July 3, 2021

What a Pain in the Neck! -- Explaining Text Neck Syndrome

Written by: Amanda Cheong, M.D.
Reviewed by: Mubashar Rehman, PHD

No one likes going to the hospital.


Yet, a 16-year-old girl found herself being admitted into a pediatric unit for a set of puzzling symptoms. Her head would often hurt, with dizziness as a twin that followed close behind. She had a sudden onset of pain in her neck. Imagine something dull and twisted instead of the sharpness that comes with trauma because they didn’t unearth any history of trauma or fever-- otherwise helpful symptoms that would readily point the compass towards the correct diagnosis. Her blood was taken and analyzed. Then she was passed on from one doctor and one set of physical exams to another. The ophthalmologist examined her and jotted down that the dizziness had nothing to do with her eyes. A head and neck doctor similarly wrote that the dizziness was not an ear problem. A neurologist figured that the dizziness might be from brain pathology, and an MRI or a kind of brain scan was advised. There, they caught a glimpse of the culprit-- but it wasn’t the brain. It was a little lower, right at her neck. Posterior disc protrusion at the C4-C5 level, the report wrote. That’s when a key piece of evidence stood out like neon lights. See, our adolescent patient had been rather studious with a daily routine that incorporated almost 6 hours of studying daily.


What you’ve read was a retelling of a case report from Italy [1] showcasing a very real phenomenon called Text Neck Syndrome.


It shouldn’t be hard to surmise what this means. It’s a problem of the neck, likely because of frequent smartphone use. But our teenager wasn’t brought to the hospital because of smartphone use. She came in because she was studying for too long. Though the syndrome contains the word “text”, it is the mechanism that ties this syndrome together.


Text Neck Syndrome


Take this moment to be aware of your posture as you read this article. How are your shoulders? Are they brought back or hunched forward? Where is your head with respect to your torso? Is it tilted slightly to the front, or does it rest in easy alignment with your body? Do you notice any tightness in the muscles of the area?


The human spine curves with a purpose, with mountains and valleys in the spine having specific names such as kyphosis and lordosis. There is a natural posture that decreases the strain-- especially on the neck and the shoulders[2]. I won’t bore you with the nitty-gritty specifics. But the shorthand is that the ear is supposed to form a straight line down to the ankle bone, crossing the shoulder, the hip bone, and the knee along the way.


The way our necks angle forward when we’re engrossed in our smartphones does not support this kind of posture. The same is true when we’re leaning over books to read and notes to write [1].


This flexion or frequent forward bending of the neck causes the degeneration of the spine in the Text Neck Syndrome. When the neck brings the head forward, the head feels heavier on the spine. A head that normally weighs 5lbs would feel twice as heavy when the neck is flexed even 15 degrees forward. Both the degree of flexion and the frequency affect the neck. This is no joke to a developing spine when most adolescents spend 5-7 hours daily looking down on their phones. Or, in some cases, academics demand a similar amount of time pouring over books [1].


The effects of Text Neck Syndrome


The primary effect of text neck Syndrome is musculoskeletal pain. The posture that creates this forward bending forward of the head, with a slight tilt, would cause an increase in the muscle activity of the upper trapezius, erector spinae, and neck extensors. This in turn causes pain in the neck, which is worse when sitting down in that posture for prolonged periods. More pain is felt when the position is held for longer or in those who frequently hold this position. The pain also comes with some underlying damage to the surrounding skeletal structures and ligaments [3,4,5].


Text neck syndrome also causes musculoskeletal pain in the shoulders and arms. This is borne from holding up the smartphone and texting. While a regular phone doesn’t seem to weigh much, prolonged use does have a toll on the body [3]. Eye strain is another feature that comes with text neck syndrome--- especially when the smartphone is too close to the person and too often used [1]. This eye strain can, in turn, contribute to dizziness and headaches. The fact that very tight muscles on the neck can also cause headaches does not help.


What can you do?


While there is still a lack of solid evidence on the treatment of text neck syndrome, several studies have pushed forward their recommendations.


The best evidence for chronic neck pain purports neck and upper back strengthening programs to help relieve short-term neck pain [6]. For office workers, neck and shoulder stretching done throughout the week for four weeks were found to be effective in decreasing neck and shoulder pain as well [7].


There are also ways to prevent text neck syndrome. Avoiding prolonged postures, whether sitting down or standing up, should help. Taking breaks of 20 minutes from looking down at a phone or a book would also give time to realign the posture [1,4]. Researchers also prefer the screen to be at eye level instead of lower so that the head isn’t flexed when it’s trying to read something. But others remind us that holding the phone up, especially with one hand, can backfire and cause some strain on the elbow and shoulder area [8]. Lumbar rolls were also effective in decreasing the forward head flexion when sitting down [9].


There are also rules for screen time, with those younger than two years having no screen time and those 2-5 years old only having one hour a day[1]. However, there aren’t any clear-cut recommendations for those who are of the older group.


In the end, it can come down to mindfulness and how our posture relates to our use of smart gadgets. Now, you can take this as a cue to get up, put this device down, stretch your neck, and walk a little bit.



  1. 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. Published 2021 Feb 7. doi:10.3390/ijerph18041565
  2. Giglio CA, Volpon JB. Development and evaluation of thoracic kyphosis and lumbar lordosis during growth. J Child Orthop. 2007;1(3):187-193. doi:10.1007/s11832-007-0033-5
  3. Eitivipart AC, Viriyarojanakul S, Redhead L. Musculoskeletal disorder and pain associated with smartphone use: A systematic review of biomechanical evidence. Hong Kong Physiother J. 2018;38(2):77-90. doi:10.1142/S1013702518300010
  4. Kim SY, Koo SJ. Effect of duration of smartphone use on muscle fatigue and pain caused by forward head posture in adults. J Phys Ther Sci. 2016;28(6):1669-1672. doi:10.1589/jpts.28.1669
  5. Lee J, Seo K. The comparison of cervical repositioning errors according to smartphone addiction grades. J Phys Ther Sci. 2014;26(4):595-598. doi:10.1589/jpts.26.595
  6. Sterling M, de Zoete RMJ, Coppieters I, Farrell SF. Best Evidence Rehabilitation for Chronic Pain Part 4: Neck Pain. J Clin Med. 2019;8(8):1219. Published 2019 Aug 15. doi:10.3390/jcm8081219
  7. Tunwattanapong P, Kongkasuwan R, Kuptniratsaikul V. The effectiveness of a neck and shoulder stretching exercise program among office workers with neck pain: a randomized controlled trial. Clin Rehabil. 2016;30(1):64-72. doi:10.1177/0269215515575747
  8. Meziat-Filho N, Ferreira AS, Nogueira LAC, Reis FJJ. "Text-neck": an epidemic of the modern era of cell phones?. Spine J. 2018;18(4):714-715. doi:10.1016/j.spinee.2017.11.022
  9. Handa Y, Okada K, Takasaki H. Lumbar Roll Usage While Sitting Reduces the Forward Head Posture in Healthy Individuals: A Systematic Review with Meta-Analysis. Int J Environ Res Public Health. 2021 May 13;18(10):5171. doi: 10.3390/ijerph18105171. PMID: 34068139; PMCID: PMC8152998.
Article written by Amanda Cheong, M.D.
Dr. Amanda Cheong spent her formative medical years within the walls of the Philippine General Hospital, a high-volume tertiary institution built to serve the underserved. After graduating with a degree in medicine, she went on to write, edit, and compile healthcare stories from the start of the COVID-19 pandemic for an online anthology. Currently, she is involved in medical research as well as volunteer telemedicine consults. She enjoys writing fiction on the side when she’s not tending to her plants and three pet turtles.

Leave a Reply

Your email address will not be published. Required fields are marked *