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Twitter. Pinterest. Instagram. Facebook. Trivia Crack. Fantasy football. Email. Text messaging. Many other things. We use our phones for almost everything but phone calls. All of these things involve staring at the screen, usually with some scrolling or tapping thrown in for good measure.

In our sports clinic, my friend and fellow PT, Mark, states it best. He sees a patient sitting in our waiting chairs, hunched over and cramped up like a wadded up napkin after dinner (hopefully without the meatball stains). The question that follows is as perfect as the answer he gives to his own question. He asks them: "Do you have back pain (or neck or shoulder pain)? No, not yet? Ok, you will."

Unfortunately, a second list complements the list from the first paragraph. Most of the terms on this list are terms we have made up, but you'll get the idea: Texter's Thumb, Cell Phone Neck, Tablet Tendonitis, iPhone and iPad wrist, etc. Unfortunately, we see these more and more frequently in our patients. These great gadgets we use are designed to be so intuitive, fun, and creative (my wife hates it when I quote the iPad commercials) that they are tough to put down. This leads to hours of uninterrupted use for anything imaginable. During this time, we are locked in positions that might not be the best for us. TV watching, reading, typing, Xbox, etc. can also adversely affect our musculoskeletal system and posture, but for the purposes of this article, we'll just stick to tablets and phones.

The classic tablet or smart phone posture we see is typically as follows (or similar): seated and slumped into a chair, leaning slouched to one side, one elbow resting on the arm rest, one elbow and hand supporting the head, head leaned down or forward and tilted or turned to one side. Time passes and passes, maybe a momentary stirring, but then right back to the same position or something similar. I can almost hear my boss say "That's classic." From time to time, all of us are guilty of this. Some of us are doing this more than just from time to time, however.

One of the first things I talk with my neck, shoulder, elbow, wrist, hand, back, hip, knee, ankle, and feet patients (i.e. almost everyone) about is their sitting and standing posture. Patients often get hung up on their exercise and daily living activities while ignoring or overlooking what they spend the majority of their time doing (sitting, standing, sleeping). It's what we don't know that does us in with our posture. These little things are like drops of water in a bucket. We do them every day without realizing it and the drops keep falling until one day the bucket overflows. Posture related pain can be like that. Many times it can be of insidious onset. Nothing traumatic or out of the ordinary happens to precipitate it. But that is precisely the issue. The cause is ordinary and we often ignore it. It's buried in how we read, how we hold our phones, how we use our laptop, how we drive to work, how we vacuum or do other chores, how we sit, stand, and sleep. For many of my patients, figuring out what and how normal activities might be contributing to their pain is often the most challenging part because it is difficult to consider the very activities that could be causing it.

For our patients in the chairs, their tablet or phone posture contributes to many things. Starting from the top, let's work our way down. The neck is held bent and out of neutral spine position. This puts the cervical vertebrae, ligaments, and soft tissues under increased stress, shear, and tension. Over time, these tissues adapt to the stress they are put under. Even though it might be for only 5-10 minutes here or there, being in this posture multiple times per day every day eventually causes one side of your neck tissues to become excessively tight and the other to turn into the equivalent of overstretched salt water taffy. Both of those can contribute to weakness, pain, and dysfunction.

The shoulders can be similarly affected by too much tablet time. They tend to roll or hunch forward, shortening up the big thick muscles on the top and back of the shoulders. This tightness leads to abnormal movement patterns in the neck and shoulders, which can cause pain and dysfunction. This can also open the door to a potential increased risk of traumatic injury during activity due to the increased stress present on the joint from its poor movement patterns.

The low back is also especially susceptible to postural related issues. It turns out that sitting slumped and molded into your chair might not be the best thing for your back. While certainly comfortable, sitting without the use of any core or glute musculature to support the spine allows the lumbar vertebrae, ligaments, and soft tissues to shift, weaken, stretch, etc. What about all those great core and glute muscles we spend so much time in the gym working on with our planks, crunches, and squats? Say goodbye – these muscles shut down and become inhibited due to prolonged or repetitive sitting.

For the sake of brevity, we are going to gloss through some other body parts. Areas of the body such as the elbows, wrists, fingers, hips, knees, feet, and ankles can also be affected by this classic iPosture. Tightness and pressure in the hips from sitting crunched up can lead to increased pull on the low back or to potential deterioration in the hip joints. Repetitive movements of poorly positioned joints in the hands, wrists, and elbows can lead to painful overuse conditions such as tendonitis, tennis elbow, carpal tunnel syndrome, and other inflammatory conditions. The knees, ankles, and feet can also be affected by such postures.

Depending on how you sit when you are melting into that love seat or man-cave chair, curled up clutching your Kindle, the latest episode of This American Life podcast, watching the Seattle Seahawks make a miraculous comeback, or taking some time to play 2048, all of these joints could be at risk. Start taking a look around you. See if you can notice what others are doing with their necks, backs, arms, and legs when they text, email, play Bejeweled, or check Instagram. Odds are good that you're like them. Likely, you are not the outlier with perfect and impeccable posture. What's the remedy? Stand up and shake out every 30-45 minutes, sit on an exercise ball, stand while playing Candy Crush, and generally fidget while you sit. Get moving and bail out that metaphorical bucket of water before it overflows.

Danny Singles, PT, DPT, MA

Danny is a sports physical therapist who specializes in manual therapy. His clinical interests include injury prevention, working with sports and orthopedic injuries, pre and post surgical rehab, and working with the pediatric patient population. He attended the University of Delaware for his Doctorate in Physical Therapy. Currently, he works full time as an outpatient sports therapist and provides educational outreach through lectures at local schools and fitness centers. He can be reached at Elite PT in Hockessin, DE at: (302-234-1030) or emailed directly at: This email address is being protected from spambots. You need JavaScript enabled to view it.. He can also be followed on Twitter (@MoveEqualsLife) for current updates about health and wellness.