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MUSCULOSKELETAL BACK PAIN
the different use of computers by boys, who tend to use it more for games (3). An American study also showed a link between computer use and spinal pain, although this included pre-adolescent children (4). Likewise, a slightly older Norwegian study showed that back pain was related to use of the computer for more than 15 hours a week (5). In contrast, a recent study from the Netherlands (6) and
a previous Danish study (7) do not suggest any association between computer use and spinal pain in adolescents. Like the positive Finnish studies, both these studies had good sample sizes and correctly adjusted their results for factors such as strenuous physical activity levels and psychosocial variables (both of which could affect computer use and spinal pain, and which could therefore affect results if not considered). These very different findings might therefore simply relate to differences in the definitions of spinal pain. The inconclusive studies tended to recognise only more severe forms of pain and may therefore have tended to miss out the milder cases, which may be the type relating to computer use. On balance, then, it appears that prolonged computer use
may relate to the less severe forms of spinal pain. Does this mean that we should advise adolescents and parents to cut down on excessive computer use? If we want to err on the side of caution, then the answer is probably yes. However, before we brand computers as “dangerous” to the spine, it should be remembered that we still have no firm evidence that computer use actually causes spinal pain. A drawback of all the adolescent studies in this area is that they have been snapshot studies, observing the levels of activity and spinal pain at the same points in time. This does not allow us to be sure of what caused what. For example, instead of computer use actually causing spinal pain, it might be that those adolescents with spinal pain may tend to towards less demanding sedentary activities such as computer use. Longitudinal studies, observing computer use at the start of a study and then the incidence of new cases of spinal pain over a follow-up period, would allow more assumptions of cause and effect. Until such studies are done, we can say only that there is an association. Second, even if there is a causal link between computers and spinal pain, it is likely that posture during the activity is an intermediate factor. Recent work from Perth, Western Australia, suggests that greater amounts of computer use are associated with a greater tendency towards certain habitual sitting postures: greater neck flexion and a poking chin in males, and a greater lumbar lordosis in females (Fig. 1) (8). Such changed habitual postures were also shown to be related to prolonged neck pain in a further study by the same group (9). Given the possibility that these habitual postures might be the result of assuming such postures during computer use, gender-specific advice on posture during computer use may be a sensible option.
BOLD HEAD LIGHT HEAD
It may be that moving away from the extremes of flexion or extension to a more neutral posture (Fig. 2) during computer use will reduce much of the spinal pain risk and permit safe computer use for longer durations. The above studies included computer use involving
game-playing, but the few studies that have investigated gaming devices not attached to a desktop or laptop computer, such as the PlayStation, have not shown any relationship with spinal pain (1,4). Mobile phone use is now widespread among adolescents
and involves not only verbal communication but also texting and game-playing. The only study so far to assess its effect on spinal pain suggests it is not important (1), but further studies are required in this growing area.
WATCHING TELEVISION Studies investigating the relationship between watching television and spinal pain are conflicting. Greater amounts of
Figure 1: Postures to avoid when
using a computer: (a) poking chin, (b) excessive lumbar lordosis
Figure 2: Neutral sitting posture
PAIN MAY TEND TO TOWARDS LESS DEMANDING SEDENTARY ACTIVITIES SUCH AS COMPUTER USE
IT MIGHT BE THAT THOSE ADOLESCENTS WITH SPINAL
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