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Text Neck

Original Editor - Vidhu Sindwani

Top Contributors - Lucinda hampton, Shoko Otsuka, Kim Jackson, Khloud Shreif, Angeliki Chorti, Vidhu Sindwani, Lauren Lopez, Rucha Gadgil and Kalyani Yajnanarayan  

Defining Text Neck

The definition of text neck needs further clarification in the literature. At present, the term lacks clarity. For research purposes, text neck has been linked to texting on the smartphone in a flexed neck position; furthermore, no scientific evidence has been found to date linking text neck with neck pain regardless of the definition used. [1] Some variations in the definition of the term text neck may relate to:

  1. Posture (the defining characteristic of text neck in the academic literature), often referring to forward head posture e.g. when using hand-held mobile devices [2]
  2. Overuse.
  3. Tissue damage
  4. Mechanical stress/tension
  5. Musculoskeletal symptoms

Text neck as a term appears to have little clinical value at the present moment. However, many studies look into this new phenomenon and a problem exists around "text neck" and its' relevance in regard to use of emerging technologies.[3]

Conflicting Findings

Although there is published material on the association between using a mobile device and neck pain or symptoms which suggested the negative effects of text neck, the majority of studies have concluded that existing evidence is limited. [2][4][5][6][7][8][9][10]

Forward neck and neck pain/headache

  • A study investigated the association between text neck and neck pain in adults and reported that the cervical flexion angle of the standing and sitting participant using a smartphone did not associate with the prevalence of neck pain, neck pain frequency, and maximum neck pain intensity.[11]
  • A systematic review found that forward head posture was significantly correlated with neck pain measures in adults, whilst no association was found between FHP and most of neck pain measures in adolescents.[12]

Text neck and musculoskeletal symptoms

A study investigated the associations of mobile touch screen device (MTSD) use with musculoskeletal symptoms and exposures, however there was limited evidence showing their associations.[13]

Lack of Solid Evidence

Looking at the literature on the association between texting and neck pain, the answer is really muddled, because the studies that have been done on the topic are flawed.[14][15] Scientific studies don’t appear in a vacuum; they are part of a growing body of evidence. To simply report on a single study is misleading.

Further trials and longitudinal research is needed to establish association between texting and neck pain and guidelines for use. [15]

Clinical Presentation of Text Neck

A paper [4] proposed that the most common presentation of Text Neck is neck pain, stiffness and soreness. The main symptoms include:

  • Stiff neck: soreness and difficulty in moving the neck is usually present when trying to move the neck after long usages
  • Pain: can be localized to one spot or may be diffused over an area, usually lower part of the neck. Can be described as dull aching or can also be sharp or stabbing in extreme cases
  • Radiating pain: there can often be radiation of pain into the shoulders and arms.
  • Muscular weakness: shoulders muscles namely, trapezius, rhomboids and shoulder external rotators are often weak
  • Headache: sub-occipital muscle tightness can lead to tension type headaches.


Whereas, the symptoms indicated above were not given any supporting evidence in the article.[4]

  • No evidence of the correlation between text neck and pain has not been found.[11][12][16]
  • Mousavi-Khatir et al (2016)[7] found the increased range of motion in cervical flexion after 10 minutes’ neck flexion and suggested the possibility of creep in the posterior ligaments of the spine due to forward head posture. This can affect the length-tension relationship of posterior cervical muscles and the stability provided by the posterior ligaments, and increase the activation of erector spinae, which may result in disc herniation led by the abnormal movements between vertebral segments.[2] However, the study[7] measured only range of motion and amplitude of neck muscle after 10 mins’ cervical flexion, not a change in actual ligaments. Thus, this hypothesis has not been proven.[2]

Assessment

Assessment: including medical history, duration of electronic device usage and the onset of symptoms. Pain should be assessed primally such as intensity, character, frequency and radiation to the neck or lower back.

Management

Prevention is the key when it comes to Text Neck. The following recommendations from a systematic review [15] of Text Neck should be kept in mind while using smartphones or other hand held devices:

  1. Avoid excessive usage and take frequent breaks
  2. Avoid prolonged static postures
  3. Position the device such that it reduces stresses both on the head/neck and the upper extremities
  4. Avoid high repetitions of movements such as prolonged typing or swiping
  5. Avoid holding large or heavy devices in one hand for long duration

Physiotherapy

Rehabilitation is found to be very effective in treating the stress injury resulting from Text Neck. Rehabilitation can be designed as a 2-4 week program starting with soft tissue mobilisation, Grade 1 and 2 joint mobilisation, active and passive stretches of tight muscles and progressing to muscle strengthening, posture retraining and home exercise programme.[8]

In acute cases, pain relief is the main goal. It can be achieved by:

In extreme chronic cases pain medication, injection into the facet joint or trigger point or acupuncture can be done.[4]

Different techniques may also be used to treat text neck:

  • Kinesio-taping: Kinesio-tapes are light, thin, elastic material that helps to decrease pain and spasm, improve blood circulation, decrease swelling, strengthen weak muscles, maintain neck alignment while not restricting joint movement. 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.[18]
  • Progressive resistance exercise (PRE): Progressive resistance exercise to the neck muscles is proven to be effective in the treatment of neck pain. [19] [20] 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. [21] [22]
  • Global postural re– education (GPE): A study has shown that GPE is effective in reducing neck pain and disability when done for a long duration. 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. [23]
  • Evidence has shown that electrotherapy e.g., TENS, EMS may be effective but available studies are of low quality; furthermore, electrotherapy must be combined with other forms of conservative management such as: [24][25]
    1. Ultrasound
    2. Manual traction
    3. Manual exercise
    4. Cervical joint mobilisation
    5. Isometric exercise to cervical muscles
    6. Behavioral therapy

You can also find particular issues partaining to text neck in younger ages here.

References

  1. ↑ Grasser T, Borges Dario A, Parreira PCS, Correia IMT, Meziat-Filho N. Defining text neck: a scoping review. Eur Spine J. 2023 Oct;32(10):3463-3484.
  2. ↑ 2.0 2.1 2.2 2.3 Fiebert I, Kistner F, Gissendanner C, DaSilva C. Text neck: An adverse postural phenomenon. Work. 2021;69(4):1261-70.
  3. ↑ Grasser T, Dario AB, Parreira PD, Correia IM, Meziat-Filho N. DEFINING TEXT NECK: A SCOPING REVIEW. Br J Phys Ther. 2024 Apr 1;28:100998.
  4. ↑ 4.0 4.1 4.2 4.3 Neupane S, Ifthikar Ali UT, Mathew A. Text-Neck Syndrome-Systemic review. Imp J Interdisc Res. 2017;3(7):141-148.
  5. ↑ Shahar D, Sayers MGL. Prominent exostosis projecting from the occipital squama more substantial and prevalent in young adult than older age groups [published correction appears in Sci Rep. 2019 Sep 18;9(1):13707]. Sci Rep. 2018;8(1):3354.
  6. ↑ David D, Giannini C, Chiarelli F, Mohn A. Text Neck Syndrome in Children and Adolescents. Int J Environ Res Public Health. 2021;18(4):1565.
  7. ↑ 7.0 7.1 7.2 Mousavi-Khatir R, Talebian S, Maroufi N, Olyaei GR. Effect of static neck flexion in cervical flexion-relaxation phenomenon in healthy males and females. J Bodyw Mov Ther. 2016;20(2):235-42.
  8. ↑ 8.0 8.1 Sharan D, Mohandoss M, Ranganathan R, Jose J. Musculoskeletal disorders of upper extremities due to extensive usage of hand held devices. Ann Occup Environ Med. 2014; 26:22.
  9. ↑ Jyothsna G. Text Neck Syndrome in Adolescents: How to Stem the Tide?. IJPEN.:5(1):35-40.
  10. ↑ Kim HJ, Kim JS. The relationship between smartphone use and subjective musculoskeletal symptoms and university students. J Phys Ther Sci. 2015;27(3):575-9.
  11. ↑ 11.0 11.1 Correia IMT, Ferreira AS, Fernandez J, Reis FJJ, Nogueira LAC, Meziat-Filho N. Association Between Text Neck and Neck Pain in Adults. Spine. 2021;46(9):571-78.
  12. ↑ 12.0 12.1 Mahmoud NF, Hassan KA, Abdelmajeed SF, Moustafa IM, Silva AG. The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis. Curr Rev Musculoskelet Med. 2019;12(4):562-77.
  13. ↑ Toh SH, Coenen P, Howie EK, Straker LM. The associations of mobile touch screen device use with musculoskeletal symptoms and exposures: A systematic review. PLoS One. 2017;12(8):e0181220.
  14. ↑ McGill. Text neck: Is the Epidemic Truly Over?. Available from: https://www.mcgill.ca/oss/article/technology-general-science/text-neck-epidemic-truly-over [accessed 21.11.2024]
  15. ↑ 15.0 15.1 15.2 Toh SH, Coenen P, Howie EK, Straker LM. The associations of mobile touch screen device use with musculoskeletal symptoms and exposures: a systematic review. PLoS One 2017; 12(8): e0181220.
  16. ↑ Richards KV, Beales DJ, Smith AJ, O'Sullivan PB, Straker LM. Neck Posture Clusters and Their Association With Biopsychosocial Factors and Neck Pain in Australian Adolescents. Phys Ther. 2016;96(10):1576-1587.
  17. ↑ Kwon JW, Son SM, Lee NK. Changes in upper-extremity muscle activities due to head position in subjects with a forward head posture and rounded shoulders. J Phys Ther Sci. 2015. 27; 6:1739–42.
  18. ↑ 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.
  19. ↑ Neupane S, Ali U, Mathew A. Text Neck Syndrome - Systematic Review. IJIR. 2017; 7:141–8.
  20. ↑ Jain D, Jawade S, Chitale N. Effectiveness of Progressive Resisted Exercise along with Conventional Exercise and Conventional Exercise Program alone in Subjects with Text Neck Syndrome. JPRI. 2021; 33: 536–42.
  21. ↑ Jain D, Jawade S, & Chitale N. Effectiveness of Progressive Resisted Exercise along with Conventional Exercise and Conventional Exercise Program alone in Subjects with Text Neck Syndrome. JPRI. 2021; 33(59B): 536-42.
  22. ↑ 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.
  23. ↑ 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.
  24. ↑ Kroeling P, Gross A, Graham N, Burnie SJ, Szeto G, Goldsmith CH, Haines T, Forget M. Electrotherapy for neck pain. Cochrane Database Syst Rev. 2013 Aug 26;2013(8):CD004251.
  25. ↑ Kurniawati D. The Mckenzie Exercise Methods For Prevent Text Neck Syndrome Due to Gadget Overused. Urban Health. 2021;3(1): 213–7.
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