Joey Wahler (Host): It's a painful condition that can result from overuse of our mobile device. So, we're discussing text neck syndrome. Our guest, Dr. Clifford Solomon. He's a Neurological Spine Surgery Specialist, Director of the Spine and Neuroscience Center at UM Baltimore Washington Medical Center and a member of the UM Spine Network.

Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. Thanks for listening. I'm Joey Wahler. Hi there, Dr. Solomon. Thanks for joining us.

Clifford Solomon, MD: Thanks for having me, Joey.

Host: Great to have you aboard, doc. So first, in a nutshell, what exactly is text neck syndrome? And since texting hasn't been around all that long, I would imagine that if not the condition, that at least the name for it there is relatively new.

Clifford Solomon, MD: Exactly. It is relatively new with the advent of smartphones and people messaging, looking at email, going down the YouTube rabbit hole, and doing it on the go. So normally, prior to the advent of all this technology that we hold in our hands, a lot of information we got by reading books. And then as computers became more and more in our mainstream, people were sitting at a desk, again, mostly looking forward. As time went on, people started coming up with standing desks to help more of the low back, but most of the data was being presented straight on. With the advent of cell phones and smartphones, which may be like jumbo shrimp or military intelligence, our daily lives now are spent kind of being hunched over for, on the average person, a few hours a day, kind of like having an eight-pound dog or child around your neck, not that you wouldn't love your child or your dog, but being on the back of your neck hunched over in a forward flexed position, kind of like looking down, chin to chest, has taken its toll on people over the last decade. And that was the beginning of kind of long-term implications to your body and somewhat to your mind. I mean, there's some mental implications, but text neck in itself is really looking at the ligamentous overuse and the muscle overuse. And then subsequently, the joints in your neck being pissed off, that's a medical term. And you having this kind of painful neck from hours of being forward flexed and not even realizing that you're doing it.

Host: And so as a result, how can we recognize the common signs and symptoms of text neck? And what exactly is happening there that's causing this discomfort?

Clifford Solomon, MD: I don't know that anybody really knows a hundred percent, but common sense would say the way we're normally built is your head is kind of straight ahead and then, your cervical spine, your neck, is connected to the base of the skull. The neck spine's connected-- sounds like a game-- to the thoracic spine, where your ribs give you a lot of protection. Thoracic is connected to the lumbar, and then your tailbone, your sacrum. And then, sideways, you know, you have your hip joints, and going down to your feet. And so, we look like an S normally with the neck and the head backwards a little bit, a little rounding in the thoracic and then tip taking position in the lumbosacral region, low back. And what happens with text neck the thought is repetitively being forward flexed, you're just loading the back of your neck with between eight and 40 pounds of weight, depending on how far you're forward flexed.

And ultimately, there is over time and no one's really sure how long, but certainly over a year, two years, three years, 10 years, you develop chronic inflammation in the joints in the back of your neck. In the front of your neck, you have the airway, the trachea behind that, the feeding tube, the esophagus behind that, the square bones on the skeleton with the discs, so square bone discs from the neck all the way down to your tailbone. What we think is happening behind those bones is your spinal cord and the nerves going out on the sides of your arms, and behind that, the bones you feel with your finger on the back of your neck. Those are the spinous processes and the lamina. And they go to the joints in the back of the neck. Discs on the front, joints on the back. We think that the discs are getting a lot of pressure. They're made of 86% water. So, they're getting dried out and we think the joints are taking the hit. And as they take the hit and have to work harder by all this extra weight with you being forward flexed and hunched over forward, those joints get pissed off. And then, they get irritated enough, the nerve underneath it gets irritated, and you can have numbness and tingling in your fingers. You could even develop a stinger, like football players get a little weakness here and there. When you move your neck at the end of the day, it can be really sore in your neck or your arms. And that's probably the majority of why people are hurting from text neck.

Host: Any specific age groups more susceptible to getting this or people more susceptible to getting it for any other reason?

Clifford Solomon, MD: So, good question. We certainly don't want to miss something more serious. So, somebody that wakes up with pain in the middle of the night from a dead sleep, that's concerning. Somebody who has that and unexplained weight loss who smokes, very concerning. Age group-wise, it was originally described in younger people. And now, phones are ubiquitous and, even across every generation, there are a lot of people using smartphones. And so, it's really becoming something that we're seeing everywhere in all age groups. The more you are tied to your smartphone, the more likely you are to have neck pain. And most neck pain will settle down if you do certain things, which we can talk about. If they don't settle down on their own within six weeks, you definitely should seek out a doctor to look over you and make sure it's nothing more serious, which normally it's not, and you don't want to miss that. And so, having really bad weakness in your arms, biceps, triceps, you know, picking up things, you know, like pick up sticks, that'll rhyme, you know, close the gate, triceps, grip would be concerning. Having electric shock going down your whole spinal cord if you cough or sneeze or bear down, very concerning to have that checked out. That may not just be text neck, probably is not actually. But as far as text neck goes, probably now every generation has it.

Host: So, what are the potential long-term effects of text neck if someone does let it go, doesn't take the advice you just gave, and if it's not addressed in a timely manner? Any other health issues associated with it, for instance, if it's not nipped in the bud?

Clifford Solomon, MD: So, I don't think that nipping in the bud is going to happen. I think people, unfortunately, love their phones, love YouTube, TikTok, Instagram, and everything else. By the time they're down that rabbit hole, they probably already have some degree of inflammation more than just the normal wear and tear. The most common levels are the bottom of your neck, C5-C6, C6-C7. You basically have your head. Then, the bottom of your head, there's a hole called the foramen magnum and then C1 to C7. And so, 90% of degenerative disc disease in your neck is C5-C6, C6-C7, C7-T1 is where the first thoracic is. And so, it's the last mobile joint before your rib cage comes in and takes up 300% of the stress off of your neck and your shoulder. So, the bottom of the moving stick, C6-C7, and the level above it, C5-C7, are the two most common levels that you get it.

Once you do have it, even though it wasn't overnight, the long-term biggest ramification I can think of is when you see people who are like in their 80s, 90s, some 70s, and I worry that it may go lower, like 60s and 50-year-olds, is you see how they're like looking at the ground, they have what's called a swan neck deformity, or really bad kyphosis. Kyphosis means you're looking at the ground and you have a big round hump in your neck like Quasimodo, you know, the Hunchback of Notre Dame. And that's, as older people, you do not want to have that.

And so, the way to avoid this, the way to avoid getting text neck, the simplest way is just to stand up straight. Put whatever you're reading, most likely your smartphone, at eye level. That's by far the best thing. If you can't do that, putting your smartphone on a stand is a good idea. But as much as you can bring in your arms or whatever you're using to put whatever you're reading in front of your eyes is going to be the key to not developing text neck from repetitive stressing of the neck while in a forward flex position, like you're looking down.

Host: That being said, what about maintaining good posture in general, doc? Any tips for doing that, whether we're looking at our phones or just otherwise.

Clifford Solomon, MD: Yeah. It's a great observation and great question. And yes, it's something that we don't think about. And so, as much as we can try to get in the habit of just thinking about our posture and breathing, just taking nice gentle breaths in whatever you're doing, just try to stay present. You know, if you stay present, it's hard to get too anxious about life. If you start worrying about things, just take a big breath in. The mental game is as much a part of this as the physical. But the physical, just head up, chest out, chin a little tucked, not crazy. You know, you don't have to be like a Marine, but more like a Marine than somebody looking down at their smartphone.

But good posture, always really thinking about pulling your shoulders away from your ears when you feel stressed, trying to pull your shoulder blades down just by really imagining that they're down and they'll come down. And then, as I was saying, putting things at eye level. You know, posturally, that's a really good start.

There are some specific exercises you can do to help keep your posture. And a good physical therapist is really helpful, because they can show you things to do with the caveat that your doctor or whoever's doing showing you, you know, "It hurts when I do this," you know, don't do that. I mean, no pain, no gain doesn't work for this. It should not hurt.

Having said that, doing a little bit more every day, before you know it, you're doing a lot more stretching, and you'll notice that you in a month or 6 weeks that you're doing things you couldn't do before just because your posture was out of balance. And absolutely, we see people change their x-rays just by good posture and then good exercises as well will help.

Host: And so, in order to learn and carry out those exercises, you're suggesting seeing a professional to make sure you're doing the right thing.

Clifford Solomon, MD: Correct. And to make sure that there's nothing else that's concerning to somebody that they'd want to send you to a neurosurgeon or orthopedic spine surgeon or a physiatrist, not a psychiatrist, but a physiatrist is a pain management, physical therapy, rehab medicine MD. And they're very helpful at again trying to sort these things out. And then, if you need to be seen by a surgeon, we're the last resort. You know, I try to be very conservative, but then they can send you on to an orthopedic spine surgeon or neurosurgeon if they think that something really needs to be addressed, it's not going to go away on its own.

Host: Because, just to be clear, you make a great point there, doc, and then I want to ask you one other thing in a moment. We're talking here about trying to avoid, or if it's already happened, eliminate pain caused by keeping yourself in a bad position if no other further tangible damage has been done that might require surgery, because that would involve a whole other level of care, obviously.

So, in summary here, what's your overall message for our listeners regarding the general prospects for alleviating that text neck pain, if in fact that's what it is?

Clifford Solomon, MD: Best thing I would think is trying to put your smartphone or your laptop up at eye level. And as you said, when you're just walking around living your life, try to really look forward head up, chest out as much as you can. The repetitive forward flexing, which is what gets us into trouble over a lifetime, usually it's C5-C7, C6-C7 in the neck and in the low back. Same idea at the very bottom of the stick, L4-L5, L5-S1, which is the last mobile segment to the tailbone. But same idea, good posture, core strength, tuck your stomach in all the time. When you're thinking about it, when you're sitting, really try to sit straight. When you're walking, try to be forward with your eyes, looking at where you're going, obviously, and not texting.

And then, when you really are texting, as much as you can, keep things at eye level. And then if it's not going away, see a professional, get them to give you the once over. Eighty-five to 90% of all people who have this, symptom will go away without doing much of anything except some modifications. And then, obviously, not getting caught in that small group where something really needs to be looked at further. And so, like I said, if it's chronic or you see that you're losing weight with it, or you're just overly fatigued with it, then definitely get checked out sooner than later.

Host: So, the good news here from a takeaway standpoint, it sounds like, doc, is that much of this is within our own control. Well, folks, we trust you're now more familiar with text neck syndrome. Dr. Clifford Solomon, a pleasure. Thanks so much again.

Clifford Solomon, MD: You too, Joey. Thanks. And thanks to everybody. Take care.

Host: Absolutely. And for more information, you can visit umms.org/podcast, umms.org/podcast as well as their YouTube channel. Please do share this podcast on your social media. I'm Joey Wahler. Thanks again for listening to Live Greater, a health and wellness podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again.