A Real Pain in the Neck

 By Donna Shryer, November 1, 2021

Surveys say there are more than 290 million smartphone users in the United States,¹ which translates to 85 percent of Americans now talking, texting, scrolling, pinching and tapping a smartphone.²

Distilling the data down to individual usage, the average American spends about four hours and 23 minutes every day staring at a six- or seven-inch mobile screen—and experts predict that this total will reach around four hours and 35 minutes by 2023.³

It’s important to point out that this prediction is being adjusted daily, with a new survey from the financial planning firm TIAA reporting that the pandemic has Americans now spending four times longer than ever before scrolling through social media.⁴

It’s no wonder that hunching forward over small screens while holding the shoulder girdle in a less than ideal position has produced a chronic lifestyle condition called tech neck, sometimes referred to as text neck.

“I would guess that almost everybody has some degree of tech neck these days,” says Brian P. McCullough, LMT, owner of Relaxation Restoration in Wheaton, Ill. “We’re working from home and most of us are on small devices and sitting on a kitchen chair, a couch or even a bed. That puts a lot of stress on the back, spine, shoulders, arms and legs. And since I don’t see a permanent return to the traditional office with ergonomically correct workstations, I think tech neck is going to get worse.”

The Devil Is in the Details

In simple terms, this chronic affliction results from hunching forward with rounded shoulders for extended periods of time over a hand-held mobile phone or tablet. And desktop users aren’t exempt. Tech neck can also result from holding your head unnaturally far forward to stare at a desktop computer monitor.

This unnatural posture, over time, can cause repetitive strain and injury that presents as neck pain, shoulder pain, upper back pain, chronic headaches and increased curvature of the spine. The soreness can range from chronic, nagging discomfort to sharp, stabbing, localized pain.⁵

No single muscle gets full credit for tech neck, says Jessica Crow, LMT, registered yoga and meditation instructor based in New York City. Crow paints a mental image of what’s going on. “The human head weighs 10 to 12 pounds, and with every inch the head moves forward and out of alignment—balanced on top of the neck and shoulders—it doubles in weight, essentially. The muscles, tendons, ligaments, etc., have to work that much harder to keep the head up.”

Holding this unnatural forward posture results in overstretched, hypertonic, fatigued muscles in the posterior neck and upper back. In the front of the body, muscles can begin to shorten from being in a slack position for long periods of time, says Donald Wolfkill, LMT, owner of Customer Performance Massage in Wexford, PA.

“I think the key neck muscle that’s particularly important to this specific condition is the sternocleidomastoid muscle (SCM),” says Bridget A. Riley, LMT, owner of The Pampered Spirit Wellness Center in Point Pleasant, N.J. The SCM is an important landmark in the neck because it divides the neck into an anterior and posterior triangle. The muscle binds the skull to the sternum and clavicle, with its anchoring point in front of the body and the attachment point in the back of the head. Because of this, the SCM pulls the head forward and tilts the head into extension.

By no means a definitive list of muscles affected by tech neck, these are the posterior muscles most often linked to weakness due to a long-term forward head and hunched shoulder posture.

Deep cervical flexors, including the cervical spine’s C1-C7 vertebrae, weaken and lengthen when the chin tilts down and away from the neck, which is sometimes called chin poking.

Erector spinae muscles, attached to the lower cervical spine and upper thoracic spine, help the spine rotate and straighten up. When these muscles lengthen and lose strength, they’re less able to keep the neck and upper back from hunching forward.

Shoulder blade retractors, meaning the upper back’s middle trapezius and rhomboid muscles, help hold the shoulder blades back and the chest open. When weakened, these muscles collapse into a hunchback posture, which worsens tech neck symptoms.

While not a muscle, occipital neuralgia plays a key role in tech neck. These nerves, which exit the spine at the base of the neck, thread their way up the back of the neck and through several muscles until reaching the skull. Tense neck muscles have been known to put pressure on occipital nerves and exacerbate tech neck.

While it may seem counterintuitive, tech neck often includes anterior muscles, Wolfkill says. “Opposing muscles that pull you forward when you’re hunched over can become artificially shortened. So, when I first see a client lie face up on the table and their shoulders are curled forward, that can indicate tightness in the pecs, coracobrachialis and rotator cuff muscles.”

As muscles tighten, shorten, lengthen and generally remodel themselves into new positions, they can “forget” their purpose. “Our bodies try to make things easier for us,” McCullough says. “So, if you’re always going into a hunched over position, your muscles will get trained to encourage that position.”

With some muscles overworking to achieve a hunched over position, other muscles aren’t firing at all, and that’s when atrophy can creep in, says Heather LeFevre, LMT, based in Oakland, Calif. “If you break your arm and it’s in a cast, the arm muscles atrophy—and we need physical and massage therapy to bring the muscles back. It’s the same thing when we spend 12 hours a day for years on end hunched over a small screen. In both cases, muscles are atrophying.”

Massage For Tech Neck

The consensus says that tech neck responds well to muscle release techniques, also known as Myofascial Release (MFR). The strategy puts light sustained pressure on targeted fascia connective tissue to reduce pain and reestablish motion. “This is my main technique for anything—but especially for tech neck,” says McCullough. “It combines the aspects of active isolated stretching with light massage, or pressure, over the affected muscle groups.”

Specific to anterior muscles, Riley sends out a cautionary reminder: “People hear ‘neck’ and work from the back. But to be effective, you have to work the front also. Everything’s connected. And in front, I use trigger point therapy.” In this way, she can soften anterior muscles with appropriate pressure on knots in the muscle fiber that contribute to the neck pain.

Down to a Science

“About five years ago, I started teaching a class called Working With Tech Neck: A Digital Age Epidemic. And so many people said it was ‘fake news’ that chiropractors made up,” Crow recalls. “But it’s a real syndrome, and I’m glad the information is finally getting out there.”

Science, too, is bearing down on why and how tech neck develops. Here are five studies gaining attention.

Prolonged use of smartphones can negatively impact both posture and respiratory function, reported a study titled The Effect of Smartphone Usage Time on Posture and Respiratory Function. The study found that those who used their phone for more than four hours daily had a lower CVA (craniovertebral angle) measurement, referring to how much the head protrudes forward, and a lower scapular index, a measurement of rounded shoulder. Peak expiratory flow (PEF) tests concluded that those with prolonged smartphone usage exhibited poor posture that leads to shallow breathing.⁶

A systematic review, titled Musculoskeletal Disorder and Pain Associated with Smartphone Use: A Systematic Review of Biomechanical Evidence, revealed that the use of smartphones may contribute to the occurrence of clinical and subclinical musculoskeletal changes as well as associated factors in the head and neck, shoulder and arms, and hand and thumb areas. The review pointed to evidence that smartphone use in a sitting position “seems to cause more shift in head and neck angle than in a standing position.⁷

A cross-sectional study, titled The Relationship Between Smartphone Addiction and Musculoskeletal Pain Prevalence Among Young Population, indicated that the upper back, neck and wrists/hands have a higher prevalence of musculoskeletal pain among smartphone users, “particularly those with a smartphone addiction.” Smartphone addiction scores correlated with duration of smartphone use on a typical day and musculoskeletal pain prevalence in the neck, wrists/hands, shoulders and upper back.⁸

A systematic review, titled Text Neck Syndrome, investigated 10 studies and concluded that “timely interpretation and interventions along with good knowledge about postural correction” are key to diagnosing and treating text neck syndrome.⁹

Recent data would indicate that new technologies are causing a shift in tech neck prevalence from adults to those of pediatric ages. To confirm this hypothesis, a case report, titled Text Neck Syndrome in Children and Adolescents, followed a 16-year-old girl with a medical history of headache, dizziness and acute neck pain. The study set out to determine if she had text neck syndrome and to then consider if prolonged and excessive use of smartphones or computers could trigger increased stresses on the cervical spine that might lead to cervical degeneration along with other developmental, medical, psychological and social complications. There was no definitive conclusion, although the study strongly recommends further examination.¹⁰

Soothing the Pain

There are at-home, DIY ways that may help alleviate or even avoid tech neck. Here are several self-care practices to share with clients suffering tech neck symptoms.

Stretch. Riley recommends the doorway stretch for a few minutes several times a day. Place palms and forearms against the door jambs, with fingertips toward the sky and elbows shoulder height. Now look forward—not down or up—and lean forward for a good stretch but without moving your arms’ positions. To add an extra stretch, do as above but put one leg forward and stretch. Then switch legs. Be careful to not step so far forward that your back arches, Riley adds.

Create an ergonomic work base. “Working from home is still here—almost two years later—so it’s time to give yourself a proper workstation,” LeFevre says. And it need not break the budget, she adds. “When you sit, you want a stool where your hips are higher than your knees. And you want a desk high enough to keep your eyes at the top third of your screen. To help prevent hunching forward and keep your arms at a 90-degree angle, it’s best to have a keyboard and trackpad separate from the laptop, which can help keep the forearms resting on the table.”

Reverse the hunch. “Some clients who work on digital devices all day and all night will assume a hunchback position,” Wolfkill says. So, I coach them to lie flat on the floor—for a few minutes a couple times a day—and think about letting their shoulders drop back.” To intensify the stretch, slip a rolled blanket or yoga roller under the back perpendicular to the spine. “The stretch counteracts your usual hunchback posture,” Wolfkill says.

“We need to pay closer attention to this chronic condition we call tech neck,” cautions Crow. “Companies are talking about keeping the workweek semi-remote, which means people really need to rethink their workstation. And we need a serious discussion about boundaries. Our bodies can’t take hunching over a small device all day for business and all night for entertainment. It’s more important than ever to be mindful about how many hours you’re on the phone or tablet and how often you take breaks.”

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