Dean Fishman, a chiropractor in Florida, was examining an X-ray of a 17-year-old patient's neck in 2009 when he noticed something unusual. The ghostly image of her vertebral column showed a reversal of the curvature that normally appears in the cervical spine — a degenerative state he'd most often seen in middle-aged people who had spent several decades of their life in poor posture.

 "That's when I looked over at the patient," Fishman says. She was slumped in her chair, head tilted downward, madly typing away on her cellphone. When he mentioned to the patient's mother that the girl's posture could be causing her headaches, he got what he describes as an "emotional response." It seemed the teen spent much of her life in that position. Right then, Fishman says, "I knew I was on to something."

He theorized that prolonged periods of tilting her head downward to peer into her mobile device had created excessive strain on the cervical spine, causing a repetitive stress injury that ultimately led to spinal degeneration. He began looking through all the recent X-rays he had of young people — many of whom had come in for neck pain or headaches — and he saw the same thing: signs of premature degeneration.

Fishman coined the term "text neck" to describe the condition and founded the Text Neck Institute (textneck.com), a place where people can go for information, prevention and treatment. "The head in neutral has a normal weight" of 10 to 12 pounds, says Fishman, explaining that neutral position is ears over shoulders with shoulder blades pulled back. "If you start to tilt your head forward, with gravity and the distance from neutral, the weight starts to increase."

"When your head tilts forward, you're loading the front of the disks," says Dr. Kenneth Hansraj, study author and chief of spine surgery at New York Spine Surgery & Rehabilitation Medicine. Though the study didn't look at long-term effects of this position, Hansraj says that, after seeing approximately 30,000 spinal surgery patients, he's witnessed "the way the neck falls apart."

In addition, Fishman says, text-neck posture can lead to pinched nerves, arthritis, bone spurs and muscular deformations. "The head and shoulder blades act like a seesaw. When the head goes forward, the shoulder blades will flare out … and the muscles start to change over time."

Much like tennis elbow doesn't occur only in people who play tennis, text neck isn't exclusive to people who compulsively send text messages. Hansraj says people in high-risk careers include dentists, architects and welders, whose heavy helmets make them especially vulnerable. He adds that many daily activities involve tilting the head down, but they differ from mobile-device use in intensity and propensity.

"Washing dishes is something nobody enjoys, so you do it quickly. And while your head is forward, it's probably tilted at 30 or 40 degrees," he says. People tend to change position periodically while reading a book, and they glance up frequently while holding an infant. But mobile devices are typically held with the neck flexed forward at 60 degrees or greater, and many users, particularly teens, use them compulsively. The study reports that people spend an average of two to four hours a day with their heads tilted at a sharp angle over their smartphones, amounting to 700 to 1,400 hours a year.

To remedy the problem, Hansraj has a simple message: "Keep your head up." While texting or scrolling, people should raise their mobile devices closer to their line of sight. The Text Neck Institute has developed the Text Neck Indicator, an interactive app that alerts users when their smartphones are held at an angle that puts them at risk for text neck.

Fishman also recommends that people take frequent breaks while using their mobile devices, as well as do exercises that strengthen muscles behind the neck and between the shoulder blades in order to increase endurance for holding the device properly.

He adds, "I'm an avid technology user — and I use it in the proper posture."

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