If You Keep Texting, Your Head Will Fall Off

"It is an epidemic. Or, at least, it's very common," New York-based spine surgeon Kenneth Hansraj told The Washington Post last week. He was referring to something that is being called "text neck," a purported condition of the spine related to the posture of bending forward to look at a phone.

Hansraj's comments came in wake of a short article on the matter that he published in an obscure medical journal called Surgical Technology International. Last week my colleague Olga Khazan mentioned the paper in a brief post for our site that included Hansraj's diagram of how flexing your neck increases stress on your cervical spine. It was an interesting account of the suggestions of one private-practice neurosurgeon. But the post and the illustration spread widely around the Internet, and the stakes elevated quickly.

In the past week, the study and the diagram have been published by hundreds of outlets, including The Chicago Tribune, Slate, NPR, Business Insider, The Sydney Morning Herald, NBC News, The Globe and Mail, Today, Time, Yahoo, Shape, BuzzFeed, The Huffington Post, and many others. New York's headline, for example, was "Look at How Texting Is Warping Your Spine." At several publications, the story was the most popular post on the site. With claims of epidemic and implications of serious spinal damage, the story has elevated to something that maybe warrants a closer look.

Hunching over isn't ideal, and it's worth thinking about sitting or standing up straight when possible. But our necks are made to bend forward, and it's not something that's new to humans. Texting invokes the same posture as holding a book.

Or a baby.

Or a rock.

Physicists and engineers have taken to blogs and comments to argue over the accuracy of Hansraj's calculations. But whatever the exact numbers (we used Hansraj's in our illustrations here), it is true that there's more force on the base of the cervical spine when the head is bent forward. And the farther forward a person bends his head to look at their phone, the more force that puts onto spine. That's all true. The question is whether that matters, and if so, how much.

One of the people who tweeted in discontent was Ian Dorward, a neurosurgeon at Washington University in Saint Louis. He rebuked The Washington Post thusly:

I talked with Dorward for his counterperspective on last week's text-neck mania. Being a neurosurgeon, he not only knows a lot about spinal anatomy and biomechanics, but he also spends as much of his day bent forward over people's exposed spinal cords as even the most angsty of Instagram-mongering tweens do over their text machines.

"To say that there's this epidemic of 'text neck' is totally unfounded," Dorward said. "All he [Hansraj] has is a computer model, and he doesn't even spell out where these numbers are coming from."

The reality is that an axial load, one applied from the top down onto the spine, at the weights in question is not dangerous. "People can carry a lot more than 60 pounds on top of their head if it's actually an axial load," Dorward said, noting that people have evolved to have their heads flexed in a variety of different angles and postures without issue.

"If you apply external weight to the head and then flex it forward, that would be a real issue," he continued. "Certainly if you spend an inordinate amount of time leaning forward, it can cause musculoskeletal problems like exacerbating arthritis." When he's huddled over a surgical field in the operating room, Dorward wears loupes and a head lamp. The weight of those devices combines with the weight of his cranium to significantly increase torque on his spine. "The stresses that I'm applying to my spine are vastly greater than what someone would be experiencing when they're texting," he said. And that is, for someone in his line of work, a legitimate concern.

For most people, though, the point remains that good posture is generally good when possible, but texting is not an imminent threat to spinal health.

In his paper Hansraj goes on to talk about power posing, how posture and assuming certain stances seems to affect a person's hormonal milieu. Research has shown that assuming "high-power" postures—sitting up straight and throwing your shoulders back and aligning your ears over your shoulders—can lead to very real elevations in testosterone, serotonin, and tolerance for risk taking. That's cool stuff to consider, but a separate issue from the hypothetical scourge of text neck.

"People are walking around now while texting, falling into water fountains and lakes and walking into traffic—that's a real danger," Dorward added.

The more important idea that has been studied with regard to biomechanical forces on the spine is related to the American "epidemic" of obesity. As a person gains weight, their center of gravity moves forward, and that can drastically increase force on a person's lumbar spine. "That's a real problem for spine disease," Dorward said. "Looking down at your phone is really not."

James Hamblin, M.D., is a staff writer at The Atlantic. He is also a lecturer at Yale School of Public Health and author of the forthcoming book Clean: The New Science of Skin.

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