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Our modern culture is dominated by devices, chiefly smartphones, which have a way of consuming many individuals’ free time with their countless functions—and distractions. Spending too much time on a smartphone is commonly regarded as an unhealthy habit for various reasons, one of which is perhaps less commonly known than others: a higher risk for a condition called “text neck.” It had been thought that spending excessive time with the neck too far forward in a flexed position—which is a common posture when using a smartphone—leads to painful symptoms that have been classified under the diagnosis of text neck; however, the findings of a 2021 study have called into question this commonly held belief.

Text neck is a relatively new diagnostic term that’s been used to describe a variety of painful symptoms caused by excessive flexing of the neck, usually from too much time looking at a smartphone or tablet. The theory behind text neck is that although neck muscles and joints can handle our normal everyday movements, they are not built to withstand being overstretched for countless hours every day. Therefore, spending numerous hours each day on one’s phone could push the neck past its limits, resulting in text neck over time. The most common symptom of text neck is neck pain and soreness, while some patients also report headaches and shoulder, arm, or wrist pain.

Although neck pain is prevalent in adolescence, there is a lack of literature on the association between neck pain and postural habits. Therefore, a team of researchers conducted a study to examine the relationship between these factors in adolescents and to better determine if forward head posture contributes to text neck.

Nearly 3,000 children are tracked for 22 years

To conduct the study, researchers used data from a cohort of 2,868 individuals from Western Australia who had been tracked from before birth until the age of 22 years. At the age of 17, all participants were assessed with various measurements to determine their posture type: upright, intermediate, slumped thorax with forward head, or erect thorax with forward head. Participants were also asked several questions about neck pain—such as if they had ever experienced neck pain and if it had persisted for up to three months—and about their exercise habits. At the age of 22, participants were once again asked the same questions regarding neck pain and were also asked to describe the type of work they performed in their current job, such as a sedentary job (which involves mainly sitting), a standing job with no intense physical effort, physical work, or heavy manual work. Answers to these questions were than analyzed alongside the postural measurements to determine if there were any connections between posture and neck pain.

Results showed that at 17 years, 22% of participants reported persistent neck pain, and this rate increased to 28% of participants at 22 years. In addition, participants who had neck pain at age 17 were about four times more likely to have neck pain at 22 years. Further analysis revealed that female participants with an upright posture at 17 years had the highest risk for persistent neck pain at 22 years (40.1%). This was followed by erect thorax with forward head posture (32.1%), intermediate posture (21.8%), and slumped thorax with forward head posture, which had the lowest risk for persistent neck pain at 15.6%. Clear associations between posture type and persistent neck pain were not identified for male participants.

These findings contradict the belief that forward head posture contributes to neck pain and text neck, as no posture was a predictive factor for neck pain in male participants and in female participants, slumped thorax with forward head posture was associated with the lowest prevalence of persistent neck pain. The subgroup of patients with upright posture had the highest rate of neck pain, which also runs contrary to the nearly universal recommendation to sit up straight with good posture to avoid neck pain and other health issues.

The study’s authors therefore recommend that experts reexamine the relationship between posture and neck pain with additional research to determine if “bad” posture is truly bad for us after all. In the meantime, understand that spending too much time on your smartphone is still not a healthy habit, but for now, those reasons are more related to associations with sedentary behavior and a lack of physical activity than neck pain.