Effects of head alignment devices on working memory and postural support during computer work.

The most common risk factor of computer workers is poor head and neck posture. Therefore, upright seated posture has been recommended repeatedly. However, maintaining an upright seated posture is challenging during computer work and induces various complaints, such as fatigue and discomfort, which can interfere working performance. Therefore, it is necessary to maintain an upright posture without complaints or intentional efforts during long-term computer work. Alignment devices are an appropriate maneuver to support postural control for maintaining head-neck orientation and reduce head weight. This study aimed to demonstrate the effects of workstations combined with alignment device on head-neck alignment, muscle properties, comfort and working memory ability in computer workers. Computer workers (n = 37) participated in a total of three sessions (upright computer (CPT_U), upright support computer (CPT_US), traction computer (CPT_T) workstations). The craniovertebral angle, muscles tone and stiffness, visual analog discomfort scale score, 2-back working memory performance, and electroencephalogram signals were measured. All three workstations had a substantial effect on maintaining head-neck alignment (p< 0.001), but only CPT_US showed significant improvement on psychological comfort (p = 0.04) and working memory performance (p = 0.024), which is consistent with an increase in delta power. CPT_U showed the increased beta 2 activity, discomfort, and false rates compared to CPT_US. CPT_T showed increased alpha and beta 2 activity and decreased delta activity, which are not conductive to working memory performance. In conclusion, CPT_US can effectively induce efficient neural oscillations without causing any discomfort by increasing delta and decreasing beta 2 activity for working memory tasks.

Advanced subject-specific neck musculoskeletal modeling unveils sex differences in muscle moment arm and cervical spine loading.

Neck pain and injuries are growing healthcare burdens with women having a higher incidence rate and poorer treatment outcomes than males. A better understanding of sex differences in neck biomechanics, foundational for more targeted, effective prevention or treatment strategies, calls for more advanced subject-specific musculoskeletal modeling. Current neck musculoskeletal models are based on generic anatomy, lack subject specificity beyond anthropometric scaling, and are unable to accurately reproduce neck strengths exhibited in vivo without arbitrary muscle force scaling factors or residual torque actuators. In this work, subject-specific neck musculoskeletal models of 23 individuals (11 male, 12 female) were constructed by integrating multi-modality imaging and biomechanical measurements. Each model simulated maximal voluntary neck static exertions in three postures: neck flexion in a neutral posture, flexion in a 40° extended posture, and extension in a 40° flexed posture. Quantitative model validation showed close agreement between model-predicted muscle activation and EMG measurement. The models unveiled that (1) males have greater moment arms in one flexor muscle group and five extensor muscle groups, (2) females exhibited higher cervical spinal compression per unit exertion force in the flexed posture, and (3) the variability of compression force was much greater in females in all three exertions but most notably in the extension with a flexed "dropped head" position. These insights illuminated a plausible pathway from sex differences in neck biomechanics to sex disparities in the risk and prevalence of neck pain.

Characteristics of head and neck alignment and function of deep cervical flexor muscles in patients with nonspecific neck pain.

OBJECTIVES: The objectives were to compare forward head posture (FHP) in natural and corrected head postures between patients with nonspecific neck pain (NSNP) and controls and to clarify the relationship between natural and corrected head posture angle differences and deep cervical flexor function. This study aimed to provide useful evidence for postural assessment and treatment in patients with NSNP. METHODS: In this cross-sectional study, 19 patients with NSNP reporting a pain score of 3-7 for at least 3 months and 19 participants with no neck pain within the previous 12 months were recruited. To evaluate FHP, the cranial rotation and vertical angles were measured using lateral head and neck photographs. The craniocervical flexion test was used to evaluate deep cervical flexor activation and endurance. We evaluated the head and neck alignment in natural and corrected head postures and the relationship between the degree of change and deep cervical flexor function. RESULTS: FHP in the natural head posture did not differ between groups. In the corrected head posture, FHP was significantly smaller in the NSNP group than in the control group. In the NSNP group, the cranial rotation and vertical angles were significantly different between the natural and corrected head postures, and the angle difference correlated significantly with deep cervical flexor function. CONCLUSIONS: Patients with NSNP show hypercorrection in the corrected head posture, which may be correlated with deep cervical flexor dysfunction. Further investigation into the causal relationship between hypercorrection, deep neck flexor dysfunction, and neck pain is required.

Gender differences in neck muscle activity during near-maximum forward head flexion while using smartphones with varied postures.

Women frequently express heightened neck discomfort even though they exhibit smaller neck flexion (NF) during smartphone use. Differences in natural posture while using smartphones may result in varying muscle activation patterns between genders. However, no study focused on this issue. This study investigated the influence of gender on neck muscle activity and NF when using smartphones, ranging from slight (20°) to nearly maximal forward head flexion, across different postures. We analyzed smartphone usage patterns in 16 men and 16 women and examined these behaviors across different scenarios: standing, supported sitting, and unsupported sitting, at 20°, 30°, 40°, and the maximum head angles. During data collection, muscle activity was measured, expressed as a percentage of the maximum voluntary contraction (%MVC), in the cervical erector spinae (CES) and upper trapezius (UTZ), along with NF. Results show significant influences of gender, head angle, and posture on all measures, with notable interactions among these variables. Women displayed higher muscle activities in CES and UTZ, yet exhibited lesser NF, while using smartphones in both standing (12.3%MVC, 10.7% MVC, and 69.0°, respectively) and unsupported sitting (10.8%MVC, 12.3%MVC, and 71.8°, respectively) compared to men (standing: 9.5%MVC, 8.8%MVC, and 76.1°; unsupported sitting: 9.7%MVC, 10.8%MVC, and 76.1°). This study provides a potential rationale for gender-related disparities in injury outcomes, emphasizing that women experience higher neck and shoulder discomfort level, despite their smaller NF during smartphone use, as found in previous research. Additionally, the cervical flexion-relaxation phenomenon may occur when the head angle exceeded 40°. The near-maximum head angle during smartphone use might induce the cervical flexion-relaxation phenomenon, potentially aggravating neck issues. We recommend limiting smartphone usage postures that exceed the near-maximum head angle, as they are commonly adopted by individuals in the daily smartphone activities.

Responsiveness of the cervical joint position error test to detect changes in neck proprioception following four weeks of home-based proprioceptive training.

INTRODUCTION: People with chronic neck pain (CNP) commonly exhibit a range of physical impairments including cervical proprioceptive deficits. Assessing proprioception using a head mounted laser to assess joint position error (JPE) is a reliable and valid measure. However, the responsiveness of this measure has not been assessed. OBJECTIVE: To assess the responsiveness of the measure of cervical JPE after a 4-week home-based neck proprioceptive training intervention in people with CNP. DESIGN: An observational study to assess the responsiveness of the measure of cervical JPE. METHODS: The JPE test was assessed in people with CNP before and after 4 weeks of neck proprioception training. JPE was assessed as participants performed neck joint position sense tests for flexion, extension, right rotation, and left rotation in sitting and standing which were performed in a random order. Both the absolute and constant JPE were assessed. The intervention consisted of neck repositioning exercises as well as movement sense exercises. Cohen's d effect size was used to assess the internal responsiveness of the JPE test. The Pearson's correlation was used to assess the change of scores of the laser pointer and measures from inertial measurement units (IMUs) (external responsiveness). RESULTS: After 4 weeks of proprioception training, JPE assessed in sitting reduced from 2.69◦-3.57◦ to 1.88◦-1.98◦ for flexion, extension, and right rotation with large effect sizes (Cohen's d range: 1.25-2.00). For left rotation, JPE reduced from 3.23◦ to 1.9◦, and the effect size was close to being large (Cohen's d: 0.79). When assessed in standing, JPE reduced from 3.49◦-4.52◦ to 1.5◦-2.33◦ with large effect sizes (Cohen's d range: 0.89-1.25) for flexion, extension, right rotation, and left rotation. Large effect sizes were not observed for the constant JPE when assessed in either sitting or standing. The assessment of the external responsiveness revealed weak correlations between the change of scores obtained from the laser pointer and the IMUs for all movements, apart from the constant JPE in sitting for left rotation, which showed a strong correlation (r = 0.7). CONCLUSION: The results of this study showed that the measure of the JPE has sufficient internal responsiveness, however, the external responsiveness was inadequate. Further research is advised.

Neck strength alone does not mitigate adverse associations of soccer heading with cognitive performance in adult amateur players.

OBJECTIVES: Soccer heading is adversely associated with neurocognitive performance, but whether greater neck strength or anthropometrics mitigates these outcomes is controversial. Here, we examine the effect of neck strength or anthropometrics on associations of soccer heading with neurocognitive outcomes in a large cohort of adult amateur players. METHODS: 380 adult amateur league soccer players underwent standardized measurement of neck strength (forward flexion, extension, left lateral flexion, right lateral flexion) and head/neck anthropometric measures (head circumference, neck length, neck circumference and neck volume). Participants were assessed for heading (HeadCount) and cognitive performance (Cogstate) on up to 7 visits over a period of two years. Principal components analysis (PCA) was performed on 8 neck strength and anthropometric measures. We used generalized estimating equations to test the moderation effect of each of the three PCs on 8 previously identified adverse associations of 2-week and 12-month heading estimates with cognitive performance (psychomotor speed, immediate verbal recall, verbal episodic memory, attention, working memory) and of unintentional head impacts on moderate to severe central nervous system symptoms. RESULTS: 3 principal components (PC's) account for 80% of the variance in the PCA. In men, PC1 represents head/neck anthropometric measures, PC2 represents neck strength measures, and PC3 represents the flexor/extensor (F/E) ratio. In women, PC1 represents neck strength, PC2 represents anthropometrics, and PC3 represents the F/E ratio. Of the 48 moderation effects tested, only one showed statistical significance after Bonferroni correction, which was not robust to extensive sensitivity analyses. CONCLUSION: Neither neck strength nor anthropometrics mitigate adverse associations of soccer heading with cognitive performance in adult amateur players.

The role of the deep cervical extensor muscles in multi-directional isometric neck strength.

Clinical management of whiplash-associated disorders is challenging and often unsuccessful, with over a third of whiplash injuries progressing to chronic neck pain. Previous imaging studies have identified muscle fat infiltration, indicative of muscle weakness, in the deep cervical extensor muscles (multifidus and semispinalis cervicis). Yet, kinematic and muscle redundancy prevent the direct assessment of individual neck muscle strength, making it difficult to determine the role of these muscles in motor dysfunction. The purpose of this study was to determine the effects of deep cervical extensor muscle weakness on multi-directional neck strength and muscle activation patterns. Maximum isometric forces and associated muscle activation patterns were computed in 25 test directions using a 3-joint, 24-muscle musculoskeletal model of the head and neck. The computational approach accounts for differential torques about the upper and lower cervical spine. To facilitate clinical translation, the test directions were selected based on locations where resistance could realistically be applied to the head during clinical strength assessments. Simulation results reveal that the deep cervical extensor muscles are active and contribute to neck strength in directions with an extension component. Weakness of this muscle group leads to complex compensatory muscle activation patterns characterized primarily by increased activation of the superficial extensors and deep upper cervical flexors, and decreased activation of the deep upper cervical extensors. These results provide a biomechanistic explanation for movement dysfunction that can be used to develop targeted diagnostics and treatments for chronic neck pain in whiplash-associated disorders.

Evaluation of Apparatus and Protocols to Measure Human Passive Neck Stiffness and Range of Motion.

Understanding of human neck stiffness and range of motion (ROM) with minimal neck muscle activation ("passive") is important for clinical and bioengineering applications. The aim of this study was to develop, implement, and evaluate the reliability of methods for assessing passive-lying stiffness and ROM, in six head-neck rotation directions. Six participants completed two assessment sessions. To perform passive-lying tests, the participant's head and torso were strapped to a bending (flexion, extension, lateral bending) or a rotation (axial rotation) apparatus, and clinical bed, respectively. The head and neck were manually rotated by the researcher to the participant's maximum ROM, to assess passive-lying stiffness. Participant-initiated ("active") head ROM was also assessed in the apparatus, and seated. Various measures of apparatus functionality were assessed. ROM was similar for all assessment configurations in each motion direction except flexion. In each direction, passive stiffness generally increased throughout neck rotation. Within-session reliability for stiffness (ICC > 0.656) and ROM (ICC > 0.872) was acceptable, but between-session reliability was low for some motion directions, probably due to intrinsic participant factors, participant-apparatus interaction, and the relatively low participant number. Moment-angle corridors from both assessment sessions were similar, suggesting that with greater sample size, these methods may be suitable for estimating population-level corridors.

Neck stiffness and range of motion for young males and females.

Well characterised mechanical response of the normal head-neck complex during passive motion is important to inform and verify physical surrogate and computational models of the human neck, and to inform normal baseline for clinical assessments. For 10 male and 10 female participants aged 20 to 29, the range of motion (ROM) of the neck about three anatomical axes was evaluated in active-seated, passive-lying and active-lying configurations, and the neck stiffness was evaluated in passive-lying. Electromyographic signals from the agonist muscles, normalised to maximum voluntary contractions, were used to provide feedback during passive motions. The effect of sex and configuration on ROM, and the effect of sex on linear estimates of stiffness in three regions of the moment-angle curve, were assessed with linear mixed models and generalised linear models. There were no differences in male and female ROM across all motion directions and configurations. Flexion and axial rotation ROM were configuration dependent. The passive-lying moment-angle relationship was typically non-linear, with higher stiffness (slope) closer to end of ROM. When normalising the passive moment-angle curve to active lying ROM, passive stiffness was sex dependent only for lateral bending region 1 and 2. Aggregate moment-angle corridors were similar for males and females in flexion and extension, but exhibited a higher degree of variation in applied moment for males in lateral bending and axial rotation. These data provide the passive response of the neck to low rate bending and axial rotation angular displacement, which may be useful for computational and surrogate modelling of the human neck.

Measurement proprieties of the CROM instrument for assessing head posture, neck retraction and protraction.

BACKGROUND: The CROM instrument is widely used clinically and in research to measure neck range of motion. However, its measurement proprieties during the assessment of protraction and retraction movements were not examined so far. OBJECTIVE: To analyse the intra- and inter-rater reliability, the concurrent validity of the CROM for measuring head posture, retraction and protraction in healthy subjects. METHODS: Thirty-three asymptomatic subjects were recruited and assigned in a random order to one of two raters. After a 10-min break, they were examined by a second rater (Assessment 1). After a 30-min break, both raters repeated the examination (Assessment 2). The examination consisted of measuring the head posture, maximum head protraction and maximum retraction. Each movement was repeated 3 times and measured simultaneously with the CROM and with a 3D capture system laboratory. RESULTS: The intra-rater reliability of the CROM was excellent for both raters for head posture and all head movements (ICC>0.9, 95% CI: 0.82-0.99, p < 0.01). The inter-rater reliability was excellent for head posture (ICC>0.95, 95% CI: 0.92-0.98, p < 0.01) and good-to-excellent for all movements at both time-points (ICC = 0.73-0.98, 95%CI: 0.45-0.99, p < 0.01). The validity analysis showed moderate-to-strong correlation between instruments for the head posture and head movements [(r) = -0.47 to -0.78), 95% CI: 0.99 to -0.24, p < 0.01]. CONCLUSION: The CROM instrument has good-to-excellent reliability and adequate validity for measuring cervical position and displacement in the sagittal plane.

Effect of smartphone use on cervical spine stability.

Using a smartphone often involves a sustained head-forward tilt posture, which may deteriorate the mechanism of muscle reaction efficiency or reduce the stiffness of connective tissues of the cervical spine. These changes in muscular and connective tissues can impair cervical spine stability and contribute to developing neck pain symptoms. In this experiment, change in the cervical spine stability associated with a sustained smartphone use posture was evaluated by quantifying the effective stiffness and the reflexive responses of the head to sudden perturbations. Seventeen young smartphone users maintained their heads tilted forward approximately 30° for 30 min while watching videos on their smartphones in sitting. Data show that the measures of cervical spine stability did not change significantly after the smartphone use task despite developing mild to moderate neck and upper body discomfort symptoms. Study findings imply that keeping the head tilt posture for 30 min for smartphone use did not significantly alter spinal stability, rejecting its association with neck discomfort.

Close relationships between neck and upper-back stiffness and transverse cervical artery flow velocity.

PURPOSE: Neck and upper-back stiffness is encountered in daily life, with symptoms appearing as dullness or aches predominantly in the trapezius muscle (TM). Our previous study demonstrated that TM hardness as measured with a muscle hardness meter correlates well with transverse cervical artery (TCA) flow supplying the TM. Muscle hardness meters, however, cannot measure hardness in the TM alone. Meanwhile, recent advances in ultrasound elastography have enabled the evaluation of localized hardness in targeted tissues. The present study, therefore, aimed to clarify the relationship between TM hardness as measured by elastography and TCA hemodynamics as measured on Doppler sonography, with reference to daily symptoms of upper-back stiffness. METHODS: The study population comprised 66 healthy young adults (32 males, 34 females; mean age, 21 ± 1 years). Relationships were evaluated between TM hardness as a negative correlate of strain ratio from elastography and TCA hemodynamics on Doppler sonography. Hemodynamics in the TCA were evaluated according to the frequency of neck and upper-back stiffness. RESULTS: TM strain ratio correlated with peak systolic velocity (PSV) in the TCA (r = 0.273, p = 0.036), particularly in symptomatic subjects (r = 0.417, p = 0.022). PSV in the TCA decreased with increasing frequency of daily symptoms (p = 0.045). CONCLUSION: TCA hemodynamics correlated with muscle hardness when evaluating localized TM hardness. This relationship and low PSV in the TCA were evident in symptomatic subjects. These results suggest that PSV in the TCA is associated with neck and upper-back stiffness.

Effect of muscle pre-tension and pre-impact neck posture on the kinematic response of the cervical spine in simulated low-speed rear impacts.

Computational human body models (HBMs) can identify potential injury pathways not easily accessible through experimental studies, such as whiplash induced injuries. However, previous computational studies investigating neck response to simulated impact conditions have neglected the effect of pre-impact neck posture and muscle pre-tension on the intervertebral kinematics and tissue-level response. The purpose of the present study was addressing this knowledge gap using a detailed neck model subjected to simulated low-acceleration rear impact conditions, towards improved intervertebral kinematics and soft tissue response for injury assessment. An improved muscle path implementation in the model enabled the modeling of muscle pre-tension using experimental muscle pre-stretch data determined from previous cadaver studies. Cadaveric neck impact tests and human volunteer tests with the corresponding cervical spine posture were simulated using a detailed neck model with the reported boundary conditions and no muscle activation. Computed intervertebral kinematics of the model with pre-tension achieved, for the first time, the S-shape behavior of the neck observed in low severity rear impacts of both cadaver and volunteer studies. The maximum first principal strain in the muscles for the model with pre-tension was 27% higher than that without pre-tension. Although, the pre-impact neck posture was updated to match the average posture reported in the experimental tests, the change in posture was generally small with only small changes in vertebral kinematics and muscle strain. This study provides a method to incorporate muscle pre-tension in HBM and quantifies the importance of pre-tension in calculating tissue-level distractions.

Characterizing neck and spinal response in booster seated reclined children in frontal impacts.

OBJECTIVE: Belt-positioning booster seats (BPB) and pre-pretensioner (PPT) belts may be effective in preventing injuries from submarining and head excursion in reclined children. It is unknown if injuries at the neck and spine could still occur. This study's goal is to characterize neck and spine responses in reclined children with and without the BPB and the PPT. METHODS: Eleven frontal impact sled tests were performed (56 kph) with the Large Omnidirectional Child (LODC) dummy on a production vehicle seat. A 3-point simulated seat-integrated-belt was used with a load-limiter (∼4.5 kN). Testing was conducted with and without the BPB with the seatback at ∼25°, ∼45° and repeated once. One test was conducted at ∼60° with the BPB. 100 mm of belt-slack was removed to simulate PPT in two 45° BPB tests and the BPB 60° test. The LODC peak thoracic spine accelerations and angular rotations, and peak neck and lumbar force/moment loads were compared between conditions. RESULTS: Neck shear forces were the highest in the 60° BPB & PPT (-1.9 kN) and 45° noBPB (-1.3 kN) than all other BPB conditions (-0.5 to -0.8 kN). The highest peak neck moments were found in the 45° noBPB (-40.5 N-m), and in the 60° BPB & PPT (-34.2 N-m) conditions compared to all others (-20.8 to -27.9 N-m.). The 60° BPB and PPT condition demonstrated thoracic forward rotation similar to the 25° noBPB condition (25° noBPB -24.8 to -35.0 deg, 60° BPB&PPT -27.5 to -43.2 deg.). Thoracic spine peak resultant accelerations (T1, T6, T12) were higher in the 25° and 45° noBPB conditions (53 g to 71 g) and in the 60° BPB & PPT (T6: 61.8 g) compared to all other BPB conditions (48.4 g to 53.1 g). The lumbar peak shear forces and moments were the highest in the 45° noBPB (4.9 kN, -296 N-m) and the 60° BPB & PPT condition (1.7 kN, -146 N-m). CONCLUSION: These findings show similarities in neck, spine, and lumbar responses between the 60° reclined condition with BPB and PPT and the 25° and 45° conditions without the same countermeasures. This study highlights the need for future restraint developments to protect moderate and severe reclined BPB-seated child occupants.

Comparative biofidelity of the Hybrid III and THOR 50th male ATDs under three restraint conditions during frontal sled tests.

OBJECTIVE: The purpose of this study was to provide a whole-body biofidelity assessment of the Hybrid III (HIII) and THOR 50th percentile male anthropomorphic test devices (ATDs) during frontal sled tests, incorporating data from kinematics, chest deflection, and test buck reaction load cells. Additionally, the accuracy of the injury risk prediction capabilities for each ATD was evaluated against injuries observed in matched postmortem human surrogate (PMHS) tests. METHODS: Sled tests, designed to simulate a United States New Car Assessment Program (US-NCAP) frontal test, were conducted using the HIII, THOR, and 8 approximately 50th percentile male PMHS under 3 restraint conditions. The test buck was instrumented with load cells on the steering column, knee bolster supports, and foot supports. ATD and PMHS reaction force-time histories were quantitatively compared using the ISO/TS-18571 objective rating metric. Previously published biofidelity analyses of kinematic and chest deflection data from the same tests were combined with the reaction force analyses to perform an overall assessment of the comparative biofidelity of each ATD. Injury risk predictions from existing HIII and proposed THOR injury risk curves for the US-NCAP were compared to observed injuries. RESULTS: For the reaction forces, the HIII and THOR had similar levels of biofidelity on average, except for 2 locations. The HIII produced more biofidelic knee bolster support forces, and the THOR lap belt forces were more biofidelic. The comparative biofidelity of the ATDs also varied by body region. The THOR head response was more biofidelic, whereas the HIII thorax and lower extremity responses had higher biofidelity. When all body regions were pooled, the HIII was more biofidelic, but differences between ATDs were generally small. Both ATDs were able to predict the observed injuries, except for the HIII chest, HIII neck, and THOR neck, all of which underpredicted PMHS injury outcomes. CONCLUSIONS: This study revealed that biofidelity assessed through response time histories and accuracy of injury risk predictions do not always align. Specifically, the HIII had marginally better time history biofidelity, whereas the THOR had better injury prediction. However, not all THOR responses could be fully assessed, so more work is needed to assess the THOR in complex loading environments.

A Prospective Cohort Study on Risk Factors for Cervico-Thoracic Pain in Military Aircrew.

BACKGROUND: Military aircrew frequently report cervico-thoracic pain and injury. The relationship between risk factors and future pain episodes is, however, uncertain. The aim of this study was to identify risk factors for cervico-thoracic pain and to determine the 1-yr cumulative incidence of such pain.METHODS: A total of 47 Swedish aircrew (fighter and helicopter pilots and rear crew) without pain in the cervico-thoracic region were surveyed about work-related and personal factors and pain prevalence using the Musculoskeletal Screening Protocol questionnaire. They also performed tests of movement control, active cervical range of motion, and isometric neck muscle strength and endurance. Aircrew were followed for a year with questionnaires. Logistic regressions were used to identify potential risk factors for future cervico-thoracic pain.RESULTS: Previous cervico-thoracic pain (OR: 22.39, CI: 1.79-280.63), lower cervical flexion range of motion (OR: 0.78, CI: 0.64-0.96), and lower neck flexor muscular endurance (OR: 0.91, CI: 0.83-0.99) were identified as risk factors for reporting cervico-thoracic pain. At follow-up, 23.4% (CI: 13.6-37.2) had reported cervico-thoracic pain during the 12-mo follow-up period.DISCUSSION: The Musculoskeletal Screening Protocol can identify risk factors for cervico-thoracic pain. The link between cervico-thoracic pain and previous pain, as well as lower performance of neck range of motion and muscular endurance, highlights the need for primary and secondary preventive action. The findings from this study can facilitate the development of such pain prevention programs for aircrew.Tegern M, Aasa U, Larsson H. A prospective cohort study on risk factors for cervico-thoracic pain in military aircrew. Aerosp Med Hum Perform. 2023; 94(7):500-507.

Laptop use and muscle activity in adult females: Ground sitting has lower muscular demand than using a chair.

BACKGROUND: With progressing technology in the portable computing field, laptops are now integral for work, home and social settings. Different working postures adopted by laptop users impose different loads on the relevant muscles, which can be associated with musculoskeletal discomfort in the various body regions. Some Arabic and Asian cultures adopted postures are not well investigated, particularly for the 20-30 years age-group. OBJECTIVE: This study compared muscle activity in the cervical spine, arm, and wrist among different laptop workstation setups. METHODS: In this cross-sectional study, 23 healthy female university students (age = 24.2±2.28 years, range 20-26 years) performed a standardized 10 minute typing task in four different laptop workstation setups: DESK, SOFA, GROUND sitting with back support, and laptop table (LAP-Tab). Differences between electromyography (EMG) muscle activity recorded in the trapezius (TR), cervical extensors (CE), deltoid (DEL), and wrist extensors (WE) were determined using one-way repeated ANOVA measures with a post-hoc Bonferroni test. RESULTS: Significantly higher muscle activity was observed respectively in the workstations of DESK > LAP-Tab > SOFA > GROUND. Significant differences were found between WE muscle activity and the three other muscle groups (p < 0.001). There was a significant interaction between workstations and muscle activity (F(9,264) = 3.81, p < 0.001, = 0.11), where the WE and DEL muscles showed respectively higher and lower muscle activity in all setups. CONCLUSION: Muscles showed variable activity in different workstations such that the GROUND workstation provided the minimum load, while the DESK workstation showed the maximum load on the measured muscle groups. These findings require further investigation in different cultural and gender specific groups.

Neck strength and force in reaction time task of adolescent athletes with and without concussion history: A pilot study.

OBJECTIVES: Assess the impact of concussion by comparing reaction time, peak force recruitment, and rate of force development of adolescent athletes returning from concussion against age- and sex-matched controls in visual-elicited neck movement. DESIGN: Athletes sat secured in a custom-built isometric device with their heads secured in a helmet and attached to a 6-axis load cell. They performed neck flexion, extension, and lateral flexion in response to a visual cue. Three trials in each direction were used for statistical analyses; peak force and rate of force development were normalized against athlete mass. SETTING: Laboratory. PARTICIPANTS: 26 adolescent/young adult athletes (8F/18M), either recently concussed (and cleared for return to sport) or an age- and sex-matched healthy control. MAIN OUTCOME MEASURES: Reaction time, angle, standard deviation of angle, deviation from target angle, peak force, and RFD over 50, 100, 150,and 200 ms of movement were measured for each trial. RESULTS: Concussed athletes had decreased normalized peak force (P = 0.008) and rate of force development (P < 0.001-0.007). In neck extension, concussed athletes also had decreased movement precision (P = 0.012). CONCLUSIONS: Concussion is associated with alterations of neck biomechanics that decrease overall neck strength.

The effect of tablet tilt angles and time on posture, muscle activity, and discomfort at the neck and shoulder in healthy young adults.

BACKGROUND: Although young adults regularly perform tablet writing, biomechanics during the tablet writing with different tilt angles has not been studied. The objective of this study was to compare posture, muscle activity, and discomfort at the neck and shoulder between tablet writing with 0° (horizontal) and 30° tablet tilt angles over 40 minutes in healthy young adults. METHODS: Twenty participants wrote continuously for 40 minutes on a tablet with both tilt angles in a randomized order. Between conditions, there was a 5-minute activity break. Differences in neck and shoulder posture, muscle activity, and discomfort between both tablet tilt angles and changes in the outcomes every 10 minutes over 40 minutes were investigated. RESULTS: With the tilted tablet, there were lower neck flexion (Z = -4.637, P<0.001), lower shoulder extension (Z = -3.734, P<0.001), and lower neck Visual Analogue Scale (VAS) (left; Z = -4.699, P<0.001 and right; Z = -3.874, P<0.001) as compared to the no tilt condition. However, the right upper trapezius muscle activity was higher in the tilted condition as compared to the no tilt one. Over 40 minutes, the neck VAS (left; χ2(4) = 30.235, P<0.001 and right; χ2(4) = 32.560, P<0.001) and heart rate variability (χ2(4) = 12.906, P = 0.012) showed notable increases after 20 minutes compared to baseline. CONCLUSION: In conclusion, adjusting the tablet tilt to 30° and limiting time spent to 20 minutes are recommended for young adults during the tablet writing to prevent neck problems.

Influence of smartphone game play on head flexion angle, muscle activity, and load at C7 among adolescents.

BACKGROUND: Smartphones cause physiological problems due to inappropriate postures and extensive usage. India, being the second leading country with the highest number of smartphone users (492 million in 2021), has witnessed a significant rise in smartphone-related musculoskeletal disorders (MSD). OBJECTIVE: This study compared the effects of 60-min smartphone gameplay on head flexion angle, muscle activity, and loads at C7 on Indian adolescents. METHODS: A subjective assessment was conducted on 1659 participants, of which, 40 young male adults aged between 20-28 years performed the experimental trial. Muscle (Sternocleidomastoid) activity, head flexion angle, and load acting at the neck (C7) were analyzed through postural assessment, pre-and post-subjective analysis. RESULTS: Participants maintained an average of 28.46°±4.04° head flexion angle for more than 43 min (71%) in an hour while performing the task. The muscle activity increased to 23% (p < 0.001) of MVC at the end of the task compared to the beginning. CONCLUSION: The results indicated a significant increase in muscle activity (1.61 times), spinal loads (4.6 times) and subjective discomfort (2.9 times) after prolonged smartphone usage. It is evident that various aspects (duration, posture, content) play a vital role in smartphone-related MSD and there is a potential risk of cervical spine problems. The increased loads reduce muscle stiffness and increase intervertebral disc pressure.