An increasing number of Hong Kong people are developing a condition called 'iPhone syndrome' because of bad posture and addiction to their smartphones, wherever they are and whatever they are doing. Hazel Parry investigates the trend.

It is a condition experts are calling "iPhone syndrome" and they are seeing more and more cases as Hong Kong people become ever more attached to their smartphones.

Travel the MTR at peak times, take a look around a restaurant or bar, or even watch people walking through any shopping mall, and you'll spot potential sufferers everywhere, says chiropractor Dr Sophia Ng Mo-tack.

They all have the same tell-tale stance: head-down, shoulders hunched in a curve, as their thumb and fingers taps away at the phone.

It may seem harmless enough and a part of modern everyday life, but adopt this stance too often and for too long and the smartphone will literally become a pain in the neck, as well shoulders, elbows, wrists and thumbs.

Ng, the chairwoman of public relations committee of the Hong Kong Chiropractors' Association, said in the long-term this bad posture associated with smartphone use puts strain on muscles which in turn leads to reoccurring episodes of pain.

Left untreated or unchecked, the overuse of these muscles and tendons will lead to degenerative conditions, arthritis and even irreversible damage to tendons and nerves.

"These are degenerative conditions previously associated with people in their 40s and 50s but we are now seeing an increasing number of cases among people in their 30s and even younger. We are calling it 'iPhone syndrome,'" she said.

"Lifestyles have changed. There are kids now who are being given iPhones by their parents so by the time they reach their 30s they will have been using them 20 years already. I have even heard of kids developing 'iPhone syndrome' when they are 15 and 16," she said,

According to Ng, repeated and overuse of smartphones while adopting this bad posture can have long-term effects on two areas: the wrist and the neck.

"The most serious of these is the neck which occurs as a result of people arching their necks to look down at their phones whether to check emails, play games or send messages, continuously wherever they are," said Ng.

"We call this hyper-flexion - hyper means too much, because the neck is hyper-flexion for a long period of time.

"The first thing people might find is that the muscles tire in their neck and shoulders. If they don't correct this bad posture, they will start to have pain which in the long term could lead to degenerative arthritis."

Ng said repeated bad posture may also result in the development of bone spurs, extra growths of bones in the joints in the neck, which can impinge the nerves leading down the arms and hands causing numbness in the wrist and fingers.

"The second area which is can be affected by overuse of smartphones is the wrist," said Ng.

"If you use two hands it will lead to pain in the one holding the phone as constant pressure is put on the wrist by the pushing on the keys with the fingers of the other hand.

"If you use one hand and key in with the thumb on the same hand, it will also affect the thumb. The joint will become stiff and tight and lead to a lot of pain.

"Usingsmartphoneswhile standing on the MTR is even worse because all your muscles have to tense up more as you try to balance yourself. It also affects your eyes which have to work harder to focus and for children whose eyes are still developing, it can be really bad."

All of these aches and pains associated with smartphone overuse are not new medical conditions and many have been documented in medicine for more than 100 years with names like "tennis elbow" and even "washerwoman's sprain".

More recently, they have labeled "tech-neck" to describe the pain associated with long periods of arching your neck while staring down at a computer and "Blackberry thumb", named after the pain which occurs when you used your thumb in a movement it was never intended for to type on a Blackberry.

However, experts fear that whereas the Blackberry is a tool of the executive, the smartphone has a much wider range of users from schoolchildren to housewives, potentially putting a greater number of people at risk to developing this so-called iPhone syndrome.

Figures from Hong Kong's Office of Telecommunications Authority show that by March 2011 the city of 7 million had more than 13 million mobile phone subscribers, of these 6.8 million were 2.5G and 3G subscribers.

How many of those subscribers use smartphones is not specified but these figures show almost 7 million people have the opportunity to be online, surfing, checking email, facebooking and playing games, 24 hours a day, wherever they are.

But why is it that people feed the need to use the smartphone and be online almost continually? Some studies have talked about internet addiction with the number of suspected addicts ranging from 0.9 percent to 30 percent of the population depending on the criteria adopted.

A survey of 200 studentsat the Stanford University in California even suggested the existence of iPhone addiction with 70 percent saying his particular smartphone made them feel cool.

According to the 2010 year survey, almost half of those interviewed described themselves as being "very or completed addicted" to their iPhones while many described it as being indispensable part of their lives, with 69 percent said they were more likely to forget their wallet than their iPhone when leaving in the morning.

Around 25 per cent of the surveyed students said their iPhone was "dangerously alluring", while 41 percent said losing their iPhone would be a tragedy.

Professor Tanya Luhrmann, the anthropology professor who led the study, said one of the most striking things to emerge from the survey was that many of those interview iPhone almost saw their phone as an extension of their brain and body.

"It was not so much with the object itself, but it had so much personal information that it became a kind of extension of the mind and a means to have a social life. It just kind of captured part of their identity."

In November 2010, Taiwanese psychologist Dr Yang Tsung-tsai made the headlines when he talked about a schoolboy "whose eyes were glued to hisiPhone screen during 24/7" and who stayed up all night surfing the interneton his phone.

Yang saidthe boy had to be hospitalized in a psychiatric ward after his daily lifewas completely disrupted by his iPhone addiction.

Taipei-based psychiatrist Dr Kuang-hui Lee even claimed the previously common problem called CAD, or "computer addiction disorder", has been eclipsed by iPhone disorders.

Fu King-wa, a research assistant professor at the Journalism and Media Studies Centre ofthe University of Hong Kong, believes much more research needs to be done before we can jump to the conclusion about the existence of internet and iPhone addictions.

Fu co-authored a study on Internet addiction among Hong Kong adolescents published in 2010, which found that by using a criteria normally used for pathological gamblersinvolving a check-list ofeight criteria, they found 6.7 percent of young people in Hong Kong could be described as addicted to the Internet.

Other studies carried out earlier in 2004 and 2008 have suggested the number is as high as 38 percent and 20 percent in Hong Kong.

"I don't want to give you the impression that because people spend a lot of time on the Internet they are addicted. It could be they have good reason (for that use) which may be cultural or work related or as result of family pressure," said Fu.

"You could see it as a lifestyle issue and that people are making use of the internet to stay better connected with friends. I have noticed a lot of people use iPads for reading. If they have an acceptable purpose to their use, we can't say they are addicted."

The jury is still out on the existence of internet addiction.Itis not as yet included in the list of recognized mental disorders by the American Psychiatric Association. However, doctors would appear to agree that how we surf the Internet on smartphones could have physically consequences.

Orthopedic doctor Josephine Ip Wing-yuk said that over-use combined with bad posture while using smartphones could bring pains which adversely effects on people's ability to work and could lead to more and more sick days being taken.

Dr Ip, a clinical associate professor of the Department of Orthopaedics and Traumatology at the University of Hong Kong, said around 10 to 20 percent of the people she sees with "over-use" problems did use smartphones but it was combined with long-term computer use.

She believes, however, the numbers of people suffering from overuse problems as a result of suing smartphones is already increasing.

"In the past few years, we have started to see people coming with just one problem, especially the thumb, which is caused by using the thumb to type rather than the fingers.

"Once you have a overuse problem, it can take weeks to recover, and during this time your working capacity will be decreased. You will have pains here and there and you will not be able to tolerate your usual amount of work.

"If you don't manage it properly and if there is an inflammatory response, and your body heals with fibrosis, you have an increased chance of repeated episodes of pain.

"You may need conservative treatment such as physiotherapy, or an injection to control the inflammation, or in the worse scenario you may need an operation."

Ip said it was important people realized pains associated with overuseshould not be ignored.

"My advice to anyone using a smartphone, is to keep an upright posture," she said. "Try not to flex the spine too much, keep it in a neutral position, Try not to bend your thumb, it is better to touch the screen with your fingers."

(HK Edition 06/21/2011 page4)