Is text neck causing your neck pain?
In the modern age of technology, most of the population spend prolonged periods looking at their screens. The smartphones which almost all of us possess, have been the major contributor to this increased screen time. Historically and culturally having a flexed neck or forward head position is seen as problematic. How many times have you been told you have “bad posture” and to “sit up straight”? Whether it be your phone, iPad, computer or television, the posture is typically the same and is viewed as being “bad”. For this reason, some people have referred to it as “tech neck”. But is this posture a bad thing? Does it cause neck pain? As always, I will present the research and give you these answers.
There are quite a few research studies that have investigated whether sustained flexed neck postures or forward head position postures, correlate with neck pain. One study observed the association between text neck and neck pain in adults. They observed 582 individuals aged 18-65 years. They observed these participants in both standing and sitting, whilst typing on their smart phones. In both the standing posture and seated posture positions, there was no association between the prevalence of neck pain, or the frequency or intensity of neck pain (Correia et al., 2021).
Another study by Richards et al., 2016 investigated 1108 adolescents 17 years of age. They observed four different clusters of sitting neck posture. These were upright, intermediate (slightly slouched), slumped thorax with forward head position, and erect thorax with forward head position. They found “Participants classified as having slumped thorax/forward head posture were at higher odds of mild, moderate, or severe depression. Participants classified as having upright posture exercised more frequently. There was no significant difference in the odds of neck pain or headache across the clusters.” In other words, they concluded no correlation between posture and neck pain. However, they interestingly found that psychosocial factors contributed to a forward neck position in 17 year olds.
Young adults between the ages of 18-30 are accepted as the population who spend the most time on their phones and computers. With long periods of study and social media, they accumulate long periods of screen time. Many studies investigating these groups have come to the same conclusion. They all conclude that flexed neck postures or text neck is not a risk factor for neck pain, or persistent neck pain. Damasceno et al., 2018 investigated 150 young adults aged 18-21 and concluded that there is no association between text neck and neck pain. In a study biased towards finding a link between text neck and neck pain by Bertozzi et al., 2021, they also found there is no correlation. They investigated young university students aged 18-30 and concluded that hours spent bent over a phone, was not detrimental to their health. Considering this group of researchers were hunting a connection and still found the opposite of their hypothesis, really says it all about text neck posture.
There was a study with a 5 year follow up from the ages of 17-22, which had a very interesting finding to this question. They concluded that a flexed sitting posture of the neck from 17 to 22, was not a risk factor for persistent neck pain. After a five-year period of this demonised “bad posture” there was no correlation between text neck and neck pain. However, this is not what was interesting about the findings of this study. The interesting finding was that young females who sat in a slouched thorax and forward head position, had a lower risk of developing persistent neck pain. The slumped “bad posture” was deemed to be protective for neck pain development.
Is there research that supports text neck?
There was a systematic review that supported the findings that in young adults and adolescents, there is no association between text neck and neck pain. However, in adults they found there to be a correlation between increased forward neck position and neck pain. This systematic review had 3 studies which supported this correlation. However, on closer investigation into these studies they were of very poor quality and heavily underpowered with a small sample of participants. In this systematic review they highlight that forward head posture was more frequent with age. This then asks the question, is a forward head posture just a normal variant of aging? More research can be done to determine this, however it probably is just a waste of money and time.
Summary
The evidence consistently shows that text neck or a forward head posture is not a bad thing. There is no correlation between this demonised “bad posture” and neck pain. As I always say, the best posture is your next posture. Pain or postural tension can occur, and it occurs when being in a position for too long. My advice as always is to move when you feel tension, as our body thrives off movement. If you want passive relief like manual therapy, this can help and your osteopath can provide this. The power though comes from movement. Movement is medicine. At The Reform Lab Osteopathy, we can provide manual therapy and exercise therapy in a fully equipped state of the art gym. Project Reform is one of the best exercise facilities in Brisbane!
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