Neck Pain: Everything You Need To Know About “Text Neck” Syndrome

Neck pain affects majority of the people at least once in their lives. You would have probably heard people saying poor posture causes neck pain. Maybe even damage your spinal cord or cause a lump in your neck … Sounds familiar?

If you do a quick search on Google on the harmful effects of bad posture, you’d get PLENTY of hits! I am not kidding. Some of the commonly cited harms are:

  • Worsens depression and stress
  • Neck pain
  • Tension headaches
  • Exacerbating arthritis
  • Sexual function
  • Reduce blood supply

Are these true?

Posture is not static

Before we go on, it’s important to understand what is posture.

By posture, most people refer to the position in during a particular activity. You could be sitting in the plane, running, using the phone in your daily MRT commute, etc.

But posture is not static!

To maintain the position you are in, your body works in response to your environment you are in to keep you in a certain position. Remember the guy who was falling asleep in the bus? Yep, he couldn’t keep himself upright.

To maintain a sitting posture, you will need awareness of where your body is in space and your neck and shoulder muscles will need to work to stop you from falling over. It’s a dynamic pattern of reflexes, adaptive responses, and also your habits.

When it comes to keeping yourself upright, gravity – not posture – is your biggest enemy.

Good posture is a social construct

posture, neck pain, text neck, chiropractor singapore
posture, chiropractor singapore, back pain, neck pain

The considerations of what is good posture has barely changed through time.

Wearing a corset was introduced into French court by Catherine de Medici in 1500s and it was considered “dispensable to the beauty of the female figure”. The purpose was to keep ladies in an upright posture with the shoulders down, and shoulder blades tucked back together. In those days, that was the good posture.

At the turn of the 19th century, an upright posture was regarded as a sign of superior intelligence. During that period, physical traits were linked to everything from homosexuality to insanity to intelligence. Because the torso contains vital organs, men and women with long trunks and short legs were highly regarded.

Then came the American Posture League in 1914 (now defunct). They believed an upright posture was necessary for full health. They organised postural programs throughout American schools. Children were often stripped to their underwear for posture and testing purposes.

The current day concept of good posture hasn’t changed much since then. You would probably find the illustrations by the American Posture League still familiar.

Good posture is a social construct (that is not based on science – more on this later).

“Text neck syndrome” existed for hundreds, if not thousands, of years

neck pain, bad posture, chiropractor, outram park

Leather Dressing Factory from Impact and Images of the Industrial Revolution, Thames and Hudson

neck pain, chiropractor, bad posture, back pain

Painting in Sennedjem’s burial chamber. He served King Tut who reigned 1332-1323 BC (18th Dynasty)

We like to attribute neck pain as a societal norm because of the “text neck” epidemic or too much mobile phone use. But is it though?

Industrial Revolution happened during 1760 to 1820. During this period of time, there was a shift into manufacturing jobs. This meant people spent their time with their heads bent over along factory assembly lines.

During the both agricultural revolutions, people were spending more time in fields, you can see from the art works in that period showing similar instances of “bad posture”. Clearly their head posture is not upright and their “work stations” are not adjusted to their eye level.

While mobile phone is a recent technology, “turtle neck syndrome” has been around for centuries if not millenniums.

Neck pain is an epidemic


lower back pain, neck pain, chiropractor
While low back pain has been around throughout recorded history, disability increased exponentially in mid 1900s. Credit: Waddell 1996, Spine

Unfortunately historic data for neck pain is limited compared to lower back pain. However, if we were to look at research for low back pain, we see an exponential increase in disability beginning around the 1970s.

The increase in disability was so apparent, New York Times published an article titled The Special Pain of the Late 20th Century in 1974.

We still do not understand why low back pain has become such an epidemic but we know it only started in the last few decades.

Regardless, neck pain is one of the world’s top disorders. When it comes to the number of years lived with disability, neck pain (The Lancet) ranks fourth out of 291 conditions. (Low back pain is #1.)

While most of your neck pain episodes will resolve within six weeks even without treatment, almost 50% of you will continue to experience some degree pain or recurrent episodes of neck pain (PubMed).

In short, yes. Neck pain is an epidemic. However, “text neck” is not. It is also unlikely for “text neck” to be the cause of your neck symptoms.

Your neck is stronger than your WORST posture

best chiropractor singapore, text neck, neck pain

This picture has been making rounds on social media and it does look pretty convincing. If you were to look into the actual paper (pdf accessible here), the numbers were calculated through an engineering software. There was no human studies, no cadaver studies, no animal studies!

Furthermore, it was not clear if the author took into consideration that the human neck is alive. Your cervical spine is held together by muscles and ligaments. It is robust, dynamic, and has a high capacity for load.

Strength of the cervical spine

A paper published in 2007 (before all this “text neck” rubbish) looking at the strength of the neck in 22 cadavers found it took 250kg (2.4kN) of compressive force before causing observable damage. That is give or take 35 bowling balls!

Would you choose to believe an engineering software calculation or real studies with hard data?

What are the symptoms of text neck?

text neck, bad posture, neck pain
Source: The Conversation

This is the biggest myth we want to debunk: Bad posture or “text neck” doesn’t actually give you neck pain. We have research to support this.

Text neck is not a disease. Therefore, you can’t have “text neck symptoms”

Study 1: Text neck and neck pain in 18-21-year-old young adults.

This study looked at 150 young adults (pretty decent sample size) who were asked to report their mobile phone use and rate their own posture. Their posture were then assessed separately by a registered physiotherapists.

The study reported no relationship between self-assessed neck posture and neck pain (Pubmed). There was no association between neck posture assessed by a physiotherapist and neck pain as well.

Your neck is good. Your neck is strong. Don’t let the internet tell you otherwise.

Study 2: Texting on mobile phones and musculoskeletal disorders in young adults: A five-year cohort study.

This is a big deal for me because it’s a FIVE year study that followed 7092 young adults (20-24 years old).

Participants WITHOUT neck pain at the start of the five year study did not develop neck pain regardless of mobile phone use. They did find an association between hand symptoms and text messaging (PubMed) though. This may be a case of repetitive stress injury of the hand with excessive mobile phone usage.

Study 3: The associations of mobile touch screen device use with musculoskeletal symptoms and exposures

A systematic review looking 45 articles also found limited, poor evidence linking mobile phone use to musculoskeletal pain (PubMed). The reason why the evidence was limited? Well, the studies were poorly designed.

Study 4: Does cervical kyphosis relate to symptoms following whiplash injury?

It’s common to see before and after x-rays at chiropractic clinic chains in Singapore showing a straight neck (as a bad neck) and a curved as a good one. You might here them talk about cervical kyphosis chiropractic treatment aka chiropractic treatment for “straight neck” syndrome.

Essentially, they are selling your posture as being “bad” because it’s a narrative we identify well with (i.e. more likely to convert to sales).

In light of these studies, do you still think bad posture –> neck pain is evidence-based?

A study looking at 171 participants for a year published that it is clear neck pain should not be attributed to a straight spine on MRI.

There are no good quality studies to link your neck symptoms to neck alignment or posture. Also, no clinical guidelines ever recommended posture correction for neck pain. Go figure.

Bottom line: You can’t just bury your head in the sand and let mainstream press or urban myths feed your garbage health information. These are peer reviewed academic studies with big sample sizes!

How do you get rid of text neck?

Don’t fix it.

Because of all the broscience on social media, most of us blame our bad posture for chronic neck pain. The good news is that that is false!

Your neck ache and soreness occur independently of your neck posture (check out the studies in #8). I know this is difficult to accept but research has consistently demonstrate that to be true.

Furthermore, your current posture is a biological adaption over your lifetime. This is the position you are in because your body is most comfortable in it. Can you change it? Yes, you can. There are ‘text neck’ exercises that we can prescribe you to help with the forward head carriage.

Because most adaption occur over decades, it will be challenging to undo. If this is what you are after, we can definitely help you with it. But remember, “fixing” your posture is not going to make your pain go away.

Wearable contraptions are not evidence based

No. Remember, neck pain and neck posture are independent of each other. While your posture might appear to have “improved” while using one of those contraceptions, nothing actually changes.

There might be an intermittent relief for your chronic neck and shoulder tension, but the symptoms are likely to return.

No neck clinical guidelines recommend using wearable contraptions.

Furthermore, prolonged use is likely to cause dependency. If your neck muscle and ligament adapt to the device, you might struggle more in the future when you are not using it.

When in doubt, always seek medical advice.

“Text neck” exercises? Yes, you can exercise with neck pain


neck pain, chiropractor, exercise
Clare Yau, the owner of wakeboarding school Ryders at Marina Country Club, performing neck pain exercises with Singapore chiropractor Jesse Cai.

To understand your neck pain better, check out our blog post: Neck Pain & When to See a Chiropractor.

The best way to relieve neck pain is work on it with exercise therapy. Regardless if it’s a muscle strain or a facet joint sprain, exercise is your best bet. At Square One, we develop individualised exercise prescription programs to help our clients find pain-free living.

What do chiropractors do?

While most Singapore chiropractors offer only chiropractic adjustments, chiropractic care is more than just that. Chiropractic treatment can include spinal adjustments, physical therapy, IASTM, soft tissue therapy, and exercise prescription.

Some people to misunderstand what we do as strength training or physiotherapy. This is not what we do at Square One. In fact, making your neck stronger on its own is unlikely to make your pain go away as well.

Square One focuses on getting you to where you want to be. If you want to sit at the computer for eight hours without pain, we make it a point to get you there. If you want to be able to workout without neck pain, we help you get there as well.

Don’t trust everything you read about neck pain

There are lots of fake news going around. We always encourage people to ask for references rather than just accepting whatever you are told.

Most people (or even orthopaedic surgeons) will scare you into believing bad posture is bad for you. Some may even say exercising causes wear and tear to your neck.

None of these claims are based on evidence.

Example 1: Horns Are Growing On Young People’s Skull Due To Cell Phone Use, The Straits Times 20 June 2019

neck x-ray, cervical kyphosis chiropractic treatmentUm. How about no?

Forbes, in the spirit of good journalism, published a rebuttal article and highlighted many good points:

1. The article ignores DECADES of anthropological research

2. Disappointingly, there were multiple errors in The Nature article

3. The interpretation of “phone bone” was an overreach

Example 2: Mobile phones a pain in the neck? Surge in young people suffering from ‘text neck’

mobile phones, turtle neck posture

They interviewed THREE chiropractors and one orthopaedic surgeon. None of whom cited any studies to support their claim that “text neck” is bad for you.

The journalist didn’t even make mention of any scientific studies as well. This is disappointing journalism, no?

Orthopaedic Surgeon Henry Chan of HC Orthopaedic Surgery: “Kids are now exposed to mobile devices early and if proper habits are not adopted, they may face serious problems later.” Sure, they also may not. In fact, research says they MOST LIKELY may not. Refer to studies under #6

Chiropractor Glen Osgoodby of ActiveLife Chiropractic: “Important to take breaks when using devices and perform stretch exercises during breaks.” To be fair, stretching is a super common recommendation when it comes to muscle and joint pain. But does stretching (blog post with references) even work in the first place?

As pain patients and consumer of health content, always ask for research and references. Unfortunately, we live in a time when people can get away with sharing low value, unscientific content.

When in doubt, seek advice from an evidence-based and good chiropractor, physiotherapist, or healthcare professional.

This is another controversial blog post from Square One Active Recovery. We are 100% about evidence-based care. Our aim is to challenge attitudes and beliefs towards pain that are not supported by the latest research. If you have a text neck question or would like to make a correction to our blog post, do drop us a message.

Alternatively, you can book an appointment with us via our online form for your neck pain. Our office two minutes walk from Outram Park MRT (Dorsett Hotel) and five minutes from Tanjong Pagar (via Tras Street or Duxton).