【Chiropractic Research】Preventing the progression of text neck in a young man
This case highlights the progression of text neck, which was insufficiently treated in a young man. The patient subsequently underwent nine months of chiropractic intervention. He reported resolution of pain and neurological symptoms in the neck and shoulder and regained neck mobility, which were supported by the improvement of radiographic and electromyological findings. Surgery is usually not indicated for mechanical causes of neck pain, unless there are progressive neurologic deficits or intractable pain and disability that is unresponsive to conservative treatments . Avoiding prolonged texting along with maintaining a correct position are keys in preventing or addressing text neck .
A 24-year-old male YouTuber presented with head and neck pain and paresthesia of the right upper limb for 12 months. He denied any injury event. During the past three years, the patient regularly edited blogging and videos on the YouTube website. He relied heavily, at least 16 hours a day, on a smartphone for both job resources and personal tasks. He would check his screen every 10 minutes. One year prior to this diagnosis, the patient experienced similar symptoms and visited his family physician. Cervical radiographs (Fig. 1) exhibited reduced cervical lordosis, axial rotation of the C5 vertebra, and degenerative proliferation of facets (white arrows) and uncovertebral joints (yellow arrows), suggestive of cervical spondylosis. Previous management included pain medication and muscle relaxants. Interventions included repeated physical therapy, cervical traction, and acupuncture, with some temporary relief. However, 12 months later, the patient repeatedly experienced severe flare-ups of the symptoms. This time, the patient could keep his head up for only a minute and was unable to move his neck without pain. These new difficulties forced him to seek chiropractic attention.
Mobile texting and gaming is a growing lifestyle and health concern, with the constant growth in mobile/smartphone usage and adoption. Researches [9,10] revealed that the distinct cervical flexion seen in heavy smartphone users is causing a new overuse condition known as "text neck." The fulcrum for flexion in the cervical spine in adults is at the C5/C6 level . A neck flexion of 0° to 15° is akin to having the head squarely over the shoulders, wherein the stress on the cervical muscles is acceptably low . A static and flexed neck posture can cause continuous strain of the posterior cervical musculature (the cervical erector spinae and suboccipital muscles, levator scapulae, and semispinalis and trapezius muscles), producing tension headaches, neck and shoulder pain, temporomandibular joint pain, and decreased cervical and upper thoracic ranges of motion . Sustained flexed stress can also slacken posterior ligamentous structures, resulting in instability between vertebral segments, degenerative spondylosis, and vertebral body sliding [2,11]. In the long term, text neck can lead to plastic changes within the nervous system, causing sensorimotor integration deficiencies and further dysfunction .
When the neck is in flexion position, the paraspinal muscles act as antagonistic muscles to maintain compliance of the posture, which results in increased myoelectric activity . Surface electromyography (sEMG) is a reliable technique to evaluate muscle activity. Applying two handheld recording electrodes on both sides of the spine 4 cm apart, static sEMG will record and process the level of muscle guarding quantitatively. The signal amplitude of sEMG is positively related to the amount of force produced by the muscles. The levels of muscle tension are displayed with the length and color of the bars in the schematic representation. The sum of all muscle activity readings (in microvolts) for both sides at all levels of the spine is referred to as the electrophysiological (EP) stress score (Fig. 3). In the present study, sEMG was used to assess the myoelectric activity of the paraspinal muscles in the patient with text neck syndrome before and after treatment. It was found that the signal amplitude and EP stress score were significantly different before and after the 9-month chiropractic therapy and were significantly correlated with symptom relief and cervical curvature correction, suggesting that sEMG could be used to objectively assess muscle functional change.
A long-lasting neck flexion due to excessive texting on a smartphone was assumed to be hazardous to cervical structures. Researchers have observed that 10 minutes of static flexion can lead to changes in mechanical and neuromuscular behavior of the cervical spine, potentially leading to decreased strength of cervical spine structures . Surgery is usually not indicated for mechanical causes of neck pain, unless there are progressive neurologic deficits or intractable pain and disability that is unresponsive to conservative treatments . Manual therapy has been shown to have a clinical benefit in correcting reversed cervical curvature [4,6,14]. Treatments for text neck syndrome should target neck problems and be tailored for individual patients based on their treatment responses. Regarding the current case, extension traction therapy is designed to target the anterior longitudinal ligament that attaches to the front of each vertebra. The viscoelastic properties of ligament fibers allow them to accommodate sustained loads. It is presumed that the restoration of natural cervical lordosis following extension traction therapy is mostly due to ligamentous creep (stretching) . Text neck is an altogether preventable overuse degeneration that must be brought into high awareness for smartphone users .
Conclusion: In conclusion, the current study reported a progression of text neck, which has been insufficiently treated. Sustained flexion of the neck will cause cervical spine distortion. The improvement of neurologic symptoms has been shown to correlate with radiographic and electromyological alterations responding to the correction of cervical misalignment.
- David D, Giannini C, Chiarelli F, Mohn A. Text neck syndrome in children and adolescents. Int J Environ Res Public Health. 2021;18(4):1565. doi: 10.3390/ijerph18041565. - DOI - PMC - PubMed
- Chu ECP, Wong AYL. Cervicogenic dizziness in an 11-year-old girl: A case report. Adolesc Health Med Ther. 2021;(12):111–116. doi: 10.2147/AHMT.S341069. - DOI - PMC - PubMed
- Chu ECP, Chu VKY, Lin AFC. Cervicogenic headache alleviating by spinal adjustment in combination with extension-compression traction. Arch. Clin Med Case Rep. 2019;3(5):269–273. doi: 10.26502/acmcr.96550090. - DOI
- Chu ECP, Chin WL, Bhaumik A. Cervicogenic dizziness. Oxf Med Case Rep. 2019;2019(11):476–478. doi: 10.1093/omcr/omz115. - DOI - PMC - PubMed
- Chu ECP, Lim T, Mak KC. Cervical radiculopathy alleviating by manipulative correction of cervical hypolordosis. J Med Cases. 2018;9(5):139–141. doi: 10.14740/jmc3051w. - DOI
- Chu ECP. Alleviating cervical radiculopathy by manipulative correction of reversed cervical lordosis: 4 years follow-up. J Fam Med Prim Care. 2021;10(11):4303–4306. doi: 10.4103/jfmpc.jfmpc_648_21. - DOI
- Neupane S, Ali U, Mathew A. Text neck syndrome-systematic review. Imperial J Interdiscipl Res. 2017;3(7):141–148.
- Safikhani S, Gries KS, Trudeau JJ, Reasner D, Rüdell K, Coons SJ, et al. Response scale selection in adult pain measures: results from a literature review. J Patient Rep Outcomes. 2017;2:40. doi: 10.1186/s41687-018-0053-6. - DOI - PMC - PubMed
- Namwongsa S, Puntumetakul R, Neubert MS, Boucaut R. Effect of neck flexion angles on neck muscle activity among smartphone users with and without neck pain. Ergonomics. 2019;62(12):1524–1533. doi: 10.1080/00140139.2019.1661525. - DOI - PubMed
- Ahmed S, Akter R, Pokhrel N, Samuel AJ. Prevalence of text neck syndrome and SMS thumb among smartphone users in college-going students: a cross-sectional survey study. J Public Health (Berl) 2021;29(2):411–416. doi: 10.1007/s10389-019-01139-4. - DOI
- Fiebert I, Kistner F, Gissendanner C, DaSilva C. Text neck: an adverse postural phenomenon. Work. 2021;69(4):1261–1270. doi: 10.3233/WOR-213547. - DOI - PubMed
- Qiao J, Zhang SL, Zhang J, Feng D. A study on the paraspinal muscle surface electromyography in acute nonspecific lower back pain. Med (Baltim) 2019;98(34):e16904. doi: 10.1097/MD.0000000000016904. - DOI - PMC - PubMed
- Mousavi-Khatir R, Talebian S, Toosizadeh N, Olyaei GR, Maroufi N. The effect of static neck flexion on mechanical and neuromuscular behaviors of the cervical spine. J Biomech. 2018;72:152–158. doi: 10.1016/j.jbiomech.2018.03.004. - DOI - PubMed
- Chu ECP, Lo FS, Bhaumik A. Plausible impact of forward head posture on upper cervical spine stability. J Fam Med Prim Care. 2020;9(5):2517–2520. doi: 10.4103/jfmpc.jfmpc_95_20. - DOI - PMC - PubMed
- Fortner MO, Oakley PA, Harrison DE. Cervical extension traction as part of a multimodal rehabilitation program relieves whiplash-associated disorders in a patient having failed previous chiropractic treatment: a CBP ® case report. J Phys Ther Sci. 2018;30(2):266–270. doi: 10.1589/jpts.30.266. - DOI - PMC - PubMed