Text Neck: Epidemic or Fear Mongering?

An article from The Washington Post has been making it’s way around social media proclaiming we are suffering from an epidemic of ‘Text Neck’. As the name implies, Text Neck is the idea that due to the wide-spread use of smartphones, which people often tilt their necks to look at, there is a corresponding increase in cervical spine injuries. Are we really in danger of damaging our spines by over-using (or improperly using) our smartphones?

Dr. Hansraj’s 60 Pounds

The only piece of research referenced by The Washington Post article was conducted by Kenneth K. Hansraj in the journal Surgical Technology International. Using a piece of engineering software called COSMOSWorks, Dr. Hansraj argues that as the head tilts forward, the weight experienced by the spine increases, such that at a tilt of 60 degrees, you are adding 60 pounds of weight. As he admits, this calculation does not take into account mitigating factors such as muscles, tendons, and ligaments, which help to relieve spinal stress.

The 60 pound figure is what caught the media’s attention. Lindsey Bever, of the original Washington Post article writes,

“Can’t grasp the significance of 60 pounds? Imagine carrying an 8-year-old around your neck several hours per day. Smartphone users spend an average of two to four hours per day hunched over, reading e-mails, sending texts or checking social media sites. That’s 700 to 1,400 hours per year people are putting stress on their spines, according to the research.”

The 60 pound figure was emphasized by The Atlantic, Vice, Time, and CBS News, as well as pretty much every other news outlet which covered this story, yet all of them omitted the important qualification that it is not a complete representation of the amount of stress caused by tilting your head down.

Ultimately, the question that should be asked is, to what extent does Dr. Hansraj’s computer model allow us to generalize about spinal health? In the discussion section of the paper, which functions as a way for researchers to link their current study with other research findings, Dr. Hansraj does discuss spinal health. However, this is done in the context of how his model might help cervical spine surgeons, and none of the research on spinal health is originally his.

The only sources Dr. Hansraj uses to indicate the possible health benefits of good posture is work done on the psychological effects of power and posture. This research, conducted by Dana R. Carney, Amy J.C. Cuddy, and Andy J. Yap, though interesting, has no direct link to spinal injuries caused by Text Neck. What they found was, that individuals in brief high-power-poses, had changes in neuroendocrine levels and risk tolerance compared to individuals in brief low-power-poses. As they put it, “That a person can, by assuming two simple 1-min poses, embody power and instantly become more powerful has real-world actionable implications”. Given the brevity by which individuals can adopt these poses, I see no reason to think that smartphone use will prevent people from these posturing benefits. Unless, of course, Text Neck causes actual damage to the spine, rendering people incapable of adopting those poses, but no evidence is offered in Dr. Hansraj’s paper in defense of this idea.

Why then, has the media failed to cover this story properly? Part of this is the fault of Dr. Hansraj himself. In an interview with Nick Grimm on ‘The World Today’ he explains,

“KEN HANSRAJ: Nick, I’m a spinal surgeon and I only see spine cases. There are so many young people that are coming to me with neck and back pain when it’s just related to the posture that they’re engaged in all day.

NICK GRIMM: And these are sort of problems that young people of previous generations wouldn’t necessarily have been presenting with?

KEN HANSRAJ: I would have to say yes because they did not have the pervasiveness of the smart devices that we have right now.”

This exchange highlights what is known as confirmation bias; a psychological process by which individuals only look for evidence which confirms their hypothesis. Dr. Hansraj, who only sees people with spine injuries, is using that as the evidence that Text-Neck is a real concern, but is not counting all the people who may never need spinal help and are currently using smartphones with bad posture. In order to make sure that what you are seeing is an actual increase in spine related injuries, several robust studies would need to be conducted, which assess the extent to which those who text with bad posture compare to those who text with good posture when it comes to spinal injuries. As far as I am aware, a study like this has not been conducted.

This does not prevent Dr. Hansraj from using words like, “pandemic”, to describe the state of American spine problems. In an awkwardly scripted interview with his wife posted on youtube, Dr. Hansraj claims that, “studies show that 4-out-of-5 human beings have significant spinal conditions”. There are a few studies which back up this claim. For example, in 1998 in the journal Spine, researchers found that 84.1% of people in Saskatchewan had experienced low back pain in their lives. This number does not tell us much by itself, it does not for example, tell us how many individuals had low-intensity, short-duration, low back pain or had high-intensity, chronic, low back pain. If I had a stiff back for a few days, I don’t think it would be considered a, “significant spinal condition”.

Every Problem Has It’s Institute

On the website for the Text-Neck Institute you are greeted by this dire warning,

“TEXT NECK IS A GLOBAL EPIDEMIC! ‘Text Neck’ is a world-wide health concern, affecting millions of all ages and from all walks of life. Widespread overuse of handheld mobile technology is resulting in a harmful and dangerous physical condition on the human body, which is known as Text Neck

The institution even boasts that they invented the term. In fact, they have trademarked it. They have also developed a phone app they are selling for $2.99 that helps notify you when you are ruining your posture while using your device.

Chiropractor, Dean Fishman, founder of the Text Neck Institute, has made an appearance on the television show ‘The Doctors’. This particular episode was focused on health issues due to new technology, which makes for good television because it appeals to the Luddite in all of us. Parents have, throughout the ages, looked at the younger generation and have been shocked at what they see. Even back in ancient Greece, Socrates feared that the introduction of books would rot young minds, and we all see how that turned out.

The Doctors are also a good place to go when you want to peddle medical hype, as a recent study shows, only 63% of what they discuss is backed up by the lowest forms of evidential support. This number dropped to 53% when more robust evidence was considered. For a show called ‘The Doctors’, I would expect more than 53% of what they say to be backed up by evidence, but sadly, television has never been a repository of good information. Just spend one afternoon watching the History Channel and this becomes evidently clear. This is to be expected, as one of televisions main purposes is entertainment, and The Doctors are good looking, confident, and interesting to watch.

On the show, Fishman is presented with a child who is apparently suffering from headaches. There is no evidence that chiropractic treatment can help alleviate headaches, let alone any evidence that the child’s headache is caused by some sort of spinal condition. Yet, after an initial consultation with his young patient, Fishman suggests x-rays. As Dr. Edzard Ernst points out, the reason why chiropractors x-ray for non-specific back pain is two-fold. The first is that they believe in the long outdated notion of subluxation. Subluxations, to chiropractors, are structural displacements of the spine which lead to neurological and biomechanical disorders. Chiropractic subluxations don’t exist, yet many chiropractors still believe that they are the cause of pretty much everything that ails us. The use of the x-ray is supposed to help the chiropractor see these non-existent subluxations so that they can treat the patient. Often what they are really looking at is various  types of spinal misalignment, although there is little to no evidence linking these alignment issues with the chiropractic notion of subluxation. Secondly, x-rays are money makers, so there is a financial incentive to x-ray patients even if it isn’t necessary. This is problematic, considering that x-rays expose you to radiation. Being exposed to radiation is not bad in itself, but is problematic considering that the over-use of x-rays by chiropractors are unnecessary. Health care should appropriately match risk to benefit; chiropractic x-rays are a risk with no benefit.

Chiropractic itself can be a considered a risk with no benefit. Chiropractic neck manipulation has caused strokes in some patients. Given that there is very little evidence that chiropractic does anything, being exposed to the possibility of a stroke seems far too risky compared to the benefits. As Dr. Mark Crislip explains,

“…the biggest concern with making [Text Neck] a worry to people is the ‘solution’ to the problem. Somehow I suspect the treatment will be chiropractic manipulation of the neck. And that could lead to an increase in strokes. Great.”

Conclusion

There is no evidence that we are currently suffering from an epidemic of Text Neck. As James Hamblin writes, in response to the previously less-critical article in The Atlantic, “Texting invokes the same posture as holding a book. Or a baby. Or a rock”. So, if there was no Book Neck epidemic, why are we so worried about texting?

As we make technological progress, there are bound to be those who fear the effects these products have on us. However, we shouldn’t let our intuitive technophobia override our need for evidence.

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