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Text Neck Syndrome:

A Growing Health Concern
Angelina Febrina
RS Awal Bros Batam, Indonesia

ABSTRACT
In recent decades, a breakthrough in digital technology has multiplied smartphone use for many purposes like work, socialization, and
entertainment. People may use smartphones constantly anytime and anywhere while standing or sitting. This style is associated with the
evolution of a new medical syndrome called text neck syndrome. Many studies suggest a correlation between this syndrome and prolonged
use of handheld media devices. This article will discuss text neck syndrome, its manifestations, and methods to treat and prevent the progression
of the disease.

Keywords: Smartphone, syndrome, text neck.

ABSTRAK
Dalam beberapa dekade terakhir, inovasi teknologi digital telah melipatgandakan penggunaan ponsel pintar untuk berbagai tujuan seperti
pekerjaan, sosialisasi, serta hiburan. Masyarakat cenderung menggunakannya kapan saja dan di mana saja, saat berdiri ataupun duduk. Gaya
hidup seperti ini berkaitan dengan evolusi sindrom medis baru yang disebut sindrom text neck. Penelitian menunjukkan korelasi antara sindrom
ini dan penggunaan perangkat media genggam jangka lama. Artikel ini membahas sindrom text neck, manifestasinya, serta cara mengobati dan
mencegah perkembangan penyakit ini. Angelina Febrina. Text Neck Syndrome: Masalah Kesehatan yang Mengemuka.

Kata kunci: Ponsel pintar, sindrom, text neck.

Cermin Dunia Kedokteran is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

INTRODUCTION 18-44 have their cell phones with them almost who described it as a repetitive stress injury or
Smartphone is a portable computer device that all the time, with only 2 hours of their working an overuse syndrome when a person had his/
combines mobile phone features like make day spent without their cellphone.3 Even her head flexed forward and was bent down
calls or send text messages and computing preschool children are exposed to internet- looking at smartphones or other electronic
functions such as browsing the internet, friendly environments that surely catch their devices for a long time.3,5 Maintaining this
play games, video chat, and many more. This attention. An American survey stated that the poor position at most time may eventually
modern technology is readily accessible for percentage of children aged 0-8 years of using cause the flattening of the normal curvature
anyone, making smartphone much more a mobile device increased from 38% in 2011 to of the cervical spine and stretch the neck
convenient. In 2016 there were only 3,668 72% in 2013. Focusing on 2-years-old children, musculatures leading to chronic neck pain,
billion smartphone users, around 49% of that the increment was even higher, from 10% in upper back muscle tightness and spasms,
year’s global population. The number has 2011 to 38% in 2013.4 This situation becomes a shoulder pain, and headache.5,6
boomed in 2022 to 6,648 billion smartphone concern because many health problems may
users or around 83% world population.1 arise from long-term smartphones use. Text A full-grown head in neutral position is
According to Statista, Indonesia is the fourth- neck syndrome is the term to describe pain or normally weighed about 10-12 pounds. At
largest smartphone market worldwide soreness around the neck and shoulders due this position, the gravitational moment is
after China, India, and the United States. to looking down at the smartphones, tablets, considered the lowest and associated with
Smartphone users in Indonesia were around or other wireless devices too frequently or too the least complain of neck discomfort.3,7
44.44% population in 2017 and increased long.3 Forces on the neck increased linearly with
up to 67% in 2020. This number is estimated the increment of the angle of neck flexion. It
to reach 82% by 2026.2 In this modern era, DEFINITION is doubled when the head tilts forward at 15°
smartphones can be used by various age The term “Text neck” was first pioneered by Dr. to roughly 27 pounds; reaching 40 pounds if
groups; 79% population between the ages of Dean L. Fishman, an American chiropractor, the neck is flexed to 30°, 49 pounds at 45°, and
Alamat Korespondensi email: [email protected]

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more than fivefold effect at 60 pounds at 60° Susilowati, et al, among Universitas Indonesia smartphone use in Korea indicated that
(Figure).3 Study in Korea compared alterations community during work-from-home program individuals complaining with mild neck pain
of cervical spine posture in young adults with due to the COVID-19 pandemic indicated adopted a greater neck flexion posture than
and without neck pain during smartphone that 70.5% of respondents complained individuals without neck pain while using
use and discovered that young adults with musculoskeletal discomforts, especially in smartphones.6 This finding, together with the
neck pain exhibited greater neck flexion angle the neck (86.4%), lower back (75.9%), and studies mentioned earlier, emphasized on
when using smartphone than users in the shoulders (76.2%).10 These studies showed the awareness of maintaining a correct neck
control group.6 Another study collected data high prevalence of text neck syndrome and posture.
on neck flexion in college students during may grow even higher with the significant
8 hours of typical smartphone use using increment of smartphone users. Aside from the musculoskeletal manifestations,
wearable motion sensors and discovered that the previous study also mentioned eye
they tended to spend more time with neck CLINICAL FEATURES involvement among smartphone users.
flexion exceeding 30° during smartphone use A prolonged and repetitive neck flexion Texting with neck flexion can cause eye strain
than during other activities.7 In this current may severely harm the cervical structures. and nearsightedness.14 A reduced blink rate
situation, mobile technology is within reach Researchers have observed 10-minute static during continuous smartphone use causes
and people tend to spend more time on their neck flexion can result in mechanical and the evaporation of tear film to be faster and
smartphones or mobile devices and may neuromuscular behavior changes of the may potentially produce dry eye disease.4,14
end up with prolonged neck flexion causing cervical spine, leading to decreased strength
text neck syndrome. This is a growing health of cervical structures.11 Neck flexion indicates Text neck syndrome manifested not only
concern and may influence mostly young the forward pull of the weight of the head physically, but also psychologically. Commonly
generation.5 and put excessive load on the vertebrae of experienced by young participants (82%),
the lower neck, causing strain on the posterior parents usually noticed changes in behavior
PREVALENCE neck musculature and commonly produce and social interactions. Complains like easily
Various studies had been conducted to neck pain. This poor posture causes the upper irritated, alienated, hostile, and aggressive
assess the prevalence of text neck syndrome back muscles to constantly counterbalance behavior, decrements in attention and focus,
and most were involving the young adult the pull of gravity on the forward head, hence low school grade, communication skills and
population, the major population with the producing upper back pain. Meanwhile, this sleep disturbance are frequently reported.4,14
greatness attachment to smartphones. position is often accompanied by forward Previous study has shown that about 92% of
Outcomes of a study in 2021 among 283 shoulders and rounded upper back, which children started to use a mobile media device
college students in India showed 76.6% eventually cause shoulder pain.3,11,12 Chronic before the age of 1 year-old, and at the age
of total respondents reported text neck pain in the neck and shoulders can be of 2 years, most children use devices on daily
syndrome.8 Ayhualem, et al, conducted a referred to the head, causing headache, basis. Parents often used smartphones as a
study to assess the prevalence of neck pain especially tension-type.13 Recent study distraction or as means to manage children’s
among smartphone user students in Ethiopia found that smartphone users between 38- behavior, to keep them calm in public places
for a year and discovered that this particular 48 year-old are the most affected group. (65%), while doing house chores (70%),
symptom was complained by 47.4% users.9 Also, it stated that the severity of neck pain is and/or at around bedtime (29%) to put
The finding of this study is actually lower than increasing gradually when the duration of the their children to sleep.15 This daily routine
studies conducted in China (72.9%), Saudi smartphone use increases, spending for more will distract parents-children’s face-to-face
Arabia (71.2%), Brazil (66.7%), Singapore (74%), than 5 hours has the highest effect on neck interactions and resulting in a negative
and Taiwan (52%).9 In our country, a study by pain.13 A study focused on neck pain during impact on cognitive, learning, and emotional
development.4

Smartphones with 21st century features

generate an extremely low-frequency
electromagnetic field. Electromagnetic
radiation is also a risk and may cause many
symptoms, such as dizziness, headache,
tingling in the hands, ringing in the ears, eye
pain, electro-sensitivity, sleep disturbance,
low immunity, ADHD, and autism.14 Attentions
should be focused on the radiation effects on
children as the absorption rate is much greater
than that on adults.14

TREATMENT AND PREVENTION

Figure. Changes in neck forces with the increment of flexion angle.3 Treatment for text neck syndrome should aim

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at the specific problems and be personalized seconds to strengthen the muscles of the to screens as early as 6 months old exhibited
for each patient individually based on the neck and head stabilizing muscles and to a lower cognitive and language development
treatment responses. Generally, it can be unload neck pain and postural instability. at 14 months of age.17 Recent study of 296
done in two major ways, conservative 5. Rest is important. It allows the possibility preschoolers were conducted in Germany
management, and surgery. Text neck of spontaneous healing of muscles and also revealed the same result that high screen
syndrome is rarely categorized as a severe tendons. times in children (>1 h/day) were significantly
case that needs surgical interventions, unless 6. Applying ice or cold pack as an anti- associated with lower percentile ranks in
there are progressive neurologic deficits or inflammatory to reduce swelling and pain. cognition, language, and socio-emotional
intractable pain and disability unresponsive to After a couple of days, ice or heat pack skills.18 Due to the escalating number of
conservative management. Though text neck can be applied on an alternating basis. smartphone users among preschool children,
syndrome is mostly mild-moderate cases, if Applying continuous heat can cause many health societies, such as the American
left untreated, symptoms may worsen over increased swelling. Academy of Pediatrics, Italian Pediatric
time and cause great length of physical health 7. Massage can soothe muscle tension and Society, and also the Australian Department
problems such as early arthritis, degenerative spasm, hence reducing pain. of Health, strongly suggest limiting media
disc diseases, overuse syndrome, or permanent 8. Pain reliever medication may reduce device exposure in childhood. They strictly
damages.3,5,11 Maintaining a correct position inflammation and hinder pain signals recommend no screen time or media devices
and avoiding prolonged texting are keys in from reaching the brain. use (smartphone, TV, DVDs, computer, or
the management and further progression of 9. Talk more, text less. other electronic games) in children under 2
text neck syndrome. years old, during mealtime, and at least an
Conservative management is still the first hour before bedtime. Also, they suggest to
Though prevention is the key, the most treatment option for chronic cases. Physical limit media exposure in children aged 2-5
acute cases symptoms can be relieved by therapy is mostly included in the treatment years old to no more than an hour a day and
techniques mentioned below:3,7,12,13 program to improve the neck strength and less than 2 hours a day for children aged 5-8
1. Correct posture is essential. Studies flexibility. To counteract the strain caused by years old. Parents or caregivers are obliged
recommend correct texting techniques by text neck syndrome, exercises like cervical to present during screen time to promote
raising the smartphone closer to the eye retraction, cervical extension, and cervical children’s learning and interactions.4,19
level with a straight back while sitting or stabilization can be done daily to ease pain
standing. When sitting, backrest is proven and to increase the neck flexibility.16 Steroid CONCLUSION
to reduce neck flexion and thus alleviate injection can reduce inflammation of the Smartphones users are growing from time to
the load on the neck muscles. Also, it is nerves or nearby tissues caused by disc time. This situation creates a health concern
necessary to make sure that both arms herniation. It can temporarily help to ease when users spend hours on their phones and
and hand are well supported by anything the pain and enable the patient to return bend their head down to a certain angle that
like armrest, table, or other supporting to normal activities and/or make progress may overburden the neck and upper back
arm techniques. with the physical therapy program.3 Manual muscles. Neck flexion should be less than 15°
2. Avoid prolonged static posture. Warm manipulation by a health professional can while using smartphones or media devices
up neck muscles every 30-40 minutes improve the range of motion and reduce pain. to minimize cervical spine strain. Practicing
while using your smartphones by doing Text neck symptoms may also be relieved by better posture and frequent breaks with
exercises like rotating your head for at acupuncture. It is usually well-tolerated and is small stretches or exercises can be the simple
least 10 times. generally considered safe.3 solutions. Parents and caregivers should
3. Muscles stretches such as side neck, be good role models for the children and
levator scapulae, front neck, etc, and hold A study involving more than 250 families in the proactive interaction is the best approach.
them for at least 10 seconds. US assessed the influence of screen exposure
4. Chin and scapula retraction for 20-30 and showed that children who were exposed

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