Advanced Technological Usage in Nuchal Posture Among Students (TEXT NECK)

Definition of Posture[edit | edit source]

Posture refers to the way one positions the body in space and the way the body reacts or is influenced by the force of gravity, the alignment of body parts with respect to one another. It can be defined as the body's position that determines the body's balance, stability, and anatomical structures. Studies have shown that the maintenance of Posture is greatly affected by the musculoskeletal system[1].

Normal Posture of the Neck[edit | edit source]

Maintaining muscle strength around the neck and shoulders helps to keep a normal neck posture[2].The bones responsible for the posture of the neck are the 7 cervical vertebra bones, having a slight concave alignment, referred to as cervical lordosis. The normal lordosis range should be maintained at 31° - 40°[2].This neck curve allows for correct motion, including flexion and extension with a healthy range of motion[3].

Poor Posture of the Neck[edit | edit source]

Loss of cervical lordosis can occur as there is a deviation from the normal alignment of the neck[4], so that the concavity of the cervical bones begins to form a simple straightening or even become inverted into a kyphosis. As the bones of the neck become deformed, it affects the normal positioning of the neck muscles and structures, thereby causing neck pain[5]. A poor neck posture causes neck pain, typically with muscle aches due to the tensing of the muscles[6].  As there are several muscles connecting the neck to the upper back and shoulders, the aches in the neck muscles are radiated to these regions, leading to pain in the upper back and the shoulders, which can sometimes radiate to the rotator cuff muscles of the arm[7].

Long-term poor posture cause to damage to important structures in the cervical spine[7], including:

  1. Degeneration of the cervical disk.
  2. Abnormal wear and tear of the facet joints
  3. Irritation of the nerve and inflammation.

Advanced technology and poor neck posture (Text neck)[edit | edit source]

The present-day advanced technology i.e., the use of smart phone, computers and tablets has however had great effects on the postures of the neck especially student[8]. The most common abnormal posture caused by use of these advanced technologies is the Forward Head Posture (FHP) and this Posture is also referred to as 'text neck' or 'nerd neck'. It is due to muscle imbalances around the neck and shoulder[4]and sustained posture of long duration whiling using a cell phone , tablet or system[9]. In this posture, the head is held forward in relation to the trunk, such that the head's position is anterior to the vertical line of the body's center of gravity[4]. The text neck is a result of repetitive stress injury in the cervical spine due to the prolonged forward flexion of the neck[10]. Nowadays, the use of technology requires flexing of the head downwards to look into devices, causing the straining of the muscles of the neck[11].

Sitting in this poor posture for long hours causes health issues usually associated with muscle pains[12]. The prolonged bending over computer screens or hunching over a laptop or cell phone results in forward flexion posture  also known as “ turtle neck”[11]. As one bends the neck forward or downward continuously, it can cause the neck muscles to lengthen and shorten the chest muscles which in turn causes increased spinal pressure on the neck, so that the length-tension relationship of the cervical musculature is altered[4].

Muscles that can lengthen include:[edit | edit source]
  1. Deep cervical flexors      
  2. Erector spinae      
  3. Shoulder blade retractors
  4. Upper Trapezius muscle.
Muscles that can shorten and tighten include:[edit | edit source]
  1. Suboccipital muscles        
  2. Pectoralis muscles         
  3. Levator scapulae muscles

Text neck affects the spine alignment while flexing, the head when forward is at varying degrees. When the head slopes forward at 15 degrees, the forces on the neck increases to 27 pounds, when at 30 degrees 40 pounds, at 450 degrees 49 pounds and at 60 degrees 60 pounds, then at 90 degrees the model prediction was not reliable. This is a serious incident that happens to adolescents, this is because their head is bigger than their body size which predisposes them to text neck considering the fact that the use of advance technology is more In this age group[13].

Clinical Presentation.[edit | edit source]
  1. Stiff neck: the individual experience pain in moving the neck, mostly after turning towards the sides after long hours on smart phone
  2. Sharp pain: usually experienced by patient with neck pain, they notice sharp localized pain on one spot
  3. General soreness: this individual experience around the neck and trapezius muscles
  4. Cervical Radiculopathy: some might experience pain radiating from the neck to the shoulders and arms due to extreme forward head posture
  5. Weakness and numbness: most patient experience weakness of the shoulder muscles.
  6. Cervicogenic headaches: irritation from the neck can also affect muscles and nerve of head this is known as tension headache[9].
Others include:[edit | edit source]
  1. Cervicogenic dizziness
  2. Strain of the posterior cervical musculature (the cervical erector spinae and suboccipital muscles, levator scapulae, and semispinalis and trapezius muscles),
  3. Neck and shoulder pain
  4. Temporomandibular joint pain
  5. Decreased cervical and upper thoracic ranges of motion
  6. In the long term if left unattended to, it can cause plastic changes within the nervous system, causing sensorimotor integration deficiencies and further dysfunction[14].

It is often associated with Kyphosis (rounded shoulders). In which there is increase in the forward curvature of the spine that is seen along the sagittal plane[15]. The chest muscles can become tight, and this can have effects on breathing i.e. Reduced inspiratory capacity because of tightness of the chest muscle, due to compression of the chest muscles on the lungs and ribs[15].

Physiotherapy Management[edit | edit source]

Physiotherapy is one of the best conservative managements, used to treat text neck, different physiotherapy technique can be used to treat text neck.


A  study has shown that using Kinesio-tape for more than three days to the Upper Trapezius muscle bilaterally is effective in relieving pain and preventing discomfort[8]. Kinesio-tapes are light, thin, elastic material that helps to decrease pain and spasm, improve blood circulation, decrease swelling strengthen weak muscles, main neck alignment while not restricting joint movement[16].


Progressive resistance exercise to the neck muscles is proven to be effective in the treatment of neck pain[17][9]. PRE improves the muscle’s ability to produce force, if a muscle has no capacity to produce force due to injury or disease progressive resistance can be used to rehabilitate the muscle[18].


A study has shown that GPE is effective in reducing neck pain and disability when done for a long duration[19]. Global postural re– education aids to elongate and stretch muscles of the neck that have been shortened, this is done by using active movement and contraction of antagonist muscles to improve muscle balance and postures[20].


Evidence has a shown that electrotherapy e.g., TENS, EMS and so on are effective but of low quality and must be done in conjunction with other form of conservative management[21].

Other forms of treatment include;

  1. Ultrasound
  2. Manual traction
  3. Manual exercise
  4. Cervical joint mobilization
  5. Isometric exercise to cervical muscles
  6. Behavioral therapy[22].

References.[edit | edit source]

  1. Carini F, Mazzola M, Fici C, Palmeri S, Messina M, Damiani P, Tomasello G. Posture and posturology, anatomical and physiological profiles: overview and current state of art. Acta Biomed. 2017 Apr 28;88(1):11-16. doi: 10.23750/abm.v88i1.5309. PMID: 28467328; PMCID: PMC6166197.
  2. 2.0 2.1 McAviney J, Schulz D, Bock R, Harrison DE, Holland B. Determining the relationship between cervical lordosis and neck complaints. J Manipulative Physiol Ther. 2005 Mar-Apr;28(3):187-93. doi: 10.1016/j.jmpt.2005.02.015. PMID: 15855907.
  3. Swartz EE, Floyd RT, Cendoma M. Cervical spine functional anatomy and the biomechanics of injury due to compressive loading. J Athl Train. 2005 Jul-Sep;40(3):155-61. PMID: 16284634; PMCID: PMC1250253.
  4. 4.0 4.1 4.2 4.3 Subbarayalu AV, Ameer MA. Relationships among head posture, pain intensity, disability and deep cervical flexor muscle performance in subjects with postural neck pain. J Taibah Univ Med Sci. 2017 Aug 12;12(6):541-547. doi: 10.1016/j.jtumed.2017.07.001. PMID: 31435292; PMCID: PMC6694898.
  5. Lippa L, Lippa L, Cacciola F. Loss of cervical lordosis: What is the prognosis? J Craniovertebr Junction Spine. 2017 Jan-Mar;8(1):9-14. doi: 10.4103/0974-8237.199877. PMID: 28250631; PMCID: PMC5324370.
  6. Cervical spondylosis and neck pain Allan I. Binder British Medical Journal, 334, 7592, 3 2007
  7. 7.0 7.1 David D, Giannini C, Chiarelli F, Mohn A. Text Neck Syndrome in Children and Adolescents. Int J Environ Res Public Health. 2021 Feb 7;18(4):1565. doi: 10.3390/ijerph18041565. PMID: 33562204; PMCID: PMC7914771.
  8. 8.0 8.1 Kothare, H., Patil, C., & Muley, R. (2019). Immediate effects of kinesio taping on upper trapezius muscle on subjects having text neck. 4(2), 131–133.
  9. 9.0 9.1 9.2 Neupane, S., Ali, U. T. I., Mathew, A., & College, M. V. S. (2017). Text Neck Syndrome - Systematic Review. 7, 141–148.
  10. Chu EC. Preventing the progression of text neck in a young man: A case report. Radiol Case Rep. 2022 Jan 18;17(3):978-982. doi: 10.1016/j.radcr.2021.12.053. PMID: 35106108; PMCID: PMC8784282.
  11. 11.0 11.1 David D, Giannini C, Chiarelli F, Mohn A. Text Neck Syndrome in Children and Adolescents. Int J Environ Res Public Health. 2021 Feb 7;18(4):1565. doi: 10.3390/ijerph18041565. PMID: 33562204; PMCID: PMC7914771
  12. Lu L, Robinson M, Tan Y, Goonewardena K, Guo X, Mareels I, Oetomo D. Effective Assessments of a Short-Duration Poor Posture on Upper Limb Muscle Fatigue Before Physical Exercise. Front Physiol. 2020 Oct 6;11:541974. doi: 10.3389/fphys.2020.541974. PMID: 33132916; PMCID: PMC7579401.
  13. Kumari, Supriya & Kumar, Ravi & Sharma, Divyam. (2021). Text Neck Syndrome: The Pain of Modern Era. Journal of Health Sciences & Research. 11. 161-165. 10.52403/ijhsr.20211121.
  14. Chu EC. Preventing the progression of text neck in a young man: A case report. Radiol Case Rep. 2022 Jan 18;17(3):978-982. doi: 10.1016/j.radcr.2021.12.053. PMID: 35106108; PMCID: PMC8784282.
  15. 15.0 15.1 Zappalá M, Lightbourne S, Heneghan NR. The relationship between thoracic kyphosis and age, and normative values across age groups: a systematic review of healthy adults. J Orthop Surg Res. 2021 Jul 9;16(1):447. doi: 10.1186/s13018-021-02592-2. PMID: 34243795; PMCID: PMC8268398.
  16. Morente-Sánchez J, Zandonai T, Mateo-March M, Sanabria D, Sánchez-Muñoz C, Chiamulera C, Zabala Díaz M. Acute effect of Snus on physical performance and perceived cognitive load on amateur footballers. Scand J Med Sci Sports. 2015 Aug;25(4):e423-31. doi: 10.1111/sms.12321. Epub 2014 Sep 28. PMID: 25262592.
  17. Jain, D., Jawade, S., & Chitale, N. (2021). Effectiveness of Progressive Resisted Exercise along with Conventional Exercise and Conventional Exercise Program alone in Subjects with Text Neck Syndrome. 33, 536–542.
  18. Taylor NF, Dodd KJ, Damiano DL. Progressive resistance exercise in physical therapy: a summary of systematic reviews. Phys Ther. 2005 Nov;85(11):1208-23. PMID: 16253049.
  19. Brage K, Ris I, Falla D, Søgaard K, Juul-Kristensen B. Pain education combined with neck- and aerobic training is more effective at relieving chronic neck pain than pain education alone--A preliminary randomized controlled trial. Man Ther. 2015 Oct;20(5):686-93. doi: 10.1016/j.math.2015.06.003. Epub 2015 Jun 25. PMID: 26169796.
  20. Bonetti F, Curti S, Mattioli S, Mugnai R, Vanti C, Violante FS, Pillastrini P. Effectiveness of a 'Global Postural Reeducation' program for persistent low back pain: a non-randomized controlled trial. BMC Musculoskelet Disord. 2010 Dec 16;11:285. doi: 10.1186/1471-2474-11-285. PMID: 21162726; PMCID: PMC3020172.
  21. Kroeling, P., Gross, A., Graham, N., Sj, B., Szeto, G., Ch, G., Haines, T., Forget, M., Kroeling, P., Gross, A., Graham, N., Sj, B., Szeto, G., Ch, G., Haines, T., & Forget, M. (2013). Electrotherapy for neck pain (Review).
  22. Kurniawati, D. (2021). The Mckenzie Exercise Methods For Prevent Text Neck Syndrome Due to Gadget Overused. 3(1), 213–217.