The effects of shoulder posture on neck and shoulder musculoskeletal loading and discomfort during smartphone usage

While using their smartphone, users tend to adopt awkward neck and shoulder postures for an extended duration. Such postures impose the risk of MSDs on those body parts. Numerous studies have been undertaken to examine neck posture; however, few studies have investigated shoulder postures. This study examined various shoulder postures during smartphone use and their effect on neck and shoulder kinematics, muscle loading, and neck/shoulder discomfort. Thirty-two asymptomatic young adult smartphone users randomly performed texting tasks for 3 min at four different shoulder flexion angles (15°, 30°, 45°, and 60°), while maintained a neck posture in the neutral position (0° neck flexion angle). Measures were taken of neck and shoulder muscle activity of the cervical erector spinae (CES), anterior deltoid (AD), upper trapezius (UT) and lower trapezius (LT), and kinematic data (angle, distance and gravitational moment). Results showed AD and LT muscle activity significantly increased when the shoulder flexion angle increased with an opposite effect on CES and UT. A recommended shoulder posture was identified as 30° flexion, as this yielded the best compromise between activation levels of the four muscles studied. This angle also induced the lowest neck/shoulder discomfort score. The findings suggest smartphone users hold their device at approximately 30° shoulder flexion angle with their neck in a neutral posture to reduce the risk of shoulder and neck musculoskeletal disorders when smartphone texting.Relevance to industrySmartphone use in the manufacturing and service industries is an integral part of work and useful means of communication tool. Awkward postures during extensive smartphone use impose an increased risk of both neck and shoulder musculoskeletal disorders. Shoulder flexion angles need consideration when making recommendations about safe work postures during smartphone use.     

The effect of upper extremity support on upper extremity posture and muscle activity during keyboard use

Forearm support during keyboard use has been reported to reduce neck and shoulder muscle activity and discomfort. However, the effect of forearm support on wrist posture has not been examined. The aim of this study was to examine the effect of 3 different postures during keyboard use: forearm support, wrist support and "floating". The floating posture (no support) was used as the reference condition. A wrist rest was present in all test conditions. Thirteen participants completed 20 min wordprocessing tasks in each of the test conditions. Electromyography was used to monitor neck, shoulder and forearm muscle activity. Bilateral and overhead video cameras recorded left and right wrist extension, shoulder and elbow flexion and radial and ulnar deviation. The forearm support condition resulted in significantly less ulnar deviation (p < or = 0.007), less time spent in extreme ulnar deviation (p = 0.002) and less reports of discomfort than the "floating" condition (p = 0.002). The wrist support but not the forearm support condition resulted in less trapezius and anterior deltoid muscular activity (p < 0.007). These findings indicate that typing with upper extremity support in conjunction with a wrist rest may be preferable to the "floating" posture implicit in current guidelines.     

The effects of knee angles on subjective discomfort ratings,heart rates,and muscle fatigue of lower extremities in static-sustaining tasks

The purpose of this study was to investigate the effects of knee-flexion angles on subjective discomfort ratings, heart rates, and muscle fatigue using median frequency (MDF) in a static-sustaining task. Thirty healthy participants maintained 13 postures including standing, squatting, sitting, and kneeling postures and then MDFs from the erector spinae, biceps femoris, vastus medialis, gastrocnemius, and tibialis anterior muscles, subjective discomfort, and heart rates were collected every 3 min during a sustained 15 min task. Results showed that the discomfort, heart rate and muscle fatigue were significantly influenced by the body postures. In general, standing and sitting postures showed less discomfort as well as lower heart rates, whereas squatting postures (KF120, KF90, KF60) had higher discomfort and heart rates. Three MDF change trends were reported associated with postures in this study. First, there were less changes of MDFs for standing and sitting postures; second, all patterns of MDFs for KF 150 and KF120 decreased, and lastly some MDFs had increasing trends and others showed decreasing trends for KF30, KF30T, and kneeling postures.     

The effects of knee angles on subjective discomfort ratings, heart rates, and muscle fatigue of lower extremities in static-sustaining tasks

The purpose of this study was to investigate the effects of knee-flexion angles on subjective discomfort ratings, heart rates, and muscle fatigue using median frequency (MDF) in a static-sustaining task. Thirty healthy participants maintained 13 postures including standing, squatting, sitting, and kneeling postures and then MDFs from the erector spinae, biceps femoris, vastus medialis, gastrocnemius, and tibialis anterior muscles, subjective discomfort, and heart rates were collected every 3 min during a sustained 15 min task. Results showed that the discomfort, heart rate and muscle fatigue were significantly influenced by the body postures. In general, standing and sitting postures showed less discomfort as well as lower heart rates, whereas squatting postures (KF120, KF90, KF60) had higher discomfort and heart rates. Three MDF change trends were reported associated with postures in this study. First, there were less changes of MDFs for standing and sitting postures; second, all patterns of MDFs for KF 150 and KF120 decreased, and lastly some MDFs had increasing trends and others showed decreasing trends for KF30, KF30T, and kneeling postures.     

Ergonomic evaluation of an alternative tool for cake decorating

AimCake decorating involves several hand intensive steps with high grip force during the application of icing. The purpose of this laboratory study was to evaluate forearm muscle activity, discomfort, productivity, and usability of an alternative tool for cake decorating compared to decorating with the traditional piping bag.MethodsParticipants (n = 17) performed 2 h of cake decorating tasks using the two tools. Subjective hand and arm fatigue, usability, upper extremity posture, and muscle activity from three forearm muscles were assessed for each tool. Outcome measures were evaluated using the Wilcoxon Signed Rank test and the paired t-test.ResultsLess fatigue was reported in the dominant hand (p = 0.001), forearm (p = 0.003) and shoulder (p = 0.02) for the alternative tool when compared to the piping bag. Average median (APDF 50%) and peak (APDF 90%) muscle activity was significantly less for the alternative tool across all three forearm muscles. The alternative tool significantly reduced grip force, an important risk factor for distal upper extremity pain and disorders. Participants rated usability of the alternative tool superior for refill and comfort but the traditional method was rated better for accuracy, stability, positioning and control.ConclusionsThe alternative tool was associated with less dominant arm fatigue, muscle activity, and grip force when compared with the piping bag. However, the alternative tool did not receive the best overall usability rating due to problems with accuracy and overflow, especially with smaller decorating tips. Recommendations were made for addressing these problems with the alternative tool.     

Influence of arm and wrist support on forearm and back muscle activity in computer keyboard operation

The effects of forearm and wrist supports on the upper extremity postures in computer keying tasks and associated EMG activity of arm and back muscles were examined (N=8). Four positions were forearms unsupported (floating) and supported, wrists supported by bead packed (WR1) and gel-filled (WR2) wrist rest. The right and left elbow extensions were 65° and 68°, respectively, in unsupported forearms. Bilateral elbow extension increased with the forearm/wrist supports and mostly, the elbow was maintained at around 90° or greater. The wrist extension decreased with forearm/wrist supports over the unsupported condition. The forearm support significantly reduced the activity of forearm extensor digitorum, i.e., right (F_{(1, 47)}=12.19, p<0.01) and left (F_{(1, 47)}=5.38, p<0.05) and upper trapezius muscles over the floating posture. Wrist rests, however, increased load on the upper trapezius; the activities of flexor digitorum superficialis and erector spinae were close to the resting EMG activity for both forearm and/or wrist support. The type of wrist rests was a concern and this study indicated that the gel filled wrist rest was advantageous in reducing the forearm muscle load, in comparison to the bead packed cushions.     

Analysis of muscle fatigue in helicopter pilots

Helicopter pilots espouse ergonomically unfavourable postures and endure vibration which result in low back pain. The objective of this study was to investigate the effects of a helicopter flight on pilots back and shoulder muscles using surface Electromyography (sEMG) analysis. This study also correlates low back pain symptoms from Rehabilitation Bioengineering Group Pain Scale (RBGPS) questionnaire with muscle fatigue rates obtained. RBGPS was administered on 20 Coast Guard helicopter pilots. sEMG was acquired before and after flight from erector spinae and trapezius muscles in 8 of these 20 pilots. Statistical analysis of time and frequency domain parameters indicated significant fatigue in right trapezius muscle due to flying. Muscle fatigue correlated with average duration of flight (r² = 0.913), total service as pilot (r² = 0.825), pain (r² = 0.463) and total flying hours (r² = 0.507). However, muscle fatigue weakly correlated with Body Mass Index (BMI) (r² = 0.000144) and age (r² = 0.033).     

Muscle fatigue based evaluation of bicycle design

Bicycling posture leads to considerable discomfort and a variety of chronic injuries. This necessitates a proper bicycle design to avoid injuries and thereby enhance rider comfort. The objective of this study was to investigate the muscle activity during cycling on three different bicycle designs, i.e., rigid frame (RF), suspension (SU) and sports (SP) using surface electromyography (sEMG). Twelve male volunteers participated in this study. sEMG signals were acquired bilaterally from extensor carpi radialis (ECR), trapezius medial (TM), latissimus dorsi medial (LDM) and erector spinae (ES), during 30 min of cycling on each bicycle and after cycling. Time domain (RMS) and frequency domain (MPF) parameters were extracted from acquired sEMG signals. From the sEMG study, it was found that the fatigue in right LDM and ES were significantly (p < 0.05) higher in SP bicycle. This was corroborated by a psychophysical assessment based on RBG pain scale. The study also showed that there was a significantly lesser fatigue with the SU bicycle than the RF and SP bicycles.     

Effects of sitting versus standing and scanner type on cashiers

In the retail supermarket industry where cashiers perform repetitive, light manual material-handling tasks when scanning and handling products, reports of musculoskeletal disorders and discomfort are high. Ergonomics tradeoffs exist between sitting and standing postures, which are further confounded by the checkstand design and point-of-sale technology, such as the scanner. A laboratory experiment study was conducted to understand the effects of working position (sitting versus standing) and scanner type (bi-optic versus single window) on muscle activity, upper limb and spinal posture, and subjective preference of cashiers. Ten cashiers from a Dutch retailer participated in the study. Cashiers exhibited lower muscle activity in the neck and shoulders when standing and using a bi-optic scanner. Shoulder abduction was also less for standing conditions. In addition, all cashiers preferred using the bi-optic scanner with mixed preferences for sitting n = 6) and standing (n = 4). Static loading of the muscles was relatively high compared with benchmarks, suggesting that during the task of scanning, cashiers may not have adequate recovery time to prevent fatigue. It is recommended that retailers integrate bi-optic scanners into standing checkstands to minimize postural stress, fatigue and discomfort in cashiers.     

Lumbar posture and trunk muscle activation during a typing task when sitting on a novel dynamic ergonomic chair

Low back pain (LBP) is a common musculoskeletal disorder and prolonged sitting often aggravates LBP. A novel dynamic ergonomic chair (‘Back App’), which facilitates less hip flexion while sitting on an unstable base has been developed. This study compared lumbar posture and trunk muscle activation on this novel chair with a standard backless office chair. Twelve painfree participants completed a typing task on both chairs. Lumbar posture and trunk muscle activation were collected simultaneously and were analysed using paired t-tests. Sitting on the novel dynamic chair significantly (p < 0.05) reduced both lumbar flexion and the activation of one back muscle (Iliocostalis Lumborum pars Thoracis). The discomfort experienced was mild and was similar (p > 0.05) between chairs. Maintaining lordosis with less muscle activation during prolonged sitting could reduce the fatigue associated with upright sitting postures. Studies with longer sitting durations, and in people with LBP, are required.

Practitioner Summary: Sitting on a novel dynamic chair resulted in less lumbar flexion and less back muscle activation than sitting on a standard backless office chair during a typing task among pain-free participants. Facilitating lordotic sitting with less muscle activation may reduce the fatigue and discomfort often associated with lordotic sitting postures.     

Relationship analysis between body flexion angles and smartphone tilt during smartphone use

Although smartphones are used as essential devices in everyday life, many users are exposed to joint diseases owing to prolonged use. The objectives of this study were to analyze how posture and smartphone tasks affect various body flexion angles and develop an algorithm to classify posture/task and estimate body flexion angles using smartphone tilt data. Eighteen participants performed two tasks (playing a game and reading news) in two postures (sitting and standing) in a laboratory environment. The three-axis orientation data (azimuth, pitch, and roll) of the smartphone and the participants’ body flexion angles were measured simultaneously. This study found that the cervical, thoracic, lumbar, and overall flexion angles were all statistically significantly different depending on the posture of the smartphone user, and the cervical flexion angle was significantly different depending on the task. Furthermore, task and task × posture can be classified with high accuracy based on smartphone tilt data, and tilt data had a high correlation with body flexion angles. Relevance to industry: The results of this study can be used as a reference for designing various products and interfaces for neck health. The results can be applied as a smartphone alarm or a built-in application, which can inform the user of the need to stretch his or her neck.     

Wrist posture affects hand and forearm muscle stress during tapping

Non-neutral wrist posture is a risk factor of the musculoskeletal disorders among computer users. This study aimed to assess internal loads on hand and forearm musculature while tapping in different wrist postures. Ten healthy subjects tapped on a key switch using their index finger in four wrist postures: straight, ulnar deviated, flexed and extended. Torque at the finger and wrist joints were calculated from measured joint postures and fingertip force. Muscle stresses of the six finger muscles and four wrist muscles that balanced the calculated joint torques were estimated using a musculoskeletal model and optimization algorithm minimizing the squared sum of muscle stress. Non-neutral wrist postures resulted in greater muscle stresses than the neutral (straight) wrist posture, and the stress in the extensor muscles were greater than the flexors in all conditions. Wrist extensors stress remained higher than 4.5 N/cm² and wrist flexor stress remained below 0.5 N/cm² during tapping. The sustained high motor unit recruitment of extensors suggests a greater risk than other muscles especially in flexed wrist posture. This study demonstrated from the perspective of internal tissue loading the importance of maintaining neutral wrist posture during keying activities.     

Comparison of stoop versus prone postures for a simulated agricultural harvesting task

Physical and psychophysical differences between working in the stooped and prone postures were compared while performing a simulated agricultural harvesting task for 30 min. Fifteen male subjects participated. The measures used to compare the two postures included perceived discomfort, electromyography (EMG), and heart rate (HR). Average hamstrings localized discomfort (0-10 scale) was 6.17 (SD=2.9) for the stoop posture and 0.67 (SD=1.29) for the prone posture. Erector spinae and hamstring EMG RMS increased 68% and 18%, respectively, while mean power frequency for the hamstrings decreased 13% for the stoop task. Mean power frequency for the middle trapezius muscle decreased in both postures (stoop 4.13%, prone 3.79%). Average heart rate during the last work cycle was 35% greater than the resting heart rate for the stoop posture while average heart rate was 17% greater for the prone posture. Subjects worked on the prone workstation without rest during the 15 min work simulations with less discomfort, no localized fatigue in the back or leg muscles tested, and lower working heart rates than subjects working in the stoop posture.     

Sex-specific effects of muscle fatigue on upper body kinematics and discomfort during a repetitive point task performed on a sit-stand stool

When performing repetitive work-like tasks while standing, people may develop leg discomfort and adapt their whole-body motion to arm fatigue. How these responses are affected when working while sitting on a sit-stand stool is unknown. Asymptomatic young adults (N = 29, 15 females) performed a repetitive pointing task sitting on a sit-stand stool, while whole-body kinematics was recorded. Results showed no leg discomfort increase with fatigue. The upper body leaned more backwards and towards the non-reaching side. Variability increased at the seat (p = 0.002), shoulder (p = 0.001) and elbow (p = 0.005) but was preserved at wrist (p = 0.058) and endpoint (p = 0.088). Participants who were more fatigable increased seat variability (males, p = 0.01) or seat range of motion (females, p = 0.022) after fatigue. The sit-stand stool contributed to the response to arm fatigue, although females and males developed different strategies. The maintained endpoint variability and leg discomfort suggest that the sit-stand stool could be recommended as an alternate workstation with minimal disruption to work performance or worker discomfort.     

Linking head and neck posture with muscular activity and perceived discomfort during prolonged smartphone texting

Prolonged use of the smartphone for texting was studied on a sample of 17 healthy young adult participants (11 females), who were asked to type interactively on a handheld device while standing and sitting. Upper body kinematics ad upper trapezius surface EMG were recorded to capture parameters of joint kinematics and muscular activity, which were then compared with self-reported indicators of discomfort through the Borg's CR 10 scale questionnaire. The results indicated that, while showing a similar postural strategy in both conditions that is assumed to be controlled by the visual system to maintain a constant viewing distance from the device, the participants adopted a “stiffer” posture of the head and neck during standing than when sitting, with a direct correlation between upper trapezius muscle activity, neck angle and perceived discomfort. The evidence obtained in this study highlights the importance of monitoring muscle activity and head and neck kinematics, to assess the biomechanical risk factors of neuromuscular disorders associated with smartphone overuse.     

Effects of sitting versus standing and scanner type on cashiers.

In the retail supermarket industry where cashiers perform repetitive, light manual material-handling tasks when scanning and handling products, reports of musculoskeletal disorders and discomfort are high. Ergonomics tradeoffs exist between sitting and standing postures, which are further confounded by the checkstand design and point-of-sale technology, such as the scanner. A laboratory experiment study was conducted to understand the effects of working position (sitting versus standing) and scanner type (bi-optic versus single window) on muscle activity, upper limb and spinal posture, and subjective preference of cashiers. Ten cashiers from a Dutch retailer participated in the study. Cashiers exhibited lower muscle activity in the neck and shoulders when standing and using a bi-optic scanner. Shoulder abduction was also less for standing conditions. In addition, all cashiers preferred using the bi-optic scanner with mixed preferences for sitting (n = 6) and standing (n = 4). Static loading of the muscles was relatively high compared with benchmarks, suggesting that during the task of scanning, cashiers may not have adequate recovery time to prevent fatigue. It is recommended that retailers integrate bi-optic scanners into standing checkstands to minimize postural stress, fatigue and discomfort in cashiers.     

Task rotation effects on upper extremity and back muscle activity

Job rotation is an intuitive approach to distributing work to minimize muscular fatigue. The purpose of the current study was to evaluate rotation between lifting and gripping on muscle activity and effort. Ten male participants performed all 4 combinations of two 15 min tasks in 30 min trials split between separate days to prevent fatigue. The tasks of lifting a 12 kg box and gripping at 20% of maximum were performed 6 times per minute (5 s work: 5 s rest). Muscle activity (percentiles, gaps) and perceived effort were significantly affected by the task combinations. The forearm and upper erector spinae muscles did not benefit as greatly from rotating between lifting and gripping tasks as the lower erector spinae, deltoid or trapezius. In addition to gross task differences, overlaps in muscle activity between “low back” and “upper extremity” tasks must be considered when creating effective job rotation schemes.     

A comparison of muscle activity in using touchscreen smartphone among young people with and without chronic neck–shoulder pain

This study aimed to examine differences in muscle activity between young people with and without neck–shoulder pain (n = 20 in each group), when they performed texting on a smartphone. Texting was compared between using both hands (‘bilateral texting’) and with only one hand (‘unilateral texting’). Texting tasks were also compared with computer typing. Surface electromyography from three proximal postural muscles and four distal hand/thumb muscles on the right side was recorded. Compared with healthy controls, young people with neck–shoulder pain showed altered motor control consisting of higher muscle activity in the cervical erector spinae and upper trapezius when performing texting and typing tasks. Generally, unilateral texting was associated with higher muscle loading compared with bilateral texting especially in the forearm muscles. Compared with computer typing, smartphone texting was associated with higher activity in neck extensor and thumb muscles but lower activity in upper and lower trapezius as well as wrist extensors.     

Neck and shoulder muscle activity during standardized work-related postural tasks

The aim of the present study was to assess the activity levels of the sternocleidomastoid muscle and upper trapezius muscle during static postures under controlled and standardized conditions, and to determine whether the muscle activity differed between sexes. Electromyographic (EMG) activity was recorded unilaterally from the sternocleidomastoid and upper trapezius muscle in 17 participants whilst they were performing various postural tasks. EMG amplitude was measured by the root mean square values of the raw signals and normalized to peak maximum contractile values for each muscle (%MVC). The intensity of muscle activity was ranked as light (<3%MVC), moderate (3%MVC ≤ EMG ≤ 8%MVC), and substantial (>8%MVC). During most tasks the two muscles contracted light to moderately. Head leaning and shoulder shrugging postures yielded substantial muscle activity in both muscles. Muscle activity did not differ significantly between male and female participants (F = 3.1; p = 0.078). Our findings provided normative values, which will enhance future studies of muscle activity during work in a natural, unrestrained environment.     

An ergonomics study of thumb movements on smartphone touch screen

This study investigated the relationships between thumb muscle activity and thumb operating tasks on a smartphone touch screen with one-hand posture. Six muscles in the right thumb and forearm were targeted in this study, namely adductor pollicis, flexor pollicis brevis, abductor pollicis brevis (APB), abductor pollicis longus, first dorsal interosseous (FDI) and extensor digitorum. The performance measures showed that the thumb developed fatigue rapidly when tapping on smaller buttons (diameter: 9 mm compared with 3 mm), and moved more slowly in flexion–extension than in adduction–abduction orientation. Meanwhile, the electromyography and perceived exertion values of FDI significantly increased in small button and flexion–extension tasks, while those of APB were greater in the adduction–abduction task. This study reveals that muscle effort among thumb muscles on a touch screen smartphone varies according to the task, and suggests that the use of small touch buttons should be minimised for better thumb performance.