Let's get straight to it, text neck is not a diagnosis. Text neck, which is an alternate term used for pain as a result of forward neck posture (FNP)/ rounded shoulders is often exploited as a lazy cause of neck pain, shoulder pain, and many more aches.
One of the many reasons given for the occurrence of text neck or forward head posture (FNP) is the process of constantly looking down (bending the neck) on our phones and laptops. However, is it really a modern phenomenon that people are bending their necks to read? Didn't people read and write centuries before us, or engage in trades that involved looking down, such as stitching, cobbling, and cooking—occupations that still exist today? The healthcare practitioners have picked up the trick from our mothers to blame everything on the phones, only it might not work this time.
Turns out people with ‘text neck’ have the same neck angle as asymptomatic people (people with text neck/ FHP but without pain).
For text neck to be considered a cause of neck pain, individuals with text neck should experience pain or more pain than those without it. However, research shows that people with neck pain tend to have more FNP. Simply put, many people have FNP without any neck pain, while those who do experience neck pain are more likely to exhibit FNP. (it might be a possibility that FNP in people with neck pain exists as a protective adaptation, discussed at the end of the blog).
This systematic review concluded, “Adults with neck pain have significantly more FHP than asymptomatic adults. In contrast, no significant difference was found for FHP between adolescents with and without neck pain and between adults with and without neck pain who aged 50 years old or more.”
Additionally, people with increased phone usage should have more pain due to persistent FNH for long hours. This study aimed to find out the relationship between phone usage and alteration in posture causing functional limitation and found that, “50.8% of young medical students are affected by neck pain, but there was no significant correlation between the number of hours spent using a cell phone and neck pain and disability.”
Furthermore, the study concluded, “neck posture during mobile phone texting, assessed by physiotherapists or by self-perception, was associated with neither neck pain nor the frequency of neck pain in 18–21-year-old young adults. Our results conflict with the idea that the mechanical stress caused by poor posture due to mobile phone use is a threat to cervical spine integrity. Although the cervical spine seems to be more vulnerable in bending in cadaveric samples when compared to the lower back, the average compression force at which the cervical disc-vertebral body units reach their elastic limit is 540 lb before reaching breaking points”
So yes, of course, a structure capable of handling 540lb/245kg weight will not get damaged by merely a kg of weight. Concepts like the FHP generally tend to target the false fragility of the body, however, it is important to remember our body’s capability to resist and adapt to load.
Like almost all conditions, posture is influenced by many things, one of them being our mood and a forward head/slumped thorax can be associated with depressive symptoms.
Moreover, trying to stay upright for extended periods requires work from the muscles of our spine. Not only is it unsustainable and inefficient but can be tiring leading to potential discomfort and pain.
On a surprising note, forward head posture even might be protective against persistent neck pain in late adolescent women. This study states, “In contrast, our findings found there was no difference in the presence of NP between posture subgroups in males and that in females the lowest prevalence of NP was in the slumped thorax/forward head posture subgroup while the subgroup with the highest prevalence of NP was the upright posture.”
These findings question the commonly accepted idea that the forward neck posture increases the load on the spine leading to neck pain. Sitting the way we like, be it slump, sounds like a better bet and comes with the added benefit of comfort.
Furthermore, non-modifiable risk factors for neck pain include age, gender (female), and genetics, while modifiable risk factors include smoking and a lack of physical activity. Therefore, the only way ‘text neck’ is associated with neck pain is via an excess of screen time that could lead to physical inactivity.
In conclusion, there is poor evidence to support the idea that “text neck”/forward head posture causes or correlates well with neck pain. Body posture causing pain through imbalances and misalignments is an overexploited notion that escapes through established concepts of human adaptability and robustness. Keep moving, and be wary of explanations that sound too simplistic!
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