1. 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)
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2. AR-IMPACT website: arimpact.uams.edu
AR-IMPACT address:
Facebook: AR-IMPACT
Joining the Conference:
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3. 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.

4. 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# JA L01-P
AAFP Credit: Submit your AMA credit
Pharmacists: Please us your NABP number and month and day of birth

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

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

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

10. Leah Tobey, PT, DPT Physical Therapist
UAMS Physical Therapy Clinics:
Spine Center
Autumn Clinic
Colonel Glenn

11. 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

13. 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…

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

15. 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

16. 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

17. 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.’

18. 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

19. 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)

20. Do ergonomics matter?

22. 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)

23. Ergonomic factors:
Intimidating?!

24. UAMS Occupation Health and Safety department
Consultation Request for ergonomic set up

25. 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 times for up to 3-5 minutes
Scapular retraction
Squeeze shoulder blades together, hold 5 seconds, + resistance as tolerated

26. For every degree forward, we’re adding weight

27. 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.

28. Do yourself a service…avoid tech-neck

29. Questions about the Topic
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30. Case Conference and Feedback
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