As the use of personal electronic devices continues to entrench itself into our society, we are beginning to see connections between the posture created by staring downward at a screen and associated physical problems in the upper extremities and spine. Neck, shoulder, and upper thoracic spine issues seem to present themselves together on a more consistent basis with the ever-increasing use of handheld devices.
According to data from DataReportal, the average American spends seven hours and four minutes looking at a screen every day.1 Another study by the University of California San Francisco found that U.S. adolescents’ screen time doubled during the pandemic. Researchers found that 12 to 13-year-old children in the United States doubled their non-school-related screen time to 7.7 hours in May 2020, compared to just 3.8 hours the day before the pandemic.2
Does tech neck affect the neck, upper back, shoulders, and arms? A study looking at the association between forward head, rounded shoulders, and thoracic kyphosis concludes that these can exist alone or in any combination.3
Quantifying posture with an app such as PostureScreen and scanning the feet with a 3D laser technology kiosk gives an accurate assessment of where the patient’s posture is weak and if the feet are a contributing factor to that posture.
According to Kendall et al.,4 there should be vertical alignment between the midline of the shoulder and the mastoid process. If the acromion processes are more anteriorly positioned compared with the mastoid processes, a condition known as forward shoulder posture (FSP) or rounded shoulders or protracted shoulders occurs.5 6 This condition is characterized by protracted, internally rotated, anteriorly tilted, elevated, and abducted scapula along with winging of scapula.6 7 8 This poor alignment of the shoulders leads to greater torque production by gravitational forces, which is offset by greater internal forces generated by muscles and other soft tissues around the shoulder.
These imbalances create stress at the cellular level, resulting in the pain-producing inflammation that we see every day. The persistence of the inflammatory reaction creates the potential for injury and degeneration.
The Origins of Tech Neck
As chiropractors, we know that posture is developed by repetition. Neural networks that affect posture and movement patterns are developed by what we practice the most. If you sit slumped over a computer screen eight hours a day, that posture pattern will be created. Those patterns are significantly affected by bilateral, asymmetrical pronation patterns of the feet, which feed sensory input into the cortex with every step and moment of standing.
In addition to the physical stress created by the tech neck posture, spending more time on screens has mental health effects, including more depression and anxiety, said Jason Nagata, MD, lead author on the JAMA Pediatrics study and UCSF assistant professor of pediatrics. “As screen time increased, so did adolescents’ worry and stress, while their coping abilities declined,” Nagata said.
The presence of anxiety and worry are components of an overaroused sympathetic nervous system that also contributes to inhibited postural tone. This forward head posture has been shown to create significant stress on our ability to process sensory information.
The use of a cervical pillow to support the lordotic curve during sleep is also beneficial.
According to the cross-sectional study by Ibrahim M. Moustafa, Ahmed Youssef, Amal Ahbouch, May Tamim, and Deed E. Harrison, “Is forward head posture relevant to autonomic nervous system function and cervical sensorimotor control?”9, it was concluded that forward head posture negatively affects cervical sensorimotor control and the autonomic nervous system, and that there is a strong correlation between the cervical vertebral angle and cervical sensorimotor outcomes. Forward head posture, which is commonly the result of our chronic, persistent use of electronic devices, negatively affects our ability to efficiently process sensory input, which produces optimal movement patterns and posture.
This is such an important point; the body is not capable of good posture and efficient functional movement if the sensory input telling the muscles when and how to contract is compromised neurologically. This process is also deeply rooted in the feet with the asymmetrical pronation pattern that is typically seen. This foundational pattern elicits a nociceptive reflex that inhibits postural tone. The presence of a neurologically compromised pedal foundation along with the habitual cervicothoracic flexion posture creates the perfect storm for developing neck pain, upper back pain, rotator cuff syndrome, and radiating symptoms into the arm and hands.
Chiropractors Are Uniquely Skilled to Treat Tech Neck
As chiropractors, we have a significant number of tools available to us to address the various components of this potential pain syndrome, but it is important to be sure to address all the major contributors. Only addressing pain with chiropractic adjustments and modalities misses many long-standing causes of dysfunction and pain.
Successful resolution of the upper extremity /rotator cuff syndrome often includes a multifaceted approach. This approach can include a strategy that addresses the effect feet have on posture with custom, threearch flexible orthotics. Spinal and extremity adjusting paired with therapeutic exercise to reengage muscles of posture is effective in creating new patterns of movement. The use of a cervical pillow to support the lordotic curve during sleep is also beneficial. Cervical decompression and cervical extension-traction exercise are also helpful in creating new postural patterns. While we can do many things in our practice, behavior modifications must also be implemented. Creating a more ergonomic workspace with a standing desk may be helpful. Being mindful to hold the phone or tablet at eye level while reading or texting will break the cycle of looking down in flexion.
As we continue down the path of increasing technology use, we must create new habits and patterns to counteract the negative effects of tech neck.
Dr. BrianJensenisagraduateofPalmerChiropractic College and owner of Cave Spring Chiropractic 'n Roan°ke, Virginia. He has been in practice for 'Jlv over 31 years. As a member of the Foot Levelers A\ JO Speakers Bureau, he travels the country sharing his B'/nW knowledge and insights. See continuing education seminars with Dr. Jensen and other Foot Levelers Speakers at footlevelers.com/continuing-education-seminars.
References
1. comparitech.com/tv-streaming/screen-time-statistics/
2. ucsf.edu/neM> s/2021/11/421701/adolescent s-recreational-screen-time-doubled-during-pandemic-affecting-mental
3. ncbi. nlm. nih.gov pmc articles PMC5659804/.
4. Kendall FP, McCreary EK, Provance PG, Rodgers M, Romani W. 5th ed. Lippincott Williams & Wilkins; Philadelphia, PA: 2005. Muscles: Testing and Function, With Posture and Pain. [Google Scholar]
5. Raine S, TM’omey LT. Head and shoulder posture variations in 160 asymptomatic women and men. Arch Phys Med Rehabil. 1997;78(11):1215-1223. [PubMed][Google Scholar[
6. Michener LA, McClure PW, Karduna AR. Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech (Bristol, Avon) 2003;18(5):369-379. [PubMed] [Google Scholar]
7. RuivoRM, Pezarat-Correia P, CaritaAI. Cervical and shoulder postural assessment of adolescents between 15 and 17years old and associationwith upper quadrant pain. BrazJPhys Ther. 2014;18(4):364— 371. [PMCfive article] [PubMed] [Google Scholar]
8. Ghanbari A, Ghaffarinejad F, Mohammadi F, Khorrami M, Sobhani S. Effect of forward shoulder posture on pulmonary capacities of women. Br J Sports Med. 2008;42(7):622-623. [PubMed] [Google Scholar]
9. https://doi.org/10.1016f.gaitp...
