Is This You?

Who thinks that the above and below postures lead to neck pain or discomfort? They are a common sight now since smart phones have become widely available.

There is a general consensus that the flexed (or forward bending) posture of the neck and head while reading and typing, also known as text neck is harmful, and is related to neck pain and other physical discomfort.

This impression that neck pain is caused by excessive smartphone use started after one computational model study in 2017 suggested that the greater the neck bending forward, the greater the overload. The theory is based purely on biomechanics and does not consider that pain is multifactorial and modulated by several factors.

Previous studies did not find an association between text neck and neck pain. Bertozzi et al (2023) also did not find an association between neck posture and time spent on smartphones with neck pain or disability.

The present study aims to investigate whether text neck is a risk factor for neck pain, while considering the influence of psychosocial and lifestyle factors. This longitudinal study with a 12 month follow-up using a self reported questionnaire and objective assessment of posture while sending messages on a smartphone. 

396 participants (87 percent) completed the 1-year follow-up. Average age of the participants was 27 years. 319 (70 percent) were female. The average neck flexion angle using the smartphone was 34 degrees. Only 4 subjects (1 percent) had neck pain "very often", 20 subjects (5 percent) had neck pain "often". 129 subjects 33 percent) had neck pain "occasionally", 158 subjects (40 percent) rarely had neck pain 85 subjects (21 percent) "never" had neck pain.

The researchers concluded that neck flexion posture was not a risk factor for neck pain or frequency of neck pain. They found that psychosocial factors like low sleep quality and insufficient levels of physical activity were contributing factors of neck pain.

So it's not really just what position you neck is in or how long you spend on your phone that can cause your neck to hurt. However, if you spend a lot of your time on your phone, please make sure you get in enough exercise and sleep well to avoid neck pain.

Reference

Correia IMT, Ferreira ADS, Gomes JFM et al (2025). Cervical Flexion Posture During Smartphone Use Was Not A Risk Factor For Neck Pain, But Low Sleep Quality And Insufficient Levels Of Physical Activity Were. A Longitudinal Investigation. Braz J PT. 29(6): 101258. DOI: 10.1016j.bjpt.2025.101258

Patient Has 'Tight' Upper Trapezius Muscles?

My patient came in to our clinic yesterday complaining of 'tightness' in his upper trapezius muscles. He saw me two weeks ago for his R knee pain and that had settled, but now it was discomfort in his upper trapezius area. He had been using the trigger ball in his upper trapezius area and there were marks all over the area.

Other than tightness, he was complaining of a deep ache and constant discomfort there. He thinks this sometimes causes him to have headaches and neck pain as well.

Upright scapula

What gave me the most clues was looking at him from the side view. While looking at him from his left side (I'm using the picture above to keep his identity anonymous), his trunk was tilting backwards with respect to his hips. However, when I got him to straighten up you can see his left scapula tilting forward (right side of the picture below).

See how his left scapula tilts forward

Having explained to him what I saw, I then proceeded to treat him. I did not do any deep tissue massages/ or release his upper trapezius muscles (the area of his complaint). Neither did I stick any needles there to relieve the 'tight' muscle tone. I did not even treat his neck.

So what did I do? I treated his Front and Back Arm Lines. Yes, you read correctly. I treated his arms. If you look at work done by Tom Myers, he's able to dissect the "arm lines" (see picture below) from a cadaver.

In the picture on the right, the Superficial Back Arm Line has been laid over a skeleton model to show the fascia connections.

My patient was amazed, fascinated and happy that I got him better just by treating his arms. He almost couldn't believe it.
Treating the Deep Front Arm Line is key to getting his condition better because of the anterior tilting scapula. Treat the cause of the problem, not the pain.

Deep Front Arm Line

Change The Arms, Change The Neck

First assessment

Here's another patient who came in to our clinic complaining of neck pain, tingling, and sensations of electric currents/ pins and needles, down his left arm.

This patient works as an electrician and often has to be in awkward positions running electrical wires. He feels worse after prolonged time spent looking upwards - mostly due to running ceiling electrical wires.

He was referred to our clinic by another friend who had seen us and gotten better without needing surgery as suggesting by his surgeon.

Just like the other lady who had neck pain, I didn't treat his neck. Just treated his arms and shoulder girdle.

Have a look at the picture after treatment.

After treatment

You can see quite an dramatic change not only in his neck but in his rib cage and hips too. Even his nephew who came with him was amazed at the change.

Before and after

Have a look when I put both pictures together above. Quite a big difference? All done in less than an hour.

What did I do? No mobilizations or manipulations of the thoracic and cervical spine at all. Just treating the arm lines as seen in the picture below except for levator scapulae. Left that out as I wanted to "exclude" the neck.

Superficial and deep back, front arm lines

Not The Neck, Not The Leg, But The Arms

This patient who came in recently this week complaining of neck pain, was a really interesting case.

She had pain in the cervical spine (neck) area with numbness and tingling sensations radiating down to her right arm and thumb. Sleeping on her right side made the pain worse.

Remember I had written about my patient with neck pain and I made her better by treating her leg. Well, this particular patient's presentation was definitely different.

This patient of mine lives on a yacht in the One 15 Marina Sentosa Cove. Recently it's been raining and she's had to work a lot harder cleaning her yacht so there won't be stains. Because of the proximity of the refinery nearby, whenever it rains it makes their yacht very dirty. Her husband cleans the hull, and she needs to polish the silicone joints.

She had also seen the spine surgeon and he sent her for an MRI just to be sure. Here's the whatsapp message I received from the doctor telling me my patient had R spinal exit stenosis from prolapsed discs in her neck.

That was a big clue for me as her neck didn't didn't seem particularly "bad" upon palpation. Her upper limb tension tests elicited some tenderness as well.

Superficial and deep front, back arm lines

So I treated her arm lines instead of treating her neck. Yes, at no point did I treat her neck, just her arms and nothing else.

When she sat up, her first comment was "it's like a whole weight have been lifted off my shoulders".

Surprised? I was, but I was hoping for a good result since she told me about all the extra cleaning she did earlier. Treating her arms was key in her case, not her neck.

Patient Has Neck Pain, But I Treated Her Leg

Last year I wrote about how your hips are connected to your shoulder, which turned out to be a really popular post.

Well, today I had a patient who told me she had neck pain as well. This was after I treated her for her plantar fasciitis problem and knee pain. I had only 2 mins left before my next patient. Here's a screen shot of the video I took before I treated her neck pain.

Before -12:58 pm

Here's the before video.

After treatment at 1:05 pm. Here's the screen shot of the video after at 1:05 pm.

After - 1:05 pm

Believe it or not I treated her leg, yes you read correctly. Watch the video how her neck range changed, without me going near her neck at all.

Many thanks to my patient for allowing me to post the images and videos.

Want to know what I treated? Here's a clue, look at the picture below.

SFL

Treat Your Chronic Neck Pain

Women keep saying that we men don't get it, well that's quite true in some cases. We've written before on why women get neck pain (take a look at the video too).

A sustained forward flexion (or poke chin) posture is associated with increased cervical (neck) compressive loading and creep response (or deformation) in the connective tissue.

Here's more evidence from Australian researchers that people with chronic neck pain demonstrated a reduced ability to keep an upright posture when distracted. This means you may start sitting in your office chair with a good posture but your posture deteriorates when you get distracted (e.g. when your boss calls you or when your workload piles up).

58 female subjects with greater than 3 months on chronic neck pain (and 10 control subjects with no pain) participated in the study. Changes in the participants' cervical and thoracic (neck and upper back) posture were measured every 2 minutes during a 10 minute computer task.They were then split in two different exercise groups.

One group received training of the cranio-cervical flexor muscles - picture below (CCF, for which renowned neck researcher Gwen Jull is known for) while the other group received endurance-strength training of the superficial cervical flexor muscles.

Longus Colli and longus Capitis (from Wikipedia)

The researchers showed that after an exercise program targeted at training the deep neck flexors (CCF), people with chronic neck pain demonstrated an improved ability to maintain a neutral neck posture with prolonged sitting.

So here's why you should come to either of our clinics if you have neck pain. Aized has trained under Gwen Jull and she can definitely help you with your neck pain.

Reference

Falla, D Jull G et al (2007). Effect Of Neck Exercise On Sitting Posture In Patients With Chronic Neck Pain. Physical Therapy 87(4) : pg 408-417.

* Thanks to Ming and Dew for helping me get the article.