The effects of ‘text neck’ on head repositioning accuracy: a two group comparative study

Abstract

Background: ‘Text Neck’ is a condition that presents as insidious onset neck pain believed to be associated with long periods of cervical spine flexion while testing or using unsupported electronic devices. Previous studies have shown cervical spine proprioceptive deficits in participants with neck pain. Purpose: To investigate whether participants with ‘Text Neck’ have impaired proprioception compared to asymptomatic controls. Methods: A two group comparative observational study was conducted at a University in Australia. All participants were required to spend≥4 hours per day on unsupported electronic devices. The neck pain group were also required to have a 3-month history of cervical spine pain ≥20/100mm on a visual analogue scale (VAS). Twenty-two volunteers (13 females, 9 males) with neck pain (‘Text Neck’ group) and 22 asymptomatic controls (15 females, 7 males) were assessed using the head repositioning accuracy test to measure proprioception during four cervical movements (flexion, extension, left rotation and right rotation). A questionnaire was completed detailing age, gender, and average time per day spent on unsupported electronic mediums. Participants in the pain group completed a VAS to record intensity of cervical spine pain. Analysis of differences between the neck pain and control groups was calculated using independent samples t-tests. Correlations were performed using Pearson’s bivariate analysis. Results: The average age for the neck pain group (59% female) was 21 years (SD 3.5) and time spent on unsupported electronic mediums was 5.4 hours (SD 1.4) per day, compared to the control group (68% female) aged 20.1 years (SD 1.2) spending 4.8 hours (SD 0.8) per day. The ‘Text Neck’ group had significantly (p= 0.02) decreased head repositioning accuracy during cervical spine flexion compared to the control group. The neck pain group had a mean head repositioning accuracy deficit of 3.91◦ (SD 1.44) during flexion compared to the asymptomatic control group’s deficit of 2.95◦ (SD 1.17). For the other movements there was no difference between groups. There was a moderately significant correlation (p≤ 0.05) between time spent on electronic mediums and cervical spine pain intensity, and between cervical spine pain intensity and deficits in head repositioning accuracy during flexion. There was no correlation between intensity of cervical spine pain and the other threemovements tested, or time spent on unsupported mediums and the head repositioning tests. Conclusion(s): Participants with ‘Text Neck’ revealed impaired proprioception during cervical spine flexion compared to asymptomatic controls. The greater time spent on unsupported mediums, the greater cervical spine pain experienced, and the greater the pain, the poorer the proprioception during cervical spine flexion. Implications: These findings suggest the need for advice on reducing the time spent in sustained flexion while using unsupported electronic mediums. These proprioceptive deficits in participants with ‘Text Neck’ during cervical spine flexion could possibility be treated with retraining of head repositioning accuracy.