 Welcome to Much More on Medicine on Think Tech Hawaii, broadcasting live from our downtown studios at Pioneer Plaza in downtown Honolulu. I'm your host, Catherine Noor. Joining me in the studio today is physical therapist Christine Linders. Today, we're going to talk about how technology is ruining your neck and back and how to solve it. Remember that our talk shows are streamed live on the internet from noon to 5 p.m. every weekday and earlier shows are streamed all night long. I'm delighted to be talking with Christine Linders today. She's been practicing physical therapy for over 23 years in California, New York, Connecticut and now Hawaii and has been a board certified orthopedic clinical specialist since 2006. Christine is a three-time Iron Man triathlete and competitive beach volleyball player and is passionate at keeping her patients active and getting them back to work and enjoying their lives. Christine, aloha, welcome. Thank you so much for having me, Catherine. What do you do as a physical therapist? As a physical therapist, someone would come to me with either pain somewhere, muscle weakness, or maybe not being able to do something that they love, a hobby or a sport. So first, I find out where their pain is and then I go and do my process to find out what is actually causing their pain, what is a strain that's causing them to have that pain in that part of their body. After that, I would do some manual therapy treatment to restore the tissue or the joint more towards normal and then teach them a simple exercise or two or three that they can do and incorporate most likely into their day to start the process of restoring their body back towards normal. Okay. And when I'm not in front of a TV camera, I'm usually holding a phone or a tablet or I'm in front of a computer or in front of a laptop. So can these objects cause problems? Yes. These devices are great, but they're posing certain challenges for our bodies because we tend to be on them for prolonged periods of time. And also we tend to be on them in postures that are less than ideal, but we're not aware of how we can be hurting our bodies and doing that. Okay. And a lot of our audience members spend their day on computers and laptops. Can these cause problems to their bodies? Yes, they can. I think the device itself is not, per se, harmful to your body. It's how we're holding ourselves and that we're doing it for a prolonged period of time while we're on them. People don't realize that when they're involved in a project, they might be hunching forward or they're sitting relaxed looking at their cell phone. They just not thinking because the device is so engaging. There's an important message coming through or they're playing a game that they're not thinking about, oh, let me hold my posture upright. And that's what makes us at risk for injury. Well, let's look at image one. Okay. So what injuries are caused by laptop use? What I see with someone sitting on their laptop in this picture is a lot of back pain, neck pain, and sometimes shoulder pain. And the reason why that happens, if you could see in the photo, the person's ear is that much further forward than their shoulder and their spine is very rounded. So that puts a lot of stress on the body. Now in image two, you see the corrected posture where the person's ear is falling almost directly over their shoulder and almost directly over their hip with their hands or something supported on the device so that gravity can go straight down through their body, not causing excess strain on the muscles or the tissues. And do employers, are they concerned about this? Yeah, I think employers, it poses a big problem for employers because employers need people to be at work and they need to be productive and feeling good to give their best. And so when someone's in pain, often they're distracted. They're distracted because they're sitting and they're uncomfortable, but they're not sure what they're doing to cause that pain. And eventually, if it gets bad enough and that's where people come to see me, they're taking time off of work because they can't do their job well anymore. Okay, now smartphones have become a fifth appendage. Okay, and we have them all the time in our hands. Why don't you tell us a bit about that and let's take a look at image three. Okay, so in image three, you can see what I see so often in the waiting room while people are waiting for you to come get them or walking into a coffee shop on the train, on the plane. We love our phones, they're great. They can entertain us, they provide information, they allow us to stay in touch for people near and far. But when you sit like that on your phone, you're not thinking about the fact that your head, which is somewhere between six and eight pounds, is hanging on your neck muscles, and then all of that is hanging on your lower back until something hurts. And that's where we're at risk with phones. We need to be aware to have good posture while we use these glorious devices. Okay, so I go to seminars or meetings and I want to look at my phone underneath the desk or the table. Is that okay? Yeah, I suppose that would be okay, but it's not okay for your body. So when you're leaning down to look at your phone like that, trust me, the presenter knows what you're doing. You may as well just do your neck and back a favor, glance at your phone up here, get your message done and then put it away. Okay, and so I know a lot of our viewers are actually streaming this on tablets. Okay, now, are there any concerns about tablets? And we can take a look at image five. Yeah, so the concern for tablets that's different from laptops and cell phones is cell phones are smaller and they weigh less. Laptops are big enough that you're not going to carry them and work on them. You're going to put them on a surface. But tablets are that in between they're a little bigger, they're a little heavier, but people sometimes want to treat them like the lighter devices. So there's wrist and hand and shoulder injuries that I'm seeing now from people carrying a heavy object outright in front of them that don't need to happen if they rest it on a surface. Okay, and what about binge watching? Okay, I know that's a big thing. People are binge watching Netflix shows or whatever show or probably binge watching a lot of think-tack Hawaiian. Absolutely, I know I am. Well, binge watching is a term I've been hearing a lot about because people want to see what's out there. There's a lot of good things. But what I've heard patients complain of that have come to me is how they're binge watching. They're laying out on their sofa with their head cranked up against the sidearm or against pillows pushing their head and neck for it or they're laying in bed, even just watching TV without being on their tablet with their head pushed up against the pillows and that causes so much stress on the head and neck. And I never realized people were doing that until I asked someone, you're not in bed like this all the time, are they? And they went, I do that every night while I'm checking my emails. And I realized the strain they're putting on their neck by having it fixed up against the headboard like that was causing all of their pain. OK, so now what about walking and standing with your phone? OK, I see people walking around with their phones or standing around with their phones. Is there a way that people can do that safely? And we can look at image seven, please. Right, so in this image, you'll see what we've all seen. And I lived in New York City, people on the subway, people walking down the street, people here looking at their phones to catch a glance. I was in a talk this weekend seminar and the gentleman when he played a video was looking at his phone like this. That puts a big strain on your neck looking down like that again. Your head weighs quite a bit. But in the next image, you'll see the solution where you just rest your hand comfortably underneath your elbow. You keep your arms tucked into your side. You can sit like that all day and look at your phone. So it's easy to look here, do your quick whatever you need to do. And then you're back in action with good posture, no strain. OK, are you saying that we can actually walk around holding our phones and do that safely? No, I don't recommend anybody walk with their cell phones. I could tell a funny story because people have tripped in potholes and sprained their ankles. I don't find that funny, but the story that they tell me, they're laughing. You shouldn't do it. It's not safe. You could bump into somebody. You could miss a great opportunity. We want to keep you safe. And I don't want you to be in my office with some injury because you're walking with your cell phone. So just stop. I do it too. I stop quick, see where I'm going if I'm looking at directions, and put my cell phone down. And I keep walking along with my day. And I'm sure that you stand there with perfect posture while you're looking at it. Of course. OK, fantastic. Oh. So I guess, scam likely, someone's calling with me about a car warranty. Let me tell you something, Catherine. If you're going to be looking at your smartwatch like that, this position is not so good for your shoulder. It's what we physical therapists and health professions call the impingement sign. So it can give you shoulder pain. So what I recommend for people that are using smartwatches or FitBits is you either keep it down here and you tuck your chin and gaze your eyes down to look at it so your head and neck stay in good form. Or if you're going to be busily looking at it during a conference or a meeting, put the face so it's on the underside of your wrist. But what I found out is that with the Apple Watches, you need to set the watch to the other hand in order to be able to flip it to look at it safely for your shoulder. OK, so if I only look at my watch kind of to tell time, is that a problem? No, if you're only looking at to tell time, I would just say try not to raise your elbow so high. Just kind of flip your wrist more out in front of you. OK, OK. So maybe I'm OK then. Yeah, I think you're OK. OK. Don't look at it again. All right, so what about hobbies? Are there any hobbies that you like to do that you might do with poor posture? Yes, there is. So I have always wanted to play the ukulele. And my dad learned to play it. And now that I'm on Hawaii, I would love to learn to play the ukulele. So in this next image, image nine, you'll see me learning. And I'm learning. I don't know the chords. I don't know the strings. And I have to look down to see what I'm doing. I can't read the music to know. So in the learning phase, you're going to be in bad posture, just like me at work. And people taking care of their baby, they're going to be in bad postures. The key is to make sure you do something to get yourself out of that bad posture afterward. And in the next image, image 10, you'll see I'm doing my best I can still see. But I've tucked my chin down and I'm gazing my eyes down instead of bending my neck so forward so that I will put less strain on my head and neck. OK, well, that's good. I hope that you'll eventually be a great ukulele player and you'll have good posture all the time. I hope so. OK, so can you think of any other hobbies that people do that they come in because they have injury from? Yeah, absolutely. I've seen piano players come in with injuries because now we're also using laptops, cell phones, and they've had strain in one wrist. It's usually the typical wrist where they're either mousing with it or if they're holding their cell phone in that. And so now they're doing their hobby of playing piano, but they have wrist pain on the one side that they've been overusing their devices. And I've also seen baseball players with shoulder injuries from using the joystick on the games, the ones that have a joystick. I had a baseball player. I asked him that, do you sit like this all day? And he said, oh my gosh, I'm an obsessive gamer. So we're talking about gamers. Gamers or devices. So the first one was cell phones, the second one with a game. It's the same thing. It's posture and the devices. So gamers, that's a big challenge. If you're a gamer, you have a potential of having a lot of injuries, correct? It is. It is. And I'm seeing it in younger and younger kids because there's so many great games out there to play. We didn't have that when I was younger. We had some small games that were fun for kids, but not like they have today with all the virtual things that they're so engrossed in these games for hours and hours in less than optimal postures. So do they have thumb injuries also from doing this? I've seen thumb injuries from Blackberry use when I used to live in the city. I've seen thumb injuries for holding the cell phone and using one hand to do the button pushing. And I've seen the thumb injuries from using all the buttons on those, I don't know, Nintendo. Or what's the latest thing out there right now? Xbox, I think, is one of them, yeah. Sure. Yeah. Well, I think with eSports and with that becoming such a big thing, that's going to continue to keep your office full. It will. So OK, we're going to take a short break. I'm Catherine Norr. This is Much More on Medicine on Think Tech Hawaii. We're talking with physical therapist Christine Linders about how technology is ruining your neck and back and how to solve it. Hi, I'm Rusty Komori, host of Beyond the Lines. I was the head coach for the Punahou Boys varsity tennis team for 22 years. And we're fortunate to win 22 consecutive state championship. This show is based on my book, which is also titled Beyond the Lines. And it's about leadership, creating a superior culture of excellence, achieving and sustaining success, and finding greatness. If you're a student, parent, sports or business person, and want to improve your life and the lives of people around you, tune in and join me on Mondays at 11 AM as we go Beyond the Lines on Think Tech Hawaii. Aloha. Aloha. I'm Marcia Joyner, inviting you to join us on Wednesdays at 1 o'clock for Cannabis Chronicles, a 10,000-year odyssey where we take a look at cannabis as food, cannabis as medicine, cannabis and religion, cannabis, and dear old Uncle Sam. So please join us to learn all about cannabis. Again, Wednesdays at 1 o'clock. Thank you. We're back. We're live. I'm Catherine Norr, and this is much more on medicine on Think Tech's live streaming network series, talking about how technology is ruining your neck and back and how to solve it. We're here with Christine Linders, a physical therapist, and Christine. We've talked a lot about different devices that cause problems to our back and neck and thumbs and all sorts of things. And so when patients come to you and complain of pain, is there anything you can do about it for them? Absolutely, Catherine. One of the first things that I will do is look for any sort of muscle tension that's in their body that has developed because of their injury process. That's our body's way to protect itself is to develop tension in the muscle, which people call muscle spasm. So the first thing I like to do is identify that, use my hands to loosen up their muscle and restore it to normal, and then make sure the person has normal joint mobility, whether it's their shoulder, whether it's something in their spine. And after that, and I've restored them towards more normal, I usually have them go through a series of exercises in the clinic to re-educate that body part and that muscle that it's OK to move now because muscles have a memory. And so they will oftentimes spring back the first time after you loosen them up if you don't give the person some sort of movement or exercise to re-teach the body that it's OK to move in that realm. That's my first course of action. OK. And I understand that you actually are very good with low back. Is that right? You may be right. So do you have some special techniques that you use for low back? I do have some special techniques that I have used for low backs, as a matter of fact. I've been using a technique since 2000, I believe, I think, is when I learned this special technique that works your deepest core muscle, your abdominal muscle, with your deepest back muscle. And when these two muscles are engaged, they form your anatomical girdle. And when I started teaching people this technique, a lot of my back pain patients who'd had pain for, some have said up to last year, 35 years, they were getting results with getting rid of their low back pain. Because that technique has been proven, I've done research on it now, that without the mechanism of your deepest abdominal muscle, with your deepest back muscles, you can have recurrent episodes of back pain. And each time you get one, you're more likely to have another one sooner. I've been happily helping people with back pain for 19 years. So people who have these problems, they need to seek you out. I think they should seek me out. I do, I'm happy to help them. OK, and then are you able to work with patients so that they can avoid surgery? Yeah, absolutely. I'm definitely big into empowering people that we own our body and we need to take charge of our body. Yeah, sure, there's some injuries where you may need surgery, and that's your only route. But it's always great to try to prevent that surgery. And oftentimes I see people who are thinking when I meet them for the first time, well, they said I may need surgery. I want, they wanted me to try physical therapy first. 95% of those people get back to where they want to get without having to have that surgery. Because of all the faults that we were talking about earlier, you don't know that your head is far forward. You don't know that your shoulders forward while you're gaming. And as soon as the baseball player, as soon as I identify that and re-educate the proper muscle so that the joint and the body moves well, the pain and the dysfunction is no longer there, which we're thinking might lead them to have surgery. So it's wonderful. All right, and do you have particular home exercises that you usually tell your patients to do or instruct them about? I do. My favorite ones for people who work at a desk or are on their devices for their job all day long is a lot of things dealing with posture. And one of my favorite ones for people to do at their desk because I like to incorporate it there, I don't want to burden anyone with exercises. I know sometimes I say, okay, you're gonna have to do them, but I try to incorporate them during the day. So my favorite is to sit at their desk or they can stand too and take a break. That's better for their body to stand up and take a break from sitting. Put their elbows touching their side with their palms up and I have them rotate their hands out and squeeze their shoulder blades. Ooh, that feels nice. It feels good. I don't know if you noticed, but both of our chins drop down and that's because doing that stops us from having that little bit of a slouch that kicks our head forward. So as soon as you go out, your neck gets straighter in a way that aligns your ear over your shoulder over your hip. Now some people might have shoulder pain and might not be able to do this right away or they've been bent over for so long like a stitcher or someone that makes clothing that they're tight in the front and they need to be stretched first. Well, I have another one where I call it the stick them up. You put your hands on either side of your shoulder and you just squeeze back. Oh, that feels good. It feels good. So if you have time to do two and then get back to your important project, great. If you have time to do five, that's even better. If you have time to do 10, even better. But I try to tell people it's not the reps is that you're breaking your pattern of being in the wrong position and re-educating all the muscles on the backside of your body that are holding your frame up when you have to lean forward because you can't see the screen. If you have five focals, there's times we're gonna be in bad posture. So these things are great. You undo those bad posture. So maybe next time you see me, I'll after I do these, I'll have better posture because I know it's horrible now. I'm expecting that. Well, that's fantastic. But you actually have really good posture. Okay, if a patient comes to you, do they need a doctor's referral? Sometimes they do and sometimes they don't. So it depends on their insurance plan. There's plans that you absolutely need a prescription to see a physical therapist. And there's other plans that you may be able to have direct access and access to physical therapists without a prescription. I usually tell people to call first and find out what their insurance is or if they don't even want to use their insurance to find out whether they would need one or not to facilitate the process. So as you may know, I'm an insurance defense attorney who does defense work. And I definitely look at medical records. And I see sometimes people will have two years of physical therapy. Do they need years of physical therapy or can they resolve their problems with fewer visits? I believe from my experience that they can get better, I couldn't think of the word, with way fewer visits. There's some instances where people's condition car accidents can take a longer period of time, but it's definitely way shorter than two years for the majority of people. If you have an injury from a car accident and you get into some quality physical therapy that's restoring your muscle tissue tension to normal, giving you exercises that are not hard exercises but just reeducation exercises initially when you're in pain to get your body more towards that alignment and then giving you a home program and stretching, you should be able to go through, depending on how many body parts are injured from a car accident or if your mostly car accidents have multiple body parts. Depending on that, you should go through the cycle at a nice, steady pace and continue to progress with decreased pain steadily along that process. Now I've been working out a lot at the gym, doing a lot of classes, weightlifting type classes, Zumba, combat classes cycle. And is there a role for reducing injuries or staying uninjured by doing those type of activities? Are you at risk for those injuries? Can, by doing those activities, can that make you less susceptible to these type of injuries? I see what you mean, yeah. Motion is lotion. I'm sure a lot of people have heard that and for those of haven't, motion is lotion. It basically means when you move, you're lubricating your body, you're putting your body through ranges of motion so any kind of exercise is better than not exercise. So when you do the Zumba classes and combat classes, you're keeping your body and your muscles strong on your frame and that's very important. The one thing I wanna say about doing exercise and I think a lot of people tend to forget and I'm saying that from my experience working with my patients, people forget to stretch after they do workout. So there was research a long time ago that proved that people when they were trying to lift weights and grow muscle, gained muscle more quickly if they stretched even for five to 10 minutes after their weight workout than the people that did the weight workout and didn't stretch after. So there's huge benefits of stretching. Okay, so you've sold me. Okay, good. So have you written any articles about what we've talked about? I have, I have. I have an article that's being published in the Hospital for Special Surgery's orthopedic journal this October. I'm looking forward to that coming out. They're having a special rehab edition and also within the next two months I have my book coming out on my technique using the deep core to get rid of low back pain. Okay, so your book that is coming out, do you address these issues that we've talked about today that technology issues? I do, I address the technology issues in adults and the dilemma that we face in the youths coming up because now they're having laptops in school as young as six years old, my nephew. So I address that, I address posture, the problems that we're facing, how you can change your habits, how to become more aware of changing your habits, how to look at yourself so that you can see your alignment. And then these exercises, more than the two that I've shown you, it's pretty comprehensive on simple exercises that there's something for everyone in there to do wherever they are during the day. Fantastic. Well, you've been a wonderful guest today, Christine. And thank you so much. We've learned so much today. Okay, so we're out of time and we'll have to wrap it up. And I'm Catherine Norm. This is Much More on Medicine on Think Tech Hawaii. We've been talking with physical therapist, Christine Linders, about how technology is ruining your neck and back and how to solve it. Thank you for joining us today and thanks to our broadcast engineer, our floor manager, and to Jay Fidel, our executive producer who puts it all together. And we ask that you please join us for our future Think Tech productions. You know, I hope that you walk away today and that you use some of these techniques and that you can, like, you... Why don't you just, like, you go like, Yes? Is it like this? I thought, open the door. Open the door? Open the door. And then what was it, hands up? Stick them up. Stick them up. Okay, so, and then a quick recap on posture, like, with the devices. Nod your chin down, gaze your eyes down, don't bend your head down. Thank you so much, Christine. Thank you, Catherine.