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Text Neck - The Risks of using a Smart Phone

There has been increase in the number of young patients seeking help for neck and upper back pain. They are appearing with changes in their neck which are normally associated with older age groups. The factor they have in common is their use of smart phones which are held in their hand and involve them looking down for long periods of time.

Neck pain is the most commonly reported source of musculo-skeletal pain for mobile phone users, with some studies showing a link between the amount of flexion in their neck when holding their phone in their hand and the amount of pain they are experiencing.1 People holding a smart phone are found to bend their neck more than those using a tablet. Holding a phone in the hand seems to result in a greater bend in the neck and increased muscle activity than when the phone is on the table. 2 There is an association between the time texting and persistent neck and upper back pain, as well as pain in the shoulder and numbness or tingling in their fingers. Activities such as browsing on the internet and gaming leads to more pain than using a phone for reading.3Another study found those spending more time internet browsing had an increased likelihood of pain in their right thumb and shoulder. 4

Holding the neck in flexion for long periods of time is likely to increase pressure through the discs in the neck. Studies of people with low back pain who spent a lot of time leaning forward were found to have increased pressure through their lumbar discs.5  The greater amount of flexion the neck is held in, the greater the weight of the head, resulting in increased load on the discs. A head held in a neutral position weighs about 10-12 pounds compared to 49 pounds if the neck is held in 45 degrees of forward flexion.6This could lead to herniation of discs (so called slipped discs) as well as shortening of ligaments in the front of the neck and permanent curves in the cervical spine (including the so-called dowagers hump). This could have greater consequences for younger people whose bone structures are not fully developed.

It is important that there is greater patient awareness and lifestyle changes. Holding a mobile at eye level using 2 thumbs may make things more symmetrical and reduce the amount of flexion in the neck. Using stands and separate keyboards and mouse are helpful for those using laptops and tablets. Patients should be given stretches for the front of the neck and strengthening exercises for the back of the neck and upper back. It is however, important to reduce the amount of time spent using these devices.


  1. Xie Y et al. “Prevalence and risk factors associated with musculo-skeletal comlaints among users of mobile handheld devices” Applied Ergonomics 2017;59:132-4
  2. Ning et al International Journal of Industrial Ergonomics 2015
  3. Gustafsson E et al. “Texting on mobile phones and musculoskeletal disorders in young adults: A 5 year cohort study” Applied Ergonomics 2017;58:208-14
  4. Berolo S et al “Musculoskeletal symptoms among mobile hand-held device users and their relationship to device use” Applied Ergonomics 2011;42:371-378
  5. Nachemson AL, “Disc Pressure Measurements” Spine 1 1981 93-7
  6. Cueller JM et al. “Text neck: an epidemic of the modern era of cell phones” Spine Journal 2017;17(6):901-2