Neck Pain or iPad Neck and Tablet Habits

Most people leap for joy when they receive a new touchscreen tablet computer, ignoring the one body part that most suffers from the use of these mobile electronic devices—the neck! A recent study in the Journal of Physical Therapy Science found that 68% of tablet computer users complained of neck ache. Mesmerized by a game, social media, or other information, tablet users gaze down, slump, or find other awkward positions in which to stare at their screens, and later, according to the study’s findings, report neck stiffness, soreness, aches and pain. The study found that of those who reported musculoskeletal symptoms, most were reported in the neck (85%), with 65% reporting upper back/shoulder symptoms, and 34% reporting arm or hand pain. Being female and having a history of neck pain or back pain predisposed users to pain. Almost humorous is the study’s finding that only 46% of users report that they would stop using the device when experiencing discomfort.
Young woman holding a painful neck while using her tablet.Being female and having a history of neck pain or back pain predisposed users to pain. Photo Source: to tear away from tablet use came as no surprise to the study’s primary author, Szu-Ping Lee, PT, PhD, a physical therapy researcher and Associate Professor at the University of Nevada, Las Vegas, who first got the idea for the study when he noticed how obsessively physical therapy patients would hunch over their touchscreens. “A lot of research ideas are from our everyday observations,” Lee said. One patient, when asked to lay face down on a physical therapy table designed with a hole to cushion the face, Lee said, peeked through the hole to continue playing an electronic game.

This particular study zeroed in on only users of tablet computers 9-10 inches or less in diagonal, and not smart phones. While his study is being hailed nationwide as the first to study a condition some have coined “tablet neck,” or “iPad neck” the premise is not original, Lee insists. “Grandma told us to sit up, shoulders back, in an upright posture,” he said. “This is nothing new.”

The basic problem with tablet reading posture, from a physics standpoint, is that our human heads weigh 10-12 pounds. When we flex them forward, the forces seen by the neck surge to 27 pounds at 15 degrees and climb incrementally upward to an astounding 60 pounds at 60 degrees, according to a study published in a journal called Surgical Technology International.

The article’s author, Kenneth Hansraj, MD, Chief of Spine Surgery at New York Spine Surgery and Rehabilitation Medicine, cites in the study that it is possible for a high school student to spend an extra 5,000 hours each year in poor posture. “These stresses may lead to early wear, tear, degeneration and possibly surgeries,” the study states. Individuals should make an effort to gaze at their electronic devices with a neutral spine, the study suggests. A neutral spine, according to the Hansraj’s study, “is defined as ears aligned with the shoulders and the ‘angel wings,’ or the shoulder blades, retracted.”

Muscles involved in neck and shoulder pain often include the upper trapezius, rhomboid, levator scapulae and neck superficial and deep extensors, Lee said. Secondary to muscle fatigue, supporting structures such as the spinal facet joints and joint ligaments get involved. The tablet users in Lee’s study confirmed that severe neck flexion causes pain. "The worst posture we have discovered,” Lee said, “is if you put your iPad on your lap and stare down at it with your neck flexed.” His study also examined side lying, back lying, and looking down at a tablet lying flat on a desk, all of which also came with reports of pain. Posture during use was more of a determinant of pain than time spent on the tablet.

One surprising finding in the study, Lee said, was that 70% of females experienced symptoms in the upper back and shoulder region, while only 30% of the males complained of pain in this particular area, perhaps due to male’s generally stronger trapezius and other muscles. Lee’s study also found that women were more likely to use their tablet device on the floor (77%) versus men (23%). The 412 participants in Lee’s study were students, faculty, alumni and staff at the University of Nevada, Las Vegas.

When asked about solutions, Lee stated that any stand or accessory that props your tablet computer at eye level and allows your spine to remain in a neutral position would be preferable. Sitting slumped in a chair with no back support was noted in the study to cause significant pain. However, technically, when sitting in the ideal upright posture, your back doesn’t touch a chair’s back support, so using a forward tilting seat that puts your hips and spine in neutral position is a good idea. Lee mentioned that projection glasses, which are under development, may solve the postural problems with handheld tablets. “If we have those projection glasses, maybe this won’t be that big of a deal,” he said. “But you have to deal with the challenges of your day.”

Lee is concerned with the influx of youth complaining of neck pain, long before they are due to experience the natural degeneration of the neck and spine due to age. “You have young people developing neck pain issues at 18 or 19 years old,“ he said. “Who knows what’s going to happen with them on down the road?” Universities, high schools and even elementary schools are moving to tablet-only technology, eliminating textbooks and handouts. As a result, young people, less likely to use ergonomic work stations, are crumpling themselves into all sorts of awkward positions to get their homework done, watch a movie, or play video games. Even though the device may only weigh one pound, an extended time in the same position activates muscles, Lee said. “You may be watching a movie. One pound of weight doesn’t seem like much, but if you are holding it for two hours, it leads to muscle activation.”

Lee said his wife experiences neck pain while using her tablet in bed, but refuses to heed expert advice. “My wife complains all the time,” Lee said. Lee has a PhD from the University of Southern California in Biokinesiology, a Master of Science degree in Human Performance from the University of Florida, and experience as a physical therapist in Taiwan, but in this situation, all he can do is sigh amiably. They have discussed it before. “I say, ‘You’re asking for it,’” Lee said, and references his own research. “The study shows…” But she remains slumped against her pillow, her index finger occasionally flipping the screen.

Updated on: 04/05/19
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