1. Digital Media and Developing Bodies: the musculoskeletal system
Cordelia W. Carter MD
Pediatric Sports Medicine Program Director
Hassenfeld Children’s Hospital
NYU-Langone Medical Center
Digital Media and Developing Minds National Conference Cold Spring Harbor Laboratory October 17, 2018

2. Digital Media and Developing Bodies
Repetitive strain injury
Neck and shoulder pain
50% youth report symptoms
Hand and wrist pain
42% youth report symptoms
DeQuervain’s tenosynovitis
Other tendonitis, repetitive strain injury (e.g., EPL)
Other musculoskeletal disorders
Temporomandibular joint (TMJ) pain
Carpal tunnel syndrome
Back pain

3. Digital Media and Developing Bodies
“text neck”
Cervical erector spinae
Trapezius
Shoulder protraction and elevation

4. Digital Media and Developing Bodies
“text neck”
RULA
Rapid Upper Limb Assessment
0 neck flexion
0 head/neck tilt
Eyes straight ahead
Arms at sides
91% > 10 degrees
Majority degrees

5. Digital Media and Developing Bodies
“text thumb”

6. Digital Media and Developing Bodies
“text thumb”
56 Swedish youth
19-25 years
41 sx, 15 no sx
Used electrogoniometer and EMG (electromyography) during texting
Symptoms correlate with:
Neck flexion
No forearm support
One-thumbed texting
E Gustafsson, Ergonomic recommendations when texting on mobile phones.

7. Digital Media and Developing Bodies
Initial recommendations for prevention
Support the forearms
e.g., use an armrest, thighs, table
Decreases trapezius activation
Use both thumbs
Do not sit with the head bent forward
Do not text with high velocity
Increases extensor muscle activity
E Gustafsson, Ergonomic recommendations when texting on mobile phones.

8. Digital Media and Developing Bodies
Initial recommendations for prevention
Avoid excessive total usage
Avoid prolonged static postures
Use opportunities to vary whole body, head/neck and upper extremity postures during use
Avoid awkward postures during prolonged or repetitive use
Position device at a height to balance head/neck and upper extremity stress
holding device at eye level encourages neutral head/neck posture but increases upper extremity loading
holding device at waist/lap level increases head/neck flexion but reduces upper extremity loading
For longer durations of use, support device at a tilt angle (e.g. with the use of device accessories) to balance head/neck and upper extremity stress
a higher tilt encourages neutral head/neck posture and is good for viewing only tasks
a lower tilt allows lower wrist and finger stresses and is good for tasks requiring finger or thumb input
Avoid high repetition of movements such as prolonged typing or swiping
Avoid forceful exertions such as holding larger or heavy device in one hand for long durations
Toh et al, The associations of mobile touch screen device use with musculoskeletal symptoms and exposures: A systematic review.

9. Digital Media and Developing Bodies
Opportunity costs
Physical literacy
Physical fitness

10. Digital Media and Developing Bodies
Traumatic injury
Distracted walking and driving
Clear increased incidence in injury
Most affects youth (<30 years)
Mechanism typically a fall
Concussion
Musculoskeletal injuries
Fracture
Bruises
Lacerations

11. Digital Media and Developing Bodies
It’s not all bad – tools for physical fitness

12. Digital Media and Developing Bodies
unknowns
Growth plates
Reversibility