Text neck (or “tech neck”) is the new buzzword about the poor posture of modern life.
Patients increasingly blame their worsening neck and back pain on their phones, tablets, and computers. This burgeoning awareness of posture’s impact on health is a boon for DCs who congruently address these new chronic pain syndromes in their clinical approach and recommendations for patient self-management.
Text neck correlates to the biomechanics of another postural theme in the media: “sitting is the new smoking.” The biomechanical stress of typing and texting while sitting is fairly new, and it’s linked to worsening neck and back pain occurring earlier in life.
And the health consequences of heavy technology use are just the tip of the iceberg. New research indicates the limitations of the human body to adapt to the functional demands of using technology. As young people increasingly live in front of keyboards and screens, they’ll experience cumulative postural compensations and adaptations, and these same risks pose challenges for baby boomers as well.
You’ll see these effects on college students who spend eight to 10 hours a day on their phones, and you’ll even see even middle- and high-school kids suffering from headaches, migraines, neck and upper back pain, and TMJ disorders.1-2 MRIs of these patients generally won’t show the exact cause of the pain.3 And while the simple explanation may be that it’s the result of poor posture, research shows significant consequences of postural degeneration, including early mortality and the onset of disease.
A 2015 meta-analysis of 47 studies found prolonged sitting to be associated with significant health consequences. In addition to cardiovascular issues, sitting 12 hours a day was associated with a slightly greater than 90 percent increased risk of type 2 diabetes and increased overall mortality risk of about 25 percent.4 This is vital data for everyone—especially boomers looking to stay active and age well.
Postural biomechanics and crossed syndromes
There’s more to text neck and the dangers of prolonged sitting than inactivity and forward head position. These two modern posture problems are linked in the work of Vladimir Janda and the Prague school of rehabilitation.5 Janda first described in 1980 the “proximal and distal crossed syndromes,” later refined to Upper Cross syndrome (the forward head and rolled in shoulder posture pattern of text neck) and Lower Cross syndrome (the folded kinetic chain at the root of problems related to prolonged sitting).6
When it was pointed out to Janda that American audiences would not understand his “crossed” model, he replied by saying, “This is truth, how you tell it is your problem.”
Collapse of the kinetic box
Using a phone with hands close together is a perfect storm for Upper Cross and Lower Cross syndromes. Muscles move bones, whether a person is standing, sitting, running, or walking (and everything in between). And muscles work in pairs, each being opposed by another. Meaning dysfunctional muscles cause joints to work abnormally, and dysfunctional joints cause muscles to work abnormally.
The imbalance caused by positioning the head in front of the body overuses some muscles and underuses others.
Over time, the overused muscles shorten and tighten, while their underused partners lengthen and weaken. As a result, the head drifts further forward in a gradually worsening pattern.
A key insight of Janda’s is that the sensorimotor system functions as a single unit, and dysfunctional motion causes motor learning that initially causes functional compensation. Over time, this leads to structural adap- tations in muscle, connective tissue, and the nervous system.
In other words, the body gets better at doing whatever you train it to do. Muscles weaken when specific muscle fibers atrophy from disuse, as when not recruited in their arc of motion. In turn, the neuroplastic nerves controlling those fibers become inhibited from disuse.
In addition, connective tissue and fascia shape to the way the body is used. The result of chronic muscle imbalances are changed patterns of proprioception and control, which alter the kinetics normally supporting the body-mass structure so that it collapses and locks in a folded position.
Think of a cardboard box. With the ends folded closed, it’s stable and will support weight. However, open the ends and the box becomes floppy and will readily buckle under weight. Upper Crossed syndrome is the collapse of the head-torso kinetic box from forward head translation and the imbalance of tight and short upper posterior cervical muscles unbalanced against deep anterior muscles.
The simultaneous structural adap- tation is a shortening of the anterior chest and shoulder stabilization muscles through structural adaptation, and a weakening of their antagonistic posterior torso and glenohumeral stabilizers.
The body masses (or posture zones) of the head-torso box then fold and lock in that buckled geometry.
The phone-texting-posture that causes Upper Crossed syndrome creates a chronic muscle imbalance that locks the head forward of the torso with the shoulders rolled in, and it shortens the coracobrachialis muscle, which is an additional factor in the collapse of the kinetic box.
Texting while walking, sitting, and (unfortunately) driving requires people to stabilize for the precise placement of fingers when typing. The fine motor control necessary to accurately type on a small keyboard (especially with onscreen keys lacking haptic feedback for fingertip proprioception) requires locking the proximal upper extremities, often accomplished by shrugging the shoulders up and anterior, while stabilizing forearms to the ribs. This texting adaptation explains why posture pictures increasingly show people with shoulders that are actually anterior to the front of the chest wall.
Posture patterns are activity specific. Internal humeral rotation to hold a phone shortens the pectoral muscles. Plus, many people lock their arms in flexion with shoulder roll-in, restricting glenohumeral motion by over-recruiting an oft-neglected deep stabilizer, the coracobrachialis muscle. Manipulation, muscle therapy, and postural exercises can help this frequently overlooked text-neck issue.
Communication and cueing
The posture zone model views static posture as a proxy for the complexities of kinetic chain breakdowns, and as the beginning point of all motion. You can observe how people perceptually balance, objectively vertically align, and dynamically move the four body masses: head, torso, pelvis, and lower extremities.7
The concept of posture zones elegantly communicates complex concepts in common-sense language understood by patients as well as the public, the media, and other professionals. In addition, it facilitates a systematic cueing of rehabilitation exercises using focused attention to target balance, alignment, and motion.8
Janda’s Upper Crossed syndrome is described as the dysfunction of head- torso biomechanics. The Lower Cross syndrome is the dysfunction of torso- pelvis-lower-extremity biomechanics. And both can be benchmarked with a picture measuring the deviation of head, torso, and pelvis from gravity line center.
You can use pictures to show the problem and record changes over time. And communication demonstrations such as a “text-breathe demo” can deepen understanding and awareness.
The text-breathe demo
To help your patients understand how text neck and prolonged sitting can adversely affect their health, try the following demonstration.
- Sit down and type a short email (or text) on your phone.
- Now breathe in.
- Notice how much air you inhale.
- Scoot your pelvis back, lift torso and head up to sit tall.
- Strengthen posture by pulling shoulders back and down, pull elbows in, and lift your device up (so you don’t bend to see screen).
- Then take in another large breath.
Most people find strengthening their posture literally gives them more air.
Ultimately, chiropractors restore motion. Retrain that motion toward symmetry to help people sit and stand taller (and breathe deeply). Breathing fully and moving well is extremely good for health.
Steven Weiniger, DC, authored Stand Taller Live Longer and teaches the advanced posture specialist certification, Certified Posture Exercise Professional (CPEP), setting the clinical standard for posture improvement and rehab protocols with clinicians worldwide. He is managing partner of posturepractice.com and bodyzone.com. He can be contacted at 866- 443-8966 or firstname.lastname@example.org.
1 Goodrich T. “Cellphone Addiction Is ‘an Increasingly Realistic Possibility,’ Baylor Study of College Students Reveals.” https://www.baylor.edu/ mediacommunications/news.php?action=story &story=145864. Published Aug. 2014. Accessed April 2016.
2 Jacobs K, Hudak S, McGiffert J. Computer- related posture and musculoskeletal discomfort in middle school students. Work. 2009;32(3):275-283.
3 Shah SA, Saller J. Evaluation and diagnosis of back pain in children and adolescents. Journal of the American Academy of Orthopaedic Surgeons. 2016;24(1):37-45.
4 Biswas A, Oh PI, Faulkner GE, et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: A systematic review and meta-analysis. Annals of Internal Medicine. 2015;162(2):123-32. 5 Page P, Frank C, Lardner R. (2009). Assessment and Treatment of Muscle Imbalance: The Janda Approach. Champaign, IL: Human Kinetics.
6 Janda V. Muscles as a pathogenic factor in back pain. Proceedings of the IFOMPT Conference. Christchurch, New Zealand. 1980:1-20.
7 Weiniger S. (2010). Photographic Manual of Regional Orthopaedic and Neurologic Tests. Posture Chapter, 5th ed. Philadelphia: Lippincott Williams & Wilkins.
8 Weiniger S. (2008). Stand Taller Live Longer: An Anti-Aging Strategy. Alpharetta, GA: BodyZone Press.