A review of the literature with regard to neck posture and related neck pain finds many interesting articles.
In 2017, Reuters Health published a study titled:
Leaning Forward During Phone Use May Cause ‘Text Neck’
This article makes these points:
- Spine surgeons are noticing an increase in patients with neck and upper back pain, likely related to poor posture during prolonged smartphone use.
- Young patients who should not have back and neck issues are reporting disc hernias and spinal alignment problems.
- In an x-ray, the neck curve typically is being reversed as people look down at their phones for hours each day.
- Prolonged abnormal stresses on a growing spinal column may lead to abnormal spinal development with dire long-term spinal health consequences in adulthood.
- Simple lifestyle changes are suggested to relieve the stress from the “text neck” posture, including holding cell phones in front of the face while texting and using two hands and two thumbs to create a more symmetrical and comfortable position for the spine.
- People who work on computers or on tablets should use an elevated monitor stand that sits at a natural horizontal eye level.
- Take frequent rest breaks and/or engage in some physical exercise that can strengthen the neck and shoulder muscles.
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In 2018, The New York Post published a study titled:
Tech is Turning Millennials into a Generation of Hunchbacks
This article profiles the situation of a young man who began suffering from upper-back pain and neck soreness while in his late teens, subsequent to a habit of hunching over his cellular phone. As his symptoms progressed, he developed constant pain, he hunched his shoulders, and the pain caused him to wake up numerous times throughout every night.
After a decade of suffering, the patient’s chiropractor diagnosed him with “tech neck,” explaining that the cause was the forward/bent neck posture he assumed while using his laptop and iPhone. “Tech neck” is a painful forward head syndrome. It is an increasingly common condition caused by slumping over devices for hours a day, leading to a reversal of the natural neck spinal curve and triggering a physiological imbalance in the upper body.
The loss or reversal of the normal cervical curve is easily diagnosed with postural x-rays.
“Undoing the damage is a process that includes breaking bad habits, taking standing breaks and doing exercises such as yoga, foam rolling and stretches that promote good carriage and strengthen core and upper body muscles. Experts also advise patients to hold mobile devices with their elbows at 180 degrees so the screen is in front of their faces.”
Treatment options included chiropractic, restorative postural traction, and postural and core exercises.
In 2014, a study was published in the journal Surgical Technology International, titled:
Assessment of Stresses in the Cervical Spine
Caused by Posture and Position of the Head
In this article, the author notes that billions of people are using cell phone devices, essentially in poor posture. The purpose of this study was to assess the forces incrementally seen by the neck (cervical spine) as the head is tilted forward, worsening forward head posture.
The author indicates that in 2014, the average person spent 2-4 hours a day with their heads tilted forward reading and texting on their smart phones, amassing 700-1400 hours of excess, abnormal cervical spine stress per year. A high school student may spend an extra 5,000 hours in poor posture per year.
The author notes:
“Poor posture invariably occurs with the head in a tilted forward position and the shoulders drooping forward in a rounded position.”
“The weight seen by the spine dramatically increases when flexing the head forward at varying degrees.”
“Loss of the natural curve of the cervical spine leads to incrementally increased stresses about the cervical spine. These stresses may lead to early wear, tear, degeneration, and possibly surgeries.”
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In 2017, a study was published in the journal Applied Ergonomics, titled:
Texting on Mobile Phones and
Musculoskeletal Disorders in Young Adults
The aim of this study was to examine whether texting on a mobile phone is a risk factor for musculoskeletal disorders in the neck and upper extremities in a population of young adults, aged 20-24 years. The study duration was 5 years.
The authors indicate that young adults have grown up with mobile phones as an ever-present part of their lives. Access to mobile phones was 99% in the group of young adults they studied. In the United States, text messaging is the most frequently used type of communicative medium.
The authors note that text messaging places a repetitive physical stress on the neck, shoulders, arms and thumbs. The authors concluded:
“Sitting with the head bent forward while texting was more common among those with musculoskeletal symptoms.”
“Associations were found between text messaging and reported pain in the neck/upper back, shoulder/upper extremities, and numbness/tingling in the hand/fingers for both men and women.”
“There were clear associations between the highest category of text messaging and pain in the neck/upper back.”
“Sustained neck flexion may be a risk factor for developing pain in the neck, shoulder, and upper extremities.”
“Sitting with the head bent forward without supporting the arms causes a static load in the neck and shoulder muscles, which could explain the reported pain from neck/upper back.”
“Sustained muscle load and posture are considered to be risk factors for developing musculoskeletal disorders.”
“Associations with neck and upper extremity pain were found at levels of text messaging as low as 6 texts/day.”
“The strongest associations with neck/upper back and shoulder pain concerned the highest exposure category (>20 texts/day) in both men and women.”
These authors believe that the associations between cell phone use and health symptoms are underestimated because they did not include data on how much the participants use their mobile phones for other activities, e.g. gaming.
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Neck pain can result from bad neck posture.
Also in 2017, a study was published in The Spine Journal, titled:
“Text Neck”
An Epidemic of the Modern Era of Cell Phones?
The authors note that cellular/smart phones are everywhere. They are being extensively used by people of all ages. A concern to the modern era physician is the potential musculoskeletal consequence of this extensive cell phone usage, especially texting.
Extensive cell phone use and associated postures cause spondylotic changes consistent with an aged spine, but they are now being found in younger and younger age groups, including:
- Disc herniations
- Kyphotic alignment
- Abnormal imaging studies
The authors suggest that the rise in the number of patients with neck and upper back pain is related to accelerated cervicothoracic disc degeneration. These authors propose that there are significant increases in intradiscal pressure during flexion, and that “chronic increased intradiscal pressure likely contributes to disk degeneration [cervical spondylosis] and herniation.”
These authors also cite a study of over 7,000 young adult subjects (age 20–24) over a 5-year period that showed “persistent neck pain and upper back pain is associated with time spent text messaging.”
“It now seems rather clear that repetitive texting, or similar activity while using a forward flexed neck position, may lead to neck pain or ‘text neck.’”
These authors have great concern for the consequences of prolonged cervical spine flexion while texting on the developing (growing) spine. They note that persistent, prolonged forward flexed neck position may lead to anterior ligamentous contractures, accelerating cervical disc degeneration and cervical kyphosis.
These authors make these recommendations to avoid and/or treat text/tech neck:
- Patients hold their cell phone up at or near eye level while texting.
- “For patients who spend significant time working at a computer or tablet we recommend the use of elevated stands for desktop monitors so that the monitor is at a natural horizontal gaze level.”
- Subjects should perform basic exercises that stretch and strengthen the cervical and upper thoracic soft tissue.
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In 2021, a study was published in the International Journal of Environmental Research and Public Health, titled:
Text Neck Syndrome in Children and Adolescents
The authors present a case report of a 16-year-old female presenting with headache, dizziness, neck pain, vertigo, and ataxia. She had no fever or trauma. All labs were normal. Eye examination was negative. There was no vestibular pathology. MRI (Magnetic Resonance Imaging) of the cervical spine showed a reversal of cervical lordosis and posterior disc protrusion at the C4–C5 level. The doctor’s working diagnosis was “text neck syndrome.”
The authors note that the improper use of personal computers and cell phones might be related to the development of a complex cluster of clinical symptoms commonly defined as “text neck syndrome.” Children and adolescents spend 5 to 7 hours a day on their smartphones and handheld devices with their heads flexed forward to read and text. The cumulative effects of this exposure cause an alarming excess stress to the cervical spinal structures. The authors state:
The “text neck syndrome has increased stresses on the cervical spine, which can lead to cervical degeneration along with other developmental, medical, psychological, and social complications.”
“This clinical condition refers to the onset of cervical spinal degeneration that results from the repeated stress of frequent forward head flexion while we look down at the screens of mobile devices and while we text for long periods of time.”
“The weight of the head on the spine is dramatically increased when it is flexed forward, and the effects and amount of weight are strongly and progressively enhanced by varying the degrees.”
“Frequent forward flexion can change the cervical spine curvature, supporting ligaments, tendons, musculature, and the bony segments, commonly causing postural change and pain on the neck and associated areas.”
The authors make these “text neck” preventative recommendations:
- Keeping one’s spine in a neutral position as much as possible, avoiding excessive neck flexion.
- Avoid excessive device usage, and take frequent breaks.
- Position the device so that it reduces stress both on the head and neck.
- Limit the time of use of smartphones, tablets, and PCs.
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Chiropractors are expertly trained in the ergonomic avoidance of the postures that lead to text/tech neck, advising and coaching thousands of patients on these issues daily. Chiropractic clinical practice offers a variety of treatment approaches that are very effective in the management of the text/tech neck syndrome.
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“To the best of my ability, I agree to provide my patients convenient, affordable, and mainstream Chiropractic care. I will not use unnecessary long-term treatment plans and/or therapies.”
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