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

Original Editor - Oluwafikunayomi Wole-Bankole Top Contributors - Angeliki Chorti, Oluwafikunayomi Wole-Bankole, Tony Lowe, Kim Jackson and Rucha Gadgil

Definition of Posture

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

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

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.
Foward neck posture when doing computer work

Advanced Technology Use and Poor Neck Posture (Text Neck)

The present-day advanced technology use i.e., the use of smart phones, computers and tablets has had great effects on the postures of the neck especially in students.[8] The most common abnormal posture caused by use of these advanced technologies is the Forward Head Posture (FHP) and this posture is frequently referred to as 'text neck' or 'nerd neck'. It is attributed to muscle imbalances around the neck and shoulder [4]and sustained posture of long duration whiling using a cell phone, tablet or other device. [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 may be a result of repetitive stress injury in the cervical spine due to the prolonged forward flexion of the neck. [10] Nowadays, the increased use of technology by children and adolescents requires flexing of the head downwards to look into devices, causing the straining of the muscles of the neck. [7]

Sitting in this poor posture for long hours may cause health issues usually associated with muscle pains.[11] The prolonged bending over computer screens or hunching over a laptop or cell phone results in forward flexion posture  also known as “ turtle neck”. [7] 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:

  1. Deep cervical flexors      
  2. Erector spinae      
  3. Shoulder blade retractors
  4. Upper Trapezius muscle.

Muscles that can shorten and tighten include:

  1. Suboccipital muscles        
  2. Pectoralis muscles         
  3. Levator scapulae muscles

Age Relevance

Text neck may affect the spine alignment while flexing, when the head is forward at varying degrees. At 15 degrees, the forces on the neck increase to 27 pounds, when at 30 degrees 40 pounds, at 45 degrees 49 pounds, at 60 degrees 60 pounds, and last, at 90 degrees the model prediction is not reliable. This is particularly evident in adolescents, because their head is usually bigger than their body size which predisposes them to text neck considering the fact that the use of advance technology is greater in this age group. [7] [12][13] Atakla et al. [13] found that almost half of university students had neck pain due to prolonged neck flexion when writing messages. The vast majority actually reported constant communication by telephone message, and all students did not keep their neck straight when writing a message.[13] In other studies, it was found that head and neck angles when using smartphones in a sitting chair position without a backrest were the most awkward postures compared with others. [14] [15] These findings have also been observed in other young populations [16] and sedentary behavior, poor posture and other findings have been identified as risk factors for neck pain in high school students. [17] However, findings are not consistent in all young populations; some evidence suggests a lack of association between text neck and neck pain in 18-21-year-old young adults, implying that other factors may be of greater relevance. [18]For example, physical acts of neck sustained-till-exhaustion exertions have to be fatiguing to modify mechanics and possibly, propensity for injury. [19]

Clinical Presentation

  1. Stiff neck: the individual may experience pain when moving the neck, mostly after turning towards the sides after long hours on smart phone
  2. Kyphosis (rounded shoulders): increase in the forward curvature of the thoracic spine that is seen along the sagittal plane. [20] This can influence 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.[20]
  3. Sharp pain: usually experienced by patient with neck pain, they notice sharp localised pain on one spot
  4. General soreness: this individual experience around the neck and trapezius muscles
  5. Cervical Radiculopathy: some might experience pain radiating from the neck to the shoulders and arms due to extreme forward head posture
  6. Weakness and numbness: patients may experience weakness of the shoulder muscles.
  7. Cervicogenic headaches: irritation from the neck can also affect muscles and nerve of head this is known as tension headache.[9]

Other symptoms may include:

  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 neuroplastic changes, leading to sensorimotor integration deficiencies and further dysfunction. [10]

Physiotherapy Management

Physiotherapy is one of the most common conservative approaches used to treat text neck. Examples of physiotherapy techniques that can be used to treat this condition are found in the page Text Neck.

When looking at university students using smartphones, a study examining the impact of self-management corrective exercises on text neck syndrome found that a 36.6% reduction of symptoms measured by the visual analogue scale and 13.3% of the Neck Disability Index when doing 5 days a week for 8 weeks. [14]

References

  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):11-6.
  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.
  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.
  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):541-47.
  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.
  6. ↑ Binder AI. Cervical spondylosis and neck pain BMJ. 2007; 334(7592):3
  7. ↑ 7.0 7.1 7.2 7.3 7.4 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.
  8. ↑ Kothare H, Patil C, Muley R. Immediate effects of kinesio taping on upper trapezius muscle on subjects having text neck. Int J Physiol Nutr Phys Educ. 2019; 4(2):131–33.
  9. ↑ 9.0 9.1 Neupane S, Ali U, Mathew A. Text Neck Syndrome - Systematic Review. IJIR. 2017; 7:141–8.
  10. ↑ 10.0 10.1 Chu EC. Preventing the progression of text neck in a young man: A case report. Radiol Case Rep. 2022 Jan 18;17(3):978-82.
  11. ↑ 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.
  12. ↑ Kumari S, Kumar R, Sharma D. Text Neck Syndrome: The Pain of Modern Era. IJHSR. 2021; 11(11): 161-5.
  13. ↑ 13.0 13.1 13.2 Atakla HG, Mbaye M, Dakurah TK, Quenum MK, Barry LF, Wague D, Sossa CI, Houinato DS,Thiam AB, Ba MC. Tech Neck Syndrome: A global epidemic of the modern era among students at the University of Abomey Calavi in Benin. Interdisciplinary Neurosurgery 2023; 34:101812.
  14. ↑ 14.0 14.1 Sarraf F, Abbasi S, Varmazyar S. Self-Management Exercises Intervention on Text Neck Syndrome Among University Students Using Smartphones. Pain Manag Nurs. 2023 Dec;24(6):595-602.
  15. ↑ Sarraf F, Varmazyar S. Comparing the effect of the posture of using smartphones on head and neck angles among college students. Ergonomics. 2022 Dec;65(12):1631-8.
  16. ↑ Azadvari M, Sarzaeim M, Rajabi S, Yahyaee A, Razavi SZE, Haghparast A, Biderafsh A, Nakhostin-Ansari A, Hosseini M, Ghahvechi M. Associations between exposure to common technology devices and reported neck pain among Iranian school-age adolescents: a cross sectional study. BMC Musculoskelet Disord. 2023 Nov 13;24(1):883.
  17. ↑ Wang R, Yin Y, Zhang H, Pan L, Zhu Y, Wang M, Huang Z, Wang W, Deng G. Risk factors associated with the prevalence of neck and shoulder pain among high school students: a cross-sectional survey in China. BMC Musculoskelet Disord. 2023 Aug 9;24(1):641.
  18. ↑ Damasceno GM, Ferreira AS, Nogueira LAC, Reis FJJ, Andrade ICS, Meziat-Filho N. Text neck and neck pain in 18-21-year-old young adults. Eur Spine J. 2018 Jun;27(6):1249-1254.
  19. ↑ Zhou Y, Reddy C, Zhang X. The deflection of fatigued neck. Proc Natl Acad Sci U S A. 2024 Aug 20;121(34):e2401874121.
  20. ↑ 20.0 20.1 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.
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