Learning to care for Cinderella is crucial for all screen users.

The Cinderella hypothesis aims to explain the link between low-level muscular activation to an elevated risk of developing chronic pain, including the chronic pain now commonly experienced among computer/screen users.

You will recognise that pain. It starts as an ache, or a cramp, or numbness, and keeps getting worse, until one day you have a frozen shoulder, or your tension headaches are now migraines, or you’re having treatment for the shooting pains running down your arm, RSI or Carpal Tunnel Syndrome.

Why is Cinderella related to Neck and Back Pain?

In 1991, Hägg coined the term “Cinderella hypothesis” while researching factors associated with the development of musculoskeletal disorders (MSDs). It associates low-threshold motor units with Cinderella, who was recruited early and left to do all the work. The theory hypothesises that with muscle activation, low-threshold motor units are always recruited and remain activated until total muscular relaxation.

In the long run, and due to a lack of recovery time, metabolic overload at the membrane level may occur, resulting in degenerative processes that lead to cell damage, necrosis, and pain [1].  

This framework is still one of the most recognised pathomechanistic theories (or mechanisms by which a pathological condition occurs) underlying the development of MSD [2].

Especially Relevant to Computer/Screen Users

Muscles held in static, awkward (i.e. non-neutral) or extreme positions [3-5], create fixed, constrained postures with low levels of muscle exertion (static loads) [6]. Discomfort or injury is believed to occur as a result of muscles being held in a contracted state, but which are not doing heavy work [7].

Computer work is characterised by low levels of muscle activity, especially of the trapezius muscles [8]. Work tools and workstations also have uniform elements leading to other recurring postural issues, including excessive wrist flexion/extension and ulnar/radial deviation, repetition of movements about the elbow and shoulders, and extended time exposure [9] [10] [11]. “Visual information is presented on a screen, and the information is handled by manual input devices like the keyboard or mouse. All the equipment is stable in the same position on the table and therefore requires the worker to keep the same static posture during work” [12].

This is why your mini and microbreaks are so important!

Visser’s 2006[13] literature review notes the risk factors leading to functional changes accompanying upper extremity muscle disorders (UEMDs) included: sustained muscle activity, especially of type I (Cinderella) motor units, (maybe a primary cause of UEMDs) and that it seems plausible suboptimal blood flow plays a role in pathogenesis of UEMDs [13].

 

How to Care for Cinderella and Reduce Back and Neck Pain

The purpose of this article is to promote the development of personal skills that can reduce pain and the risk of injury while increasing comfort and productivity.

The skills are simple, requiring only that you release tension, keep moving, and return to a relaxed, neutral work posture.

Roll – Reset – Relax

This skill is very important. It helps you switch off and relax, reducing low-level muscle activation, and enables the development of postural awareness to re-establish a Relaxed Neutral Work Posture. Simply

• Sit back in your chair
• Plant both feet flat on the floor or footrest
• Pull your spine to the sky (think ‘Tall Head’)
• Move your chin back a little. Feel your ears are over your shoulders, and your shoulders over hips.
• Rest your arms in your lap or on a work surface
• Roll your shoulders back and forward several times
• Finally, take a deep breath and consciously relax.

This Roll–Reset–Relax is a vital work skill!

It is central to your ability to manage upper-body discomfort. As we work, we build up tension in our neck and shoulders, and the only way to release this tension is by doing big movements and consciously relaxing. 

By doing this one action (ROLL, RESET, RELAX) every time you find yourself leaning forward, leaning on your elbow or working with tense shoulders, you can reduce the discomfort in your neck and shoulders by up to – 50% – just by MAKING THIS YOUR NEW HABIT

Last Word

While the lines between work and leisure may be blurred, there is no line between the tools we use for work and those we need to stay fit and well in our lives.

Become aware of the tension in your shoulders and consciously relax. Think of your ‘Roll – Reset – Relax’ routine while you wait for your coffee, stand in line, or get ready for bed. 

Like any new health habit, it will take a while before this becomes automatic, but the benefits to your musculoskeletal comfort will be substantial.

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References

1. Kadefors, R. and T. Laubli, Muscular disorders in computer users: introduction. International Journal of Industrial Ergonomics, 2002. 30(4-5): p. 203–210.
2. Côté, J.N. Adaptations to Neck/Shoulder Fatigue and Injuries. 2014. New York, NY: Springer New York.
3. Guide to Health and Safety in the Call Centre Industry., D.o.I.R.-W.H. Safelty, Editor. 2003, Queensland Government: Queensland. p. 33.
4. Cook, C., The Relationship Between Working Posture and musculoskeletal Disorders in Computer Users, in Division of Occupational Therapy. 2000, University of Western Syndey: Sydney. p. 27.
5. Marcus, M., et al., A prospective study of computer users: II. Postural risk factors for musculoskeletal symptoms and disorders. American Journal of Industrial Medicine, 2002. 41(4): p. 236–249.
6. Macdonald, W. and O. Evans, Research on the prevention of work-related musculoskeletal disorders: Stage 1–Literature review 2006, A.S.a.C. Council., Editor. 2006, Australian Government: Barton ACT 2600. p. 129.
7. Dryson, E. O.O.S.–An ongoing problem. Information Sheets 2001 13th June 2001 [cited 2007 1st July]; Available from: http://www.mcs.vuw.ac.nz/comp/General/OOS/articles/.
8. Wahlstrom, J., Ergonomics, musculoskeletal disorders and computer work. Occupational Medicine, 2005. 55(3): p. 168–176.
9. Aaras, A., G. Horgen, and O. Ro, Work with the visual display unit: Health consequences. International Journal of Human-Computer Interaction;, 2000. 12(1): p. 107–134.
10. Amell, T.K. and S. Kumar, Work-Related Musculoskeletal Disorders: Design as a Prevention Strategy. A Review. Journal of Occupational Rehabilitation, 2001. 11(4): p. 255–265.
11. Burdorf, A., Measurement of Ergonomic Stressors at the Workplace: From Risk Assessment to Control Measures, in 31st Annual Conference of the Ergonomics Society of Australia Inc –Widening Your Horizons. 1995, Ergonomics Society of Australia Inc.: The Grand Hotel, Glenelg, South Australia.
12. Takala, E.P., Static muscular load, an increasing hazard in modern information technology. Scandinavian Journal of Work, Environment & Health, 2002. 28(4): p. 211–3.
13. Visser, B. and J.H. van Dieën, Pathophysiology of upper extremity muscle disorders. Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology, 2006. 16(1): p. 1–16.