Text Neck Syndrome

Ross Hauser, MD

Let’s start this article with an August 2022 review study (1). Here doctors from the National and Kapodistrian University of Athens in Greece wrote: “New technologies and the potentially harmful addiction to cell phones and computers while reading or texting are inducing an epidemic of text neck syndrome. By focusing on postural correction, both pain alleviation and a better quality of life can be achieved for the patient.”

If you are reading this article, you are likely someone who has been diagnosed with “text neck” or “text neck syndrome. You are someone who may spend long hours in front of your computer or looking down at a cell phone or tablet device. Over time, the unnatural curved posture of looking down we tend to take when using our mobile device can slowly cause many, varied, and even mysterious health issues.  The term Text Neck Syndrome was created to describe this condition that can develop from frequent texting. Returning to the above study, the Greek doctors summarized: “The predisposing factors and therapeutic approaches for this syndrome that affects public health remain to be further elucidated.” In other words there is a lot we do not understand about this syndrome.

Anatomical, Neurological and Psychiatric Symptoms

Now let’s listen to doctors at Kore University of Enna in Italy. In their paper the doctors sought to better understand the mysterious psychological side of Text Next Syndrome. After reviewing previously published studies they wrote in October 2022 in the journal Clinical neuropsychiatry (2) : “The overall results (outcomes) showed a strong association between (non-specific/chronic musculoskeletal disorder in neck, head or low back (that are called Upper Disorders)  and mood disturbance, anxiety, depression, stress, alexithymia (the inability to express emotions), and low social support. Thus, high levels of Upper Disorders were associated with high levels of psychological disease.”

What are the symptoms of text neck syndrome? For one, muscle tension and pain especially in the upper back and neck by the occiput or base of the skull. Common symptoms may include tightness across the shoulders, headaches, and neck soreness. Also pain in the back, arms, fingers, hands, wrists, and elbows. Some sufferers may also notice numbness and tingling in their upper extremities. However, if left undiagnosed or understood, the text neck lifestyle can progress to neurocatastrophic consequences as those listed in the above research. As we will discuss further below, the cervical neck ligaments, the supporting structures that hold the neck bones in place, become stretched and damaged. When the ligaments cannot hold the bones in place, the bones wander. When the bones wander they can compress the nerves, the carotid sheath and/or spinal cord. The two most common mechanisms by which severe symptoms arise are venolymphatic drainage compression (fluid gets backed up in the brain, this is explained further below) leading to intracranial hypertension and alterations of brain function and cervicovagopathy (cervical-induced vagus nerve injury or signal interference) causing dysautonomia and systemic inflammation.

Text Neck

The problem in children, mysterious pediatric disorders

The larger head to body ratio, innate ligament laxity, lower neck strength in relationship to head weight and increasing access to tablets and cell phones make ligament cervical spine instability a more prevalent and recognized problem in children. The strain on the cervical ligaments is greater in children.  C1-C2 instability is the most common instability seen with kids.

An April 2023 case history in the journal Cureus (6) writes: “Text neck syndrome is a growing concern in the pediatric population due to the increased use of mobile devices and screens, potentially leading to long-lasting musculoskeletal issues. ” The doctors then go on to describe a case of a six-year-old boy with a one-month history of cephalgia (head and face pain) and cervicalgia (neck pain), who initially received insufficient care. After nine months of chiropractic intervention, the patient reported significant improvements in pain relief, neck mobility, and neurological symptoms, supported by radiographic findings.” In summary the doctors write: “This report emphasizes the importance of early recognition and intervention in pediatric patients, as well as the role of ergonomics, exercise, and proper smartphone usage habits in preventing text neck and maintaining spinal health.”

Text Neck and Forward Head Posture

Of course it isn’t just when we are texting that we take that forward head posture. We spend hours and hours hunched in front of our computers, looking at our tablets, our readers, our media players, and our games. Even sleeping with high pillows contributes to the problem. The forward head posture that occurs with Text Neck is actually a health condition that occurs due to the position of the head as it moves forward from the center of the shoulders. As the head moves forward the center of gravity changes. This causes an increase in pressure on the musculature over the head and shoulders because of the downward angle and weight of the head while texting. The more the head shifts forward, the greater the pressure around the neck area. This pressure also increases when in this head forward posture for prolonged periods of time. The frequent and prolonged flexion of the neck causes changes in the cervical spine, the curve of the neck, and the structures that support the neck. These structures include the muscles, the ligaments and the tendons.

A November 2023 paper in the journal Healthcare (4) “conducted a preliminary exploration into the disparities in head/neck posture and viewing behaviors of smartphone users across three postures: standing and two walking speeds (slow and normal).” The goal was to see what type of strain was placed on the neck during smartphone use when the user was walking fast, walking slow, or standing still. In this study, 60 young participants (30 men and 30 women) were followed.

What the researchers found was “that, irrespective of walking speed, using a smartphone while walking led to a more pronounced disparity between the cervical and head positions, resulting in increased strain on the neck compared to smartphone use while standing. The heightened neck load can be attributed to the concurrent dynamic nature of both walking and smartphone usage.”

Furthermore, the sustained arm posture required to hold smartphones might directly impact neck flexion and viewing distance (which may lead to higher eyestrain.” The researchers suggest: “it is advisable to limit smartphone usage when walking, and particularly when employing two-handed operation (both thumbs on the phone as in texting and web browsing).

A problem that starts in childhood, worsens in adolescence and becomes a life-long chronic problem in adulthood

A February 2021 paper in the International journal of environmental research and public health (3) describes the path poor posture can take from childhood to adulthood. This paper from pediatricians at the University of Chieti in Italy suggests that the symptoms of chronic pain in the neck and shoulders can sometimes also be referred to the head, causing headache and muscle tension, frequently encountered in adolescents. In fact, the trigger points of the nociceptive (pain sensation) signal in the head, neck and shoulders share the same pathways as chronic tension headache in children, so this may justify why neck and shoulder pain can begin in childhood and early adolescence and persist into adulthood with chronic musculoskeletal problems. (the pain in children travels that same pathway later in adulthood). “Thus, maintaining incorrect sitting postures for a long time could cause the appearance and persistence of musculoskeletal disorders related to the head, neck, shoulders, and dorsal-lumbo-sacral spine.”

A March 2023 paper in the journal Healthcare (7) warned that the “pandemic of cell phone use among children and young adolescents has led to the emergence of a set of musculoskeletal symptoms that have not been seen before in this age group. These symptoms can range from neck and shoulder discomfort to pain, peripheral neurological symptoms of the upper extremity, and long-term complications such as disk prolapse and degenerative disk disease of the cervical spine.” The authors also suggest text neck syndrome could also include eye and ear symptoms, psychological problems, peripheral neurological symptoms, and poor academic performance.” The suggested treatments are: “a combination of spinal adjustment techniques, cervical extension-traction therapy (to restore natural curvature of the cervical spine), and instrument-assisted soft tissue manipulation (Graston Technique), with the primary objectives of rectifying shoulder asymmetry, spinal misalignment, and muscle tension.”

Text Neck and Arthritis

Text neck can eventually lead to arthritic degeneration of the cervical spine. Forward head posture stretches the ligaments that hold the vertebrae together. When the ligaments get overstretched from this posture and for prolonged periods, they become weakened. With weakened, stretched out and loose ligaments, the vertebrae move more than normal, putting more pressure on the discs between the vertebrae. Sometimes they move out of normal position. This is called subluxation. Chiropractors can manipulate the vertebrae back into place, but because the ligaments remain weak and stretched out, the fix is only temporary. This process leads to degeneration of the discs as well as degeneration where the different vertebrae meet, called the facet joint. Text neck with this forward head posture accelerates the aging and degeneration of the intervertebral joints, resulting in degenerative joint disease of the cervical spine.

It is important to realize that unchecked cervical instability could damage the cervical spinal cord, as, as with each faced-down posture of looking at a cell phone, the vertebrae move forward, narrowing the spinal canal. If it were not for muscle tension and spasm and other compensatory mechanisms that stop excessive cervical motions from injuring vital neurovascular structures, spinal cord damage could occur. If the ligament injury does not heal and the excess motions and forces continue in the neck, degenerative breakdown of the adjacent vertebral segments occurs in the disc, facet and uncovertebral joints, as well as the vertebral endplates. This can be manifested as a clicking, grinding or popping sensation as the person moves or manipulates their own neck. Motion eventually will be limited as bridging osteophytes occur on the facet joints along with disc degenerations, ultimately fusing the joint.

Text neck and Fibromyalgia

In October 2022, doctors at the Kochi Medical School in Japan, published the case of a 50-year-old man in the journal Rheumatology (8). This man had pain around the head, neck and shoulder blades and paraesthesia in both upper limbs. He had been treated with analgesics for 7 years for suspected fibromyalgia, but the symptoms did not improve. Laboratory examination revealed that C-reactive protein and matrix metalloproteinase-3 levels (elevated inflammatory levels seen typically in fibromyalgia patients) were within the normal ranges. Other tests that may reveal a fibromyalgia diagnosis were also negative.  Radiography and magnetic resonance imaging revealed linearization and straightening of the cervical spine. . . Thus, the patient was diagnosed with text neck syndrome. The patient was educated to take frequent rests and raise his smartphone to eye level while texting. His neck pain reduced, and neurological symptoms resolved.

Exercises and text neck syndrome

A May 2023 study  published in the journal Pain management nursing (5) examined the benefits that self-management corrective exercises on text neck syndrome may offer. Who did the researchers study? University students using smartphones.

The 60 students were divided into two groups, the experimental group which performed “corrective exercises” to strengthen and correct the neck structure for 5 days a week for 8 weeks, and a control group. Standard survey scoring was performed in regard to the patient’s pain, function and disability. The results suggested “Significant differences between the (pre-treatment scores) before and after the intervention in the experimental group showed that the head tilt angle, gaze angle, and forward head posture were reduced, and the neck tilt angle  increased and improved after the intervention in various measurement positions.”

A September 2023 paper in the journal European review for medical and pharmacological sciences (9) investigated the efficacy of neck stabilization training vs. Contrology or Pilates training in individuals with Text Neck Syndrome.

There were 75 patients in this study with a history of recurrent neck pain in the previous four months, having moderate pain (at least 4/10 on the numeric pain rating scale), and constantly using mobile phones (more than 4 hours a day) were randomly divided into one of three groups: a control group (neck isometric training) and two intervention groups (neck stabilization training and Contrology or Pilates training).

They were assessed for craniovertebral angle (CVA), numeric pain rating scale, and neck disability index (NDI questionnaire) at baseline and at four weeks post-intervention.

There was a significant difference in the craniovertebral angle (cervical spine curvature problems), numeric pain rating scale (more pain), and neck disability index (pain and function) among individuals with Text Neck Syndrome following intervention as compared to the control groups.

Both the neck stabilization and Contrology (Pilates) training increased craniovertebral angle (head moving into correct alignment) and reduced neck pain and neck disability in individuals with Text Neck Syndrome. The two intervention groups showed similar effects in all the clinical outcome measures, suggesting almost equivalent effectiveness in the individuals with Text Neck Syndrome.

ligament creepText Neck and ligament Creep

When spinal tissues are exposed to continued compression or stress, they deform and go through a transformation that can become permanent. This process is also called “creep.” Creep is a medical condition that results from the elongation of the ligaments that hold our bones together due to long-term tension upon them. This can be caused by various types of bad posture, including the forward head posture involved in text neck. As we have seen, if this goes on for too long, the ligaments will stretch to the point of no return. In our neck, we have seven vertebrae that are held together by ligaments. Text neck causes these ligaments to get too lose, to the point where they can no longer hold these seven vertebrae together. The bones shift and can pinch other nearby structures causing some of the symptoms of text neck. Since the ligaments aren’t able to hold the bones together, the muscles will try to this job. Since it’s a job they are not meant to do, muscle spasms will occur along with more of the symptoms of text neck.

Ligamentous cervical instability (LCI) is a common condition that can be overlooked or missed by current static supine diagnostic testing methods. Its incidence is increasing with the current ever-prevalent forward head-face down lifestyle. This is especially damaging for children who have a heavier head to neck strength ratio than adults and are looking at computers and down at cell phones and tablets. While these humble acts of looking at electronic devices can appear innocuous, they aren’t

What can I do for Text Neck?

Of course, prevention is ideal, by keeping your spine and posture maximized and healthy. However, once text neck has advanced, and the ligaments are stretched out, treatment to strengthen the ligaments is what is needed. Prolotherapy is the treatment that strengthens and repairs weakened and damaged ligaments.

Prolotherapy is an ideal Text Neck treatment?

By injecting a dextrose solution at the location of the stretched out ligaments and loose vertebral structures, Prolotherapy causes a mild inflammatory response in that area. This localized reaction directed at the source of the problem-the ligaments, stimulates a healing cascade. Blood flow is increased to the damaged area, as are cells the body needs for regeneration and repair. Ligaments are made of collagen, and part of this wound healing cascade includes deposits of collagen. When this new collagen matures the ligaments get tighter and stronger. Once strengthened, the ligaments are once again able to do their job of holding the vertebrae in place. The muscles will be able to relax, the spasms will stop, and the vertebrae will no longer move excessively. The symptoms of Text Neck will resolve because the ligaments are tightened.


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January 2, 2024



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