Complete Story


The Future is Looking Down

By: Anthony J. Lombardi, DC

Technology Means You Will Be Busy for Years to Come

You wake up, look down and check your watch – It’s 8 a.m. You stare at your watch for a few seconds and then you look up. Three minutes later you look down and check your watch again – it’s 8:04 and you stare with your neck flexed down for another few seconds. Now imagine doing this look-down-and-stare routine every four minutes until midnight. But you’re not just looking at your watch, you’re also checking your smartphone. 

According to a Tecmark study, the average person looks at a smartphone 221 times a day for a total of about three hours and 15 minutes – about once every four minutes for 16 hours straight. A chiropractor should find this to be worrying because in one year the average person will spend almost 1,200 hours – 50 days – staring down at a screen. 

Repetitive Strain Injury

Professionally speaking, you’d have to agree that without a doubt the magnitude of this number of repetitions could become responsible for decades of chronic neck pain. A preliminary study in the 2011 edition of Applied Ergonomics shows a relationship between mobile device use and musculoskeletal neck pain. 

Another study, from the 2012 edition of the same journal, tells us that when people use mobile devices, their posture is often poor (not a surprise). Sarah Hopkins, DC, believes the long-term side effects of text messaging and smartphone use can cause a person’s posture to change over time. “The body has an incredible ability to adapt,” Hopkins says. “Unfortunately, when people are hunched over their cell phone all day, the body adapts to that posture, too.” 

Not All Thumbs

The general public is under the impression that smartphone overuse can cause conditions like “Blackberry thumb” or “iPad finger,” but texting is actually a full-body activity. Muscles like the sternocleidomastoid, deep neck flexors, pectoralis major, latissimus dorsi, masseter, and erector spinae all contract during the traditional texting stance: head down and arm adducted with the elbow bent at 90 degrees. The continual repeated use of these tissues can trigger the release of neurogenic inflammation which can lead to motor muscle inhibition. 

Negative Outcomes

Neurogenic inflammation in the musculoskeletal system is generated by nerve impulses and the release of inflammatory substances from the sensory axon at the site of the original injury. These substances are typically (but not limited to): substance P (SP), calcitonic gene-related peptide (CGRP), and neurokinin-A (NKA). 

Prolonged inflammation and pain can lead to protective muscle spasm, accumulation of fibrous tissue, and muscle shortening. Accretion of fibrous tissue can form palpable taut muscle bands and trigger points, creating muscle dysfunction and spasm that leads to the compression of blood vessels – creating nociception. 

In short, nociception is a nerve’s reaction to the chemicals that irritate it. Neurogenic inflammation, which can be caused by injury or repetitive strain, is the chemical mixture that irritates the nerve that controls a specific muscle. This causes that muscle to become inhibited and forces adaptation of the musculoskeletal system – which contributes to long- term degradation of mechanics. 

Accelerating Problems

Alpha-motor neuron muscle inhibition occurs when the nerve that sends the impulse to contract a muscle becomes unable to function at its optimal capacity because of chemical or physical trauma. This results in a perceived weakness of the muscle that changes the biomechanics of the entire region. 

The primary cause of motor inhibition is a sufficient amount of neurogenic inflammation released by the sensory axon to inhibit the motor neuron. So, looking down at a smartphone over 1,500 times a week can not only contribute to motor inhibition but also accelerate its onset. 

Incorporating Texts into Patient History

You can adapt your history-taking to incorporate texting as part of the functional orthopedic exam. With tech-savvy patients who are suffering from neck and shoulder discomfort, you can reproduce and exacerbate their pain by taking out a phone and texting them a series of common history-taking questions. 

For example: Text them questions like, “When did the pain start,” “What makes the pain better or worse,” or “What medications are you currently taking?” 

These questions lead them to text you the answers and even though the exchange only takes three or four minutes, that is usually long enough to exacerbate their symptoms. In addition, it reveals to them the contributing factors to their chief complaint. 

The Eyes Have It

Smartphone use taxes not only the musculoskeletal system but the ocular system as well. You want to be able to explain this to your patients so you can better diagnose and treat their condition. 

Researchers from the Journal of Optometry and Vision Science found the average working distance for text messages to be about 14 inches, whereas the average working distance for viewing a webpage was about 12 inches. 

But those were both closer than the typical working distance of approximately 16 inches when reading printed text, as with a newspaper or magazine. Holding smart phones at such short distances can place increased demands on the eyes’ ability to correct for distance. 

This is why optometrists are also weighing in on the “text neck” debate. Otto Lee, OD, believes the use of smart phones, tablets, and computers is certainly on the rise regardless of age group. The growing concern with smartphone and computer use stems from the effects of increased exposure to harmful blue-violet light. 

Many digital devices use LEDs that can emit about 35 percent blue-violet light, says Lee. “Normal visible light that we can detect ranges from 380 nm to 780 nm. UVA, UVB, and UVC ranges from 315 to 1000 nm and can damage human tissue, including the eyes.” This can increase the risk of developing cataracts and age-related macular degeneration. 

Patient Protection

Lee recommends that antioxidants and vitamins can provide some protection against blue-violet light damage. In addition, lens manufacturers have developed lenses that block out harmful blue-violet light without altering image clarity and color. 

“Prevention is the key. Limiting the use of smartphones, tablets, and computers is obvious – if you can get your teens or yourself away from them,” Lee says. He also recommends regular “eye breaks,” which will complement good neck posture because eye strain is usually compensated by changing neck position. A one-minute break after every ten minutes of screen time is a good recommendation. 

Ounce of prevention

To take the pressure off of the neck and shoulder muscles, patients need to find smartphones they can hold and type on using only one hand. Some of the larger phones, known as “phablets,” generally require two hands to use and are less ergonomic. 

Repeatedly flexing the neck downward to operate a smartphone will likely cause damage over time. To combat this, patients can try using voice dictation and auto-text options that allow them to speak their message or help it type itself. Also, when they have to text, they should try sitting comfortably at a desk or table with their hand resting on the surface about 18 inches away from the body. This will put the neck at a more gradual angle, placing less strain on the muscles. 

Anthony J. Lombardi, DC, is the creator of the eXStore assessment system. He is a consultant and treatment provider to professional athletes in the NFL, NHL, and CFL. He can be contacted at or through 

Article reprinted with permission from Vol. 62, Issue 2 (February 5, 2016), of Chiropractic Economics, your first source for news. For a free subscription, go to

Common “Tech” Injuries 

Text Neck: AKA “iPosture Issues.” Caused by flexing the neck for long periods of time. Symptoms include twinges of pain, aches. Can lead to permanent arthritic damage if not treated. Solutions: Regular screen breaks, looking straight ahead while tucking the chin back toward the neck, rotating the shoulders with the arms by the side. The best way to maintaining a healthy posture is to sit straight and holding the phone high. 

Blackberry Thumb: Repetitive strain injury caused by overuse of mobile phones to send texts and emails. Symptoms: Pain at radial side of wrist, spasms, tenderness, possible burning sensation, swelling. 

Cell Phone Elbow: AKA “Cubial Tunnel Syndrome.” Caused when pressure from holding a phone to the ear damages the cubital tunnel, which allows the ulnar nerve (“funny bone”) to travel over the elbow and to the hands. Symptoms: Pain, numbness, tingling in the forearm caused by decreased blood flow and nerve ischemia. Solutions: a hands-free headset, microphone enabled headphones, etc. 

Smartphone Pinky: Caused by gripping the smartphone too tightly. Solutions: Taking frequent breaks, not holding the phone tightly. 

Text Claw: A result of repetitive fine motor activity. Often develops when phone is held in a position not natural for the thumb, wrist, or finger joints. Can lead to tendonitis.

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