D

Tech-Neck Synonym: forward head posture Symptoms: headaches, neck pain, shoulder and arm pain, breathing compromise, low back pain, etc… Examples: cell phone use, video game unit, computer/EMR, mp3, books/e-reader, etc…

Improper loading through spine Tight Suboccipital mm & tight pectorals Sharp thoracic pain Inability to take deep breaths Neural tension in arms or legs

How do I know if I’m suffering from Tech Neck? 4 signs you might be spending too much time staring at your screen: Poor posture Holding your device at chest hip level? Persistent neck pain If it occurs on a daily or even weekly basis N&T in fingers Without intervention, TOS symptoms can develop Headaches & Migraines For every inch you lean forward, you’re “adding” weight

5 PT Tips: Put your head on your body Bring your work closer to you Support your lower back when sitting Perform gentle neck stretching & exercises Keep your upper back flexible & strong

Case 1 Kate is a 27 y/o F currently in grad school to become a mental health therapist. PMHx of cervical tightness and pain with c/c of migraines since age 15. She reports HA 2-5 days/wk and most are severe. FamHx: aunt and older brother have migraines. Allergies include NSAIDs & Tylenol (hives, facial & tongue swelling). Referred to PT by her neurologist. Pain localizes to either L or R side of her head, associated with light, sound; odor sensitivity, nausea and occasional vomiting, poor concentration. She may occasionally note blurry spots in her vision as the migraine begins. She has tried: nortrtiptyline, amitriptyline, topamax, Lexapro & robaxin Current medicine regimen: alternates between sumatriptan and rizatriptan and takes 5-6 tabs per day. Neurologist provided education regarding ‘analgesic rebound headaches & the importance in limiting this class of medication.’

Kate’s Diagnosis & PT Eval Tid-Bits Two diagnoses given: Analgesic overuse headache & chronic migraine without aura intractable She was on her new pain medication regimen for about 1 month when I evaluated her in PT; Baclofen had been added C/o migraines & shooting pains along her upper traps, described as "constant right there." She denies N&T. T&Ms: observation-FHRSP with dowager’s hump; palpation- hypertonic B up traps; ROM- 75% B rotation & SB; 50% cervical flexion (greatest pain!) Assessment: Poor postural habits, hypomobility noted: C1-2, C7-T4; DNF endurance was weak <10”; poor study/ergonomic habits: laptop-couch Results: 12 visits over 2 month period Average HA (when present) improved from 8/10 to 5/10; improved concentration & no longer had visual changes NDI improved minimally from 15/50 to 13/50 *of note: “believe my pain is improving” WNL mobility through cervical and thoracic spine Indep with gym and home ex programs

Kate’s treatment plan Put your head on your body Postural retraining Proprioception retraining Recognition of postural habits Bring your work closer to you Ergonomics of work and home environments changed Instruction to keep neutral spine Pain cues, visual/mirror cues Support your lower back when sitting Morbidly obese & her chair didn’t fit her well Lumbar support pillow behind her back to achieve neutral pelvis (WB through pelvic floor not her sacrum) Perform gentle neck stretching & exercises DNF strengthening Cervical retraction/chin tucks in supine *keep pain free Isometrics: cervical spine all planes, scapular retraction resistance with therabands & pulley system Keep your upper back flexible & strong Manual therapies medically needed (joint mobilization, dry-needling upper traps (endogenous opioid, endorphins) Foam rolling for self-mobilization (daily)

Do ergonomics matter?

https://www.polleverywhere.com/multiple_choice_polls/EFV2mjnciQoiECj

Healthy Ergonomics Don’t perch—Sit all the way back in your office chair Bring your work station to you Raise your monitor to face height Rest your forearms on the armrests of your chair Use an ergonomic keyboard & mouse (build-ups with mousepad for example)

Ergonomic factors: Intimidating?!

UAMS Occupation Health and Safety department Consultation Request for ergonomic set up 501-686-5536

Take home Tid-Bits How should I sit? Perform gentle exercises: Maintain a gentle inward curve to create normal lordosis: helps align the spine when seated and lets your head rest in tall, neutral position Perform gentle exercises: Chin tucks Lay flat on your back with no pillow Place a folded hand towel (lengthwise) (~2-4” diameter roll) under the base of your skull (the bumps). Gently and slightly nod your head yes as you exhale Repeat 10-20 times for up to 3-5 minutes Scapular retraction Squeeze shoulder blades together, hold 5 seconds, + resistance as tolerated

For every degree forward, we’re adding weight

PT Pick 2 Challenge: Every 30 minutes or so, get away from your computer for 1-2 minutes Stretch Roll your shoulders down & back Grab a drink of water Do a few quick exercises 5 squats Squeeze your shoulder blades together for 10 seconds Take a few deep breaths for full diaphragm expansion These are proven to reduce pain, improve concentration and limit fatigue.

Do yourself a service…avoid tech-neck

Questions about the Topic Continuing Education Credit: TEXT: 501-406-0076 Event ID: 28352-24581

Case Conference and Feedback Continuing Education Credit: TEXT: 501-406-0076 Event ID: 28352-24581