Do you have text neck? How phones are affecting us physically

Earlier this year, a patient came to physical therapist Theresa Marko complaining of neck pain. Marko, who is based in New York City, began the appointment as usual, asking a series of questions about her lifestyle, habits and posture. Soon, a likely culprit emerged: the woman’s cellphone.

The woman, who Marko declined to name for privacy reasons, said she typically placed her phone, or her tablet, on her lap and looked down while using it. “That’s going to cause a big strain to your neck because you’re very, very flexed forward,” said Marko.

Marko says she frequently talks to patients about how they use their phones. “I don’t think that people end up coming to physical therapy because they realize that their cellphone is a problem,” said Marko. But, as she problem solves, it often becomes a focal point.

While the mental health harms associated with smartphone use are much discussed, the physical effects can also be significant. Severe outcomes, like selfie-related injury and death, can occur but chronic issues are far more common, especially in the upper body. This year, a study used hospital data to estimate that between 2011 and 2019, hand and wrist injuries due to cellphone use nearly doubled, to about 7,300 annually.

“It feels like [phone] use just keeps going up and up and up,” said Carolyn Sommerich, the director of the engineering laboratory for human factors/ergonomics/safety at Ohio State University. While that sentiment isn’t new, Gallup polling found that the number of people who reported using their smartphone “too much” went from 39% in 2015 to 58% in 2022. At 84%, twentysomethings were the most likely to feel that way.

One study told the story of a teenager coming into a hospital with a headache, vertigo and ataxia. An MRI showed that her neck was curving in the wrong way. Doctors suspected phone use was at least partly to blame and instructed the woman to limit her touch-screen use to two hours a day.

Incidents like this have become so prevalent that the resulting issues have earned nicknames, such as “text claw” and “text neck”. Opticians have documented eye strain from blue light exposure as well. Sommerich said: “You have to recognize that you’re taxing your body, even though it wouldn’t seem obvious at first blush.”

Experts say that most of the issues arise from people keeping their bodies in unnatural positions for long periods of time. Neck muscles, for instance, don’t have to work very hard when a person’s head is balanced over their body. But when using a smartphone, users often hold their head at an angle, which results in tense muscles.

“Your head is like a bowling ball. It weighs a fair amount. It gets heavy after a while,” said Sommerich – and the same principles apply to other body parts when it comes to prolonged smartphone use. “Everything can get overused.”

Another issue is that people often hold their elbows in a V shape while using a smartphone, said Brandon Donnelly, a surgeon in New Orleans who focuses on upper extremities. That stretches the ulnar – or funny bone – nerve, which can result in numbness in the ring and pinky fingers.

“If I’m sitting on my phone at night reading in bed, my pinky finger goes numb and tells me I need to straighten my elbow out,” he said. While he says it’s rare for anyone to get to the point of needing surgery, he does regularly see people with symptoms that could be attributed to cellphone use. He added that most of the issues he sees are with adults in their 30s and 40s.

“I’m not seeing it in younger kids,” Donnelly said. “Their tissue is more pliable.”

But, he said, people of all ages can develop smartphone-related problems in their hands. For example, intense gripping can lead to pain in the meaty thenar muscles of the palm, as well as tendonitis or even tendon rupture. And in older patients, prolonged holding can aggravate arthritis, especially at the base of the thumb.

The most reliable solution to these ailments is for people to not use their phones, but most experts agree that’s not realistic.

“The best we can do is to let them know the risks so they can change their behavior,” said Gwanseob Shin, who is an ergonomics researcher at Ulsan National Institute of Science and Technology in South Korea.

One of the biggest changes Shin would like to see is for people to stop using their phones while walking, a habit that increases the risk of running into obstacles like cars or other people. “You have less than a second to stop and avoid a collision,” he said. And, according to the 2023 hospital data study, falls accounted for nearly a third of all cellphone-related injuries.

Walking while using a phone also causes people to look down, putting stress not only on the neck but also the back. Shin’s research has found that neck muscle activation is roughly 21 to 42% higher when using a phone while walking, compared to sitting or standing. This is particularly true when texting compared to general browsing.

“The angle was higher when people were texting, compared to browsing or viewing websites,” said Shin. A possible (albeit theoretical) solution, he added, could be an app or phone feature that warns users when their posture is putting them at risk. “We have sufficient datasets and sensors.”

Until then, there are plenty of other steps that people can take to avoid the physical impacts of smartphone use. Adhesive handles, like PopSockets, can help keep people from clenching while holding their phones, said Donnelly. Being mindful of how bent your elbows are is critical, as is taking rest breaks, to avoid being in the same position for too long. Voice to text can also be an alternative to typing.

The most impactful change for your neck is to raise the phone to eye level. “If you’re going to be constantly on your phone you need to be looking directly at your phone,” said Jeremy James, an orthopedic surgeon in Louisiana. “That way your neck can stay in a neutral position.”

Marko, the physical therapist, is a big fan of using a stand as a way of elevating phones and other devices. That’s what she recommended to the patient who was propping her phone on her lap, and it’s starting to work.

But she knows that this won’t be her last patient with phone-related pain. “I talk about smartphones all the time,” she said.