Smartphone Neck Syndrome – Causes, Symptoms, Treatment

Smartphone neck syndrome refers to a repetitive and overuse stress injury to the neck caused by having your head in a prolonged forward position for an extended period. The forward more pending posture affects the curvature of the neck or cervical spine, the neck and shoulder muscles, and supporting ligaments. According to a review from EC Orthopaedics, “smartphone neck syndrome directly affects the spine while flexing the head more forward at varying degrees when the head tilts forward 15 degrees, the force on the neck surge to 27 pounds, at 30 degrees 40 pounds, at 45 degrees 49 pounds and at 60 degrees 60 pounds.” To give you an idea of how much extra stress is going through your neck, imagine carrying an 8-year-old around your neck for two to four hours.

Text neck syndrome is a common and overuse injury that causes pain, numbness, & tingling sensation in the neck region to upper extremities. The pain is increased during operating smartphones, cell phones & operating computers that may be radiating to one side or both sides of the body and radiating pain in the hand or partial parts of the hand. The neck and upper extremities are a wonderful creation in our body, which is used so much in day-to-day life for operating the smartphone, computer counting money & day to days life.

• In 2020, the number of smartphone users worldwide is projected to reach 3.5 billion.
  • In 2020 India had 374.8 million smartphone users. Most young adults spend an average of 3 to 4 hours daily.
  • Recent figures have shown that around 87% of teenagers (14-18 years) in the USA and 79% of teenagers (12-15 years) in the UK own and use smartphones.
  • Among adults aged 18-34 years, 92% and 95% reported owning a smartphone in USA and Australia, respectively.

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.

• 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 an association between texting and neck pain and guidelines for use.

Causes of Smartphone Neck Syndrome

Many of us are taking precautions and limiting ourselves from going to work, school, or even grocery stores due to pass a long time in-home or office. Because of these strict restrictions, we are stuck at home sitting for a prolonged period with our head poking forward, upper back hunched, and shoulders rolled forward over a laptop, a tablet, or a smartphone. According to this article in The Washington Post, “Smartphone users spend an average of two to four hours per day hunched over, reading e-mails, sending texts or checking social media sites. That’s 700 to 1,400 hours per year.

Smartphone neck syndrome typically begins as a relatively mild ache in the neck or upper back. It could also present with sharp pain or stiffness in the neck. When smartphone neck syndrome is suspected of causing pain, it is typically treated with a combination of:

• Limiting phone/tablet use to necessary tasks
• Using better posture by holding devices up closer to eye level
• Performing exercises and stretches that specifically target the neck, chest, and upper back

If not addressed, the continued forward head posture and hunched shoulders may worsen over time, which could lead to even more pain and reduced mobility in the neck, upper back, and shoulders.

In some cases, the excessive forward head posture may exacerbate or accelerate degenerative conditions in the cervical spine, such as cervical degenerative disc disease and/or cervical osteoarthritis.

• Severe neck angle to view the screen – Compared to TVs and personal computers, smartphone and tablet screens are more commonly viewed while flat on a table or lap, which means the screen angle is more severe. As such, the neck and head are typically bent further forward to view smartphones than other screens.
• Touchscreen element may bring shoulders and head further forward – Research in the journal Ergonomics found that study participants had more forward head posture while texting compared to other smartphone tasks, such as web browsing or watching a video. One possible reason may be that texting is more likely to involve the use of both hands as well as more time with the fingers touching the screen, which is more likely to require the shoulders to round forward even further.

Some other activities, such as reading a printed book or washing dishes, also prompt people to tilt their heads, but the difference may be that people use smartphones and tablets for a much longer time and are less likely to shift positions

There is special concern about the potential health impact on teenagers among the most frequent text message users whose spines are still developing. Many doctors, chiropractors, and other medical professionals have reported seeing an increase in neck pain and poor posture among teenage patients due to frequent texting and mobile device use, but thus far the evidence is mostly anecdotal.

While holding the head forward for long periods of time is widely recognized in the medical community as a risk factor for neck pain, there is some debate as to how much of a factor smartphone and tablet use plays in neck pain and poor posture in teens and young adults. While a study of young adults in Sweden found a link between texting time and neck pain, the results appeared stronger in the short-term rather than the long-term. Also, a study of 18- to 21-year-olds in Brazil did not find a correlation between texting and neck pain. More research is needed to determine the long-term impact that texting and mobile device users might have on neck health.

In general, finding ways to keep the neck and body more active, rather than hunched over a mobile device, is best for the spine. For example, try scheduling just a few times per day to check text messages and emails, rather than responding multiple times per hour.

Symptoms of Smartphone Neck Syndrome 

Some signs and symptoms of smartphone neck syndrome include:

• Pain in the neck, upper back, and/or shoulder. This pain may be located in one specific spot and feel intense or stabbing, or it may be a general achiness and soreness that covers a broader region, such as spanning from the bottom of the neck and into the shoulder(s).
• Forward head posture and rounded shoulders. Muscles in the neck, chest and upper back can become deconditioned and imbalanced due to prolonged forward head posture. This deconditioning can make it difficult to maintain good posture with the ears directly over the shoulders.
• Reduced mobility. The neck, upper back, and shoulders may all experience some tightness and reduced mobility.
• Headache. Muscles at the base of the neck could go into spasm and become painful, or pain could also be referred from the neck up into the head. Excessive amounts of time looking at screens, regardless of posture, may also increase the risk for eyestrain and headache.
• Increased pain when neck flexion. Text neck symptoms tend to worsen when the neck is flexed forward into the position that originally caused the problem, such as while looking down and texting.
• Cervical radiculopathy. Symptoms of electric shock-like pain, pins-and-needles tingling, numbness, and/or weakness may radiate from the neck down into the shoulder, arm, and/or hand. Cervical radiculopathy can occur when a cervical nerve root becomes irritated or compressed, such as from spinal changes related to degenerative disc disease or osteoarthritis. Severe cases of text neck may accelerate or worsen this process.
• Balance issues. Prolonged amounts of time in forwarding head posture have been linked to reduced balance control, due to the head’s center of gravity migrating further in front of the body. This process can result in muscle imbalances and postural control changes in the neck and torso.
• Jaw pain. A misalignment in the cervical spine and/or muscle imbalances may lead to jaw pain, or temporomandibular joint (TMJ) pain.
• Sharp or Nagging pain in the neck and shoulders
• Stiffness/tightness in shoulders and neck leading to decreased range of motion
• Intermittent or constant headaches
• Nerve pain with tingling and numbness in the upper limbs
• Eye pain

Diagnosis Of Smartphone Neck Syndrome 

• X-ray – of the neck in anterior-posterior and lateral view to identify, any, pinched nerve, muscle spasm, fracture as a cause for pain in the neck region.
• Ultrasound examination
• An EMG (electromyogram) – to check the nerves going to your neck
• Magnetic resonance imaging (MRI) – By using radio waves, an MRI creates a 3-D image of your thumb. It can show tumors, growths, and even damage to bones and ligaments.
• Computerized tomography (CT scan) – A CT scan uses X-rays to create a 3-D image. With the help of a dye injected into your body, it can show damage to soft tissue as well as issues with your bones in the text neck syndrome.

Treatment of Text Neck Syndrome

There are a variety of treatment options for dealing with pain in smartphone neck syndrome though it is important to seek the advice of a medical professional before beginning any treatment regimen to ensure you do not worsen your condition.

• Rest – One of the most important things you can do for any joint injury allows the affected area to rest. Refrain from using the neck as much as you can so it has time to recover and heal properly.
• Ultrasound – As part of a physical therapy regimen, ultrasounds can be used to help raise the temperature of the affected tissue and increase healing.
• Stretching – Certain stretches can prove to be beneficial for text neck syndrome pain. Some of the most common ones are text neck syndrome abduction stretches, which require you to gently pull your text neck away from your neck with the opposite hand for approximately 20 seconds
• Deep tissue massage
• Denervation of the 1st CMCJ
• Physiotherapy – where manipulation, massage, and exercises are used to improve the movement and function of your neck and hand.
• Occupational therapy – if you’re struggling with everyday tasks and activities, either at work or at home, an occupational therapist will be able to give you practical support to make those tasks easier

Exercises for Text Neck Syndrome

Listed below are some exercises that could prevent smartphone neck syndrome. These exercises should not increase pain. If your pain increases, then stop and contact your healthcare provider or physical therapist.

• Chin tuck: Start in an upright sitting position, gently tuck your chin as if you are making a double chin. Make sure your nose and chin are facing forward, not downward. Hold this position for 5 seconds. Repeat for 30 repetitions.
• Scapular Retraction: Start in an upright sitting position. Tighten the muscles between your shoulder blades and gently squeeze your shoulder blades together. Hold this position for 5 seconds and repeat 30 times.
• Pectoralis Stretch: Place one hand onto a door frame, up to your shoulder level. Slowly lean forward until you feel a stretch along your chest. Hold this stretch for 30 seconds and repeat 3 times on each side.
• Foam Rolling Series: for upper back mobility and anterior shoulder mobility.
• Hold your mobile device up to eye level.
• Slight tuck your chin and roll shoulder blades backward.
• Take breaks from your mobile device every 15 minutes.
• Set reminders to shift positions.
• For kids, rest the device on a table instead of in the hands or on the floor. With proper positioning, education, and awareness, one should be able to minimize text neck syndrome from developing.

Medicine for Texting Thumb

• Analgesics: Prescription-strength drugs that relieve pain but not inflammation in smartphone neck syndrome.
• Antidepressants: Drugs that block pain messages from your brain and boost the effects of endorphins (your body’s natural painkillers).
• Medication – Common pain remedies such as aspirin, acetaminophen(Tylenol), ibuprofen (Advil, Motrin), and naproxen can offer short-term relief. All are available in low doses without a prescription.
• Muscle Relaxants –  These medications provide relief from spinal muscle spasms. Other medications, including muscle relaxants and anti-seizure medications, treat aspects such as muscle spasms and damaged nerves in smartphone neck syndrome.
• Corticosteroid injections –  Your doctor will inject a steroid such as prednisone into your neck joints. Steroids make the inflammation go down. However, because of side effects, they are used sparingly.
• Anesthetics  –  Used with precision, an injection of a nerve block can stop the pain for a time.
• Neuropathic Agents – Drugs(pregabalin & gabapentin) that address neuropathic—or nerve-related—pain. This includes burning, numbness, and tingling.
• Opioids –  Also known as narcotics, these medications are intense pain relievers that should only be used under a doctor’s careful supervision.
• Topical Medications: These prescription-strength creams, gels, ointments, patches, and sprays help relieve pain and inflammation through the skin that works excellently in smartphone neck syndrome.
• Calcium & vitamin D3 – to improve bones health and heal fractures and micro repetitive injury in the neck region.
• Glucosamine & diacerein – can be used to tighten the loose tension, cartilage, ligaments in text neck syndrome and regenerate cartilage, or inhabit the further degeneration of cartilage, tendon, and ligament in the neck.

How can physical therapy help?

At Clarity Physical Therapy, we specialize in creating individualized rehabilitation programs focused on improving posture and restoring normal muscle function. Treatment plans include a combination of manual therapy and corrective exercises to decrease forces on the spine, strengthen muscles that are inhibited, and lengthen muscles that are tight and short. The Physical Therapists at Clarity can help you regain control of your posture and get rid of the pain for good. With one-on-one treatment sessions, you will receive personalized attention that will help you see results faster and decrease overall treatment time.

Prevent Text Neck Pain

Raise your phone to eye level when texting or reading.

• Raise the phone. Move the phone (and other devices) up closer to eye level so the head does not have to be tilted forward.
• Take frequent breaks. Spend some time away from the phone—or any type of head-forward posture. If needed, use an alarm or app to set automatic reminders to take breaks from handheld devices.
• Stand up straight. Good posture, with the chin, tucked in and shoulders pulled back, keeps the body aligned in a neutral position.
• Arch and stretch. Arch the neck and upper back backward periodically to ease muscle pain.
• Exercise regularly. A strong, flexible back and neck are more able to handle the extra stress. Some research indicates that teenagers who are active in low-impact team sports or endurance sports are less likely to have neck pain.
• Avoid excessive usage and take frequent breaks
• Avoid prolonged static postures
• Position the device such that it reduces stresses both on the head/neck and the upper extremities
• Avoid high repetitions of movements such as prolonged typing or swiping
• Avoid holding large or heavy devices in one hand for a long duration

In general, finding ways to keep the neck and body more active, rather than hunched over a mobile device, is best for the spine. For example, try scheduling just a few times per day to check text messages and emails, rather than responding multiple times per hour.

The Australian Department of Health (2012) published guidelines for children about the recommended time to pass on mobile devices or electronic media [rx,rx]:

1. Children < 2 years: recommended no time watching TV or using other electronic media (DVDs, computer, and other electronic games).

2. Children 2–5 years: no more than 1 h/day sitting and watching television and other electronic media (DVDs, computers, and electronic games).

3. Infants, toddlers, and preschoolers should not be sedentary, restrained or kept inactive for more than 1 h at a time, with the exception of sleeping.

Even the Italian Society of Pediatrics released their top-5 rules for families with children in 2019. These are the “Top 5 recommendations of Italian Society of Pediatrics (2019)” [rx]:

1. Talk with your son—It is important to encourage open communication between parents and adolescents, explaining to children what positive and intelligent use of media devices means, paying attention to the contents that are published and read, and reminding them that it is essential to protect online privacy to protect themselves and your family.

2. Understand, learn and control—Parents should monitor the time their child spends on tablets, smartphones, and PCs, first learning the available technologies to be able to understand them as much as possible, and playing with them, and sharing activities on media devices as much as possible.

3. Set clear limits and rules—It is necessary to limit the time of use of smartphones, tablets, and PCs during the day or on weekends, by establishing precise times of prohibition, for example during meals, homework, and family gatherings. Consider media an opportunity for the whole family to watch movies together or share social content or use chat and video messages.

4. Give a good example—The parent’s example is essential, so fathers and mothers should be the first to limit the use of smartphones when they are with the family and during meals. It is also important that the parents choose appropriate content and languages on social networks.

5. Do network—Collaboration between parents, pediatricians, and health professionals is essential to protect and support children through information campaigns that provide greater awareness of the positive aspects but also of the risks of excessive use of media devices.

References

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