As modern technology is advancing, city dwellers are always lowering their heads and indulging in their smartphones anytime, be it taking a bus or walking. Some parents may even give smartphones or tablets to their children to calm them down and keep them from wandering off. It may be a good way to get a peaceful time by letting them play mobile games and watch videos all day long, but parents have overlooked its underlying danger. As children have to bear heavy school bags, if they even lower their heads to use smartphones or tablets when walking, this poor posture will jeopardise their spine health. In the long run, it may lead to kyphosis and even bone spurs.  In March 2022, a Hong Kong academic article published in “Radiology Case Reports” under the University of Washington stated that “text neck” refers to the overuse injury of the cervical spine. It is caused by the repetitive stress of prolonged cervical flexion while using a smartphone.

In the case study, the patient who always went online experienced head and neck pain and numbness in the right upper limb for 12 months. In the past 3 years, he always sat hunched over to edit blogs and videos and relied on smartphones heavily at least 16 hours a day for both job resources and personal tasks. One year before the diagnosis, he had experienced similar symptoms and visited his family doctor. His cervical radiograph showed reduced cervical lordosis and degenerative proliferation of facets and uncovertebral joints, indicating potential cervical spondylosis. One year later, he suddenly could only raise his head for one minute and could not move his neck without triggering pain. These new problems forced him to seek help from chiropractors.

Initial examination identified his stiff neck posture. He suffered from head and neck pain and recurring numbness from his right shoulder to his lateral forearm and hand.

He was reminded to rest frequently and to raise his smartphone to his eye level when texting. The treatment started with cervical manipulation to relieve muscle spasms and release the restricted intervertebral movement, in order to help restore mobility in the neck and alleviate neurological dysfunction. Three sessions a week were arranged for the first treatment stage. After the first month, his neck pain was relieved by 60%; within two months, all of his neurological symptoms were treated. On the follow-up assessment in the ninth month, his radiographic change of the cervical curve correction reflected the improvement in his symptoms and functions.

As smartphones are becoming more and more popular among all ages, texting and gaming lead to increasing lifestyle and health concerns. Studies showed that the excessive use of smartphones can cause a prominent cervical flexion known as the ‘text neck’. For adults, their fulcrum for cervical flexion is at the C5/C6 level. When your neck bends forwards at 0° to 15°, your head will be right above your shoulders, exerting an acceptably low amount of stress on the neck muscles. A static or bent neck posture can continuously strain the posterior cervical muscles, including erector spinae and suboccipital muscles, levator scapulae muscles, semispinalis and trapezius muscles. This can consequently cause tension headaches, neck and shoulder pain, temporomandibular joint (TMJ) pain, and decreased range of motion in the neck and upper chest. The pressure from constant flexion will also cause posterior ligamentous laxity, leading to instability between vertebrae, spondylosis and sliding vertebrae. In the long run, kyphosis and a straight neck can cause plastic changes in the nervous system, resulting in sensorimotor integration deficiencies and further dysfunctions.

Continuous cervical flexion will twist the cervical spine. Since children are still in the development stage in which their bones are flexible, it is usually difficult to notice kyphosis or even bone spurs. When their bones form as they grow up, the damage from prolonged overuse due to poor posture will manifest itself in neurological symptoms, which can be improved by adjusting cervical subluxation.