Incorporate body stabilization and foot alignment into treatment when determining how to fix tech neck for patients
For more than 30 years, technology related to personal computers, laptops, tablets and smartphones has been advancing and expanding into every population around the world. Most Americans now own some type of cellphone, with 85% of them owning a smartphone compared to 35% in Pew Research Center’s first survey in 2011.1 The use of personal computers and tablets has been implemented into our school systems for nearly every age group, and while technology can be a wonderful tool and has changed our lives in so many positive ways, there have been unintended consequences from the use of these devices, and many users are asking how to fix tech neck after experiencing pain from leaning forward with the head.
Tech neck is really nothing more than the posture developed from having the head in a forward flexed position for long periods of time. It is getting more attention now than ever before because it is essentially affecting every age group in our population.
The rise of tech neck
When virtual learning and working from home were widely instituted in response to the COVID-19 pandemic, it created an environment that exacerbated the ill effects of using personal computers and tablets due to inadequate workstations.
There are countless cases of teens slouching over their computers while sitting on their beds for hours at a time. Dining tables and couches became the office desks for scores of people attending virtual meetings. All these temporary adaptations unexpectedly stretched on for over a year, forcing a habituation of weak postural patterns. These patterns contribute to neck pain, headaches, upper back and shoulder pain, stiffness, low-back pain, chest tightness and fatigue.
A recent study of upper body and limb postures across technologies and handheld device use in college students revealed that regardless of the device used — phone, tablet or laptop — all devices altered posture. However, frequent, regular use of tablets created greater deleterious effects than regular use of other handheld devices/technologies.2
Weak posture is a pattern that results from habitually overusing the neck and upper extremity flexors while the extensors are disengaged. It is the classic Upper Crossed Syndrome (USC). UCS results when the muscles in the neck, shoulders and chest become shortened, usually as a result of repetitive activity that produces poor posture.
The muscles of the upper extremities that are typically the most affected are the upper trapezius, the levator scapula, and the pectoralis major and minor which become tight and shortened. But do not forget the lower extremities and their role in posture. Lower Crossed Syndrome is also a major player in posture and there are some important keys in evaluating your patients to make sure that we have appropriate engagement of the lumbar extensors and gluteus major and minor and that the hip flexors are not overactive. Patients that present with this Upper and Lower Crossed Syndrome are our classic low-back pain, neck pain patients. So, let’s talk about quantifying posture and evaluating one of the most-often-missed contributing factors to postural weakness — the feet.
The role of a symmetrical body foundation
Since posture starts at the ground, it is important to determine if we are starting with a symmetrical foundation.
Prior to the scanning technology we enjoy today, the amount of navicular drop was measured using a Posture Stability Index card with an ink dot on the navicular bone. The distance that the navicular bone dropped between sitting and standing, which represents the amount of pronation, was measured on the card. The most significant finding in my experience is that the left and right foot rarely flatten out symmetrically. This creates an imbalance that transmits up the kinetic chain, affecting ankles, knees, hips, pelvis and spine.
If we fail to evaluate the feet and provide custom orthotics when appropriate, those biomechanical distortions are replicated every time the patient stands or takes a step. This repetition becomes the neuromusculoskeletal pattern we call posture.
Only when we interrupt the aberrant pattern with a more efficient engagement of postural tone will we truly create strong functional posture. Scanning the feet of every patient with a digital 3D laser scanner (Foot Levelers Kiosk, 3D Body View scanner) ensures that this information is available to make appropriate clinical decisions and effective treatment plans.
Posture has long been considered an important part of chiropractic care, and the health consequences of poor posture have been well-documented. Pain, movement disorders and altered physiological function are significant quality-of-life issues and the onset is insidious and progressive.
How to fix tech neck: treating postural imbalance
Posture can and should be evaluated with all our patients and thanks to advances in technology, there are apps that allow us to quantify posture, document it and then create a trend analysis as care progresses.
We have an opportunity to educate and equip our patients with strategies to improve and protect healthy posture. In my practice, I use the Posture Screen Mobile app and the most significant thing I consistently see is the functional head weight is often 2-3 times greater than the actual head weight based on anterior cervical translation. This often means that a 12-to-13-pound head acts like it weighs 25-35 pounds or more! This creates a compressive force on the cervical discs and can accelerate the degenerative process over time.
Anterior cervical translation is a result of habitually having the head in flexion, resulting in short, tight cervical and upper extremity flexors and lengthened, inhibited cervical and upper extremity extensors. This pattern can be reversed, but it takes a multifaceted approach to address all the components involved. It reminds me of the old seesaw on a playground — the influences that create the anterior cervical translation far outweigh the influences that create good posture. It is time to insert some strategies to balance the seesaw of tech neck and poor posture:
Step 1. Evaluate the feet and prescribe custom orthotics when it’s appropriate. Custom orthotics neurologically improve the engagement of postural tone with every step your patient takes.
Step 2. Use adjusting techniques that encourage the posture that is desired. There are techniques that allow us to adjust the patient in a standing position while the patient is rehearsing the desired posture. The sensory input in those positions results in an awakening of the appropriate postural response.
Step 3. Teach your patients to practice holding their tablet or phone directly in front of their face when looking at it. It’s not easy, but it’s how to fix tech neck and with time it can become part of the habit of good posture.
Step 4. In addition to supporting your patients’ posture during the day with orthotics, remember to support them at night with an appropriate cervical pillow. This encourages the appropriate cervical curve important for good posture.
Step 5. Postural exercises are an important key to creating new neural networks that engage postural tone habitually. Poor posture is a neurological habit that can be corrected by creating new neurological habits. Activating the extensors of the upper and lower body with low-tech resistance training is a highly effective remedy for better posture. I encourage my patients to complete a posture training program in the office so they can learn how to do it correctly before they apply the routines at home. If our patients are going to create new posture, they will need to apply these exercise routines at home to overcome the time they spend working or studying.
Give patients the proper tools
I am encouraged by the response I have received from my patients in their desire to tackle how to fix tech neck. They want good posture and are grateful to receive the tools they need to accomplish it. The reward comes when we re-evaluate their posture and prove that it is better.
BRIAN JENSEN, DC, is a graduate of Palmer Chiropractic College and owner of Cave Spring Chiropractic in Roanoke, Va., and has been in practice for over 30 years. As a member of Foot Levelers Speakers Bureau, he travels the country sharing his knowledge and insights. See continuing education seminars with Foot Levelers Speakers at footlevelers.com/continuing-education-seminars.