Modern technology is truly amazing. In the palm of your hand is a device that has the ability to bring you information and entertainment in an instant.
On any given day, you can look around in public places and see people engrossed in their mobile devices. Smart phones have taken over daily life and, although they bring some useful benefits, there are physical problems that can come from their use as well.
“Text neck” (or tech neck) is a trending topic these days. It has become increasingly common for health care providers to observe it in their patients. Text neck can be explained as an overuse syndrome involving the head, neck and shoulders, usually resulting from excessive strain on the spine from looking in a forward and downward position at a handheld mobile device (mobile phone, video game unit, computer, e-reader, etc.). This can cause headaches, neck pain, tension headaches, shoulder and arm pain, and even breathing issues.
You have likely witnessed this phenomenon and have started to deal with it to some degree in your practice. The visual is already forming in your mind of someone holding their phone with their neck craning down to look at it. This could be your patient, your child—or even you at any given time when you are checking your device.
So from a chiropractic standpoint, you want to understand how this clinically affects your patients and then ultimately the treatment and recommendations you give them.
A weighty problem
At 0 degrees of head tilt (neutral neck), your head weighs about 12 pounds. As you can imagine, the further forward the head tilts and the neck bends, the heavier the head becomes. By 30 degrees of head tilt, your head weighs 40 pounds. By the time your head is at 60 degrees, it weighs about 60 pounds. It’s just like holding a small child on your shoulders.
Another way to see this is the more you look down, the more your head moves forward, shifting the center of gravity. Then the upper spine shifts backward to counteract the forward head shift. Furthermore, the hips then tilt forward to compensate for the upper spine. You can see how one area of the body under stress affects adjacent areas.
Imagine the prolonged effect all of this pressure has on the muscles, ligaments, vertebrae and discs in the neck and upper thoracic regions. Smartphone users spend an average of two to four hours a day hunched over, reading emails, sending texts and checking social media sites. That adds up to about 700 to 1,400 hours a year of extra stress people are putting on their spines. And high school students may be at most risk. They conceivably spend an additional 5,000 hours in this position.
Educating your patients on the dangers of text neck is fairly straightforward. There are plenty of posters with pictures and graphics about text neck and the dangers it presents. But as with other vices or habits, even if people know it’s bad, that may not completely stop them from doing it.
Tips to reduce text neck
Any or all of the following strategies can mitigate the risks posed by excess use of electronic devices:
• Hold the device at eye level as this negates the need to crane your neck.
• Look down with your eyes and not your head.
• Take a three-minute break for every 15 to 20 minutes spent on your device (you can set auto reminders for this). The more typing you do, the more frequent you should take breaks.
• Use a phone or tablet holder so your arms and shoulders can relax.
• Be mindful of your posture. Your head should be in a neutral position, your wrists straight and your shoulders as relaxed as possible. Tensing muscles in the neck and shoulders will lead to chronic muscle issues and pain.
Be mindful of the forces being placed on the cervical and upper thoracic vertebrae in the forward translation directions. It is important to evaluate the C/T transition area and the upper thoracics.
Supine or standing anterior thoracic moves work well for these areas. If you pre-stress the C/T region properly, you can get the lower cervicals to shift comfortably with an anterior thoracic. Prone C/T moves as well as supine modified rotary break (MRB) or seated RB moves can work as well, but that will take out rotation more so than anteriority. Use your hands and they will tell you what you need to move and how to do it.
Notice occiput/C1/C2 involvement. Keep in mind that both suboccipitals do not have to be involved. It may be one or the other. Whichever occiput is inferior, look for atlas laterality on the ipsilateral side. Additionally, look for C2 to be involved on the contralateral side.
The use of spring loaded or other handheld adjusting devices instead of your hands can work when appropriate. These devices are also helpful in breaking up some of the muscle tightness.
Elastic sports taping
Another approach is to place two pieces of 2-inch tape beginning below the hairline on each side of the neck. These continue down along the spine and end up around the mid to lower scapulae. It may seem counterintuitive, but have the person bend their neck forward comfortably as you place the tape down from the neck down the spine to the thoracic area. The pre-stress gives the tape the “elastic snap-back effect” for good support. You can also teach basic exercises for patients to perform as self-care:
• Neck extensions: moving the head backward.
• Neck side bends.
• Neck rotation to both sides.
Repeat each of the above exercises while pushing your head into your hand for some resistance.
Custom foot orthotics
The relationship that the feet have with posture and head position might not be obvious. But it is now well-known that a collapse in the three arches of the foot is a major factor in determining posture and spinal alignment.
Excessively pronated or flat feet have a biomechanical effect that moves through the lower extremities, the spine and up to the head. The more pronated the feet, the more forward the head carriage. This can naturally predispose someone with text neck to have greater stress on their spine even with lesser angles of forward head motion.
Every patient who comes into my office steps on a digital foot scanner so they can have their feet evaluated. From this scan, we can see how flat their arches are, the degree of their text neck and other postural data. Then we can have custom, flexible orthotics made to help the patient’s body stay more stable and balanced from toes to nose.
Like it or not, text neck is here to stay. Mobile devices are becoming more popular, not less. Patients will likely be coming to you because their pain is becoming worse. Now it is your turn to spread the word and help those patients heal.
Kevin Wong, DC, is an expert on foot analysis, walking and standing postures, and orthotics. He discusses spinal and extremity adjusting at speaking engagements. He can be contacted through orindachiropractic.com.