Chances are that you probably haven't given much thought to how your neck and back are faring in the age of the smartphone, but studies show that you most certainly should. It's practically a reflex these days to pull out our smart phones when we're standing in line, sitting at a red light, or even walking down the street. And while it's great that we rarely need to venture beyond our phones for entertainment, our bodies are beginning to retaliate.

So, what exactly are these conveniences doing to our bodies? A surgeon-led study that published in Surgical Technology International assessed what impact surgeons' head and neck posture during surgery-a posture similar to that of smart-phone texters-has on their cervical spines.

With each degree that our heads flex forward (as we stare at a screen below eye level), the strain on our spines dramatically increases.

When an adult head (that weighs 10 to 12 pounds in the neutral position) tilts forward at 30 degrees, the weight seen by the spine climbs to a staggering 40 pounds, according to the study.

How pervasive of a problem is this? According to the study, the average person spends 14 to 28 hours each week with their heads tilted over a laptop, smartphone or similar device. Over the course of a year, that adds up to 700 to 1400 hours of strain and stress on our spines. As a result, the number of people dealing with headaches, achy necks and shoulders and other associated pain has skyrocketed. Trained to address postural changes and functional declines, the physical therapists at CTS are well versed in treating this modern-day phenomenon, widely known as "text neck."

Over time, this type of poor posture can have a cumulative effect, leading to spine degeneration, pinched nerves and muscle strains.

Scheduling an appointment with a physical therapist at CTS can help you learn how to interact with your devices without harming your spine. Your PT will prescribe an at-home program that includes strategies and exercises that focus on preserving the spine and preventing long- term damage along with stretching and strengthening activities for those over worked muscles.

Exercise is an important part of taking care of our spines as we age, but what we do when we're not in motion matters, too. So next time you pick up your smartphone or curl up with your e-reader, do a quick check of your head and neck posture. Your body will thank you for years to come.

Jill Menefee, PT

What is required to be a dancer? It means putting your art above financial gain. It means practicing your profession more hours per week than is allowed in sporting professions. It means physical AND mental toughness.

At the recent International Association of Dance Medicine and Science (IADMS) conference a proposition was made for dancers to become advocates for their own health. And for healthcare professionals to assist in promoting health for these dancers. CTS is ready to do our part! The discussion focused on elite dancers. However, the education needs to start with young dancers, before the age of 13 when foot and ankle injuries begin to be common.

So, dancers of all ages, we want to keep you dancing! Here are 6 tips to keep you performing.

#1 The minor ankle sprain is a major deal.

And is so simple to treat if seen by a physical therapist. 98% of dancers with a hip injury had a chronic ankle injury on the same leg.

Our CTS pledge to you is that we will not say the dreaded "rest, ice, compress, and elevate until it feels better." Rather we will maximize healing time by creating exercises that keep the rest of your body conditioned while providing active rest and specific exercises to best heal your ankle. Thus helping you safely return to dancing sooner and truly heal an injury that without treatment is a risk factor for more serious injury years later.

Better yet, prevent it! Come in for a complete dance-readiness screen to identify at risk areas and leave with a plan of action.

#2 Use Food as Medicine.

Eating protein, calcium, collagen, and various vitamins and minerals is important for both bone health and muscular health. Eating well helps prevent injuries and it helps heal them. Energy availability is also key. Dancers may be at risk for low energy intake (not eating enough) during peak seasons. Perhaps you are eating the same as you always do, but your energy expenditure is higher due to longer practice sessions. When your body only has enough energy to take care of you basic needs like breathing/walking/thinking after high doses of energy use from dancing, then it does not use energy for proper hormone function. This can result in amenorrhea (lack of menstrual cycle), which affects both short term and long term bone health. So, eating well helps both short and long term injury prevention.

For more information see IADMS resource paper on Nutritional Guidelines. This includes a chart with natural food sources with the vitamins and minerals important for bone health.

#3 Are you warm enough to dance?

This IADMS resource explains why warm up is important, how long it lasts, and suggestions for warm up.

#4 When can I go en pointe?

Many girls dream of this special day. Here are guidelines established per The Journal of Dance Medicine & Science, Volume 13, number 3, 2009, pages 90-92.

1. Not before age 12 due to bone development in the foot.
2. If the student is not anatomically sound (e.g., insufficient ankle and foot plantar flexion range of motion; poor lower extremity alignment), do not allow pointe work.
3. If she is not truly pre-professional, discourage pointe training.
4. If she has weak trunk and pelvic ("core") muscles or weak legs, delay pointe work (and consider implementing a strengthening program).
5. If the student is hypermobile in the feet and ankles, delay pointe work (and consider implementing a strengthening program).
6. If ballet classes are only once a week, discourage pointe training.
7. If ballet classes are twice a week, and none of the above applies, begin in the fourth year of training.

#5 Technique is key.

In reference to injury prevention, this includes:

1. Finding and maintaining good pelvic, hip, knee, and ankle alignment.
2. Being able to activate "core" muscles while in good alignment.
3. And then being able to move an arm, leg, or both while maintaining core activation in good alignment.

We can screen these 3 areas at CTS and offer exercises to make them easier to attain. Check our facebook page all month for specific tips!

#6 Training traditions are artistic, not scientific.

Let's start this dialogue! Four principles not used in dance that are used in other sports include: specificity, overload, overtraining, and periodization.

• Dancers rarely train to an end point. There is no trophy or ring. Rather they are expected to do 100%, 100% of the time.
• Elite dancers train 46 hours/week, but NCAA athletes are limited to 20 hours/week. 65% of dance injury is due to overuse.

We hope that in getting this dialogue started that artistic directors, choreographers, dance teachers, and the individual dancer will take charge of putting health as a priority and evaluate how to better manage these 4 principles. We've seen fearless and beautiful fusions of various dance languages. Now it is time to fuse science with the art of dance.

We want to keep you dancing!

Dance Injury Prevention Screenings offered at CTS:

• Pointe readiness assessment and action plan
• Dance injury prevention for all dance styles. Assessing strength, alignment, and coordination with action plan to help prevent injury.

Crystal Hazelton, PT,MPT, OCS