As the amount of time we spend on our cellphones soars to more than 15 times what it was five years ago, New Zealanders are paying an unhealthy price. Health experts report pre-school aged children suffering "text neck" and back problems. And, as phones get larger, "overstretched" thumbs are emerging, as well as eye, ear and social problems. Lee Umbers looks at the problems and how to combat them.
Getting it in the neck
Chiropractors across the country have noticed an increased number of patients with neck and upper back dysfunction, New Zealand Chiropractors' Association spokesperson Dr Cassandra Fairest says.
The increased use of handheld technology is a major cause, she says.
"Chiropractors … are seeing more and more people with anterior head carriage - when the head is positioned in front of the spine instead of ideally balanced on top of it.
"And we are now seeing school-aged children with the condition from the prolonged use of handheld devices.
"If you observe people when they're using them, their head is almost at a 90-degree angle, and it's going to become increasingly common as technology progresses."
The average adult head weighs 4kg-5kg, Fairest says. The greater the angle and length of time the head sits forward of the spine, the more likely a person will experience neck strain, plus other long-term effects associated with poor posture.
That can include the dowager's hump (where the upper back is locked in a curve forward), and tension headaches from spasms in the shoulder and neck muscles which may cause pain in the back of the skull that radiates around to the front.
Compression or irritation to nerves supplying the arms, hands and other areas can also arise.
The problem, which has been dubbed text neck, "has become far more prevalent in recent years, certainly in the last decade but even more so in the past five years with the increased usage of cell phones and handheld devices".
"It used to be fairly common in certain [demographics] - taller people, office/IT workers, military, but is now prevalent in young children, sometimes younger than school age."
How to avoid it
• Hold the device straight out from your face rather than drop the head to look at it. Take breaks every 15 minutes, or don't use the device for more than 30 minutes a time with an equal rest of 30 minutes.
• Limit usage for under 6-year-olds - no screen time is best. During rapid growth phases in children and teens, less than two hours a day.
• Have regular spinal health checkups with a chiropractor.
More people are seeking treatment for wrist and finger problems since the advent of the smartphone, orthopaedic and hand surgeon Mr Michael Boland says.
There has been a marked increase in double crush injuries, where nerves to the hand are compressed around the wrist and forearm as the hand is turned inwards holding the phone and simultaneously the nerves get pinched at the neck as the head is bent forwards to view it.
Many hand problems "fall into a category called overuse syndromes", Boland, director of the Auckland-based Hand Institute, says.
They started manifesting with people messaging on early model mobiles predominantly using their thumbs, he says.
"In particular trigger thumb, where the bending of the flexor tendon to the thumb gets caught in a small tunnel, this leads to a painful inability to straighten the thumb.
"With the advent of the smartphone, we now see an additional collection of problems relating to nerves.
"These are predominantly forearm and wrist compression syndromes involving the three major nerves to the hand.
"Holding the elbow bent and the forearm in the extreme rotated position of supination (palm upward) and pronation (palm down) lead to compression of the nerves beneath these muscles that hold these positions."
Extreme stresses on tendons in the wrists and fingers from the prolonged holding of the mobiles in this manner can lead to tenosynovitis, the inflaming of the linings of the tendons – the cords that attach muscles to bone.
Tenosynovitis can cause swelling, stiffness and pain.
"The additional problem that we see with smartphone use is the imbalance [from] usually holding the device [in] one hand with the neck bent forward, the elbow flexed and the forearm supinated.
"The combination of neck and forearm leads to a double insult to the nerves, commonly called a double crush."
Another issue starting to manifest is repetitive over reaching of the thumb, especially with more recent larger phones, causing the joint at the base of the thumb to be overused and overstretched, Hand Institute registered hand therapist Mandy Gumbley says.
"This makes the joint looser and may lead to early arthritis of this joint in the youth of today."
Also, people wanting to protect manicured nails are keeping their fingers out straight and using fingerpads to tap the screen, rather than using the fingertip in a flexed position and employing the tendons in the palm of the hand.
"This is overusing the tendons on the back of the hand in an incorrect manner and causing overuse syndromes of the finger extensor tendons."
How to avoid it
• Change hands frequently while talking on the phone.
• Take regular breaks with stretches of fingers, wrist, forearms, elbows and neck.
• If you feel discomfort, stop and rest. Change position.
• Headsets for phones.
• Use hands-free devices more.
• Talk, don't text.
The glaring issue
Cell phones and other handheld digital devices pose a number of challenges to our eyes and visual system, Wellington-based optometrist Andrew Sangster says.
"We tend to hold devices closer than is normal to our eyes, increasing the focusing effort required and also the amount of effort required to turn our eyes in to maintain a single image.
"[And] we tend to spend more time using these devices, thus prolonging the visual effort required."
Phone screens which are set too bright can cause eye fatigue though glare.
Device screens radiate light more to the blue end of the visual spectrum.
Blue light suppresses the production of the hormone melatonin and therefore suppresses our urge for sleep - a critical issue for children and adolescents as they require good quality, regular sleep for healthy neurological development, Sangster says.
Eye fatigue symptoms from mobile phone overuse may include tired, sore, gritty, watery eyes; headaches that centre around and/or behind eyes; difficulty in maintaining focus at the screen or delay in changing focus from near to distance tasks.
"It is difficult to ascertain how widespread eye-related problems are from device usage," Sangster says.
"Devices are nowadays an everyday adjunct to most people's lives.
"Due to the ubiquity of devices, we can expect to see more issues that are directly attributable to their use."
How to avoid it
• Hold your phone at least 35cm-40cm away from your face.
• Regular breaks away from devices.
• Do not have the screen too bright.
• Remember to blink to rewet the eyes. Dry eyes are a cause of discomfort.
• For younger people, no device use for at least 45 minutes before bed-time to allow normal production of sleep-controlling hormone melatonin.
• Regular eye checks.
Keep an ear out
Using earphones, with the volume too loud can not only damage your hearing but place you in a potentially-perilous "sound bubble", Dr David Welch, head of Auckland University's audiology department, says.
Cranking up the volume - "usually [for] music, but videos, games etc have the same effect" – for prolonged periods can cause noise-induced hearing loss.
It can also result in a "loss of environmental awareness when a person cannot hear dangers (e.g. an approaching car) because a combination of the occlusion to the ears from the earbuds/headphones and the sound of music drowning out the environmental sound".
NIHL results from the ear being injured through being overworked by sounds at high levels. Injuries may never recover, especially with repeated exposures.
Until recently it has been mostly associated with such things as exposure to machinery, gunshots, and power tools, Welch says.
The prevalence of NIHL in New Zealand is not known for sure, but internationally about 16 per cent of cases of hearing loss are because of noise, he says.
"Almost everyone has a smartphone though, so it is anyone who listens at higher volumes [who is at risk]."
Symptoms of NIHL are initially greater listening effort, especially in noisy places, worsening to greater hearing loss over years with potentially severe impacts on social interactions, and mental and physical health.
Tinnitus (unpleasant ringing or buzzing in the head or ears) is also a common outcome.
Loud sounds can also cause hazardous distraction, Welch says.
"Our ears normally provide us with a 'scan' of the world around us.
"When we make them busy with music, we take that away, and sometimes forget to look when we are in a dangerous position … like walking in front of a car etc."
How to avoid it
• Listen at lower volumes for shorter periods.
• Keep sound to about 70-80 per cent of maximum volume.
• Have regular hearing tests.
A number of mobile phone users are so attached to the devices, their anxiety at being separated from them or running out of battery or credit or having no network coverage, has resulted in a condition labelled nomophobia (no mobile phone phobia).
"Generally speaking, it is the irrational fear of remaining out of touch with technology," Wellington-based psychologist Susan Wall says.
"A 2008 study (in the UK) showed that 58 per cent of men and 47 per cent of women struggled with the phobia, feeling stressed or anxious when they didn't have access to their phones.
"And international research reveals that the problem is escalating."
Researchers have found excessive users of mobile phones are less happy, more worried and lonelier.
Preoccupation with devices can lead to users feeling bad about meaningless use of their time.
There are groups who are proposing that problematic overuse of devices be considered an official disorder, she says. But there needs to be four components - compulsive behaviours, tolerance, withdrawal, and functional impairment.
Compulsive behaviours can include having a phone with you at all times, always carrying a charger, checking devices first thing upon waking, last thing before sleeping, and whenever you have downtime through the day.
Indicators of tolerance would be such things as increasing the length of use over time, needing to have the latest phone or having multiple phones.
Symptoms of withdrawal include feeling anxious and nervous when separated from the mobile or when it can't be used, avoiding places and situations in which the device is banned.
Examples of functional impairment, or negative affects on everyday life, include social avoidance, choosing to only communicate to others using technologies, conflict with family or friends over the level of your usage, and using the phone in inappropriate places and at inappropriate times.
People with a "disordered" level of use of their mobile phones – as opposed to heavy users - "are likely to have some level of other mental health presentation - whether it be other addictions, depression, social anxiety, impulsive control disorder", Wall says.
"The excessive mobile usage is most likely to exacerbate, rather than cause the hazards associated with problematic use."
How to avoid it
• Set time limits for use and establish device-free zones.
• Use apps that limit time on social media.
• Ask family, friends and colleagues to tell you if they see you over-using.
• Make life more engaging and richer, reducing your need or desire to use the phone.
• Seek help from a therapist if you continue to struggle to control your usage.
Driving the message home
In 2017, driver distraction was a contributing factor in 36 fatal crashes, 192 serious injury crashes and 905 minor injury crashes.
"Essentially, anything that diverts a driver's attention for more than two seconds can significantly increase the likelihood of a crash or near-crash," NZ Transport Agency director of safety and environment Harry Wilson says.
The penalty for using a mobile phone while driving is an $80 infringement fee and 20 demerit points.
You could be charged with careless use of a vehicle if your manner of driving is affected by you being distracted from using a mobile phone or any other distraction, a police spokesperson says.
How to avoid it
• Switch mobile phones off when driving.
• Use a hands-free mobile phone, but be aware there is still a risk of being distracted.
• If you have an Apple phone, use the Do Not Disturb While Driving mode.
Black and white
Jess Cole's phone has become a lot less interesting.
The 26-year-old has set her screen to black and white mode after an Apple update started telling iPhone users how much screen time they were getting daily. Cole's phone told her one day she'd spent four hours, 15 minutes on her phone.
"I was like 'Wow, that's a lot of time'. And with my job I'm looking at a big screen a lot so how am I even fitting in that bigger screen time?
"I thought 'I can't have anyone see this number again'."
She says the change has made things "a lot less interesting to look at".
"Now, the colour screen looks way too bright for me.
"It's particularly good at night. You're not supposed to use your phone before you go to bed, but people do. It's a lot less harsh on eyes.
The Auckland lawyer suddenly has a lot more time on her hands.
"It was so easy to lie on bed and flick through endless apps.
"It has made me get back into reading a lot more. When it's black and white the only interesting thing on your phone is reading."
• 6.4m mobile connections in New Zealand, population 4.9m.
• 1987: Our first mobile network was launched.
• 159 minutes spent on cellphone calls a month – nearly double that of five years ago.
• 2GB of monthly data on average used per connection – more than 15 times that of five years ago.
• 58 % of men and 47% of women struggle with nomophobia (no mobile phone phobia)
• 23,493 mobile phone-related offences committed on our roads in 2017.
How to go grey
Step 1: Go to settings
Step 2: Click on general
Step 3: Click on accessibility, then display options
Step 4: turn on colour filters, then select grayscale
Step 1: Open settings, swipe down to the bottom and tap About Phone
Step 2: Swipe down to Build Number and tap several times until you receive a notice saying Developer Mode has been enabled
Step 4: Return to Settings
Step 5: Tap to open the new Developer Options setting menu item
Step 6: Swipe down on the Hardware Accelerated Rendering option
Step 7: Tap on Simulate Colour Space, then tap on Monochromacy option