Smartphones….A Real Pain in the Neck

Algarve Chiropractor Neck Pain Smartphone Laptop Tablet Upper Back Pain
Chiropractic Corner column, The Portugal News
(easy to read text below)

Wow…. we truly are living in the days of science fiction. In your pocket you probably carry a small little box, a smartphone, that does so many things: you can write an email or SMS/text message, talk to a friend half way around the world, make a restaurant reservation, laugh at a Facebook video, get directions, even check the weather without going outside! An entire computer right in the palm of your hand and all you have to do is… look down.  Ah, but all this convenience isn’t free, there’s a price to pay…. 

Chiropractors have seen an alarming rise in patient injuries, all due to this amazing contraption. Because of its small size, and addictive power of keeping us glued to its screen for many hours a day, we are now placing our bodies in awkward and strained posture positions for countless hours during the week. Everyone, from kids with their heads down Facebooking their friends, to adults checking their emails, is putting enormous long-term pressures on our necks and upper backs, which are having insidious consequences. We are seeing an increase in headaches, neck and upper back pain, numbness in the arms, as well as repetitive stress injuries of the hands and thumbs… caused by, what is now commonly called, ”
text neck.”

Text Neck“, look familiar?  We see it every day, all around us.
This smartphone position puts 27 kg of pressure on the neck. Ouch!

A recent study, published in Neuro and Spine Surgery, measured varying pressures in our neck as our head moves to different positions. It is quite shocking and amazing at how quickly pressure increases.  Moving from a neutral head position looking straight ahead 5 kg of pressure, to looking down at a smartphone, the pressure in the neck rises to 27 kg of pressure. An increase of 440% (that’s a BIG number!!). This is especially troublesome for those with a cervical disc problem, recovering from a neck injury, or chronic pains in the neck.  This issue can worsen just about any musculoskeletal-nerve problem of the neck/upper back/shoulder/arm and hand. We need to begin seeing this as a Repetitive Stress Injury in the making.

Look at this chart and you may recognize a head position that you commonly maintain.


With our head balanced directly above our neck, the weight of an adult head is approximately 5 kg, resulting in 5 kg of pressure in the neck.  As the head tips forward, the 5 kg of head weight, now begins to cause an increase in pressure in the neck as the head gets further away from its natural balance point. Think of it this way: if you hold a 5 liter bottle of water close to your chest, the bottle feels 5 kg heavy. Now hold that 5 kg bottle at arm’s length, and suddenly the bottle “feels” as if it’s 25 kg!  Simple leverage. The weight hasn’t changed, but the distance from the anchor or pivot point has changed. Same thing happens as the head moves forward and down, the weight of the head is dropping off of the neck, creating an increase in neck pressure. And, these pressures worsen if we turn or tip our head. To hold our head in these positions we must use our neck muscles to hold the weight and resist the increasing pressure.  The neck muscles are acting as a mechanical crane, in constant contraction holding our head in these awkward positions. The muscles and ligaments get tired and sore, the nerves are stretched and discs get compressed.  OUCH!

Now look at the chart again, and you can see just by altering your position, bringing your head closer to neutral, you can greatly decrease the pressure your neck sustains. I constantly reinforce this point to patients… a guiding principle in improving posture and ergonomic positioning is: get yourself into the most comfortable, stable and relaxed posture and position, one that you can maintain for a long time, and then “bring your work/activity to you.” We should not be bending ourselves in half to read a book or smartphone. Because, well, that’s just not… smart!

Eight tips to better your posture. Be creative, think outside the box.
1) Take frequent breaks… get up and look around, take a few deep breaths. Do some stretching.
2) Raise the smartphone closer to eye level, use your elbows or a pillow. Increase the font size, adjust the brightness, use the zoom feature to view more easily.
3) If you are using your laptop on a desk/table, put the laptop on a set of books raising the screen to eye level, (support your favorite charity shop and…) purchase a donated USB keyboard (5 euros), plug it into your laptop, now you can place your hands in a comfortable spot, possibly on a pillow on your lap.
4) If you have a tablet, use a tablet stand.
5) Reading in bed? Sit up a little straighter with some pillows behind your back, and a pillow or two on your lap to raise your reading material closer to eye level.
6) If reading a book at a table/desk, prop it up so it’s tilted at a better angle.
7) Posture Reminders: put a copy of the neck pressure chart at work or on your refrigerator; draw a “star” on a sticky note and post it on your monitor; use a happy reminder image as your smartphone “wallpaper” so every time you use it, you will have good posture.
8) See your Chiropractor for specific additional advice to help you develop better posture.
Small changes yield big dividends over time.

For over 100 years Chiropractic has been promoting the importance of good posture and specialize in treating conditions to bring your neck to a place of ease and good health. Your Chiropractor (and your Mum!) have been saying for a long time… good posture leads you to a happy and relaxed long life! Enjoy your smartphone… safely.

Study source and chart: “Assessment of Stresses in the Cervical Spine Caused by Posture and Position of the Head”, Kenneth Hansraj, MD, Chief of Spine Surgery, NY, USA.

Please call today for an appointment!
(+351)  282 352 202  (click and call)

Pain-FREE Shoulder Clinic
Bombeiros Voluntários Portimão, Suite 2
Rua dos Bombeiros Voluntários
8500-763 Portimão
282 352 202


How to Thaw a Frozen Shoulder

(Chiropractic Corner column, The Portugal News)

Many times a week, patients walk into my clinic with a “Frozen Shoulder Syndrome“.  They are usually having pain and inability to move their arm freely, with a restriction of their normal activities, whether it be lifting, playing golf or tennis, or just sleeping comfortably. In this short article, we’ll take a quick overview of the causes and look at a new treatment, the “Shoulder Revolution Solution”.


Historically, “Frozen Shoulder” meant that the true shoulder joint (made up of the shoulder blade and upper arm bone) and the capsule surrounding the joint, has become increasingly stiff due to inflammation, injury, previous surgery, or even autoimmune disease. This condition is called Adhesive Capsulitis since the commonly accepted thought is that an increase in sticky Fibrinogen, a protein that our body also uses for clotting blood, begins to tighten down the joint. This is what I was taught in school.

Increasingly in common usage, the term “frozen shoulder” has become a bit of a catch-all term for almost any limitation of the shoulder joint. Other common descriptions of shoulder limitation you might hear are tendonitis, bursitis, rotator cuff strain, impingement syndrome, and others. Interestingly, they all are a result of irritation to that particular tissue, not necessarily a separate disease process. 

There is another thought coming out of sports medicine, that the “freezing” of the shoulder is caused by irritation or injury, even very minor trauma, causing confusion of the normal muscle activities. Very minor trauma can be walking a pulling dog or suddenly reaching to catch something falling, taking a deep divot while golfing or an awkward swing in tennis, which causes strain to one of the 17 muscles that attach to the shoulder blade.

The shoulder has a very shallow joint and is highly dependent upon the muscles to keep the correct alignment of the shoulder blade and arm bone. Curiously, the “injury” may be so minor that we aren’t even aware that it has occurred, but it sets off a chain reaction throughout the shoulder muscles, leading to a confusion of coordinated muscle contraction and relaxation.

Surprisingly, there are 18 muscles involved, 17 attach to the shoulder blade, plus the large chest muscle attaching to the upper arm bone. These muscles all need to have precisely coordinated movement with each other, contracting and relaxing at just the just right time. If not, there can be big problems.

Think of the shoulder as a symphony, and these 18 “musicians” need to know when to play and when not to play. If they are playing out of sync, the music is painful to listen to! This very thing happens to the shoulder: some muscles may be working too much (spasm) and some working too little or not at all, as well as muscles can be working at the wrong time. This combination of problems begins to alter the position of the shoulder causing strain on the entire system: muscles, tendons, ligaments, joints and bursa sac (a fluid-filled bubble to cushion tendons). With the shoulder joint having a shallow surface, the arm bone is pulled improperly, the nervous system becomes aware of things being not quite right, and then the muscles, attempting to protect the shoulder, begin to lock down or “freeze”. Restricted and/or improper motion follows, causing more irritation, which leads to more “freezing”. Over weeks (sometimes just days) the shoulder/arm begins to have less and less movement, and unfortunately for some, the arm becomes completely “frozen”, no motion at all.

Rarely, do I see a true Adhesive Capsulitis, but rather most cases of “frozen shoulder” are confused muscles creating a problem, which then cause the variously known conditions of tendonitis, muscle strain, rotator cuff injuries, etc.

What can be done? Traditional treatment (also what I was taught in school long ago) has consisted of using heat/cold, massage, ultrasound, some exercise, anti-inflammatory medications, and then possibly cortisone injections. Recovery with this mode of treatment can take four to six months for the shoulder to “thaw” and regain mobility. Multiple cortisone injections can lead to weakness of the tendons and ligaments. 

Sports medicine has led the charge in finding new ways to get people back to activities much more quickly, most times within three to four weeks (instead of four to six months). First is an orthopedic examination, to rule out any underlying conditions; then determine which muscles are working too much or too little and which muscles are not doing their job at the correct time. Treatment is aimed at relaxing the spasmed muscles so they are not pulling the shoulder/arm out of position; followed by helping the weak muscles work more correctly, and all muscle working when they should.  As the movement of the shoulder/arm is brought back into a more normal function, the strain on the tendons is reduced relieving the tendinitis, decreased twisting of the joint capsule helps prevent Adhesive Capsulitis, muscles spasm is reduced and muscles regain their normal strength and motion. The shoulder can then play sweet music once again!

While working as an Olympic team doctor for track and field, seeing lots of shoulder injuries (javelin throw, pole vault, discus throw, shot-put), as well as treating many golf and tennis players, I have had the opportunity to help many shoulder injuries recovery quickly, with little or no lasting ill effects from the “Frozen Shoulder Syndrome”. If you are having difficulties with your shoulder, seek out a sports medicine rehabilitation specialist who can offer you advanced care and give you the best opportunity to get back to your activities… fast !

Call us for a FREE Orthopedic Evaluation and Examination.  Come in and see if you can quickly get back to your normal life… as 1000’s of others have!

Please call today for an appointment!
(+351)  282 352 202  (click and call)

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Thank you,
Dr. Bock

Pain-FREE Shoulder Clinic
Bombeiros Voluntários Portimão, Suite 2
Rua dos Bombeiros Voluntários
8500-763 Portimão
282 352 202

Helping people with Shoulder problems all over the Algarve, Portugal
Portimão, Lagoa, Lagos, Alvor, Carvoeiro, Silves, Porches, Monchique, Almancil, Praia da Rocha


How to exercise for fast recovery from an injury

(Chiropractic Corner column, The Portugal News, 12/2/16)

Our life is sailing along just fine, we are doing the things we love, and then a bend or twist, and suddenly…. OUCH!!  IT happens, we’ve injured some part of ourselves. There is pain and swelling with loss of movement. You see a Chiropractor for a few adjustments or Physical Therapist for a few sessions, who helps you get through the first stages of recovery… but somehow, things are not getting better fast enough. Something is missing.

I too often see patients and athletes who have had an injury, recover from the initial pain and inflammation, then really struggle with returning their injured body part to full strength. Or worse, suffer a re-injury and have to begin the process all over again.

This can be very frustrating, and lead to recurring injuries to the same area. Many people suffer from life-long recurrent sprained ankles or lower back pain that just doesn’t go away.

Image result for back pain

If we take a page from high-level sports medicine helping elite athletes and how they get back into the game quickly, we can use a few simple tricks which can help us regain our full potential. The secret? Slow and easy….

Movement of the area early and often, but gently, helps blood permeate the area increasing nutrition to speed healing. Movement also ‘teaches’ the new cells mending the micro-tears how they are going to be used in the future, giving a more functional mend.

After the downtime of an injury, when we are relatively inactive, we are recovering from two things: 1) the injury itself, and 2) de-conditioning of the area due to lack of activity. Studies show a normally active person who refrains from their activity for one week loses 10 percent of their strength gains… 10% in ONE WEEK!  It’s one of the reasons astronauts returning from space struggle to walk when back on Earth; it’s also why our muscles shrink while wearing a cast.

Regular exercise vs. Rehabilitation exercise.  All exercise is a simple balance between Activity Level & Number of Repetitions. The higher the activity the fewer the repetitions we can perform, the lower the activity the more repetitions are possible. Think… Running vs Walking.

How do we use this to recover faster?  If we injure our knee, we don’t begin re-strengthening with fast running… instead, we first begin walking = low activity level, and as we get stronger we walk further and further, with more steps = more repetitions. It is safer and helps the knee gradually get stronger, less chance of re-injury. Later, we may lightly run, and then run faster or lift weights (high activity, lower repetitions). If we apply the same idea to other body parts, lower back, neck, arms and shoulders, we get the same good results of faster recovery with less chance of re-injury.

We should only exercise to 60-80% of what the injured thing can tolerate; not to the level of surrounding healthy strong muscles. Studies also find… beginning with easy exercise for the first couple of weeks, followed by more intense workouts, patients catapult far ahead of patients who initially began with heavy exercise. The easy exercise group had almost no re-injury, whereas heavy exercise group had far higher rates of re-injury. Take your time, go easy, have fun, and you’ll get there faster!

Most of the time, these simple exercises are easy to integrate into our day, lots of repetitions, with no time lost! If you have a wrist or elbow injury, by using a water-filled 1/2 liter soft drink bottle, simply flex and extend the wrist/elbow while watching TV or talking on the phone. Easy. Sprained ankle? Trace out the letters of the alphabet with your foot… while watching TV.  Sprained Sacro-Iliac joint? Squeeze the muscles around the area while standing in a queue!

As an Olympic team doctor, I have helped many many elite athletes return to their high-level competition with these simple guidelines. It can take many months of training to again compete at a world class level. Fortunately, most of us do not need to recover to an extreme level, we just want to get on with our lives and activities, which we can do in a few short weeks. 

A true story…. some years back there was a very fit high-level athlete who injured his back while competing. He thought because he was so fit he didn’t need to follow the recommendations of his doctors and returned to his sport as fast as he could. Unfortunately, his game suffered, as did his back, and needed surgery. Again, didn’t take time for sensible rehab, returned to competition, surgery again…  His name…. Tiger Woods. You can read all over the internet, ‘didn’t take the time to recover properly’, ‘did too much too soon’, also ‘needed more rehabilitation before golfing’.

We should all learn from Tiger… s-l-o-w  is… the new fast !

Please call today for an appointment and we can help you get better fast!
(+351)  282 352 202  (click and call)

Come in so we can quickly help you get back to your normal life… as 1000’s of others have!

<- Back to Blog

Thank you,
Dr. Bock
The Pain-FREE Shoulder Clinic

Helping people with Shoulder problems all over the Algarve, Portugal
Portimão, Lagoa, Lagos, Alvor, Carvoeiro, Silves, Porches, Monchique, Almancil, Praia da Rocha