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Neck Posture and Device Use

A research-based discussion on the effects of looking at hand-held devices

It’s the school holidays and many of you in NSW will be confined to barracks (lock down, a maximum-security prison term referring to all inmates being locked in their cells for an extended period of time – usually to restore order after some sort of riotous behaviour).

What to do? The school children and adults are now faced with finding amusement within the home. Many of the holiday activities are off limits, so a screen is a great diversion. Now we have all day to fill, so the time spent on phones, tablets and gaming devices can be many hours at a time.

You are right in thinking that it is not good for posture and that the mood of the kids and adults seems to go downhill as they spend more time playing games and watching endless video clips.

I spent some time looking through the research and quite quickly found a number of articles that paint a pretty grim picture of the effects of long hours spent looking at a hand-held device.

The change in posture to a forward head posture or carriage has profound impacts. In a growing body we are creating a lifetime posture change that will create a raft of problems later in life and some immediately.

Neck tension and pain are obvious. We know from the Posture Pro analysis software that small degrees of forward head posture increase the work of the neck muscles hugely. The functional weight of the head is doubled quite quickly with a moderate degree of slouchy posture and ear forward of the shoulder.

The loss of neck lordosis or curve is a very common finding in young people when the neck is X-rayed. This is commonly a driver of headache and jaw issues.

There is good research that confirms the clinical association between forward head carriage (carpet staring) and depression. These articles quoted below also had the same findings.

In addition, we also see a change in Heart Rate Variability with slouched posture and head forward posture. The loss of HRV is significant. Low HRV is an indicator of low adaptability and increased stress response. This is a cause of lowered immunity and impaired memory.

I do understand that the target audience is hard to convince that their habits are doing them harm. The addictive nature of gaming is well documented.

https://onlinelibrary.wiley.com/doi/abs/10.1111/ajad.12110

In the several article abstracts below I have aimed to give a balanced view of the recent research on this topic. Research goes in cycles and there may be reduced funding to further research this topic as it will impinge on a very lucrative business.

Men display greater neck and head flexion than women when using mobile phone when standing.

https://www.tandfonline.com/doi/abs/10.1080/00140139.2016.1147614

Using photos it was shown that neutral posture determined the degree of neck and head flexion when viewing a phone when standing.

https://link.springer.com/article/10.1007/s00586-015-4143-3

Analysis of the predictors for pain severity showed that age (p = 0.04) and duration of use (p = 0.001) were significantly associated with the severity of neck pain, while only the duration of use was significantly associated with pain duration (p = 0.036). Subjects were divided into two groups according to the pain score, 75.8% had pain severity equal or less than 4/10 and 24.2% had pain severity more than 4/10. Of those with pain severity >4, 5.8% of students sought medical help at the emergency department and 12.4% visited clinics, compared to only 0.3% seeking medical advice at an emergency department and 4.2% visiting clinics in the group with pain severity of ≤4 (p<0.001). Regarding the use of analgesia in the two groups, 44.6% of subjects with pain severity of >4 used analgesia, compared to only 12.1% in subjects with pain severity of ≤4 (p< 0.001).

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0217231

370 subjects experienced a range of symptoms that were related to phone use.

  • Warming of ears - 57%
  • Headache among women who slept with their phone under their pillow – 29%
  • 53.3% of men who kept their phone in their chest pocket experienced palpitations
  • Frequent episodes among all participants of study was palpationas 44%
  • Migraines were experienced infrequently among 72%
  • Exposure to Cell Phone radiations was linked to anger in 29% of participants
  • Depression and Anxiety was linked to phone radiation by 40%

https://www.academia.edu/25179302/Association_of_Cell_Phone_Radiations_with_Various_Disease_Symptoms_Amongst_370_Subjects_Residing_in_Peshawar?from=cover_page

A high school survey involving 12-15 yr olds showed that high levels of phone use caused most of the respondents become lazy and they encountered lack of sleep, lack of concentration, and having misunderstanding between their classmates. These negative effects could affect their academic performance in school like they cannot participate and perform well in class. The researchers conclude that most of the respondents become addicted to their cellphone and by means of these it can cause of low academic performance in school.

https://www.academia.edu/40715458/Negative_Effects_of_Cellular_Phone_in_Academic_Performance_of_Junior_High_School_Students_in_St_Gregory_College_of_Valenzuela?from=cover_page

A syndrome, in medical practice, is the anthology of signs and symptoms that are ascertained in, and emblematic of an exceptional condition. Considering all above facts and after reviewing the literature the authors propose that it is advisable to coin the condition of head and neck pain associated with mobile phone usage as mobile phone head and neck pain syndrome (Dr Bader and Dr Santosh Syndrome) when there is presence of• Neck pain• Headache Along with other symptoms such as:• Irritability • Anxiety • Lack of concentration • Straining of eyes • Insomnia •  Memory problems • Depression • Itching or erythema of periauricular skin. We also emphasize that other than the above positive signs; there should be no history of psychological, neurological and musculoskeletal disorders before the usage of cell phone.

The aim of this study was to assess the health effects of mobile phone usage among university students of Saudi Arabia and proposal of a new syndrome. Subjects and methods: 396 students studying in dental college and medical college of Aljouf university, Kingdom of Saudi Arabia were included in the study. They were given self-administered, pre-tested questionnaire which included various mental and physical health symptoms related to mobile phone usage. Results: Cervical pain was the most commonly reported complaint, which was seen in 71.2% of study respondents, followed by headache (63.3%), irritability (54.5%), anxiety (50.7%), lack of concentration (47.4%), straining of eyes (36.8%), insomnia (31.3%), memory problems (28.5%), depression (19.69%). Itching and/or erythema of periauricular skin the least commonly seen complaint (16.91%). Conclusion: The findings of the present study demonstrate that excessive use of mobile phones pose significant health related problems, more specifically in head and neck region. The mobile phone users usually experience subjective symptoms, the intensity of which is dependent on the intensity of use of mobile phones.

https://www.dropbox.com/s/fbzv1vlpn38qrw6/mobile-phone-head-and-neck-pain-syndrome-proposal-of-a-new-entity-2247-2452-1000833-with-cover-page-v2%281%29.pdf?dl=0

Objective: To assess the co-morbid factors associated with Text-neck syndrome among mobile phone users and also identify their severity. Materials and Methods: 59 confirmed cases of Text-Neck syndrome within 18-25 years of age who use mobile phone on an average of about 3 or more than 3 hours in a day and having 3 out of 6 symptoms of Text-Neck were taken and Forward head posture, Grip strength, Active cervical joint ROM and Neck muscles’ strength were assessed in them and the measurements were noted. Results: 100% showed neck pain and Forward head posture while 94.91% with upper back pain, 89.83% with headache and poor grip strength and 59.32% with shoulder pain. Conclusion: There are various co-morbid factors of Text-Neck syndrome out of which severity of Neck pain and upper back pain is more followed by headache, shoulder pain. Also Forward Head Posture is one of the main serious co-morbid factors. Along with that, cervical joint ROM mainly flexion, extension and lateral flexion (left and right both) are restricted. As stated above, smartphone induced neck pain and other co-morbid factors are of chronic, progressive nature, timely interpretation and interventions along with postural correction will be the key entities to deal with Text-Neck syndrome.

https://www.dropbox.com/s/y699odjv5xn6cru/4701-with-cover-page-v2.pdf?dl=0

A forward head posture (turtleneck posture) is becoming more common with the increasing popularity of smartphones. The aim of this study was to evaluate the craniovertebral angle, head position angle, pain threshold of the sternocleidomastoid and upper trapezius muscles, and presence of depression in heavy smartphone users compared to a control group. Twenty healthy students participated in the study. The participants were recruited from Sahmyook University and were divided into a heavy user group (n=10) and a control group (n=10) according to smartphone addiction proneness. Participants in both groups were assessed for their pain pressure threshold of the sternocleidomastoid and upper trapezius muscles, craniovertebral angle and head position angle, and depression. When comparing the results between the two groups, there were significant differences in the pain threshold of the sternocleidomastoid and upper trapezius muscles, head position angle, and depression (p<.05), but not in the craniovertebral angle. Based on the results, this study shows that heavy smartphone use may produce considerable stresses on the cervical spine, thus changing the cervical curve and pain threshold of the muscles around the neck. Smartphones could also cause negative effects on a person’s psychological status, such as depression. Therefore, individuals should make an effort to look at their phones with a neutral spine and to avoid spending hours hunched over their screens each day.

https://www.dropbox.com/s/j6ea0d6b16iuxdy/TheEffectsofHeavySmartphoneUseontheCervicalAnglePainThresholdofNeckMusclesandDepression.pdf?dl=0

The last article is available as a PDF download on the link. It is particularly thorough as it looks at the results of a number of previous studies and then does some further study to clarify a few of the areas of concern raised by earlier research.

Of particular interest to me is the impact on depression, sleep and anxiety.

We know from our HOS data collection that the client questionnaires show significant association between posture and depression and ease and functions of daily living.

The addictive nature of many of the social media platforms and game apps, means that rational discussion will not result in changed behaviour. Cold turkey and substitution is probably the most effective course of action.

Spending time with family doing things that are fun and emotionally rewarding such as board games, camping etc. all provide social experience that will balance the sense of loss of the reward stimulation that the digital world provides.