The “text neck” phenomenon has gained momentum through the mainstream media in recent weeks. The neck is a precious and fragile component of the musculoskeletal system. Often overlooked, poor neck posture can have detrimental long term effects. Bringing attention to the general population’s poor habits is a key component of creating effective change for the long haul.
Text neck refers to the partially flexed neck position that our handheld devices have caused us to regularly adopt. Prevention and management of neck issues comes in the form of improving neck posture as well as increasing the threshold of the neck musculature.

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Case Study

Neck posture (cervical spine) has been an area of key interest for some time now. I have come across numerous cases that present as shoulder/elbow pain initially but upon evaluation the pain is caused by a cervical spine nerve impingement.
One notable case involves a middle aged man who works at a computer all day. Rather than the usual typing he was constantly clicking on his mouse as per his job description. Diagnosed with tennis elbow, I was baffled that none of his symptoms reflected the expected tennis elbow symptoms. Upon further investigation, it was deduced that the issue had a different (neurological) cause. Following an MRI on his cervical spine, a nerve root compression was found at C7 (the 7th vertebrae from the top of the spine). The neurosurgeon plans to treat the issue through surgical intervention. The case interested me as the cause of the elbow pain was not caused by fatigued soft tissue at the elbow but rather was referred pain stemming from poor neck posture while in front of the computer all day.
(Edit 09/02/15 – The aforementioned client has just informed me that he has decided to delay the surgical intervention and continue with his exercise therapy as he has been symptom free for 3 weeks. You can’t even make this stuff up. I’m claiming a win on this one).

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Anatomy

Vertebrae

The neck forms part of the cervical spine. The vertebrae of the cervical spine are relatively small compared with the greater-load-bearing thoracic and lumbar segments. The cervical spine is also the most free to move, rotate, flex/extend and laterally flex.

Musculature

There are many muscles that influence the movement of the cervical spine. Most of the muscles are small and robust muscles that are not inherently strong but have the capacity to have strong muscular endurance. That is, they are capable of holding a strong posture for prolonged period of time. Contrast that with power muscles of the upper (triceps, biceps etc.) and lower limbs (quadriceps, hamstrings, etc.) and the failure of these muscles is clear. Prolonged sitting and poor posture condition these muscles to have diminished endurance. Once they fatigue, they can switch off and leave the vertebrae in a vulnerable position. Reduced muscular endurance can result in longer periods of vertebrae to vertebrae contact which can result in nerve impingement.
As with the lumbar spine and the need to avoid trunk flexion (see Neutral Spine) the cervical spine requires muscles on the posterior aspect of the body (extensors) to be actively trained. Prolonged sitting and using technology causes the flexors to be overactive and the extensors to atrophy.

Nerves

The aim of the bony spinal structure is to protect the spinal cord which is passing all the messages between the body and the brain. At all levels of the the spine, nerves are passing out of the spinal cord to go and innervate and communicate with muscles, organs and skin. The cervical spine is no exception, at each level, there are nerve roots leaving the posterior horn of the spinal cord and travelling to the upper limb. If one of these nerve roots becomes squeezed by the collapsing vertebrae (collapsing because the muscles have fatigued and deactivated) then the signalling of that nerve is impeded. As a result, pain and reduced muscle activity to the areas which those nerves are travelling can be expected.
The brachial plexus is a sizeable wad of nerves that passes through C7. If there is a nerve root compression on the brachial plexus the associated effects may be great in magnitude.

The long term effects of poor neck posture is evident if you’re working with people who are frustrated by experiencing chronic pain. Often the chronic pain is misdiagnosed and the process can drag on for a painstaking duration of time. Having seen the ugly end of “text neck” I am inspired to try and prevent that level of discomfort in myself and those who will hear me out.

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Starting ’em young

One of the most evident issues I see daily is children who are constantly relying on iPad’s and other gadgets for their entertainment pleasure. Technology is the next generation’s Ritalin. As with medication side effects, the potential ill effects of a misuse of technology from a young age are disastrous. Poor neck posture is a habit that can be formed from a young age.

Solving the issue:

• Avoid watching a device positioned on the lap.
• Ensure that the neck is in a good position wherever possible.
• If a child starts to display poor neck posture, encourage them to correct it.
• Find safer alternatives while using technology.

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Adults Too

The term “text neck” mainly affects those who, like myself, grew up with a mobile phone as a primary means of communication. In my circle, as soon as a question is raised where the answer is unknown we are all programmed to go clamouring for our phones to search the internet for answers. Additionally, the prevalence of hand-held communication, social media, news articles, blogs (guilty) and emails are all adding to the frequency of poor neck posture. Often we demand privacy and keep our phones sheltered from those with wandering eyes. The phone stays low and we arc our neck to get a good glimpse of what we so earnestly need our phone to tell us.
A little awareness goes a long way in terms of neck position. Minimising the high risk situations in everyday life is one of the keys to preventing long term neck complications. Be aware of what situations leave you the most vulnerable and take measures to improving where possible.
Some activities to consider neck position:

• Traveling in the car/train
• Watching TV
• Using the computer
• Reading a book/magazine
• Writing/note-taking
• Sleeping (See sleep posture)

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Prevention & Management

For those in all walks of life, the silver lining is that the long term complications associated with poor neck posture can be prevented and managed with some simple considerations.

1. Minimise the damage

• Identify the areas where neck posture is compromised (texting, using the computer, reading, driving etc) and take measures to correct your posture while engaging in those tasks.
• Allow opportunity for postural correction – muscles often turn off but can be “woken up” with a few seconds of postural correction. Look up and give your neck a break every now and then.
• Create a new positive habit and a new normal for your neck position. It won’t be easy but with a little awareness and attention to detail good habits can take the place of bad ones.

2. Increase the threshold

One of the aims of exercise as I see it is to increase the threshold of the musculature in a certain region so that daily tasks are always beneath the “thereshold” where the muscle fatigues. If I can increase the endurance of my neck in difficult tasks, then the muscles will not turn off during my usual routine of working in front of the computer for example. This can be accomplished by improving neck strength, muscular endurance and neck stability through some regular neck exercise.

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Neck Exercises

Note: As everyone is unique, we encourage you to seek out your local Exercise Physiologist or Physiotherapist to help prescribe individualised exercises.

1. Neck extension (hold)

Place a pillow behind your head on the wall. Press your head back into the wall as if you are trying to look at the sky. Hold for 10-30 seconds depending on difficulty.

2. Head Slides

Standing/sitting with a wall behind you, tuck your chin to increase the pressure against the wall. Maintaining the pressure, look up and then back down. Complete 10 repetitions.

3. Deep Neck Flexors

Lie on your back on the floor/bed. Lift your head a few millimetres off the floor so that a piece of paper could just slide in between your head and the floor. Hold for 10 seconds.

4. Arm Adduction

Although not a neck exercise directly, improving the pectoral and latissimus muscles can help keep the shoulders down and reduce the stress on the nerves.
Place a pillow under your armpit and squeeze your elbows to your side and hold for 30 seconds.

5. Trapezius Stretch

While sitting/standing with good posture, anchor one hand by your side/behind your back. Look away and down from the anchored arm to allow the trapezius muscle to be stretched. Relax and hold for 30 seconds on each side.

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Summary

• Neck posture is an area that warrants evaluation and correction.
• Daily activities such as texting, using the computer, watching TV and driving are examples of areas where many people can stand to improve their neck position.
• As a society we need to be cautious about how we begin to rely on technology as the long term effects are still being identified.
• Prevention is the best solution to prevent long term neurological complications.
• Correcting neck position during daily activities is the primary prevention tool.
• Additionally, improving global neck strength, endurance and flexibility is vital to increase the neck’s “threshold” and sustain good neck posture for longer.
• There are simple exercises that can help retain neck posture and improve the long term prognosis.