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Tablet Under the Tree? Heed This Health Advice

8 ways to avoid injury, sleeplessness and even depression

By Deborah Quilter

Tablet use has exploded: Over 50 percent of Americans now own these devices. Easy portability makes tablets universally attractive, and for those at midlife, being able to enlarge the font for reading ease is a tantalizing advantage. No wonder forecasters anticipate that tablets will be among the most popular gifts this holiday season.
If you receive one, though, be alert to the health hazards of improper use. You don’t want to get a case of what’s being called I-Hurt, I-Injury or iPad hand.

(MORE: Are You Ready to Get a Tablet?)
The Trouble With Tablets
Like their predecessors, laptop computers, tablets are inherently anti-ergonomic. The advantage of a desktop monitor and keyboard is that you can place both your hands and your head in a neutral position. With a tablet, if your hands are in a good position, your neck will be strained. And if your neck is in neutral posture, your upper extremity will suffer, even with those little cases that tilt tablets up, because the screen isn’t high enough.
All of this can lead to terrific strain.
The Trouble With Tablet Keyboards
If the tablet has an external keyboard, it can be very small, which can lead to a sideways angling of the wrist called ulnar deviation, a risk factor for tennis elbow and other forms of repetitive strain injury.
Using a tablet’s embedded keyboard triggers actions you don’t want. Dr. George Piligian, an occupational medicine physician with over 20 years experience treating repetitive strain injuries in Manhattan, noted that when people keep their hands poised over tablet keyboards in order to avoid unwanted consequences of touching a key, that sustained posture can lead to unnecessary muscle tension from the neck to the hands. (With a regular keyboard, you tend to lightly rest your fingers, avoiding strain.)
When the keyboard is embedded in the monitor, you are tapping on unforgiving glass, which can lead to a great deal of damaging force going through your joints. This is akin to a dancer jumping on a concrete floor. 

People also tend to overuse their thumbs on these keyboards, which can lead to serious injuries.

(MORE: Think Twice Before You Text That Message)
Shoulder and Neck Tension
According to a new study by Dr. Kenneth Hansraj, a New York surgeon, looking down can be the equivalent of carrying 40 to 60 pounds of weight in front of your shoulders.

In a survey among students from San Francisco State University, researchers found an increase in shoulder and neck tension among users of smart phones, iPads and tablets.
Michael Reed, Executive Director of the North American Spine Foundation, added that chronic forward head position can lead to shearing of the cervical spine discs and excessive stress on the ligaments, which, in turn, can cause the ligaments to thicken and encroach upon the nerves.
Though tablets are relatively light (from 0.5 to about 1.5 pounds), carrying them in a shoulder bag full of other equipment can lead to additional musculoskeletal tension. Piligian noted that if a tablet replaced a heavier laptop or reference books, it may be viewed as a benefit. But people should still be aware of their musculoskeletal health, Piligian says.
Exhaustion, Depression and Sleep Problems
In addition to physical health, tablet users should be aware that a slouched body posture may contribute to exhaustion and depression, according to the San Francisco State survey.
“Being hunched over facilitates access to hopeless, helpless, powerless and defeated memories much easier than sitting up, while sitting up facilitates evoking positive and empowering memories,” said one of the authors of the survey, Erik Peper, professor at the Institute for Holistic Health Studies at San Francisco State University.
Fifty percent of those surveyed who use tablets experienced disturbed sleep; shallow and quickened breathing patterns, coupled with increased sustained muscle tension in the neck and dominant shoulder, were observed in smartphone and iPad/tablet users. Even though many students reported discomfort and sleep disturbances, none were aware that their breathing patterns were affected.

Peper explained that as we hunch over, our head is held forward, which means that our neck and back muscles constantly contract to keep our head positioned. “Constant contraction leads to exhaustion and pain,” noted Peper.
Where Are You Using Your Tablet?
The couch and the bed are the two most popular places people use tablets, but neither allows for good posture.

If you’re on the bed lying on your side supporting your head with your hand, it might feel comfortable momentarily because your muscles aren’t working to hold you upright against gravity. But you’re likely putting your head and neck in a cramped, awkward position. “Even without technology, reading or doing work in bed should not be done for an extended period of time, since it involves sustained muscle tension on the neck in most cases,” warned Piligian. “Though sitting is better, you shouldn’t be sitting for too long, either.”

(MORE: Stop Slouching: Poor Posture Leads to Poor Health)
It All Adds Up
The cumulative trauma of working in disadvantageous postures all day can add up: you can go from being hunched over at the desktop or tablet to being hunched over your smartphone — all of which leads to strain. 


Tablets also promote sedentary behavior, Piligian noted, a problem for musculoskeletal and general health.
Also, age is an issue: “Baby boomers are especially likely to have suffered some sort of chronic upper extremity problem already, and the demands of rapidly changing technology can exacerbate these,” Piligian says.
What To Do

  • Use a separate keyboard so your hands and arms are in good posture. Wireless models that work with tablets are available.
  • Raise the monitor to keep your head aligned with your spine while sitting tall.
  • Only use tablets for short bursts, or for activities that don’t require interaction, such as watching a movie.
  • Take frequent breaks. One break every 20 minutes makes a good rule of thumb.
  • Do gentle range of motion exercises frequently, especially after bouts at the tablet. Look right and left, then tilt your head right and left with your head facing forward.
  • Do not use self-illuminating devices for an hour before you go to bed.
  • Drastically reduce what you carry on your shoulder, or better yet, don’t carry anything.
  • Get up and move!

To learn shoulder release exercises, see author Deborah Quilter’s demonstrations below:

Deborah Quilter is an ergonomics expert, a certified Feldenkrais practitioner, a yoga therapist and the founder of the Balance Project at the Martha Stewart Center for Living at Mount Sinai Hospital in New York. She is also the author of Repetitive Strain Injury: A Computer User's Guide and The Repetitive Strain Injury Recovery Book. Read More
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