Text Neck - Is Your Smart Phone Ruining Your Cervical Spine?

Extreme head flexion angles created when texting may lead you to pain.

Text neck risk position.
Texting can cause extreme head flexion which may lead to neck pain. But holding your device up with your hands may stress your forearm muscles.. Photographer: Christopher Kimmel/Collection: Aurora Open/ Getty Images

Text Neck - Is Your Smartphone Ruining Your Cervical Spine?

Regular use of your smartphone may lead to preventable neck problems. 

The condition is called text neck, Smartphone neck, iPhone neck and now (coined by me,) Android neck. Note: These are not official medical diagnoses. All refer to posture problems in the cervical spine that are created by prolonged use of a cell phone, tablet or similar hand held electronic device.

Using small electronic devices generally means you spend a lot of time with your head bent forward.  The problem is - this head action actually takes place in your neck.

Related: Forward Head Posture

“People get so focused on these devices that they end up holding their neck and upper back in abnormal positions for a long period of time; enough that other people coined the phrase ‘text neck,’ which is essentially referring to postural pain,” says Chris Cornett, M.D., orthopaedic surgeon and spine specialist at the University of Nebraska Medical Center Department of Orthopaedic Surgery and Rehabilitation.

Dr. Cornett continues, “When you hold your body in an abnormal position, it can increase stress on the muscles, cause fatigue, muscle spasms and even stress headaches."

Related: 5 Causes of a Military Neck

Text Neck Risks

A study by Lee and colleagues published in the October 2014 issue of Ergonomics found that repetitive or prolonged head flexion posture during smart phone use is a risk factor for neck pain.

The study looked at 18 participants who performed 3 tasks with a smart phone: Texting, browsing and watching a video. Participants did these activities while sitting and also when standing.

Not only did the study identify head flexion associated with heavy smart phone use as a risk factor for neck pain, it also found that of the 3 activities, texting may be the biggest contributing factor to device use related neck pain.

 (The authors say that texting is the most frequently performed of these functions.) In the study, texting while sitting caused the largest degree of head flexion.

Text Neck Symptoms

According to Jeremy McVay, physical therapist and owner of McVay Physical Therapy in Barrington, Rhode Island, possible symptoms of "iPhone neck" (or "Android neck" - my addition) include headaches, neck pain, shoulder pain, and nerve related symptoms such as radiating pain, numbness, tingling and/or burning in one or both arms.

Related:  Do You Have Nerve Symptoms?

A 2012 study involving 18 people conducted at Google headquarters in Mountainview, California, looked at (among other things related to tablet use) how much head flexion resulted from checking email and surfing the web. This study also measured head flexion as people watched movies on their tablet while sitting at a table.

The researchers found that participants who used the tablet without a table (i.e. with the device on their laps) had extreme head flexion.

The head flexion for movie watchers at tables was less.

How to Avoid or Prevent Text Neck

Perhaps the best strategy for mitigating the effects of device usage on your neck is to raise your viewing angle. For this, there are a few things to try.  You can put the tablet on a stand or on a table. If you must work with it on your lap, consider propping it up with a pillow.

And if you think holding the tablet up with your hands may reduce your head flexion angle, beware.  This positioning will likely tighten up the muscles in your forearms, which can cause an entirely different type of discomfort or pain.

Dr. Cornett offers common sense approaches to avoiding text neck such as getting and staying physically fit and taking regular breaks from your device. Both strategies are excellent.

You may also consider engaging with a posture exercise program.  If you can only do one exercise, I recommend cervical retraction for neck re-positioning.

Related:  Try a Posture Exercise Program.


Lee S1, Kang H, Shin G. Head flexion angle while using a smartphone. Ergonomics. 2014 Oct 17:1-7. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/?term=Lee+S1%2C+Kang+H%2C+Shin+G.++Head+flexion+angle Accessed October 26, 2014

McVay, J. DPT, CSCS, MPT, BS., Are you Developing Smartphone Neck? Patient Handout. McVay Physical Therapy, Barrington, Rhode Island. Accessed October 26, 2014. http://physical-therapy.advanceweb.com/sharedResources/Downloads/2013/010713/PT_iPhoneNeck.pdf

Muller, H., Gove, J., Webb, J., Understanding Tablet Use: A Multi-Method Exploration. Google, Inc. Mountain View, CA. Accessed Oct 26 2014.

University of Nebraska Medical Center (UNMC). "Texting becoming a pain in the neck." ScienceDaily. ScienceDaily, 26 February 2013. http://www.sciencedaily.com/releases/2013/02/130226101259.htm

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