Physical Therapy for Text Neck

Physical therapy can be an effective treatment for an increasingly common condition known as text neck. Text neck refers to neck pain triggered by a handheld device like a smartphone or tablet. It occurs when you keep your neck in a forward flexed position for hours while texting, internet surfing, or reading from your mobile device.

Although long-term relief can only be achieved by altering your smartphone habits, physical therapy can help resolve the symptoms of text neck when rest and anti-inflammatory drugs are unable to provide relief.

This article explores the physical therapy techniques used to treat text neck, along with the symptoms, causes, and diagnosis of the increasingly common condition.

Man looking down while texting.
Reza Estakhrian / Getty Images

Symptoms

Common symptoms of text neck include:

  • Chronic pain in your neck
  • Pain radiating to one side of your neck, shoulder blade, or arm
  • Numbness or tingling in your arm, hand, or fingers
  • Weakness in your arm or hand
  • Stiffness in your neck or difficulty lifting your head after looking down for long periods of time

If you are experiencing symptoms like these on a recurrent or ongoing basis, it is important to speak with your healthcare provider or see a physical therapist.

Causes

A 2019 study from the University of Michigan concluded that the average daily smartphone use for adults in the United States is 234.4 minutes (roughly four hours) during which people will check their phones an average of 67 times per day. This high level of use accounts for the increasing incidence of text neck in both children and adults.

Text neck is caused by maintaining your neck in a severely forward flexed position while looking at your smartphone.  Keeping your head flexed forward for prolonged periods at 60 degrees or less increases the risk.

This abnormal posture can place increased pressure in the intervertebral discs of your neck and, in turn, cause the herniation (bulging) of discs.

Research suggests that if the pain is left untreated, text neck can cause the gradual deterioration of the cervical spine of the neck. This long-term risk may be greatest in children and adolescents whose bones are still growing.

Recap

Text neck can develop over the course of months or years when you keep your head in a forward flexed position while looking down at your phone. Over time, this can cause the disc in your cervical spine to bulge outward.

Diagnosis

Though text neck can often be recognized by the tell-tale symptoms, your healthcare provider or physical therapist will do an exam to check for tenderness, muscle weakness, and numbness and see how far you can move your head forward, backward, and side to side.

These findings, along with a review of your medical history, can help establish if the neck pain is caused by an acute injury, a degenerative condition like osteoarthritis, or repetitive stress.

If the cause is unclear, your healthcare provider may order additional tests based on the types and severity of symptoms involved. This may include:

Physical Therapy

If you are experiencing text neck, your physical therapist (PT) will offer treatments to help decrease neck pain and improve neck mobility. The PT will start by taking measurements of your neck range of motion and analyzing your general posture. This can help establish which therapies will be most effective for you as an individual.

Postural Correction

Since text neck is caused by maintaining your neck in a forward flexed position, the PT will first teach you how to maintain proper posture. This can help take some of the stress off the neck and help minimize pain.

The goals of postural correction can differ by the individual but are focused on addressing both your dynamic posture (while you are moving) and static posture (while you are sitting, standing, or sleeping).

When treating text neck, the PT will likely focus on your standing and sitting postures as well as the placement of your mobile device while reading. This includes:

  • Your general posture: This involves standing up straight and tall with your shoulders back and your stomach pulled in.
  • Your head position: The aim is to keep your head level (which includes lifting your smartphone to eye level when reading).
  • Your shoulder position: This includes relaxing your shoulders and avoiding either rounding the shoulders or pulling them back.
  • Your stance: This includes keeping your feet a shoulder-width apart and placing most of your weight on the balls of your feet.
  • Your seated position: This involves supporting your lower back, thighs, and hip while seated and keeping both feet on the floor.

To further relieve chronic neck pain, an ergonomic pillow called a cervical roll may be used to maintain proper neck posture while lying down or sleeping.

Recap

Good posture—including standing tall with your shoulders back and stomach pulled in—is the first step to relieving text neck and avoiding it in the future.

Behavior Modification

Since text neck is caused by flexing your head forward, your PT will offer strategies to help you avoid behaviors that contribute to neck pain. This may involve corrective devices like special holders or easels that prop up your tablet or mobile device to help keep your neck in a more neutral position.

You may also be encouraged to set rules to reduce the duration and/or number of times you use your mobile device. Among some of the self-help tips:

  • Turn off message alerts so that you don't reach for your smartphone with every incoming message.
  • Limit your use of mobile readers and only using them at times when you can sit or stand with your head in a neutral position.
  • Schedule "no-phone" hours during which you either turn off the phone or put it into sleep mode.
  • Answer emails on your laptop or PC instead of your smartphone.
  • Be constantly aware of your posture when using your smartphone and take time throughout the day to stretch your neck and shoulders.

Some PTs use "shoulder taping" as a teaching device. This involves applying a length of tape across the trapezius muscles (the pair of triangular muscles extending over the back of the neck and shoulders) to help maintain posture while texting.

Exercises

To counteract the strain caused by text neck, your PT will teach you exercises to perform on a regular basis. These typically involve exercises known as cervical retraction, cervical extension, and scapular stabilization. These exercises are performed three to four times daily to alleviate pain and increase the flexibility and range of motion of your neck.

Cervical retraction is an exercise that places your neck in a position of tension while actively stretching the muscles and connective tissues. To perform cervical retraction:

  1. Sit tall in a chair with equal weight on your sitting bones. 
  2. As you inhale, draw your head back as you tuck in your chin slightly and lift the base of your skull toward the ceiling. 
  3. Hold for 10 to 15 seconds.
  4. Relax as you exhale.  
  5. Repeat eight to 10 times.

You can perform variations of cervical retraction by turning your head to the side or tilting your head to your shoulder while performing Step 2.

Cervical extension is an exercise that counters cervical retraction. To perform cervical extension:

  1. Sit or stand with your arms to your side.
  2. As you inhale, push both shoulders down while tucking the chin to the chest.
  3. Extend your head back while elevating the chin to the ceiling, keeping your arms down and slightly back.
  4. Hold for 15 seconds.
  5. Relax as you exhale.
  6. Repeat eight to 10 times.

Scapular stabilization exercises help strengthen the shoulder muscles to support and stabilize the neck. They mainly target the muscles that move the scapula (shoulder blades), including the trapezius muscles and deltoid muscles. One of the most beneficial exercises, called scapular retraction, is performed as follows:

  1. Stand with a good posture with your feet a shoulder-width apart.
  2. Relax your head and neck.
  3. As you inhale, squeeze your shoulder blades back as you tighten your abdominal muscles.
  4. Hold for 10 to 15 seconds without shrugging the shoulders.
  5. Exhale as you relax the shoulders.
  6. Repeat eight to 10 times.

Your PT will offer other exercises specific to your neck pain. If these are performed as prescribed, your symptoms should resolve within three to four weeks.

Recap

Exercises used to treat text neck should be performed three to four times daily to relieve pain and increase the range of motion of your neck,

When to See a Healthcare Provider

Neck pain can sometimes persist for weeks or months even with consistent physical therapy. This may be a sign of a more serious problem, including neurological conditions such as cervical radiculopathy or aging-related conditions like cervical spondylitis. Both require more than physical therapy to achieve relief.

You should see a healthcare provider if your chronic neck pain is accompanied by any of the following:

  • Acute weakness in your shoulder, arm, forearm, or hand
  • Significant loss of balance
  • Difficulty walking (including a dragging gait)
  • Loss of fine motor tasks (like writing or buttoning a button)
  • Collapsing weakness of a limb
  • Chronic muscle spasms of the neck
  • Shooting nerve pains

When it comes to neck problems, it is always best to err on the side of caution. If the pain persists despite optimal physical therapy, seek medical help as soon as possible.

Summary

Text neck is an increasingly common condition caused when you keep your neck in a forward flexed position while looking down at your phone. It can develop over months or years, causing chronic pain, numbness, arm weakness, and neck stiffness.

Physical therapy can greatly improve text neck and help ensure that it never returns. This typically involves correcting your posture, altering your phone use habits, using assistive devices, and performing gentle but consistent exercises to decrease neck pain and increase your neck's range of motion.

A Word From Verywell

One of the most important aspects of any physical therapy program is the adoption of strategies to prevent future episodes of pain and disability. With regards to text neck, this includes maintaining proper posture while using your smartphone and stretching your neck and shoulder regularly to retain flexibility and range of motion.

There are other things you can do to avoid injuries related to the misalignment of the neck, mid-back, and low back. These include maintaining a healthy weight, wearing comfortable low-heeled shoes, and keeping work and dining surfaces are at the right height to maintain good posture.

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